Fig. 5
From: Multi-nuclear magnetic resonance spectroscopy: state of the art and future directions
Representative example of an MR-occult transition zone tumor detected on hyperpolarized 13C-MRI. a Post-surgical histopathological assessment confirmed the diagnosis of multifocal adenocarcinoma of the prostate. An International Society of Urological Pathology (ISUP) grade 3 target lesion was visible on 1H-MRI in the left peripheral zone: Prostate Imaging-Reporting and Data System (PI-RADS) 5 target lesion; black region of interest (ROI). b Standard-of-care T2-weighted MRI demonstrating a marked area of low signal intensity corresponding to the target lesion in the left peripheral zone. c ADC map demonstrating a corresponding focus of markedly restricted diffusion in the left peripheral zone. d Dynamic contrast-enhanced (DCE) MRI demonstrating the area of early enhancement in the left peripheral zone. e Pyruvate signal-to-noise ratio (SNR) map with two areas of high pyruvate signal, both corresponding to histopathology-confirmed tumor foci. f Lactate SNR map demonstrating high [1-13C]lactate signal in the grade 3 left peripheral zone lesion. g Total carbon SNR map showing higher signal in the left peripheral zone tumor. h Kpl map (presented as s − 1) showing a higher rate of pyruvate-to-lactate conversion in the more aggressive left peripheral zone lesion. Nat Commun. 2022 Jan 24;13(1):466