Clinical Applications of Hyperpolarized Magnetic Resonance Imaging in Brain Tumors: Current Evidence and Future Opportunities
Simple Summary Brain tumors undergo profound metabolic changes that drive tumor growth, treatment resistance, and disease progression. Conventional imaging primarily depicts anatomical features and often cannot identify biologic changes until structural progression has occurred. Hyperpolarized magnetic resonance imaging (hpMRI) is an emerging metabolic imaging technique that enables real-time, non-invasive visualization of cellular metabolism using hyperpolarized carbon-13-labeled substrates. Recent clinical studies have demonstrated the feasibility and safety of hpMRI in patients with gliomas and other brain tumors while highlighting its potential for assessing tumor metabolism, molecular characteristics, treatment response, and disease recurrence. This review summarizes current clinical applications of hpMRI in neuro-oncology, discusses emerging metabolic probes beyond pyruvate, and explores future opportunities for integrating metabolic imaging into precision medicine and image-guided therapeutic strategies.