PET/MRI in cancer patients: first experiences and vision from Copenhagen

Combined PET/MRI systems are now commercially available and are expected to change the medical imaging field by providing combined anato-metabolic image information. We believe this will be of particular relevance in imaging of cancer patients. At the Department of Clinical Physiology, Nuclear Medicine & PET at Rigshospitalet in Copenhagen we installed an integrated PET/MRI in December 2011. Here, we describe our first clinical PET/MR cases and discuss some of the areas within oncology where we envision promising future application of integrated PET/MR imaging in clinical routine. Cases described include brain tumors, pediatric oncology as well as lung, abdominal and pelvic cancer. In general the cases show that PET/MRI performs well in all these types of cancer when compared to PET/CT. However, future large-scale clinical studies are needed to establish when to use PET/MRI. We envision that PET/MRI in oncology will prove to become a valuable addition to PET/CT in diagnosing, tailoring and monitoring cancer therapy in selected patient populations.

[1]  D. Collins,et al.  Whole-body diffusion-weighted MR imaging in cancer: current status and research directions. , 2011, Radiology.

[2]  S. Holm,et al.  Clinical PET of Neuroendocrine Tumors Using 64Cu-DOTATATE: First-in-Humans Study , 2012, The Journal of Nuclear Medicine.

[3]  N. F. Schwenzer,et al.  Whole-body MR/PET: applications in abdominal imaging , 2012, Abdominal Imaging.

[4]  J Roehrig,et al.  The manufacturer's perspective. , 2005, The British journal of radiology.

[5]  M. Su,et al.  In vivo 1H MRS in the assessment of the therapeutic response of breast cancer patients , 2011, NMR in biomedicine.

[6]  Martin Hutchings,et al.  FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma. , 2006, Blood.

[7]  Gerald Antoch,et al.  Combined PET/MRI: a new dimension in whole-body oncology imaging? , 2009, European Journal of Nuclear Medicine and Molecular Imaging.

[8]  W. Koch,et al.  Positron Emission Tomography with O-(2-[18F]fluoroethyl)-l-tyrosine versus Magnetic Resonance Imaging in the Diagnosis of Recurrent Gliomas , 2005, Neurosurgery.

[9]  S Ted Treves,et al.  Minimizing and communicating radiation risk in pediatric nuclear medicine. , 2011, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[10]  A. Drzezga,et al.  First Clinical Experience with Integrated Whole-Body PET/MR: Comparison to PET/CT in Patients with Oncologic Diagnoses , 2012, The Journal of Nuclear Medicine.

[11]  Sune H. Keller,et al.  Image artifacts from MR-based attenuation correction in clinical, whole-body PET/MRI , 2013, Magnetic Resonance Materials in Physics, Biology and Medicine.

[12]  M Samii,et al.  Real-time 3T fMRI data of brain tumour patients for intra-operative localization of primary motor areas. , 2008, European Journal of Surgical Oncology.

[13]  M. Sehested,et al.  Early Detection of Response to Experimental Chemotherapeutic Top216 with [18F]FLT and [18F]FDG PET in Human Ovary Cancer Xenografts in Mice , 2010, PloS one.

[14]  K. Juhl,et al.  Quantitative PET of Human Urokinase-Type Plasminogen Activator Receptor with 64Cu-DOTA-AE105: Implications for Visualizing Cancer Invasion , 2012, The Journal of Nuclear Medicine.

[15]  D. Körholz,et al.  Die Bedeutung des FDG-PET für die Stadieneinteilung und Therapie des Hodgkin-Lymphoms im Kindesalter , 2011, Klinische Pädiatrie.

[16]  Matthias Hofmann,et al.  Hybrid PET/MRI of Intracranial Masses: Initial Experiences and Comparison to PET/CT , 2010, The Journal of Nuclear Medicine.

[17]  A. Kjaer,et al.  68Ga-labeling and in vivo evaluation of a uPAR binding DOTA- and NODAGA-conjugated peptide for PET imaging of invasive cancers. , 2012, Nuclear medicine and biology.

