Hyperpolarized 13c pyruvate MRI and pet in single exam using pet-mr for ischemic heart disease

Abstract

Systems, methods, and devices for performing a heart health assessment include a positron emission tomography-magnetic resonance (MR)-(PET) hybrid scanner and combining hyperpolarized 13C pyruvate magnetic resonance imaging (MRI) imaging and PET imaging into a single scanning session using the PET-MR hybrid scanner. These techniques are used for the assessment of ischemic heart disease. Furthermore, the disclosed methods include imaging viable myocardium using hyperpolarized carbon-13 (HP 13C) MRI with a [1-13C]pyruvate probe. The method can also include an analysis of bicarbonate / lactate ratio. Accordingly, a system can provide information on the oxidative activity of mitochondria and cytosolic redox state, which is critical to the function of normal myocardium. The diagnostic methods disclosed herein can improve the ability of cardiologists and thoracic surgeons to tailor therapy, revascularization, and / or medical care, to the patient, and can be added to standard clinical CMR protocols.

Description

TITLEHYPERPOLARIZED13C PYRUVATE MRI AND PET IN SINGLE EXAM USING PET-MR FOR ISCHEMIC HEART DISEASECROSS REFERENCE TO RELATED APPLICATION

[0001] This application claims priority to U.S. Provisional Patent Application Serial No. 63 / 614,369, filed December 22, 2023, and titled “HYPERPOLARIZED 13C PYRUVATE MRI AND PET IN SINGLE EXAM USING PET-MR FOR ISCHEMIC HEART DISEASE,” which is incorporated by reference herein in its entirety.BACKGROUND

[0002] Coronary Artery Disease (CAD) continues to be a significant health issue worldwide. Ischemic heart disease is a prevalent condition characterized by reduced blood flow to the heart muscle, leading to impaired myocardial metabolism and function. Traditional imaging methods, such as Positron Emission Tomography (PET) scans and dobutamine stress echocardiography, fall short of directly assessing mitochondrial metabolism.

[0003] It is with these observations in mind, among others, that various aspects of the presently disclosed technology were conceived and developed.SUMMARY

[0004] Implementations described and claimed herein address the foregoing problems by providing systems and methods for diagnosing heart disease. The systems and methods herein provide technical improvements to medical imaging, by allowing for an improved measurement of relevant information related to myocardial metabolism and mitochondrial function.

[0005] In some implementations, a computer implemented method to assess heart health can comprise: collecting hyperpolarized 13C pyruvate magnetic resonance imaging (MRI) data during a single scanning session of a heart, collecting positron emission tomography (PET) imaging data during the single scanning session of the heart, combining the hyperpolarized 13C pyruvate MRI data and the PET imaging data, and generating a plurality of fused images using the hyperpolarized 13C pyruvate MRI data and the PET imaging data for an assessment of ischemic heart disease.

[0006] In some implementations, a system to assess heart health can comprise: a PET-MR hybrid scanner device configured to collect hyperpolarized 13C pyruvate magnetic resonanceimaging (MRI) data and positron emission tomography (PET) data during a single scanning session of a heart, at least one processor, memory storing instructions that, when executed by the at least one processor, cause the system to combine the hyperpolarized 13C pyruvate MRI data with the PET imaging data, and generate one or more fused images using the hyperpolarized 13C pyruvate MRI data with the PET imaging data; and a display configured to present the one or more fused images for an assessment of heart disease..

[0007] In some implementations, a computer implemented method to assess heart health can comprise: collecting first hyperpolarized 13C pyruvate magnetic resonance imaging (MRI) data along a first axis during a scanning session of a heart, collecting second hyperpolarized 13C pyruvate MRI data along a second axis during the scanning session, collecting positron emission tomography (PET) data during the scanning session, and generating a plurality of fused images using the first hyperpolarized 13C pyruvate MRI data, the second hyperpolarized 13C pyruvate MRI data, and the PET imaging data for an assessment of ischemic heart disease.

[0008] Other implementations are also described and recited herein. Further, while multiple implementations are disclosed, still other implementations of the presently disclosed technology will become apparent to those skilled in the art from the following detailed description, which shows and describes illustrative implementations of the presently disclosed technology. As will be realized, the presently disclosed technology is capable of modifications in various aspects, all without departing from the spirit and scope of the presently disclosed technology.Accordingly, the drawings and detailed description are to be regarded as illustrative in nature and not limiting.BRIEF DESCRIPTION OF THE DRAWINGS

[0009] FIG. 1 illustrates an example system for performing a heart health assessment using a hybrid Magnetic Resonance- Positron Emission Tomography (MR-PET) scanner.

[0010] FIGS. 2A-2E illustrate an example system for performing a heart health assessment using one or more fused images.

[0011] FIG. 3 illustrates an example method of performing a heart health assessment using one or more fused images.

[0012] FIG. 4 illustrates an example method of performing a heart health assessment using one or more fused images.

[0013] FIG. 5 illustrates an example computing system that may implement various aspects of the system discussed herein.

