Functional imaging beyond anatomy: The emerging role of magnetic resonance spectroscopy and metabolic biomarkers in monitoring targeted cancer therapy

Authors

  • Hao Sun ZJU-Xinchang Joint Innovation Centre (TianMu Laboratory), Gaochang Hi-Tech Park, Xinchang 312500, China; College of Animal Sciences, Zhejiang University, Hangzhou 310058, China; Wolfson Institute for Biomedical Research, Division of Medicine, University College London, Gower St, WC1E 6BT, London, United Kingdom https://orcid.org/0009-0009-9013-5681
  • Xiaojun Dong Hunan Provincial Key Laboratory of Novel Antibody Drugs and Their Intelligent Transportation Systems, Hunan Provincial Key Laboratory of Synthetic Biology Research of Traditional Chinese Medicines, School of Medical Information and Engineering, Hunan University of Medicine, Huaihua, China https://orcid.org/0009-0009-7497-4944
  • Jinze Yu Computer Science and Communication Engineering, Global Center for Science and Engineering, Faculty of Science, Waseda University, Tokyo, Japan https://orcid.org/0009-0000-2509-0047
  • Yuanyin Teng Institute of Hematology, Zhejiang University, Hangzhou 310003, China https://orcid.org/0009-0003-5331-7220
  • Gaoyang Guo Faculty of Information Science and Technology (FTSM), Universiti Kebangsaan Malaysia (UKM), 43600 UKM Bangi, Selangor, Malaysia https://orcid.org/0000-0001-9873-8676
  • Liangyu Li Faculty of Information Science and Technology (FTSM), Universiti Kebangsaan Malaysia (UKM), 43600 UKM Bangi, Selangor, Malaysia https://orcid.org/0000-0002-7535-7448
  • Wei Wang Center for Precision Health, School of Medical and Health Science, Edith Cowan University, Perth, WA, 6027, Australia; The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China https://orcid.org/0000-0003-4821-0130
  • Bing Liu College of Animal Sciences, Zhejiang University, Hangzhou 310058, China; ZJU-Xinchang Joint Innovation Centre (TianMu Laboratory), Gaochuang Hi-Tech Park, Xinchang 312500, China https://orcid.org/0000-0003-0000-3810
  • Yuquan Li State Key Laboratory of Public Big Data, College of Computer Science and Technology, Guizhou University, Guizhou, China https://orcid.org/0009-0006-9568-3335
  • Keyang Xu Faculty of Chinese Medicine, State Key Laboratory of Mechanism and Quality of Chinese Medicine, Macau University of Science and Technology, Macau, China https://orcid.org/0000-0002-7049-2528

DOI:

https://doi.org/10.14295/bjs.v6i3.963

Keywords:

magnetic resonance spectroscopy, metabolic biomarkers, targeted cancer therapy, hyperpolarized 13C MRI, deuterium metabolic imaging

Abstract

Anatomical imaging — measurements of tumour size on computed tomography or conventional magnetic resonance imaging (MRI) — remains the backbone of oncologic response assessment, yet it is structurally blind to the earliest events of treatment action. Targeted anticancer agents, by definition, act on specific molecular pathways whose blockade alters tumour metabolism within hours to days, long before any measurable change in tumour dimensions. Magnetic resonance spectroscopy (MRS) and spectroscopic imaging (MRSI) are uniquely positioned to capture these pharmacodynamic events non-invasively, repeatedly and without ionising radiation, by quantifying endogenous metabolites that report on membrane phospholipid turnover (total choline, phosphomonoesters), aerobic glycolysis (lactate), neuronal and tissue integrity (N-acetylaspartate, citrate), oncometabolite production (2-hydroxyglutarate in IDH-mutant glioma) and, with hyperpolarised 13C and deuterium (2H) tracers, real-time metabolic fluxes. This review synthesises the principles, biomarker repertoire and clinical evidence for MRS-based monitoring of targeted cancer therapy across glioma, breast, prostate and abdominal malignancies; examines how metabolic readouts document on-target pathway modulation for kinase, PI3K/AKT/mTOR, IDH, antiangiogenic and endocrine agents; surveys the maturing technologies of hyperpolarised 13C MRSI and deuterium metabolic imaging; and discusses the integration of MRS with multiparametric MRI, artificial intelligence and nanotheranostic drug development. We argue that the field is transitioning from proof-of-principle pharmacodynamic studies toward standardised, biomarker-guided adaptive therapy, and that the principal barriers — technical harmonisation, quantification standards and prospective validation — are now well defined and addressable. Functional imaging beyond anatomy, anchored in MRS-detectable metabolic biomarkers, offers a practical route to earlier response assessment, reduced exposure to ineffective therapy and more informative oncology drug development.

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2026-08-16

How to Cite

Sun, H., Dong, X., Yu, J., Teng, Y., Guo, G., Li, L., … Xu, K. (2026). Functional imaging beyond anatomy: The emerging role of magnetic resonance spectroscopy and metabolic biomarkers in monitoring targeted cancer therapy. Brazilian Journal of Science, 6(3), 13–31. https://doi.org/10.14295/bjs.v6i3.963