[18]  R. Kluge,et al.  Whole-body MRI for primary evaluation of malignant disease in children. , 2010, European journal of radiology.

[19]  Gudrun Wagenknecht,et al.  MRI for attenuation correction in PET: methods and challenges , 2012, Magnetic Resonance Materials in Physics, Biology and Medicine.

[20]  Christopher Nimsky,et al.  Preoperative grading of gliomas by using metabolite quantification with high-spatial-resolution proton MR spectroscopic imaging. , 2006, Radiology.

[21]  A. Kjær,et al.  Multimodality functional imaging of spontaneous canine tumors using 64Cu-ATSM and 18FDG PET/CT and dynamic contrast enhanced perfusion CT. , 2012, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[22]  A. Kjær,et al.  Evaluation of 4-[18F]fluorobenzoyl-FALGEA-NH2 as a positron emission tomography tracer for epidermal growth factor receptor mutation variant III imaging in cancer. , 2011, Nuclear medicine and biology.

[23]  Christopher Nimsky,et al.  Gliomas: histopathologic evaluation of changes in directionality and magnitude of water diffusion at diffusion-tensor MR imaging. , 2006, Radiology.

[24]  H. Kostron,et al.  O-(2-18F-Fluoroethyl)-L-Tyrosine PET Predicts Failure of Antiangiogenic Treatment in Patients with Recurrent High-Grade Glioma , 2011, The Journal of Nuclear Medicine.

[25]  N. Wu,et al.  Diffusion-weighted magnetic resonance imaging of lung cancer at 3.0 T: a preliminary study on monitoring diffusion changes during chemoradiation therapy. , 2012, Clinical imaging.

[26]  Bernhard SattlerThies,et al.  Physical and organizational provision for installation, regulatory requirements and implementation of a simultaneous hybrid PET/ MR-imaging system in an integrated research and clinical setting , 2013 .

[27]  Jochen Herms,et al.  FET PET for the evaluation of untreated gliomas: correlation of FET uptake and uptake kinetics with tumour grading , 2007, European Journal of Nuclear Medicine and Molecular Imaging.

[28]  J. Biederer,et al.  MRI of pulmonary nodules: technique and diagnostic value , 2008, Cancer imaging : the official publication of the International Cancer Imaging Society.

[29]  A. Kjaer,et al.  64Cu-NODAGA-c(RGDyK) Is a Promising New Angiogenesis PET Tracer: Correlation between Tumor Uptake and Integrin α V β 3 Expression in Human Neuroendocrine Tumor Xenografts , 2012, International Journal of Molecular Imaging.

[30]  Morand Piert,et al.  Reirradiation of recurrent high-grade gliomas using amino acid PET (SPECT)/CT/MRI image fusion to determine gross tumor volume for stereotactic fractionated radiotherapy. , 2004, International journal of radiation oncology, biology, physics.

[31]  S. Kaste.  Imaging pediatric bone sarcomas. , 2011, Radiologic clinics of North America.

[32]  P. Choyke,et al.  Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. , 2009, Neoplasia.

[33]  G. Antoch,et al.  Oncologic PET/MRI, Part 1: Tumors of the Brain, Head and Neck, Chest, Abdomen, and Pelvis , 2012, The Journal of Nuclear Medicine.

[34]  M. Lassmann,et al.  The new EANM paediatric dosage card: additional notes with respect to F-18 , 2008, European Journal of Nuclear Medicine and Molecular Imaging.

[35]  Ramazan Yildiz,et al.  Radiation induced early necrosis in patients with malignant gliomas receiving temozolomide , 2010, Clinical Neurology and Neurosurgery.

[36]  Karl-Josef Langen,et al.  O-(2-[18F]fluoroethyl)-L-tyrosine PET combined with MRI improves the diagnostic assessment of cerebral gliomas. , 2005, Brain : a journal of neurology.

[37]  Thomas C. Kwee,et al.  Whole-body diffusion-weighted imaging for staging malignant lymphoma in children , 2010, Pediatric Radiology.