[0014] It will be apparent to one skilled in the art after review of the entirety disclosed that the steps illustrated in the figures listed above may be performed in other than the recited order, and that one or more steps illustrated in these figures may be optional.DETAILED DESCRIPTION

[0015] It will be appreciated that for simplicity and clarity of illustration, where appropriate, reference numerals have been repeated among the different figures to indicate corresponding or analogous elements. In addition, numerous specific details are set forth in order to provide a thorough understanding of the embodiments described herein. However, it will be understood by those of ordinary skill in the art that the embodiments described herein can be practiced without these specific details. In other instances, methods, procedures and components have not been described in detail so as not to obscure the related relevant feature being described. Also, the description is not to be considered as limiting the scope of the embodiments described herein. The drawings are not necessarily to scale and the proportions of certain parts may be exaggerated to better illustrate details and features of the present disclosure.

[0016] The phraseology and terminology employed herein are for the purpose of description and should not be regarded as limiting. For example, the use of a singular term, such as, “a” is not intended as limiting of the number of items. Also, the use of relational terms such as, but not limited to, “front,” “back,” “rear,” “top,” “bottom,” “left,” “right,” “upper,” “lower,” “down,” “up,” and “side,” are used in the description for clarity in specific reference to the figures and are not intended to limit the scope of the presently disclosed technology or the appended claims. Further, it should be understood that any one of the features of the presently disclosed technology may be used separately or in combination with other features. Other systems, methods, features, and advantages of the presently disclosed technology will be, or become, apparent to one with skill in the art upon examination of the figures and the detailed description. It is intended that all such additional systems, methods, features, and advantages be included within this description, be within the scope of the presently disclosed technology, and be protected by the accompanying claims.

[0017] Further, as the presently disclosed technology is susceptible to embodiments of many different forms, it is intended that the present disclosure be considered as an example of the principles of the presently disclosed technology and not intended to limit the presently disclosedtechnology to the specific embodiments shown and described. Any one of the features of the presently disclosed technology may be used separately or in combination with any other feature. References to the terms “embodiment,” “example,” and / or the like in the description mean that the feature and / or features being referred to are included in, at least, one aspect of the description. Separate references to the terms “examples,” “embodiments,” and / or the like in the description do not necessarily refer to the same embodiment and are also not mutually exclusive unless so stated and / or except as will be readily apparent to those skilled in the art from the description. For instance, a feature, structure, process, step, action, or the like described in one embodiment may also be included in other embodiments but is not necessarily included. Thus, the presently disclosed technology may include a variety of combinations and / or integrations of the examples described herein. Additionally, all aspects of the present disclosure, as described herein, are not essential for its practice. Likewise, other systems, methods, features, and advantages of the presently disclosed technology will be, or become, apparent to one with skill in the art upon examination of the figures and the description. It is intended that all such additional systems, methods, features, and advantages be included within this description, be within the scope of the presently disclosed technology, and be encompassed by the claims.

[0018] Any term of degree such as, but not limited to, “substantially,” as used in the description and the appended claims, should be understood to include an exact, or a similar, but not exact configuration. For example, “a substantially planar surface” means having an exact planar surface or a similar, but not exact planar surface. Similarly, the terms “about” or “approximately,” as used in the description and the appended claims, should be understood to include the recited values or a value that is greater or less than by one third of the recited values. For example, about 3 mm includes all values from 2 mm to 4 mm, and approximately 60 degrees includes all values from 40 degrees to 80 degrees.

[0019] The term "coupled" is defined as connected, whether directly or indirectly through intervening components, and is not necessarily limited to physical connections. The connection can be such that the objects are permanently connected or releasably connected. The terms "comprising," "including" and "having" are used interchangeably in this disclosure. The terms "comprising," "including" and "having" mean to include, but not necessarily be limited to the things so described. The term “real-time” or “real time” means substantially instantaneously.

[0020] Lastly, the terms “or” and “and / or,” as used herein, are to be interpreted as inclusive or meaning any one or any combination. Therefore, “A, B, or C” or “A, B, and / or C” mean any of thefollowing: “A,” “B,” or “C”; “A and B”; “A and C”; “B and C”; “A, B and C.” An exception to this definition will occur only when a combination of elements, functions, steps or acts are in some way inherently mutually exclusive.

[0021] Certain aspects of the presently disclosed technology are directed to systems, methods, and devices to facilitate a heart health assessment, for instance, to detect myocardial abnormalities. The techniques presented herein can address the aforementioned limitations by providing a simultaneous acquisition of hyperpolarized (HP) carbon-13 (13C) pyruvate Magnetic Resonance Imaging (MRI) data and Positron Emission Tomography (PET) data in a single hybrid PET-MR scan session, which can be used to detect, assess, and / or monitor ischemic heart disease and / or other heart-related conditions. For instance, systems disclosed herein can image viable myocardium using an HP 13C MRI with the probe being [1-13C] pyruvate. The imaging can be based on an analysis of the bicarbonate / lactate ratio. Although 13C pyruvate is referred to herein as the imaging agent, the disclosure is not limited as such and any suitable imaging agent may be used, such as, for example, ketones or other hyperpolarized compounds. The technology disclosed herein can provide information on the oxidative activity of mitochondria and cytosolic redox state, which can be critical to the function of normal myocardium. The method(s) disclosed herein can include a diagnostic method to improve the ability of cardiologists and thoracic surgeons to tailor therapy, revascularization, and medical care to the patient, and can be added to various clinical cardiovascular magnetic resonance (CMR) protocols.

