Multimodal imaging utilising integrated MR-PET for human brain tumour assessment
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The development of integrated magnetic resonance (MR)-positron emission tomography (PET) hybrid imaging opens up new horizons for imaging in neuro-oncology. In cerebral gliomas the definition of tumour extent may be difficult to ascertain using standard MR imaging (MRI) only. The differentiation of post-therapeutic scar tissue, tumour rests and tumour recurrence is challenging. The relationship to structures such as the pyramidal tract to the tumour mass influences the therapeutic neurosurgical approach.
The diagnostic information may be enriched by sophisticated MR techniques such as diffusion tensor imaging (DTI), multiple-volume proton MR spectroscopic imaging (MRSI) and functional MRI (fMRI). Metabolic imaging with PET, especially using amino acid tracers such as 18F-fluoroethyl-l-tyrosine (FET) or 11C-l-methionine (MET) will indicate tumour extent and response to treatment.
The new technologies comprising MR-PET hybrid systems have the advantage of providing comprehensive answers by a one-stop-job of 40-50 min. The combined approach provides data of different modalities using the same iso-centre, resulting in optimal spatial and temporal realignment. All images are acquired exactly under the same physiological conditions.
We describe the imaging protocol in detail and provide patient examples for the different imaging modalities such as FET-PET, standard structural imaging (T1-weighted, T2-weighted, T1-weighted contrast agent enhanced), DTI, MRSI and fMRI.
• Hybrid MR-PET opens up new horizons in neuroimaging
• Hybrid MR-PET allows brain tumour assessment in one stop
• Hybrid MR-PET allows simultaneous acquisition of structural, functional and molecular images
KeywordsHybrid MR-PET Brain tumours Neuro-oncology Diagnostic work-flow DTI
We thank Susanne Schaden and Cornelia Frey for their excellent technical assistance. The INM-4 is supported by the German Ministry of Education and Research/Bundesministerium für Bildung und Forschung (BMBF), and Siemens, Germany. Implementation of fMRI and DTI was in part supported by the Deutsche Forschungsgemeinschaft grant DFG SH 79/2-2.
Dr. Neuner, Dr. Kaffanke, Prof. Langen, Dr. Rota Kops, Mr. Tellmann, Dr. Stoffels, Mr. Weirich, Dr. Filss, Dr. Scheins, Prof. Herzog have no financial conflicts of interest to report. Prof. Shah has received research grants and scientific support from the German Ministry of Education and Research/Bundesministerium für Bildung und Forschung (BMBF) and Siemens, Germany.
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