Brain metastases are increasingly being treated with stereotactic radiosurgery; however, 20-30% of treated tumors recur locally post-treatment. Hyperpolarized [1-13C]pyruvate magnetic resonance imaging (HP 13C MRI) is an emerging metabolic imaging modality that measures key metabolic phenotypes indicative of tumor biology. Here we investigate pre-treatment [1-13C]pyruvate uptake – a potential marker of monocarboxylate transporter 1 expression and tumor vascularity – via HP 13C MR images as a predictor of local recurrence. [1-13C]pyruvate uptake establishes a robust predictive model (AUC = 0.73) and, as a result, can inform treatment decisions should the model predict a non-response to SRS.
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