Hyperpolarized [1-13C]-Pyruvate MRI Differentiates Benign Fibroma From High-grade Serous Carcinoma

Hyperpolarized [1-13C]pyruvate MRI enables real-time assessment of tumor glycolytic flux. We report 2 women with suspected ovarian cancer examined preoperatively with hyperpolarized [1-13C]-pyruvate MRI and FDG PET/CT. In a 49-year-old woman with a right adnexal mass, FDG uptake was limited, and hyperpolarized imaging demonstrated minimal lactate production; histopathology revealed a benign fibroma. In a 51-year-old woman with advanced disease, FDG PET/CT showed extensive metabolically active tumors. Hyperpolarized imaging demonstrated markedly increased lactate-to-pyruvate conversion within solid tumor components. Histopathology confirmed high-grade serous carcinoma. These cases illustrate the potential complementary role of hyperpolarized [1-13C]pyruvate MRI in differentiating benign from malignant adnexal masses.