Abstract
Integrated PET/MRI systems have been successfully introduced into scientific and clinical applications within the past 7 years, leveraging hybrid imaging onto a new platform of simultaneous acquisition of complementary metabolic, functional and morphologic information based on simultaneously obtained PET and MR data sets. While the integration of PET systems into whole-body MR scanners was a challenging task to overcome demanding a great amount of technological and methodological adjustments and modifications, the interchange of the CT component with MRI has been proven well worth the defying work. The unparalleled soft-tissue contrast of MRI, exact co-registration of PET and MR data and the inherent multifunctionality of MRI, in terms of the potential for multiparametric MR imaging and associated acquisition of non-invasive tissue features and biomarkers, are only some of the benefits to be named. While the transition of PET/MRI from exclusive scientific applications to clinical viability has been well demonstrated, it remains to be the source of continuous and on-going research on clinical, methodological and technical issues.
While PET/CT is still considered the gold-standard of hybrid imaging and is esteemed an invaluable diagnostic tool, the interchange to MRI as the “morphologic” partner bears the potential for innumerous emerging applications apart from its exclusive utilization for anatomic correlation, namely multiparametric imaging for tissue characterization and enhanced understanding of disease biology. At the same time continuous research and developments on new-generation PET probes arouse far-reaching interest for enticing new applications not only for diagnostic, but also theranostic approaches. This chapter is designed to give a short overview on the evolution of PET/MR applications, workflow developments and future prospects of emerging application fields.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
An YS, Kang DK, Jung YS, et al. Tumor metabolism and perfusion ratio assessed by 18F-FDG PET/CT and DCE-MRI in breast cancer patients: correlation with tumor subtype and histologic prognostic factors. Eur J Radiol. 2015;84:1365–70.
Barbosa Fde G, von Schulthess G, Veit-Haibach P. Workflow in simultaneous PET/MRI. Semin Nucl Med. 2015;45:332–44.
Barrio M, Fendler WP, Czernin J, et al. Prostate specific membrane antigen (PSMA) ligands for diagnosis and therapy of prostate cancer. Expert Rev Mol Diagn. 2016;16:1177–88.
Beiderwellen K, Gomez B, Buchbender C, et al. Depiction and characterization of liver lesions in whole body [18F]-FDG PET/MRI. Eur J Radiol. 2013;82:e669–75.
Beiderwellen K, Huebner M, Heusch P, et al. Whole-body [(1)(8)F]FDG PET/MRI vs. PET/CT in the assessment of bone lesions in oncological patients: initial results. Eur Radiol. 2014;24:2023–30.
Bonekamp D, Jacobs MA, El-Khouli R, et al. Advancements in MR imaging of the prostate: from diagnosis to interventions. Radiographics. 2011;31:677–703.
Buchbender C, Heusner TA, Lauenstein TC, et al. Oncologic PET/MRI, Part 1: tumors of the brain, head and neck, chest, abdomen, and pelvis. J Nucl Med. 2012;53:928–38.
Catalano OA, Gee MS, Nicolai E, et al. Evaluation of quantitative PET/MRI enterography biomarkers for discrimination of inflammatory strictures from fibrotic strictures in Crohn disease. Radiology. 2016;278:792–800.
Delongchamps NB, Rouanne M, Flam T, et al. Multiparametric magnetic resonance imaging for the detection and localization of prostate cancer: Combination of T2-weighted, dynamic contrast-enhanced and diffusion-weighted imaging. BJU Int. 2011;107:1411–8.
Drzezga A, Souvatzoglou M, Eiber M, et al. First clinical experience with integrated whole-body PET/MR: comparison to PET/CT in patients with oncologic diagnoses. J Nucl Med. 2012;53:845–55.
Eiber M, Takei T, Souvatzoglou M, Mayerhoefer ME, et al. Performance of whole-body integrated 18F-FDG PET/MR in comparison to PET/CT for evaluation of malignant bone lesions. J Nucl Med. 2014;55:191–7.
Eiber M, Weirich G, Holzapfel K, Souvatzoglou M, Haller B, Rauscher I, et al. Simultaneous 68Ga-PSMA HBED-CC PET/MRI improves the localization of primary prostate cancer. Eur Urol. 2016;70:829–36.
Erfanian Y, Grueneisen J, Kirchner J, et al. Integrated 18F-FDG PET/MRI compared to MRI alone for identification of local recurrences of soft tissue sarcomas: a comparison trial. Eur J Nucl Med Mol Imaging. 2017. https://doi.org/10.1007/s00259-017-3736-y.
Fendler WP, Rahbar K, Herrmann K, et al. 177Lu-PSMA radioligand therapy for prostate cancer. J Nucl Med. 2017. https://doi.org/10.2967/jnumed.117.191023. pii: jnumed.117.191023, [Epub ahead of print]
Georg P, Andrzejewski P, Baltzer P, et al. Changes in tumor biology during chemoradiation of cervix cancer assessed by multiparametric MRI and hypoxia PET. Mol Imaging Biol. 2017. https://doi.org/10.1007/s11307-017-1087-5. [Epub ahead of print].
