The combination of PET and MR imaging forms a powerful new imaging modality, PET/MR. The major advantages of concurrent PET/MR acquisitions range from patient comfort and increased throughput to multiparametric imaging and are evaluated and reviewed in this paper specifically with respect to their applications in research and diagnostics. Alongside the use of PET/MR in the field of preclinical research, this paper illuminates the impact of this new modality in the clinical field in such areas as neurology, oncology, and cardiology. Now that PET/MR technology has matured, attention is needed on standardizing education for nuclear and radiologic technologists and physicians specifically for this combined modality. Furthermore, the impact of this combined modality on health economy needs to be addressed in more detail to further propel its use. More than a decade after the first introduction of prototype preclinical PET/MR systems (1), it is time to critically reflect on the state of PET/ MR technology and its current and future applications in both the preclinical and clinical settings.Although the first ideas about combined PET/MR systems can be traced back to the late 1980s, with patent applications issued more than 20 y ago (2), the technologic evolution of PET/MR was much slower than that of PET/CT, which appeared on the horizon in the mid-1990s and was clinically available as soon as 2000 (3). The main reasons for the slow start of PET/MR into preclinical and clinical practice were mainly the technologic hurdles that needed to be overcome. Combining two imaging systems into a single PET/CT device is relatively straightforward, and the potential mutual interference between the two modalities is limited, unlike PET/MR, which requires a substantial engineering effort. However, the benefits of a combined PET/MR system are at least on a par with PET/CT, and its expected clinical and preclinical potential greatly exceeds the options for PET/CT, specifically in research applications (4).
TECHNOLOGIC IMPLICATIONSThe early years of PET/MR development focused on finding alternative approaches to photomultiplier tubes (PMTs)-the traditional PET detectors-which are sensitive to the magnetic field produced by MR systems. Field strengths near the strong main magnetic fields of MR scanners typically are 4.7-21 T preclinically and 1-3 T clinically. The primary approach to coping with the problem of strong magnetic fields was to place the PMTs outside the main magnetic field and link them by long optical fibers to the scintillation crystals (5). Most of these concepts focused on altering solely the PET detection system. However, modifications to the MR system in the form of dedicated split magnets (6) and systems that switched off the MR field during PET acquisition (7) have been presented. Unfortunately, these designs have to cope with some tradeoffs, either on the PET side, where the scintillation light is diminished by the use of long optical fibers, or on the MR side, where the MR performance is degraded by design comprom...