Whole-body hybrid PET/MRI: ready for clinical use?

Ratib, Osman; Beyer, Thomas

doi:10.1007/s00259-011-1790-4

Cited by 52 publications

(26 citation statements)

References 20 publications

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“…Since silicon avalanche photodetectors operable within an MR system were introduced, 19 several prototypes of simultaneous WB MRI-PET have been installed in clinical settings. 20 Recently, Schwenzer et al 18 compared the performance of MRI-PET imaging in the staging of lung cancer with that of PET-CT as the reference standard and compared the quantification accuracy of a new WB MRI-PET system with corresponding PET-CT data sets. Those authors concluded that MRI-PET imaging of the lung ensured diagnostic image quality in the assessment of pulmonary masses.…”

Section: Discussionmentioning

confidence: 99%

Coregistered whole body magnetic resonance imaging‐positron emission tomography (MRI‐PET) versus PET‐computed tomography plus brain MRI in staging resectable lung cancer

Lee

et al. 2013

Cancer

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BACKGROUND:The objective of this study was to assess whether coregistered whole brain (WB) magnetic resonance imaging-positron emission tomography (MRI-PET) would increase the number of correctly upstaged patients compared with WB PET-computed tomography (PET-CT) plus dedicated brain MRI in patients with nonsmall cell lung cancer (NSCLC). METHODS: From January 2010 through November 2011, patients with NSCLC who had resectable disease based on conventional staging were assigned randomly either to coregistered MRI-PET or WB PET-CT plus brain MRI (ClinicalTrials.gov trial NCT01065415). The primary endpoint was correct upstaging (the identification of lesions with higher tumor, lymph node, or metastasis classification, verified with biopsy or other diagnostic test) to have the advantage of avoiding unnecessary thoracotomy, to determine appropriate treatment, and to accurately predict patient prognosis. The secondary endpoints were over staging and under staging compared with pathologic staging. RESULTS: Lung cancer was correctly upstaged in 37 of 143 patients (25.9%) in the MRI-PET group and in 26 of 120 patients (21.7%) in the PET-CT plus brain MRI group (4.2% difference; 95% confidence interval, À6.1% to 14.5%; P ¼ .426). Lung cancer was over staged in 26 of 143 patients (18.2%) in the MRI-PET group and in 7 of 120 patients (5.8%) in the PET-CT plus brain MRI group (12.4% difference; 95% confidence interval, 4.8%-20%; P ¼ .003), whereas lung cancer was under staged in 18 of 143 patients (12.6%) and in 28 of 120 patients (23.3%), respectively (À10.7% difference; 95% confidence interval, À20.1% to À1.4%; P ¼ .022). CONCLUSIONS: Although both staging tools allowed greater than 20% correct upstaging compared with conventional staging methods, coregistered MRI-PET did not appear to help identify significantly more correctly upstaged patients than PET-CT plus brain MRI in patients with NSCLC. Cancer INTRODUCTIONIn an effort to improve diagnostic accuracy and to compensate for the drawbacks of individual imaging modalities, alternative hardware-based and software-based approaches to postprocessing alignment of each imaging device involve the fusion of different imaging techniques in a single scanner.1,2 This and other similar efforts have been directed at synergistic effect of individual performance of computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI) beyond an ordinary additive effect of those individual components.One of the most important indications for whole body (WB) imaging is the detection of metastases. PET-CT is the most popular imaging device for metastasis workup. 3,4 With the development of fast MRI techniques (fast, T2-weighted [T2W] spin-echo and 3-dimensional, gradient-echo sequences) and a rolling table platform, Currently, WB MRI also is being used for metastatic workup.

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Section: Discussionmentioning

confidence: 99%

Coregistered whole body magnetic resonance imaging‐positron emission tomography (MRI‐PET) versus PET‐computed tomography plus brain MRI in staging resectable lung cancer

Lee

et al. 2013

Cancer

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“…Integrated PET/MR opens new perspectives in biomedical research and clinical multimodality imaging [3][4][5][6]. In addition to better soft tissue contrast and lack of ionizing radiation exposure, MRI offers a wide range of advanced imaging techniques [7,8], such as apparent diffusion coefficient maps for quantification of cellular density [9], arterial spin labelling for measurement of blood flow [10], dynamic contrast enhancement to assess the characteristics of tumour vasculature, including perfusion, blood vessel permeability, blood volume and extravascular extracellular volume fraction [11], and quantification of tissue metabolite concentrations by calibrated 1 H-MR spectroscopy [12,13] or based on hyperpolarized 13 C [14].…”

