In a separate study, a multiparametric imaging approach using DCE-MRI, hyperpolarized [1-13C]pyruvate and [1,4-13C2]fumarate MRI was used to simultaneously detect early changes in tumor vascular permeability and perfusion, glycolysis, and necrotic cell death in response to combined anti-CTLA-4 and anti-PD-L1 therapy.86 Following successful response to treatment, a significant increase in [1,4-13C2]fumarate to [1,4-13C2]malate conversion indicating tumor cell death, and tumor vascular permeability and perfusion (as measured by Ktrans) was detected in MC38 colorectal tumors. Here, CTLA4 is linked to neoplasm.