MR-PET of the body: Early experience and insights

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MR-PET of the body: Early experience and insights Miguel Ramalho, Mamdoh AlObaidy, Onofrio A. Catalano, Alexander R. Guimaraes, Marco Salvatore, Richard C. Semelka European Journal of Radiology Open Volume 1, Pages 28-39 (January 2014) DOI: 10.1016/j.ejro.2014.09.001 Copyright © 2014 Terms and Conditions

Fig. 1 Soft tissue AC based on MR imaging. In-phase (A) out-of-phase (B) 2-point Dixon images from attenuation correction sequences. Resulting μMap (C) providing separate water/fat images that serve as basis for soft tissue segmentation that can be assigned to a PET attenuation map. Resulting attenuation corrected whole-body PET scan (D). European Journal of Radiology Open 2014 1, 28-39DOI: (10.1016/j.ejro.2014.09.001) Copyright © 2014 Terms and Conditions

Fig. 2 Colorectal cancer follow-up. Axial contrast-enhanced CT (A), PET (B), and PET-CT (C) images. Axial contrast-enhanced T1-weighted VIBE MR on the arterial (D) and portal phase (E), PET (F); fused PET-T1-weighted VIBE MR (G), Fat-suppressed T2 TSE (H). A new solitary hypervascular liver lesion is seen between segments # VII and # VIII on MR images (D, F). The combination of mild T2-signal intensity (arrow, H), arterial hyper-enhancement (arrow, D) and fading in portal phase allowed the diagnosis of metastasis. This lesion is not seen on contrast-enhanced CT (A). PET images do not contribute to diagnostic accuracy. European Journal of Radiology Open 2014 1, 28-39DOI: (10.1016/j.ejro.2014.09.001) Copyright © 2014 Terms and Conditions

Fig. 3 Distal metastasis in a patient with recurrent ovarian cancer post-surgery. Axial unenhanced CT (A), PET (B), and PET-CT (C) images. Axial T2-weighted HASTE MR (D), PET (E), and Axial fused PET-T2-weighted HASTE MR (F). There is a small, round right retrocrural lymph node, which is appreciated on CT and MRI, and demonstrates intense FDG uptake on both PET acquisitions (arrowhead, A–F) in keeping with nodal metastasis. There is also a focal area of mildly increased signal intensity on HASTE, with corresponding focus of intense FDG uptake on the PET acquired with MR, involving the submucosal of the gastric antrum (arrow, D–F) suspicious for submucosal gastric metastasis. There is no corresponding CT or CT PET abnormality (A–C). Patient also has significant, FDG-avid, local recurrent disease (not shown). European Journal of Radiology Open 2014 1, 28-39DOI: (10.1016/j.ejro.2014.09.001) Copyright © 2014 Terms and Conditions

Fig. 4 Relapse of acute myeloid leukemia (AML) after haploidentical allogeneic stem cell transplant. Coronal fused MR-PET with in-phase 2-point Dixon images from attenuation correction sequences (A–C). Intense uptake is seen with diffuse replacement of bone marrow (arrows, A). The patient has also leukemic nerve involvement at the brachial plexus, which is more pronounced at the right (arrow, B). Pancreatic and mammary involvement were already depicted (arrow, C). Note the excellent registration between the two modalities. European Journal of Radiology Open 2014 1, 28-39DOI: (10.1016/j.ejro.2014.09.001) Copyright © 2014 Terms and Conditions

Fig. 5 Incidental renal cancer. Axial unenhanced CT (A), PET (B), and PET-CT (C) images. Axial T2-weighted HASTE MR (D), PET (E); fused PET-T2-weighted HASTE MR (F). A right kidney mass show intense uptake in both PET datasets (B, E). This lesion is not apparent on unenhanced CT (A), and improved delineation in seen on HASTE MR (D). Fused PET-CT (C) and MR-PET (F) confirm the malignant nature. European Journal of Radiology Open 2014 1, 28-39DOI: (10.1016/j.ejro.2014.09.001) Copyright © 2014 Terms and Conditions

Fig. 6 Large left breast cancer with nodal metastasis. Axial DWI (A), ADC map (B), axial subtraction dynamic post-gadolinium 3D-GRE fat-suppressed T1-weighted image (C), and axial post-gadolinium 3D-GRE fat-suppressed T1-weighted image (D). Axial PET (E) and fused PET-T1-weighted VIBE MR (F) images. There is a large irregular mass involving the central region of the left breast, which demonstrates increased signal on the DWI (arrow, A) and low signal on the ADC map (arrow, B) images, in keeping with a true restriction. The mass demonstrates intense enhancement (arrow, C–D), intense FDG uptake (arrow, E), in keeping with aggressive breast cancer. There is also a small round ipsilateral internal mammary lymph node, which demonstrates similar signal characteristics and FDG uptake to that of the primary breast mass (arrowhead, A–F) in keeping with a metastatic nodal disease. Patient also has evidence of ipsilateral axillary nodal metastatic disease (not shown). European Journal of Radiology Open 2014 1, 28-39DOI: (10.1016/j.ejro.2014.09.001) Copyright © 2014 Terms and Conditions

Fig. 7 Images of bone metastases in a patient with breast cancer. Axial unenhanced CT (A), PET (B), and PET-CT (C) images. Axial T2-weighted HASTE MR (D), PET (E); fused PET-T2-weighted HASTE MR (F). Coronal STIR (G), PET (H), fused PET-STIR MR (I). Two bone metastases in the posterior acetabulum showing intense uptake are seen on PET and PET-CT (arrows, C) and MR-PET. Equivalent detectability is perceived between unenhanced CT and HASTE datasets (A and D). STIR images show improved morphologic characterization of PET-positive lesions (arrows, G). European Journal of Radiology Open 2014 1, 28-39DOI: (10.1016/j.ejro.2014.09.001) Copyright © 2014 Terms and Conditions

Fig. 8 Status post thyroidectomy in a patient with elevated thyroxine-binding globulin levels. Axial unenhanced CT (A), PET (B), and PET-CT (C) images. Axial T2-weighted HASTE MR (D), PET (E), fused PET-T2-weighted HASTE MR (F). A mildly T2-weighted hyperintense nodule is seen adjacent to the right aspect of the thyroid cartilage, involving the omohyoid/sternohyod muscles (arrow, D). This nodule is not seen on unenhanced CT images (A). Fused PET-CT and PET-MR show good anatomic correlation of the cervical nodule with increased activity (B, E) of this nodule a. HASTE images show improved morphologic characterization of PET-positive lesions (arrows, D). European Journal of Radiology Open 2014 1, 28-39DOI: (10.1016/j.ejro.2014.09.001) Copyright © 2014 Terms and Conditions