[38]  Janita Raskala,et al.  Methods and challenges , 2014 .

[39]  Douglas C. Miller,et al.  Gliomas: predicting time to progression or survival with cerebral blood volume measurements at dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. , 2008, Radiology.

[40]  Thomas Beyer,et al.  Combined PET/MR imaging using (68)Ga-DOTATOC for radiotherapy treatment planning in meningioma patients. , 2013, Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer.

[41]  J. Tonn,et al.  MRI-suspected low-grade glioma: is there a need to perform dynamic FET PET? , 2012, European Journal of Nuclear Medicine and Molecular Imaging.

[42]  G. Delso,et al.  Performance Measurements of the Siemens mMR Integrated Whole-Body PET/MR Scanner , 2011, The Journal of Nuclear Medicine.

[43]  S. Gambhir.  Molecular imaging of cancer with positron emission tomography , 2002, Nature Reviews Cancer.

[44]  Oliver Ganslandt,et al.  Diffusion tensor imaging and optimized fiber tracking in glioma patients: Histopathologic evaluation of tumor-invaded white matter structures , 2007, NeuroImage.

[45]  H. Amthauer,et al.  [18F]Fluorodeoxyglucose positron emission tomography for detection of bone marrow involvement in children and adolescents with Hodgkin's lymphoma. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[46]  D. Bailey,et al.  A retrospective evaluation of radiation dose associated with low dose FDG protocols in whole-body PET/CT , 2011, Australasian Physical & Engineering Sciences in Medicine.

[47]  R. Wahl,et al.  From RECIST to PERCIST: Evolving Considerations for PET Response Criteria in Solid Tumors , 2009, Journal of Nuclear Medicine.

[48]  Thomas Beyer,et al.  A combined PET/CT scanner: the path to true image fusion. , 2002, The British journal of radiology.

[49]  Heiko Schöder,et al.  Hybrid imaging (SPECT/CT and PET/CT): improving therapeutic decisions. , 2009, Seminars in nuclear medicine.

[50]  R. Kluge,et al.  [Role of FDG-PET in Staging and Therapy of Children with Hodgkin Lymphoma]. , 2011, Klinische Padiatrie.

[51]  Paul Kinahan,et al.  A combined PET/CT scanner for clinical oncology. , 2000, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[52]  Brian D Ross,et al.  Predicting and monitoring cancer treatment response with diffusion‐weighted MRI , 2010, Journal of magnetic resonance imaging : JMRI.

[53]  M. Lassmann,et al.  The new EANM paediatric dosage card , 2009, European Journal of Nuclear Medicine and Molecular Imaging.

[54]  Christopher Nimsky,et al.  Proton Magnetic Resonance Spectroscopic Imaging Integrated into Image-guided Surgery: Correlation to Standard Magnetic Resonance Imaging and Tumor Cell Density , 2005, Neurosurgery.

[55]  Julie M. Grüner,et al.  Brain perfusion CT compared with 15O-H2O PET in patients with primary brain tumours , 2012, European Journal of Nuclear Medicine and Molecular Imaging.

[56]  Rakesh Kumar,et al.  Clinical applications of PET and PET/CT in pediatric malignancies , 2010, Expert review of anticancer therapy.

[57]  Whole-body diffusion-weighted imaging in lymphoma , 2010, Cancer imaging : the official publication of the International Cancer Imaging Society.

[58]  Susanne Heinzer,et al.  Sequential whole-body PET/MR scanner: concept, clinical use, and optimisation after two years in the clinic. The manufacturer’s perspective , 2013, Magnetic Resonance Materials in Physics, Biology and Medicine.

[59]  John O. Prior,et al.  Performance of 18F-Fluoro-Ethyl-Tyrosine (18F-FET) PET for the Differential Diagnosis of Primary Brain Tumor: A Systematic Review and Metaanalysis , 2012, The Journal of Nuclear Medicine.

[60]  A. Kjaer.  Molecular imaging of cancer using PET and SPECT. , 2006, Advances in experimental medicine and biology.