Hybrid cardiac imaging using PET/MRI: a joint position statement by the European Society of Cardiovascular Radiology (ESCR) and the European Association of Nuclear Medicine (EANM)

Abstract

Positron emission tomography (PET) and magnetic resonance imaging (MRI) have both been used for decades in cardiovascular imaging. Since 2010, hybrid PET/MRI using sequential and integrated scanner platforms has been available, with hybrid cardiac PET/MR imaging protocols increasingly incorporated into clinical workflows. Given the range of complementary information provided by each method, the use of hybrid PET/MRI may be justified and beneficial in particular clinical settings for the evaluation of different disease entities. In the present joint position statement, we critically review the role and value of integrated PET/MRI in cardiovascular imaging, provide a technical overview of cardiac PET/MRI and practical advice related to the cardiac PET/MRI workflow, identify cardiovascular applications that can potentially benefit from hybrid PET/MRI, and describe the needs for future development and research. In order to encourage its wide dissemination, this article is freely accessible on the European Radiology and European Journal of Hybrid Imaging web sites.Key Points • Studies and case-reports indicate that PET/MRI is a feasible and robust technology. • Promising fields of application include a variety of cardiac conditions. • Larger studies are required to demonstrate its incremental and cost-effective value. • The translation of novel radiopharmaceuticals and MR-sequences will provide exciting new opportunities.

Assessment of sympathetic reinnervation after cardiac transplantation using hybrid cardiac PET/MRI: A pilot study

“…3) Despite differences in myocardial composition, there was no impact of reinnervation on rest LV function, WM, or WT, even when assessed on the segmental level. Hybrid cardiac PET/MRI is a relatively novel imaging technique that provides the opportunity to obtain deep insights into myocardial composition; however, its clinical value has yet to be evaluated . To date, most PET/MRI studies using [ 18 F]FDG have focused on myocardial infarction or on the assessment of inflammation in the case of cardiac sarcoidosis .…”

EANM procedural guidelines for PET/CT quantitative myocardial perfusion imaging

“…Cardiac hybrid imaging offers the ability to combine strengths of different imaging modalities for anatomical and functional evaluation of CAD [ 175 – 177 ]. Hybrid images contain two datasets that are combined into a fused image in which both modalities contribute important information.…”

“…Hybrid scanners combining PET with a multidetector CT, which can perform CT assessment of coronary anatomy, are becoming the standard for almost all commercially available devices [ 175 ]. In addition to CT, the newest generation of scanners offers the combination of PET with MRI [ 177 ].…”

“…Hybrid imaging is a relatively novel technology and there is still a need to clarify which patients can benefit most from hybrid imaging, how to optimally combine different modalities and what is the cost-effectiveness of hybrid imaging [ 175 – 177 ]. MPI and CCTA can be performed in a single session with PET/CT scanners that have a minimum of 64 detector rows.…”

PET-derived bone information from 18F-sodium fluoride: A perfect match for whole-body PET/MR attenuation correction?

“…1,2 Although the main application of hybrid PET/MR imaging to oncology and neurology studies, 3 this hybrid modality is of keen interest to cardiology where its potential applications are considered strong for studies of cardiac inflammation, ischemic heart disease and ischemic cardiomyopathies as discussed in the joint position statement between the European Society of Cardiovascular Radiology (ESCR) and European Association of Nuclear Medicine (EANM). 4 Although PET/MR systems and their applications are becoming more widespread, the quantitative accuracy of these systems are still in question because of the difficulties related to PET attenuation correction (AC) maps 5,6 derived from MR images. Unlike the use of photon transmission-based AC maps obtained for standalone PET and PET/CT systems (rotating rods or CT, respectively), the attenuation maps for PET/MR are obtained from dedicated MR imaging acquisitionswith current products based on the DIXON sequence.…”