[0022] Additional benefits and advantages of the disclosed technology will become apparent from the detailed description below.

[0023] FIG. 1 depicts an example system 100 including a hybrid Magnetic Resonance-Positron Emission Tomography (MR-PET) scanner 102 for performing a hybrid (e.g., multi-type) scan of a patient 104 in a single imaging scanning session 106. The system 100 can perform the imaging scanning session 106 with the PET-MR hybrid scanner 102, for instance, to collect hyperpolarized 13C pyruvate MRI data combined with PET data. As such, these techniques can perform simultaneous acquisition of meta bo lie- related data and anatomical information. Combining these two data types into a single scan can provide early detection and comprehensive assessment of ischemic heart disease. By harnessing the complementary strengths of hyperpolarized 13C pyruvate MRI data and PET data, the system 100 can provide a non-invasive and accurate method for evaluating myocardial metabolism, perfusion, and viability in a single, streamlined procedure.

[0024] In some examples, the system 100 can provide a method for combining hyperpolarized 13C pyruvate MR I and PET imaging for ischemic heart disease assessment by forming fused images from the two different data sources. For instance, the systems disclosed herein can combine the hyperpolarized 13C pyruvate MRI data and PET imaging data, which can include concurrently acquiring PET Data with MRI data using electrocardiography (ECG) gating. In an implementation, the fused image is generated by overlaying the hyperpolarized 13C pyruvate MRI and PET images. In an implementation, the fused images are generating by one or more processors executing at least one of an imaging processing or machine learning algorithm. The machine learning algorithm can be one or more models, such as, for example, a linear regression model, an unsupervised neural network model, gradient boosted trees, etc. The one or more machine learning models may be built from historical image data associated with successful image fusing that is stored, for example, at one or more databases. In another implementation, historical data associated with unsuccessful image fusing that is stored at the one or more databases. Thus, the one or more machine learning models leverages historical data relating to image fusing to generate the fused image. Furthermore, the method can include the administration of a hyperpolarized 13C pyruvate solution to a patient (e.g., intravenously), followed by concurrent PET data and MRI data acquisition using the PET-MR hybrid scanner 102.

[0025] The system 100 disclosed herein has various advantages over other techniques. For instance, using the hybrid PET-MR scanner 102 with the hyperpolarized 13C pyruvate MRI data can provide for a single imaging scanning session 106 rather than multiple scanning sessions for the different imaging techniques (e.g., one scanning session for the MRI and another for the PET). In other words, the systems 100 and methods disclosed herein improve conveniences and efficiencies by combining hyperpolarized 13C pyruvate MRI and PET into one procedure. This can further reduce patient stress and costs.

[0026] Additionally, the system 100 can provide improved accuracy for assessing ischemic heart disease by capturing both metabolic and perfusion data simultaneously. As such, the system 100 can provide a comprehensive view of cardiac health, which can enhance diagnostic accuracy and clinical decision-making. The system 100 can provide early detection of myocardial abnormalities, which can facilitate timely interventions and improved patient outcomes. The use of non-ionizing radiation in both MRI and hyperpolarized 13C pyruvate administration by the system 100 can improve patient safety. The techniques disclosed herein include a combination of imaging modalities which can open avenues for further research in understanding the relationship between metabolism and perfusion in ischemic heart disease. Moreover, thetechniques disclosed herein allow for the identification of viable myocardium. By providing a comprehensive evaluation of myocardial metabolism, perfusion, and viability in a single procedure, this method can transform clinical practice and advance research in the field of cardiac imaging.

[0027] FIGS. 2A-2E depict example systems 200 for performing a hybrid (e.g., multi-type) scan of a patient 104 in a single imaging scanning session 106 including one or more fused images 202. The system(s) 200 depicted in FIGS. 2A-2E can be similar to, identical to, and / or can form at least a portion of the system 100 depicted in FIG. 1.

[0028] In some examples, the HP 13C MRI performed by the system(s) 200 can be used for the non-invasive evaluation of metabolism in the human heart. This technology can be used to visualize dynamic changes in cardiac energetics associated with advanced CAD and, as such, can be used for management of CAD. The implementation of HP 13C-MRI discussed herein can provide a safe, non-invasive tool for visualizing metabolic abnormalities in CAD patients by imaging mitochondrial function in CAD, paving the way for more precise management of ischemic heart disease and prompting further comparative research with imaging methods.

[0029] The systems 200 FIGS. 2A-2E can include an HP-13C MRI examination on one or more subjects, such as two preoperative patients with advanced CAD (e.g., a first subject 201 and a second subject 203). These methods can include receiving informed consent from the subjects according to a protocol approved by the Institutional Review Board and Protocol Review Committee. In some examples, the first subject 201 can be a 60-year-old male exhibiting obstructive coronary artery disease with significant stenosis in multiple arteries and occasional chest discomfort during physical activity. The second subject 203 can be a 78-year-old male with three-vessel coronary artery disease, accompanied by comorbid conditions such as hypertension and hyperlipidemia. Before the metabolic exam, baseline blood samples can be collected and analyzed for pyruvate, triglycerides, free fatty acids, and insulin levels and can be sent to the laboratory.