George GPC, Pisaneschi F, Nguyen QD, et al. Positron emission tomographic imaging of CXCR4 in cancer: challenges and promises. Mol Imaging. 2015;14:7290201400041. https://doi.org/10.2310/7290.2014.00041.
Gillies RJ, Kinahan PE, Hricak H. Radiomics: images are more than pictures, they are data. Radiology. 2016;278:563–77.
Grueneisen J, Beiderwellen K, Heusch P, et al. Simultaneous positron emission tomography/magnetic resonance imaging for whole-body staging in patients with recurrent gynecological malignancies of the pelvis: a comparison to whole-body magnetic resonance imaging alone. Investig Radiol. 2014;49:808–15.
Grueneisen J, Schaarschmidt BM, Heubner M, et al. Implementation of FAST-PET/MRI for whole-body staging of female patients with recurrent pelvic malignancies: a comparison to PET/CT. Eur J Radiol. 2015a;84:2097–102.
Grueneisen J, Nagarajah J, Buchbender C, et al. Positron Emission tomography/magnetic resonance imaging for local tumor staging in patients with primary breast cancer: a comparison with positron emission tomography/computed tomography and magnetic resonance imaging. Investig Radiol. 2015b;50:505–13.
Herrmann K, Lapa C, Wester HJ, et al. Biodistribution and radiation dosimetry for the chemokine receptor CXCR4-targeting probe 68Ga-pentixafor. J Nucl Med. 2015;56:410–6.
Herrmann K, Schottelius M, Lapa C, et al. First-in-human experience of CXCR4-directed endoradiotherapy with 177Lu- and 90Y-labeled pentixather in advanced-stage multiple myeloma with extensive intra- and extramedullary disease. J Nucl Med. 2016;57:248–51.
Heusch P, Nensa F, Schaarschmidt B, et al. Diagnostic accuracy of whole-body PET/MRI and whole-body PET/CT for TNM staging in oncology. Eur J Nucl Med Mol Imaging. 2014;42:42–8. https://doi.org/10.1007/s00259-014-2885-5.
Ishii S, Hara T, Nanbu T, et al. Optimized workflow and imaging protocols for whole-body oncologic PET/MRI. Jpn J Radiol. 2016;34:754–62.
Kesch C, Vinsensia M, Radtke JP, et al. Intra-individual comparison of 18F–PSMA-1007-PET/CT, multi-parametric MRI and radical prostatectomy specimen in patients with primary prostate cancer – a retrospective, proof of concept study. J Nucl Med. 2017. https://doi.org/10.2967/jnumed.116.189233. pii: jnumed.116.189233, [Epub ahead of print]
Kirchner J, Sawicki LM, Suntharalingam S, et al. Whole-body staging of female patients with recurrent pelvic malignancies: ultra-fast 18F-FDG PET/MRI compared to 18F-FDG PET/CT and CT. PLoS One. 2017;12:e0172553.
Kohan AA, Kolthammer JA, Vercher-Conejero JL, et al. N staging of lung cancer patients with PET/MRI using a three-segment model attenuation correction algorithm: initial experience. Eur Radiol. 2013;23:3161–9.
Kumar V, Gu Y, Basu S, et al. Radiomics: the process and the challenges. Magn Reson Imaging. 2012;30:1234–48.
Lee MS, Cho JY, Kim SY, et al. Diagnostic value of integrated PET/MRI for detection and localization of prostate cancer: comparative study of multiparametric MRI and PET/CT. J Magn Reson Imaging. 2017;45:597–609.
Lütje S, Slavik R, Fendler W, et al. PSMA ligands in prostate cancer - Probe optimization and theranostic applications. Methods. 2017.; pii: S1046–2023(16)30344–9. doi: 10.1016/j.ymeth.2017.06.026. [Epub ahead of print] Review
Martinez-Möller A, Eiber M, Nekolla SG, et al. Workflow and scan protocol considerations for integrated whole-body PET/MRI in oncology. J Nucl Med. 2012;53:1415–26.
Martinez-Moller A, Souvatzoglou M, Delso G, et al. Tissue classification as a potential approach for attenuation correction in whole-body PET/MRI: evaluation with PET/CT data. J Nucl Med. 2009;50:520–6.
Muller A, Homey B, Soto H, et al. Involvement of chemokine receptors in breast cancer metastasis. Nature. 2001;410:50–6.
Nensa F, Beiderwellen K, Heusch P, Wetter A. Clinical applications of PET/MRI: current status and future perspectives. Diagn Interv Radiol. 2014a;20:438–47.
Nensa F, Poeppel TD, Krings P, Schlosser T. Multiparametric assessment of myocarditis using simultaneous positron emission tomography/magnetic resonance imaging. Eur Heart J. 2014b;35:2173.
