Deuterium Imaging Offers New View of Brain Metabolism

Emerging MRI technique could aid diagnosis of cancer and brain disease

BY ALEC BUTTNER October 14, 2026

Port

Bøgh

de Graaf

Two studies in Radiology highlight advances in deuterium metabolic imaging (DMI), an emerging method for imaging metabolism in the living brain. If developed further, the approach could offer a new way to diagnose conditions ranging from cancer to neurodegenerative diseases.

“DMI is a promising new technology with potentially unlimited applications, depending on the development of disease-specific tracers, and that’s exciting,” said John D. Port, MD, PhD, professor of radiology and associate professor of psychiatry at Mayo Clinic in Rochester, MN, and author of an accompanying editorial.

Together, the studies show both DMI’s promise as a metabolic imaging tool and the practical questions that must be addressed before broader clinical use.

“DMI adds another metabolic dimension compared to other technologies, allowing visualization of not only where the glucose goes but also what it turns into,” explained Nikolaj Bøgh, MD, PhD, researcher in the Department of Clinical Medicine at the MR Research Centre, Aarhus University in Denmark.

DMI relies on molecules labeled with deuterium, a form of hydrogen that can be detected by specialized MRI equipment. According to Dr. Bøgh, the most common tracer is deuterated glucose, which behaves like ordinary glucose as it moves through the body.

As cells process glucose, the deuterium label remains attached to its metabolic byproducts, allowing researchers to track how tissues use energy. Unlike conventional imaging, which primarily shows anatomy, DMI provides insight into cellular metabolism.

The technique can distinguish between different metabolic pathways. Healthy cells typically break down glucose through oxidative metabolism, producing glutamate and glutamine signal. Diseased cells rely more heavily on glycolysis, which produces lactate. Elevated lactate levels can be associated with conditions such as ischemia, inflammation and cancer.

Shutterstock image of translucent head with brain inside

Adding Metabolic Detail Beyond PET

DMI is not the first tool for imaging metabolism. For decades, FDG PET has helped diagnose and stage diseases by tracking how tissues take up a radioactive form of glucose. Because metabolically active tissues, including many tumors, consume more glucose, FDG PET can diagnose and stage many conditions.

“FDG PET is a powerful tool to generate strong image contrast based on differences in tissue uptake rates, like tumors outside the brain. However, FDG PET is limited to the initial uptake step and does not provide information on downstream metabolism,” said Robin A. de Graaf, PhD, a professor of radiology and biomedical imaging at Yale School of Medicine in New Haven, CT.

The ability to look beyond glucose uptake is one potential advantage of DMI. The technique may also offer practical benefits by combining metabolic and structural imaging.

“A DMI exam is combining the two most important scans that are performed separately today: the metabolic PET scan and the structural MRI scan,” Dr. Bøgh said. “In this way, the technology has the potential to yield important metabolic and structural information in one setting instead of two."

Dr. Bøgh noted that DMI’s tracer itself is also easier to manage. “Unlike FDG PET, DMI uses deuterated glucose, which has a long shelf life,” he explained. “This simplifies the logistics, potentially making metabolic imaging more accessible and cheaper at large scale."

To see how DMI performs in practice, Dr. Bøgh and his colleagues compared it with FDG PET in patients with Alzheimer's disease (AD). Participants with AD and healthy controls drank a solution of deuterated glucose before undergoing DMI, and the results were compared with FDG PET findings.

While DMI did not reveal the shift toward anaerobic metabolism the researchers had hypothesized, the study found that DMI closely mirrored FDG PET.

“Areas of the brain that are known to be affected in AD are hypometabolic when observed with DMI, and this correlates to FDG PET,” Dr. Bøgh explained. “When DMI is further matured, it might yield important metabolic information like FDG PET in the same session as structural imaging."

“A DMI exam is combining the two most important scans that are performed separately today: the metabolic PET scan and the structural MRI scan. In this way, the technology has the potential to yield important metabolic and structural information in one setting instead of two."

— NIKOLAJ BØGH, MD, PHD

Evidence Builds, Barriers Remain

While Dr. Bøgh’s study examined how DMI compared with FDG PET in patients with AD, the Yale-led study focused on one of its biggest practical hurdles: scan time.

A combined MRI and DMI exam can take more than an hour. Dr. de Graaf and colleagues leveraged the physics of DMI and MRI to acquire both at once.

The method works because hydrogen and deuterium respond to different frequencies. “There is an approximate seven-fold frequency difference,” Dr. de Graaf explained. “In practical terms this means that an RF pulse applied to the proton frequency does not perturb the nuclear spins at the deuterium frequency and vice versa.”

The second challenge lies in the magnetic field gradients that build the image and affect both nuclei at once. This was solved with careful timing by applying them to one nucleus at a time. “The MRI and DMI methods run effectively independently," Dr. de Graaf said.

While simultaneous acquisition could help address scan length, DMI still faces barriers before it can move from research settings to clinical adoption. One is low image resolution. “DMI images are extremely low resolution due to the low MR sensitivity of deuterium,” Dr. Port said. “New, innovative methods will be needed to increase the resolution of images to something more anatomically detailed.”

Beyond resolution, Dr. Port points to a more fundamental hurdle. “DMI and relevant deuterated tracers must be proven to diagnose diseases accurately. This sounds simple, but it will require decades of work to convince radiologists that DMI is a valuable technology worth investing in,” he said. “There’s no sense spending money on an expensive scanner upgrade (a multi-nuclear package and associated deuterium-tuned coils) if the technique is not clinically useful.”

Despite these limitations, Dr. Port sees DMI as an early glimpse of something much larger. “In my opinion, we have barely begun to explore the enormous potential of MRI technology,” he said. “If traditional proton imaging is like black and white TV, we are currently poised at the edge of a future era of non-proton color TV.”