[0030] After assessing vital signs and MRI screening, the subject(s) can receive 48 grams of glucose gel. For instance, a radioactive glucose analog can be intravenously administered (e.g., to the patient undergoing a single scanning session). The radioactive glucose analog can include Fluorodeoxyglucose 18F (FDG). The IND-approved metabolic probe, [1-13C] pyruvic acid (e.g., manufactured by Good Manufacturing Practice regulations) can be in clinical fluid paths (0.40mL / kg body weight of 250-mM HP [1-13C] pyruvate solution). After 3-4 hours of polarization in a clinical polarizer, pyruvate concentration, pH, temperature, volume, and radical concentration can be assessed using a dedicated quality control (QC) device. A hyperpolarized (HP) solution can be administered intravenously to the subjects, followed by a saline flush. One or more 1- Hydrogen(H)-steady state free precision (SSFP)-CI NE images for anatomical reference and multiecho images of [13C] bicarbonate, [1-13C] lactate, and [1-13C] pyruvate can be obtained, for instance, using MRI. These images can be acquired for the short axis 212 during the first injection and for the long axis 214 in the second HP injection. For instance, the system can collect first data along the short axis 212, the first data corresponding to a first hyperpolarized 13C pyruvate solution injection. The system can also collect second data along the long axis 214, perpendicular to the short axis 212, the second data corresponding to a second hyperpolarized 13C pyruvate solution injection. In other words, the first data can be received via a first data collection period at least partly following a first injection, and the second data can be received via a second data collection period at least partly following a second injection. The HP 13C data can be reconstructed and analyzed using one or more computer-executed algorithms, such as, for example, a linear regression model, an unsupervised neural network model, gradient boosted trees, or other machine learning model. . Regions of interest (ROIs) with prominent 13C signals can be delineated, and the average 13C signal within the different ROIs can be subsequently modeled to calculate a ratio of bicarbonate and lactate, as discussed in greater detail below.

[0031] As shown in FIG. 2A, the acquired data can be processed to generate the one or more fused images 202 by fusing the metabolic data and the anatomical data using one or more computer-executable algorithms, such as, for example, a linear regression model, an unsupervised neural network model, gradient boosted trees, or other machine learning model. The system 200 can capture and / or or fuse any combination of [13C]bicarbonate data 205, [1- 13C]lactate data 207, PET data 209 (e.g., Fluorodeoxyglucose data) and / or HP [1-13C]pyruvate data 211. By generating the one or more fused images 202, the system 100 can be used to identify regions with altered metabolism, perfusion, and / or viability. In an implementation, the regions are identified automatically by the system 200 using one or more computer-executable algorithms, such as, for example, a linear regression model, an unsupervised neural network model, gradient boosted trees, or other machine learning model. In some examples, processing the hyperpolarized 13C pyruvate MRI data and the PET imaging data can include generating cine magnetic resonance anatomical images. This integrated approach can provide a comprehensiveview of cardiac health in a single examination, as discussed in greater detail below regarding FIGS. 2B.

[0032] FIG. 2B illustrates an example system 200 for performing a hybrid (e.g., multi-type) scan of a patient 104 in a single imaging scanning session 106. The system 200 depicted in FIG. 2B can include hyperpolarized 13C imaging 204, which can be performed on the first subject 201 (e.g., a 60-year-old male) with three-vessel diseases. The Hyperpolarized 13 C imaging 204 can include dynamic 13C images, obtained by combining six echo images, which can showcase the metabolic conversions of HP [1-13C]pyruvate into [1-13C]lactate and [13C]bicarbonate. A 1 H image 208 can be for anatomical reference. These acquisitions can occur following two separate injections of HP [1-13C]pyruvate, with a first injection leading to imaging in a short axis 212 (A) and the second injection (e.g., subsequent to the first injection) being applied for imaging in a long axis 214 (B). The metabolic defects 216 in the mid-anterolateral region 218 can be identified, as indicated by arrows in FIG. 2B. In an implementation, the metabolic defects 216 are identified automatically by the system 200 using one or more computer-executable algorithms, such as, for example, a machine learning algorithm. The machine learning algorithm can be one or more models, such as, for example, a linear regression model, an unsupervised neural network model, gradient boosted trees, etc. The one or more machine learning models may be built from historical diagnostic data associated with successful identification of metabolic defects that is stored, for example, at one or more databases. In another implementation, historical data associated with unsuccessful identification of metabolic defects that is stored at the one or more databases. Thus, the one or more machine learning models leverages historical data relating to identification of metabolic defects to identify the metabolic defects. As such, the hyperpolarized 13C pyruvate MRI data can include a plurality of echo images representing a metabolic conversion of hyperpolarized 13C pyruvate into 13C lactate and 13C bicarbonate. In some instances, one or more fused images represent a mid-anterolateral region of a heart of a subject. Additionally or alternatively, the one or more fused images can represent a mid-inferolateral region of a myocardium of a heart of a subject.

