Hyperpolarised 13C MRI in Cardiovascular Disease

Cardiovascular MRI provides a comprehensive assessment of cardiac structure and function and is able to uniquely characterise myocardial tissue. Despite this, clinically available imaging modalities are limited in the assessment of metabolic derangements in myocytes and are unable to track downstream metabolism. Hyperpolarised MRI enables a greater than 10,000-fold increase in the sensitivity of MRI to detect metabolic tracers labelled with non-radioactive isotopes, specifically [1-13C]pyruvate, thereby enabling real-time investigation of oxidative metabolism, glycolysis and amino acid metabolism. Hyperpolarised 13C MRI cardiovascular research has rapidly increased over the last decade, and provides new insights into the molecular alterations seen in cardiac energy metabolism from ischaemic heart disease to cardiomyopathies, among others. This review introduces the principles of hyperpolarised 13C MRI and discusses promising applications to cardiovascular disease for this evolving technology.