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Aug 23

First European hyperpolarised MRI scan of patient with prostate cancer performed at UCLH

Katie Konyn

in News

A prostate cancer patient from University College Hospital underwent diagnosis using 13C-Pyruvate hyperpolarised Magnetic Resonance Imaging (MRI) as part of a UCL clinical trial.

  • The trial was aimed at offering more accurate and personalised treatment for cancer. The scan, carried out on Friday 11 August 2017, was the first time this experimental imaging method has been used in Europe for the assessment of prostate cancer. The scan was able to help doctors confirm the location and state of the patient’s tumour.

  • Results from the PROMIS study published in February 2017 indicated that many prostate cancer patients were undergoing unnecessary TRUS-biopsy procedures which can cause side effects including pain, bleeding and infection. The same study also indicated that multi-parametric magnetic resonance imaging used as a triage test can avoid unnecessary biopsies and improve diagnostic accuracy.

    It is hoped that by using hyperpolarised MRI and multi-parametric magnetic resonance imaging together, clinicians can further improve diagnostic accuracy by giving a clearer picture of the exact tumour location. Furthermore, by understanding the metabolic activity, clinicians hope to differentiate between aggressive or non-aggressive tumours, helping to guide treatment decisions.

    The method being trialled at UCL uses Carbon 13 labelled Pyruvate (a sugar that is part of the glycolysis cycle of normal cells) produced for injection by the UCL Good Manufacturing Practice (GMP) Lab. The MRI signal from this is boosted by >10,000 times using the process of hyperpolarisation that is enabled by the GE SpinLab machine. Following injection of 13C Pyrutate, build up 13C lactate signal can be imaged, using a standard MRI scanner, and is a hallmark of cancer metabolism.

    This can be seen in these images (right), which show an axial T2 weighted MRI (A: top image) and Apparent Diffusion Coefficient map (B: middle image) acquired as part of a routine multi-parametric MRI study of the prostate. 13C spectroscopic lactate image (C: bottom image) demonstrates high levels of lactate at the position of the biopsy positive Gleason 3+4 tumour site (red arrow).

  • Dr Shonit Punwani, Principal Investigator for the study, said “The cross-disciplinary research team have worked for the last 2 years installing and testing the equipment, creating standard operating procedures and planning the study in great detail. It is really exciting that we have now scanned our first patient. We are working closely with other sites, in the UK and internationally, to develop this technology further.”

    Prof. Mark Emberton, Dean of the Faculty of Medical Sciences at University College London and Principal Investigator for the PROMIS study, said “The technology offers a real opportunity to deal with the problem of overtreatment of patients with prostate cancer. Most prostate cancers will be non-aggressive and so being able to interrogate their metabolism may help patients with indolent disease avoid treatment.”

  • Prof. David Lomas, Vice-Provost (Health) at University College London, added “I am proud of the UCL team for achieving this milestone. UCL was one of 3 UK institutions to receive Medical Research Council (MRC) funding in 2015 for the installation of the SpinLab Hyperpolariser. UCL has a strong history of collaborative working and this is reflected in the development of this technology.”

  • Photo from Left to Right: Fiona Gong (Project Manager), Arash Latifoltojar, Ramla Awais (GMP lab manager), William Devine, Hassan Jeraj (Quality Assurance Manager), Shonit Punwani (Principal Investigator), Edward Johnston, James O’Callaghan (MR Physicist), Mrishta Brizmohun.

  • The study is supported by funding from the MRC, National Institute of Health Research UCLH Biomedical Research Centre, Cancer Research UK, and through philanthropic funding provided by the Mitchell’s Charitable Trust. The hyperpolariser is located in the University College Hospital Macmillan Cancer Centre and its use in this trial is an example of much wider UCL/UCLH collaboration to advance cancer diagnostics and therapies.