[0033] FIG. 2C illustrates an example system 200 for performing a hybrid (e.g., multi-type) scan of a patient 104 in a single imaging scanning session 106. The system 200 depicted in FIG. 2C can include hyperpolarized 13C imaging 220 which can be performed on the second subject 203, such as a 78-year-old male subject with 3V diseases, hypertension (HTN), hyperlipidemia (HLD), and / or low-grade follicular lymphoma. The imaging 220 can capture the 1-hydrogen (1 H) images 208 for anatomical reference and dynamic 13C data 222 from HP [1-13C]pyruvate, [1-13C]lactate,and [13C]bicarbonate using a combination of 6 echo sequences. The first injection of HP [1- 13C]pyruvate can yield data in the short axis 212 (A), while the second injection can provide information in the long axis 214 (B). By way of example, the arrows point to metabolic abnormalities 226 in the mid-inferolateral region 228 of the myocardium 230.

[0034] FIG. 2D illustrates an example system 200 for performing a hybrid (e.g., multi-type) scan of a patient 104 in a single imaging scanning session 106. The system 200 depicted in FIG. 2D can include comprehensive metabolic examination results 232 (e.g., Table 1.1). The comprehensive metabolic examination results 232 can be data stored and / or accessed, for instance, by a clinic computing device, and, as such, can form the underlying data used to generate the images and / or visualizations (e.g., in real-time via continuous monitoring). In an implementation, the comprehensive metabolic examination results 232 are generated by the system by executing one or more algorithms, such as, for example, a linear regression model, an unsupervised neural network model, gradient boosted trees, or other machine learning model. In an implementation, the system 200 generates the comprehensive metabolic examination results 232 without operator interaction. The system 200 depicted in FIG. 2D can be similar to, identical to, and / or can form at least a portion of the system 100 of FIG. 1.

[0035] In some examples, the comprehensive metabolic examination results 232 can include a bicarbonate-lactate ratio 234 which can be calculated from the short axis 212 and / or the long axis 214. The comprehensive metabolic examination results 232 can also include a blood glucose levels before 235 and after 236 a 45-minute glucose load preceding the metabolic examination. Furthermore, laboratory measurements 238 (Table 1.2) can be obtained before the metabolic examination for the subject(s) (e.g., the first subject 201 and / or the second subject 203), facilitating a metabolic correlation of findings. These measurements 238 can include a pyruvate measurement 240, a triglycerides measurement 242, a free fatty acids measurement 244, and / or an insulin levels measurement 246.

[0036] FIG. 2E illustrates an example system 200 for performing a hybrid (e.g., multi-type) scan of a patient 104 in a single imaging scanning session 106. The system 200 depicted in FIG. 2E can include a comparison 248 made between hyperpolarized MRI (HP MRI) images 250 obtained from the short axis 212 and / or the long axis 214 and the most closely matching frame of a Fludeoxyglucose 18F (FDG) PET-CT image 252 captured approximately 8 months before the HP 13C-MRI examination. In regions where the 18F-PET-CT scan reveals significant myocardial F18 (FDG) uptake, the HP 13C-MRI exam of the same subject can display contrasting data withreduced bicarbonate and lactate. These contrasting results can suggest that the two technologies (HP-MRI and PET-CT) may provide complementary information on myocardial metabolism.

[0037] In some examples, HP 13C-MRI is used to image hearts from two human subjects with advanced CAD. For the first subject 201 , a 60-year-old male with three-vessel diseases, dynamic 13C images were obtained along the short axis 212 and the long axis 214. The first subject 201 may exhibit a metabolic defect with reduced levels of 13C-bicarbonate and 13C-lactate in the mid- anterolateral regions. FIGS. 2C and 2E demonstrate the data from the second subject 203, a 78- year-old male with multiple conditions who displayed reduced bicarbonate and lactate in the mid- inferolateral myocardium. Comprehensive metabolic results can be determined, such as determining bicarbonate-lactate ratios 234, glucose levels, and lab measurements (e.g., as depicted in FIG. 2D). The bicarbonate-lactate ratios 234 can be similar between the short axis 212 and the long axis 214, indicating the reproducibility of results in different planes from two injections. The pre-and post-glucose load blood glucose measurements can be within the normal range for both subjects. The blood measurements for pyruvate, triglycerides, free fatty acids, and insulin can also be within the normal range for both subjects except for insulin, which can be elevated due to poor glucose control and significant carbohydrate load from breakfast in these subjects. Incidentally, the 18F-FDG PET-CT data from the second subject 203 can be influenced by this subject having low-grade follicular lymphoma. In some instances, FIG. 2E can indicate discordant results between PET-CT and HP 13C MRI data in this same subject. In regions where the 18F-FDG PET-CT scan reveals significant myocardial 18F (FDG) uptake, the HP 13C MRI exam of the same subject can display contrasting data with reduced levels of bicarbonate and lactate. As noted above, these contrasting results suggest that combining the two technologies (HP-MRI and PET-CT) may provide complementary information on myocardial metabolism.

[0038] Furthermore, the HP 13C-MRI examination techniques disclosed herein can demonstrate the feasibility of imaging metabolic abnormalities in patients with ischemic heart disease with the subject(s) tolerating the imaging well. These imaging method can provide a tool to visualize changes in cardiac energetics in hearts affected by advanced CAD. The disclosed techniques can also be used in assessing areas of the myocardium with active mitochondrial function, which might influence management decisions in patients with this disease.