Section: Introductionmentioning

confidence: 99%

Discrimination and anatomical mapping of PET-positive lesions: comparison of CT attenuation-corrected PET images with coregistered MR and CT images in the abdomen

Kuhn

Crook

Mader

et al. 2012

Eur J Nucl Med Mol Imaging

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Purpose PET/MR has the potential to become a powerful tool in clinical oncological imaging. The purpose of this prospective study was to evaluate the performance of a single T1-weighted (T1w) fat-suppressed unenhanced MR pulse sequence of the abdomen in comparison with unenhanced low-dose CT images to characterize PET-positive lesions. Methods A total of 100 oncological patients underwent sequential whole-body 18 F-FDG PET with CT-based attenuation correction (AC), 40 mAs low-dose CT and two-point Dixonbased T1w 3D MRI of the abdomen in a trimodality PET/CT-MR system. PET-positive lesions were assessed by CT and MRI with regard to their anatomical location, conspicuity and additional relevant information for characterization. Results From among 66 patients with at least one PETpositive lesion, 147 lesions were evaluated. No significant difference between MRI and CT was found regarding anatomical lesion localization. The MR pulse sequence used performed significantly better than CT regarding conspicuity of liver lesions (p<0.001, Wilcoxon signed ranks test), whereas no difference was noted for extrahepatic lesions. For overall lesion characterization, MRI was considered superior to CT in 40 % of lesions, equal to CT in 49 %, and inferior to CT in 11 %. Conclusion Fast Dixon-based T1w MRI outperformed lowdose CT in terms of conspicuity and characterization of PET-positive liver lesions and performed similarly in extrahepatic tumour manifestations. Hence, under the assumption that the technical issue of MR AC for whole-body PET examinations is solved, in abdominal PET/MR imaging the replacement of low-dose CT by a single Dixon-based MR pulse sequence for anatomical lesion correlation appears to be valid and robust.

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“…Hybrid PET/MRI is a recently developed technique which is attracting growing interest among the medical community owing to its potential clinical and research applications [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Molecular neuroimaging with PET/MRI

Garibotto¹,

Förster

Haller³

et al. 2013

Clin Transl Imaging

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Hybrid PET/MRI is a recently developed technique, which is attracting growing interest among the medical community owing to its potential clinical and research applications. PET/MRI is of special interest for neuroscience, given that PET and MRI are the neuroimaging methods of choice for many clinical and scientific applications. The first clinical studies conducted have tested the performance of PET/MRI in oncology indications, neurodegenerative disorders and epilepsy, using aminoacidic tracers and somatostatin-receptor imaging ( 68 Ga-DOTATOC), 18 F-fluorodeoxyglucose ( 18 F-FDG), and 11 C-flumazenil, respectively, and shown that the acquisition of both brain PET and MRI can be performed in a single session on a hybrid PET/MRI system achieving quality comparable to that of PET/CT and MRI acquired separately, but with some important advantages. Combined acquisition of PET and MRI maximizes the clinical information and optimizes the registration of both modalities, while minimizing patient discomfort. Sparing the patient the CT scan can reduce radiation exposure while the accurate coregistration due to the identical positioning opens new windows for better region-specific evaluation of PET data, particularly when acquired with tracers that provide little anatomical information. PET and MRI parameters can be systematically combined for diagnostic interpretation and new options concerning partial volume and motion correction can be exploited. There are still open issues, such as the selection of clinical indications, the influence of the combined design on the performance of each modality, and, in particular, the validation of quantitative PET measures with respect to attenuation correction. Overall, PET/MRI hybrid imaging is an exciting new modality and potentially the future modality of choice for neuroimaging investigations.

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Whole-body hybrid PET/MRI: ready for clinical use?

Cited by 52 publications

References 20 publications

Coregistered whole body magnetic resonance imaging‐positron emission tomography (MRI‐PET) versus PET‐computed tomography plus brain MRI in staging resectable lung cancer

Coregistered whole body magnetic resonance imaging‐positron emission tomography (MRI‐PET) versus PET‐computed tomography plus brain MRI in staging resectable lung cancer

Discrimination and anatomical mapping of PET-positive lesions: comparison of CT attenuation-corrected PET images with coregistered MR and CT images in the abdomen

Molecular neuroimaging with PET/MRI

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