Parmar C, Grossmann P, Bussink J, Lambin P, Aerts HJ. Machine Learning methods for Quantitative Radiomic Biomarkers. Sci Rep. 2015;5:13087. https://doi.org/10.1038/srep13087
Phillip –AK, Herrmann K, Knop S, et al. In vivo molecular imaging of chemokine rexept or CXCR4 expression patients with advanced multiple myeloma. EMBO Mol Med. 2015;7:477–87. 10.15252/emmm.201404698
Pinker K, Andrzejewski P, Baltzer P, et al. Multiparametric [18F]Fluorodeoxyglucose/ [18F]Fluoromisonidazole positron emission tomography/magnetic resonance imaging of locally advanced cervical cancer for the non-invasive detection of tumor heterogeneity: a pilot study. PLoS One. 2016;11:e0155333.
Platzek I, Beuthien-Baumann B, Schramm G, et al. FDG PET/MRI in initial staging of sarcoma: Initial experience and comparison with conventional imaging. Clin Imaging. 2017;42:126–32.
Rischpler C, Langwieser N, Souvatzoglou M, et al. PET/MRI early after myocardial infarction: evaluation of viability with late gadolinium enhancement transmurality vs. 18F-FDG uptake. Eur Heart J Cardiovasc Imaging. 2015;16:661–9.
Ruhlmann V, Ruhlmann M, Bellendorf A, et al. Hybrid imaging for detection of carcinoma of unknown primary: A preliminary comparison trial of whole-body PET/MRI versus PET/CT. Eur J Radiol. 2016;85:1941–7.
Sawicki LM, Deuschl C, Beiderwellen K, et al. Evaluation of 68Ga-DOTATOC PET/MRI for whole-body staging of neuroendocrine tumours in comparison with 68Ga-DOTATOC PET/CT. Eur Radiol. 2017. https://doi.org/10.1007/s00330-017-4803-2. [Epub ahead of print]
Sawicki LM, Grueneisen J, Buchbender C, et al. Evaluation of the outcome of lung nodules missed on 18F-FDG PET/MRI compared with 18F-FDG PET/CT in patients with known malignancies. J Nucl Med. 2016;57:15–20.
Schwarzenböck SM, Rauscher I, Bluemel C, et al. PSMA ligands for PET-imaging of prostate cancer. J Nucl Med. 2017. https://doi.org/10.2967/jnumed.117.191031. pii: jnumed.117.191031, [Epub ahead of print]
Sekine T, Barbosa FG, Delso G, et al. Local resectability assessment of head and neck cancer: positron emission tomography/MRI versus positron emission tomography/CT. Head Neck. 2017. https://doi.org/10.1002/hed.24783.
Von Schulthess GK, Veit-Haibach P. Workflow considerations in PET/MR imaging. J Nucl Med. 2014;55(Supplement 2):19S–24S.
Wagenknecht G, Kaiser H-JJ, Mottaghy FM, et al. MRI for attenuation correction in PET: methods and challenges. Magn Reson Mater Phys Biol Med. 2013;26:99–113.
Wang J, Shih TT, Yen RF. Multiparametric evaluation of treatment response to neoadjuvant chemotherapy in breast cancer using integrated PET/MR. Clin Nucl Med. 2017;42:506–13.
Watanabe H, Kanematsu M, Kondo H, et al. Preoperative detection of prostate cancer: a comparison with 11C-choline PET, 18Ffluorodeoxyglucose PET and MR imaging. J Magn Reson Imaging. 2011;31:1151–6.
Werner RA, Bluemel C, Lassmann M, et al. SPECT-and PET-based patient-tailored treatment in neuroendocrine tumors: a comprehensive multidisciplinary team approach. Clin Nucl Med. 2015;40:e271–7. https://doi.org/10.1097/RLU.0000000000000729.
Werner RA, Weich A, Higuchi T, et al. Imaging of chemokine receptor 4 expression in neuroendocrine tumors – a triple tracer comparative approach. Theranostics. 2017;7:1489–98.
Wetter A, Lipponer C, Nensa F, Heusch P, Ruebben H, Schlosser TW, et al. Evaluation of the PET component of simultaneous [(18)F]choline PET/MRI in prostate cancer: comparison with [(18)F]choline PET/CT. Eur J Nucl Med Mol Imaging. 2014;41:79–88.
Wiedenmann NE, Bucher S, Hentschel M et al. Serial [18F]-fluoromisonidazole PET during radiochemotherapy for locally advanced head and neck cancer and its correlation with outcome. Radiother Oncol 2015;117:113–7.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Umutlu, L., Herrmann, K. (2018). Current and Emerging Applications. In: Umutlu, L., Herrmann, K. (eds) PET/MR Imaging: Current and Emerging Applications . Springer, Cham. https://doi.org/10.1007/978-3-319-69641-6_1
Download citation
DOI: https://doi.org/10.1007/978-3-319-69641-6_1
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-69640-9
Online ISBN: 978-3-319-69641-6
eBook Packages: MedicineMedicine (R0)