[0039] FIG. 3 depicts an example method 300 for performing a heart health assessment. The method 300 can be performed by the system(s) 100 and / or 200 discussed herein.

[0040] For instance, at operation 302, the method 300 can collect hyperpolarized 13C pyruvate MRI data during a single scanning session. At operation 304, the method 300 can collect PET data during the single scanning session. At operation 306, the method 300 can combine the hyperpolarized 13C pyruvate MRI data and PET imaging data into a plurality of fused images for an assessment of ischemic heart disease.

[0041] FIG. 4 depicts an example method 400 for performing a heart health assessment. The method 400 can be performed by the system(s) 100 and / or 200 discussed herein.

[0042] For instance, at operation 402, the method 400 can collect first hyperpolarized 13C pyruvate magnetic resonance imaging (MRI) data along a first axis during a scanning session. At operation 404, the method 400 collect second hyperpolarized 13C pyruvate MRI data along a second axis during the scanning session. At operation 406, the method 400 can collect positron emission tomography (PET) data during the scanning session. At operation 408, the method 400 can generate a plurality of fused images using the first hyperpolarized 13C pyruvate MRI data, the second hyperpolarized 13C pyruvate MRI data, and the PET imaging data for an assessment of ischemic heart disease.

[0043] It is to be understood that the specific order or hierarchy of operations in the method(s) depicted in FIGS. 3 and 4 and throughout this disclosure are instances of example approaches and can be rearranged while remaining within the disclosed subject matter. For instance, any of the operations depicted in FIGS. 3 and 4 and throughout this disclosure may be omitted, repeated, performed in parallel, performed in a different order, and / or combined with any other of the operations depicted in FIGS. 3 and 4 and throughout this disclosure.

[0044] Turning to FIG. 5, a system 500 to for performing a heart health assessment can include one or more computing devices 502 for performing the techniques discussed herein. In one implementation, the one or more computing devices 502 include one or more computing devices and / or one or more servers of the system(s) 100 and / or 200 that are configured to execute software applications and / or a module or algorithmic component of software to perform the methods disclosed herein.

[0045] In some instances, the computing device 502 can include a computer, a personal computer, a desktop computer, a laptop computer, a terminal, a workstation, a server device, a cellular or mobile phone, a mobile device, a smart mobile device a tablet, a wearable device (e.g., a smart watch, smart glasses, a smart epidermal device, etc.) a multimedia console, atelevision, an Internet-of-Things (loT) device, a smart home device, a medical device, a virtual reality (VR) or augmented reality (AR) device, a vehicle (e.g., a smart bicycle, an automobile computer, etc.), and / or the like. The computing device 502 may be integrated with, form a part of, or otherwise be associated with the systems 100-200. It will be appreciated that specific implementations of these devices may be of differing possible specific computing architectures not all of which are specifically discussed herein but will be understood by those of ordinary skill in the art.

[0046] The computing device 502 may be a computing system capable of executing a computer program product to execute a computer process. Data and program files may be input to the computing device 502, which reads the files and executes the programs therein. Some of the elements of the computing device 502 include one or more processors 504, one or more memory devices 506, and / or one or more ports, such as input / output (IO) port(s) 508 and communication port(s) 510. Additionally, other elements that will be recognized by those skilled in the art may be included in the computing device 502 but are not explicitly depicted in FIG. 5 or discussed further herein. Various elements of the computing device 502 may communicate with one another by way of the communication port(s) 510 and / or one or more communication buses, point-to-point communication paths, or other communication means.

[0047] The processor 504 may include, for example, a central processing unit (CPU), a microprocessor, a microcontroller, a digital signal processor (DSP), and / or one or more internal levels of cache. There may be one or more processors 504, such that the processor 504 comprises a single central-processing unit, or a plurality of processing units capable of executing instructions and performing operations in parallel with each other, commonly referred to as a parallel processing environment.

[0048] The computing device 502 may be a conventional computer, a distributed computer, or any other type of computer, such as one or more external computers made available via a cloud computing architecture. The presently described technology is optionally implemented in software stored on the data storage device(s) such as the memory device(s) 506, and / or communicated via one or more of the I / O port(s) 508 and the communication port(s) 510, thereby transforming the computing device 502 in FIG. 5 to a special purpose machine for implementing the operations described herein. Moreover, the computing device 502, as implemented in the systems 100-200, receives various types of input data (e.g., the imaging data) and transforms the imaging data through various stages of the data flow into new types ofdata files (e.g., the fused images). Moreover, these new data files are transformed further into output data and sent to the computing device 502 to provide information regarding the data, which enables the computing device 502 to do something it could not do before - generate the comprehensive metabolic examination results 232 from hyperpolarized 13C pyruvate MRI and PET imaging acquired during a single scanning session. These techniques are rooted in technology and could not have existed prior to the advent of medical imaging.

