First prostate cancer patient scanned using hyperpolarised MRI 

29/08/2017 00:00 
A University College Hospital patient has been diagnosed with prostate cancer using a hyperpolarised MRI scan earlier this month, as part of a UCL trial looking to develop more accurate and personalised treatment for cancer.

The scan was the first time this experimental imaging method was used in Europe to scan a patient with prostate cancer and was able to help doctors confirm the location and state of the patient’s tumour. The clinical trial is a novel programme hoping to revolutionise diagnosis, risk stratification and therapy for people with cancer, based on innovations in MRI technology.

The work builds on the results of the PROMIS study published in February which showed that many prostate cancer patients were undergoing unnecessary biopsies which can cause side effects including pain, bleeding and infection. The study also showed that MRI scans used as a triage test could avoid unnecessary biopsies and improve diagnostic accuracy for patients.

These three images show an axial T2 weighted MRI (Image A) and Apparent Diffusion Coefficient map (Image B) acquired as part of a routine multi-parametric MRI study of the prostate. 13C spectroscopic lactate image (Image C) demonstrates high levels of lactate at the position of the biopsy positive Gleason 3+4 tumour site (red arrow).

Researchers are hoping to use hyperpolarised MRI and multi-parametric MRI scans together to improve diagnostic accuracy even further by giving a clearer picture of the exact tumour location. The hyperpolarised scan also helps clinicians understand the metabolic activity of the tumour which may help them differentiate between aggressive or non-aggressive tumours and guide treatment decisions.

The clinical trial at UCL uses a method which sees the patient injected with a traceable sugar before undergoing an MRI scan. Before injection, the sugar is put through a process called hyperpolarisation using specialised equipment set up at UCLH. This boosts the signal produced by the sugar by more than 10,000 times. The metabolic conversion of the sugar in the location of tumour can be picked up by MRI to determine where the tumour is, and may be helpful in determining how aggressive the tumour is.

Dr Shonit Punwani, UCLH honorary consultant radiologist, said: “The multi-disciplinary research team have spent the past two years installing and testing the equipment, creating standard operating procedures and planning the study in great detail. We are really pleased to have scanned our first patient and we will continue to work closely with other sites, in the UK and internationally, to develop this technology further.” Dr Punwani is the principal investigator of the Hyperpolarised MRI study which is developing the technology so that a full clinical evaluation can take place.

Professor Mark Emberton, UCLH honorary consultant urologist, 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 Emberton was the principal investigator on the PROMIS study.

The equipment underpinning this work is a new Spinlab Hyperpolariser from GE situated at the University College Hospital Macmillan Cancer Centre, and designed to work in conjunction with existing MRI equipment to provide non-invasive metabolic assessment of tumours. The traceable sugar injection was developed at the UCL Good Manufacturing Practice lab.

The study is supported by funding from the Medical Research Council, the Wellcome Trust, the National Institute of Health Research UCLH Biomedical Research Centre (where Dr Punwani is Director of Clinical Imaging), Cancer Research UK, as well as philanthropic funding from the Mitchell Charitable Trust.

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