FIGURE 1.

The workflow developed in this project for HP ¹³C MR research targeting of prostate biopsies based on abnormally high pyruvate-to-lactate conversion k_PL values. The HP ¹³C MR exam and research targeting were integrated into the SOC MRI fusion and systematic biopsy procedures at our institution. First, the patient undergoes an integrated mpMRI exam of the prostate, including a 1-min acquisition following the HP ¹³C-pyruvate injection. The k_PL map is calculated and uploaded to PACS and a software targeting platform (Dynacad, Philips Invivo Corp., Gainsville FL). A radiologist reads the study and outlines the research targets based on ¹³C k_PL findings, in addition to those from the PIRADS lesions based on the ¹H mpMRI. The targets and a report are uploaded to the fusion biopsy system (UroNav, Philips Invivo Corp., Gainsville FL) in the urologist’s offices, where they review the targeting and plan for the procedure. After US/MRI fusion-guided biopsies are performed, the tissue specimens are submitted to Pathology for processing and diagnosis. Thus, the HP ¹³C research biopsy integration takes advantage of the existing infrastructure and minimizes the additional workload for the researchers and clinicians involved. ¹³C, carbon-13; HP, hyperpolarized; k_PL, pyruvate-to-lactate conversion rate; mp, multiparametric; PACS, picture archiving and communication system; PIRADS, Prostate Imaging Reporting and Data System; SOC, standard- of- care; US, ultrasound.