LDHA and hepatocellular carcinoma: According to several hyperpolarized 13C MRS studies [18,19,20,21], [1-13C] Lac was significantly elevated in hepatic injuries and HCCs, and significantly higher levels of LDH-A were found in HCC than in the normal liver, suggesting that the elevated levels of Lac in HCC can be attributed to the increased LDH-A enzyme level [18].