Background:Most of the existing hyperpolarized (HP)13C MRI analyses use univariate rate maps of pyruvate-to-lactate conversion (kPL), and radiomic-style multiparametric models extracting complex, higher-order features remain unexplored.Purpose:To establish a multivariate framework based on whole abdomen/pelvis HP13C-pyruvate MRI and evaluate the association between multiparametric features of metabolism (MFM) and clinical outcome measures in advanced and metastatic prostate cancer.Methods:Retrospective statistical analysis was performed on 16 participants with metastatic or local-regionally advanced prostate cancer prospectively enrolled in a tertiary center who underwent HP-pyruvate MRI of abdomen or pelvis between November 2020 and May 2023. Five patients were hormone-sensitive and eleven were castration-resistant. GMP-grade [1-13C]pyruvate was polarized using a 5T clinical-research DNP polarizer, and HP MRI used a set of flexible vest-transmit, array-receive coils, and echo-planar imaging sequences. Three basic metabolic maps (kPL, pyruvate summed-over-time, and mean pyruvate time) were created by semi-automatic segmentation, from which 316 MFMs were extracted using an open-source, radiomic-compliant software package. Univariate risk classifier was constructed using a biologically meaningful feature (kPL,median), and the multivariate classifier used a two-step feature selection process (ranking and clustering). Both were correlated with progression-free survival (PFS) and overall survival (OS) (median follow-up = 22.0 months) using Cox proportional hazards model.Results:In the univariate analysis, patients harboring tumors with lower-kPL,medianhad longer PFS (11.2 vs. 0.5 months,p< 0.01) and OS (NR vs. 18.4 months,p< 0.05) than their higher-kPL,mediancounterparts. Using a hypothesis-generating, age-adjusted multivariate risk classifier, the lower-risk subgroup also had longer PFS (NR vs. 2.4 months,p< 0.002) and OS (NR vs. 18.4 months,p< 0.05). By contrast, established laboratory markers, including PSA, lactate dehydrogenase, and alkaline phosphatase, were not significantly associated with PFS or OS (p> 0.05). Key limitations of this study include small sample size, retrospective study design, and referral bias.Conclusions:Risk classifiers derived from select multiparametric HP features were significantly associated with clinically meaningful outcome measures in this small, heterogeneous patient cohort, strongly supporting further investigation into their prognostic values.
背景：现有超极化碳13磁共振成像分析多采用丙酮酸-乳酸转化率单变量图，而基于影像组学风格、提取复杂高阶特征的多参数模型尚未得到探索。目的：建立基于全腹/盆腔超极化碳13-丙酮酸磁共振成像的多变量分析框架，评估代谢多参数特征与晚期转移性前列腺癌临床结局指标间的关联性。方法：对2020年11月至2023年5月期间前瞻性纳入某三级医疗中心、接受腹盆腔超极化丙酮酸磁共振成像的16例转移性或局部晚期前列腺癌患者进行回顾性统计分析，其中5例为激素敏感性，11例为去势抵抗性。采用5T临床研究级动态核极化仪对GMP级[1-13C]丙酮酸进行极化，超极化磁共振成像使用柔性背心发射线圈、阵列接收线圈及平面回波成像序列。通过半自动分割生成三种基础代谢图（丙酮酸-乳酸转化率、丙酮酸时间积分图及平均丙酮酸时间图），并采用开源影像组学兼容软件包从中提取316个代谢多参数特征。分别使用具有生物学意义的特征（丙酮酸-乳酸转化率中位数）构建单变量风险分类器，采用两步特征选择流程（排序与聚类）构建多变量分类器，通过Cox比例风险模型分析其与无进展生存期和总生存期的相关性（中位随访时间22.0个月）。结果：单变量分析显示，丙酮酸-乳酸转化率中位数较低的患者比较高者具有更长的无进展生存期（11.2个月 vs 0.5个月，p<0.01）和总生存期（未达到 vs 18.4个月，p<0.05）。采用假设生成性年龄校正多变量风险分类器分析，低风险亚组同样表现出更长的无进展生存期（未达到 vs 2.4个月，p<0.002）和总生存期（未达到 vs 18.4个月，p<0.05）。相比之下，既有的实验室标志物包括前列腺特异性抗原、乳酸脱氢酶和碱性磷酸酶与无进展生存期或总生存期均无显著相关性（p>0.05）。本研究主要局限性包括样本量较小、回顾性研究设计及转诊偏倚。结论：在这组小型异质性患者队列中，基于精选超极化多参数特征构建的风险分类器与具有临床意义的结局指标显著相关，这为深入探索其预后价值提供了有力支持。
肿瘤(癌症)患者之家