[0049] The one or more memory device(s) 506 may include any non-volatile data storage device capable of storing data generated or employed within the computing device 502, such as computer executable instructions for performing a computer process, which may include instructions of both application programs and an operating system (OS) that manages the various components of the computing device 502. The memory device(s) 506 may include, without limitation, magnetic disk drives, optical disk drives, solid state drives (SSDs), flash drives, and the like. The memory device(s) 506 may include removable data storage media, non-removable data storage media, and / or external storage devices made available via a wired or wireless network architecture with such computer program products, including one or more database management products, web server products, application server products, and / or other additional software components. Examples of removable data storage media include Compact Disc Read-Only Memory (CD-ROM), Digital Versatile Disc Read-Only Memory (DVD-ROM), magneto-optical disks, flash drives, and the like. Examples of non-removable data storage media include internal magnetic hard disks, SSDs, and the like. The one or more memory device(s) 506 may include volatile memory (e.g., dynamic random access memory (DRAM), static random access memory (SRAM), etc.) and / or non-volatile memory (e.g., read-only memory (ROM), flash memory, etc.).

[0050] Computer program products containing mechanisms to effectuate the systems and methods in accordance with the presently described technology may reside in the memory device(s) 506 which may be referred to as machine-readable media. It will be appreciated that machine-readable media may include any tangible non-transitory medium that is capable of storing or encoding instructions to perform any one or more of the operations of the present disclosure for execution by a machine or that is capable of storing or encoding data structures and / or modules utilized by or associated with such instructions. Machine-readable media may include a single medium or multiple media (e.g., a centralized or distributed database, and / or associated caches and servers) that store the one or more executable instructions or data structures.

[0051] In some implementations, the computing device 502 includes one or more ports, such as the I / O port(s) 508 and the communication port(s) 510, for communicating with other computing, network, or vehicle computing devices. It will be appreciated that the I / O port 508 and the communication port 510 may be combined or separate and that more or fewer ports may be included in the computing device 502.

[0052] The I / O port 508 may be connected to an I / O device, or other device, by which information is input to or output from the computing device 502. Such I / O devices may include, without limitation, one or more input devices, output devices, and / or environment transducer devices.

[0053] In one implementation, the input devices convert a human-generated signal, such as, human voice, physical movement, physical touch or pressure, and / or the like, into electrical signals as input data into the computing device 502 via the I / O port 508. Similarly, the output devices may convert electrical signals received from the computing device 502 via the I / O port 508 into signals that may be sensed as output by a human, such as sound, light, and / or touch. The input device may be an alphanumeric input device, including alphanumeric and other keys for communicating information and / or command selections to the processor 504 via the I / O port 508. The input device may be another type of user input device including, but not limited to direction and selection control devices, such as a mouse, a trackball, cursor direction keys, a joystick, and / or a wheel; one or more sensors, such as a camera, a microphone, a positional sensor, an orientation sensor, an inertial sensor, and / or an accelerometer; and / or a touch- sensitive display screen (“touchscreen”). The output devices may include, without limitation, a display, a touchscreen, a speaker, a tactile and / or haptic output device, and / or the like. In some implementations, the input device and the output device may be the same device, for example, in the case of a touchscreen.

[0054] The environment transducer devices convert one form of energy or signal into another for input into or output from the computing device 502 via the I / O port 508. For example, an electrical signal generated within the computing device 502 may be converted to another type of signal, and / or vice-versa. In one implementation, the environment transducer devices sense characteristics or aspects of an environment local to or remote from the computing device 502, such as, light, sound, temperature, pressure, magnetic field, electric field, chemical properties, physical movement, orientation, acceleration, gravity, and / or the like.

[0055] In one implementation, the communication port 510 is connected to one or more network(s) so the computing device 502 can receive network data useful in executing the methods and systems set out herein as well as transmitting information and network configuration changes determined thereby. Stated differently, the communication port 510 connects the computing device 502 to one or more communication interface devices configured to transmit and / or receive information between the computing device 52 and other devices by way of one or more wired or wireless communication networks or connections. Examples of such networks or connections include, without limitation, Universal Serial Bus (USB), Ethernet, Wi-Fi, Bluetooth®, Near Field Communication (NFC), and so on. One or more such communication interface devices may be utilized via the communication port 510 to communicate with one or more other machines, either directly over a point-to-point communication path, over a wide area network (WAN) (e.g., the Internet), over a local area network (l_AN), over a cellular network (e.g., third generation (3G), fourth generation (4G), Long- Term Evolution (LTE), fifth generation (5G), etc.) or over another communication means. Further, the communication port 510 may communicate with an antenna or other link for electromagnetic signal transmission and / or reception.

[0056] In an example, the systems 100 and 200 and / or other software, modules, services, and operations discussed herein may be embodied by instructions stored on the memory device(s) 506 and executed by the processor 504.

[0057] While specific implementations are discussed, it should be understood that this is done for illustration purposes only. A person skilled in the relevant art will recognize that other components and configurations may be used without parting from the spirit and scope of the presently disclosed technology. Thus, the following description and drawings are illustrative and are not to be construed as limiting. Numerous specific details are described to provide a thorough understanding of the presently disclosed technology. However, in certain instances, well-known or conventional details are not described in order to avoid obscuring the description. References to one or an implementation in the presently disclosed technology can be references to the same implementation or any implementation; and such references mean at least one of the implementations.

