European Radiology

, Volume 22, Issue 12, pp 2568–2580 | Cite as

Multimodal imaging utilising integrated MR-PET for human brain tumour assessment

  • Irene Neuner
  • Joachim B. Kaffanke
  • Karl-Josef Langen
  • Elena Rota Kops
  • Lutz Tellmann
  • Gabriele Stoffels
  • Christoph Weirich
  • Christian Filss
  • Jürgen Scheins
  • Hans Herzog
  • N. Jon Shah



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.

Key Points

• 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


Hybrid 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.

Financial disclosure

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.

Supplementary material

330_2012_2543_MOESM1_ESM.png (326 kb)
ESM Fig. 1 Case 1. Simultaneously acquired data include structural anatomical data T1-weighted (top row) and FET-PET data (bottom row). The PET data show an inhomogeneous tracer uptake in the corpus callosum and cingulate gyrus. In the centre of the tumour there is no tracer uptake due to central necrosis (PNG 325 kb)
330_2012_2543_MOESM2_ESM.png (248 kb)
ESM Fig. 2 Case 2. Simultaneously acquired data include structural anatomical data T1-weighted (row 1 from top) and FET-PET data (bottom row). PET data demonstrate a pathological tracer uptake indicating a solid tumour; maximal metabolic activity lies within the inferior parts of the tumour mass (PNG 248 kb)
330_2012_2543_MOESM3_ESM.png (281 kb)
ESM Fig. 3 Case 3. Simultaneously acquired data include structural anatomical data T1-weighted (top row) and FET-PET data (bottom row) (PNG 280 kb)
330_2012_2543_MOESM4_ESM.png (191 kb)
ESM Fig. 4 Case 4. Simultaneously acquired data include structural anatomical data T1-weighted (top row) and FET-PET data (bottom row). PET data indicate a slightly increased tracer uptake at the inferior margin of the resection area without reaching threshold values indicating a tumour recurrence (PNG 191 kb)


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Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Irene Neuner
    • 1
    • 2
    • 4
  • Joachim B. Kaffanke
    • 1
    • 5
  • Karl-Josef Langen
    • 1
  • Elena Rota Kops
    • 1
  • Lutz Tellmann
    • 1
  • Gabriele Stoffels
    • 1
  • Christoph Weirich
    • 1
  • Christian Filss
    • 1
  • Jürgen Scheins
    • 1
  • Hans Herzog
    • 1
  • N. Jon Shah
    • 1
    • 3
    • 4
  1. 1.Institute of Neuroscience and Medicine 4, INM 4JülichGermany
  2. 2.Department of Psychiatry, Psychotherapy and PsychosomaticsRWTH Aachen UniversityAachenGermany
  3. 3.Department of NeurologyRWTH Aachen UniversityAachenGermany
  4. 4.JARA-BRAIN-Translational MedicineAachenGermany
  5. 5.MR-Transfer e.K.WuppertalGermany

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