[0058] The terms used in this specification generally have their ordinary meanings in the art, within the context of the presently disclosed technology, and in the specific context where each term is used. Alternative language and synonyms may be used for any one or more of the termsdiscussed herein, and no special significance should be placed upon whether or not a term is elaborated or discussed herein. In some cases, synonyms for certain terms are provided. A recital of one or more synonyms does not exclude the use of other synonyms. The use of examples anywhere in this specification including examples of any terms discussed herein is illustrative only and is not intended to further limit the scope and meaning of the presently disclosed technology or of any example term. Likewise, the presently disclosed technology is not limited to various implementations given in this specification.

Claims

CLAIMSWhat is claimed is:1 . A method to assess heart health comprising: collecting hyperpolarized 13C pyruvate magnetic resonance imaging (MRI) data during a single scanning session of a heart; collecting positron emission tomography (PET) imaging data during the single scanning session of the heart; combining the hyperpolarized 13C pyruvate MRI data and the PET imaging data; and generating a plurality of fused images using the hyperpolarized 13C pyruvate MRI data and the PET imaging data for an assessment of ischemic heart disease.

2. The method of claim 1 , further comprising: identifying regions of at least one of altered metabolism, perfusion, or viability using the plurality of fused images.

3. The method of claim 1 , further comprising: intravenously administering a radioactive glucose analog to a patient undergoing the single scanning session.

4. The method of claim 3, wherein, the radioactive glucose analog includes Fluorodeoxyglucose 18F (FDG).

5. The method of claim 1 , further comprising:intravenously administering a hyperpolarized 13C pyruvate solution to a patient undergoing the single scanning session.

6. The method of claim 1 , wherein, the combining of the hyperpolarized 13C pyruvate MRI data and PET imaging data includes concurrently acquiring PET Data with MRI data using electrocardiography (ECG) gating.

7. A method of claim 1, wherein, the combining of the hyperpolarized 13C pyruvate MRI data and the PET imaging data into the plurality of fused images includes processing the hyperpolarized 13C pyruvate MRI data and the PET imaging data to generate cine magnetic resonance anatomical images.

8. The method of claim 1 , further comprising: presenting the plurality of fused images at a display of an imaging clinic computing device.

9. The method of claim 1, wherein, the single scanning session of the heart is performed using a PET-MR hybrid scanner device.

10. The method of claim 1 , wherein, the collecting of the hyperpolarized 13C pyruvate MRI data includes:collecting first data along a short axis, the first data corresponding to a first hyperpolarized 13C pyruvate solution injection, and collecting second data along a long axis, the long axis perpendicular to the short axis, the second data corresponding to a second hyperpolarized 13C pyruvate solution injection.

11. A system to assess heart health comprising: a PET-MR hybrid scanner device configured to collect hyperpolarized 13C pyruvate magnetic resonance imaging (MRI) data and positron emission tomography (PET) data during a single scanning session of a heart; at least one processor; memory storing instructions that, when executed by the at least one processor, cause the system to: combine the hyperpolarized 13C pyruvate MRI data with the PET imaging data; and generate one or more fused images using the hyperpolarized 13C pyruvate MRI data with the PET imaging data; and a display configured to present the one or more fused images for an assessment of heart disease.

12. The system of claim 11 , wherein, the assessment of heart disease includes assessing ischemic heart disease by identifying a region of at least one of altered metabolism, perfusion, or viability.

13. The system of claim 11 , wherein,the hyperpolarized 13C pyruvate MRI data includes a plurality of echo images representing a metabolic conversion of hyperpolarized 13C pyruvate into 13C lactate and 13C bicarbonate.

14. The system of claim 11 , wherein, the one or more fused images represent a mid-anterolateral region of the heart.

15. The system of claim 11 , wherein, the one or more fused images represent a mid-inferolateral region of a myocardium of the heart.

16. The system of claim 11 , wherein, the hyperpolarized 13C pyruvate MRI data includes first data along a first axis and second data along a second axis, the first data is received via a first data collection period at least partly following a first injection, and the second data is received via a second data collection period following at least partly following a second injection.

17. A method to assess heart health comprising: collecting first hyperpolarized 13C pyruvate magnetic resonance imaging (MRI) data along a first axis during a scanning session of a heart; collecting second hyperpolarized 13C pyruvate MRI data along a second axis during the scanning session; collecting positron emission tomography (PET) data during the scanning session; andgenerating a plurality of fused images using the first hyperpolarized 13C pyruvate MRI data, the second hyperpolarized 13C pyruvate MRI data, and the PET imaging data for an assessment of ischemic heart disease.

18. The method of claim 17, further comprising: collecting one or more 1-hydrogen (1 H) images, wherein generating the plurality of fused images includes using the one or more 1 H images as an anatomical reference.

19. The method of claim 17, further comprising: determining one or more bicarbonate-lactate ratios corresponding to at least one of the first axis or the second axis; presenting the plurality of fused images at a display of an imaging clinic computing device; and presenting an indication of the one or more bicarbonate-lactate ratios at the imaging clinic computing device.

20. The method of claim 17, wherein, the assessment of ischemic heart disease includes at least one of a first blood glucose measurement before a glucose load, a second glucose measurement after the glucose load, a pyruvate measurement, a triglycerides measurement, a free fatty acids measurement, or an insulin level measurement.

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