MRI-PET: Oncologic Applications
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1 MRI-PET: Oncologic Applications Pablo R. Ros, MD University Hospitals Case Medical Center Case Western Reserve University SCBT-MR Boston, MA October, 2012
2 Acknowledgement Osman Ratib, MD, James K. ODonnell, MD Peter Faulhaber, MD Raj Paspulati, MD Karin Herrmann, MD Ray Muzik, PhD Zhenghong Lee, PhD Smitha Thomas, MD Bryan Traubergh, MD Oliver Steinbach, PhD Deborah Kaminsky, Pharm D Philips Cleveland
3 Learning Objectives Define MR-PET technology Compare PET-CT with MR-PET Discuss MR-PET opportunities and challenges Review applications focusing in abdominal oncology
4 PET-CT Anatomy Physiology Metabolism Molecular CT Nuclear
5 MR-PET Anatomy Physiology Metabolism Molecular CT MRI Nuclear PET: whole body imaging MRI: whole body AND organ based imaging MR-PET: anatomic, metabolic and functional tissue characteristics Comprehensive information
6 Current Architectures Sequential Simultaneous Philips MR/PET mmr Biograph.
7 Simultaneous: mmr
8 Sequential: MR-PET
9 MR-PET Combines in an integrated hybrid unit: A state of the art 3.0T MRI A state of the art Time-of-Flight PET Sequential design Maintains integrity of both units Whole body imaging Simplified workflow Superior soft tissue contrast Reduced radiation The Pathway to Molecular Imaging
10 PET-CT vs. MR-PET Strengths: CT in PET-CT Great attenuation correction Anatomic morphologic information CT weaknesses: Limited soft tissue contrast resolution (brain, bone marrow, prostate, uterus, liver, soft tissue tumors, ) Considerable radiation exposure (2/3 PET-CT scan) Typically not used as diagnostic CT
11 Strengths: PET-CT v MR-PET MR in MR-PET Superb soft tissue contrast Superior to CT in local cancer staging: prostate, rectum,.. Beyond anatomic morphological imaging Functional imaging (DWI, DCE, MRS) Parametric data Weaknesses: Integration with PET technically challenging Detectors, Shielding, Surface coils with cables+connectors Attenuation correction based on hydrogen nuclei and tissue relaxation not tissue density MRAC still work in progress (artifacts, sequences)
12 MR-PET Opportunities Ultimate molecular imaging machine Spectroscopy New NM agents Applications where CT lacks Less ionizing radiation Novel contrast approaches Beyond oncology Neurodegenerative diseases Cardiac Other metabolic disorders
13 MR-PET Challenges Attenuation correction validation Current socio-economic environment Question high technology without proven outcomes Unclear killer application Price Study Length (efficient MR protocols) Practical operational aspects Intrinsic MRI complexity Ownership (NM-Radiology) Collaboration
14 Technical Challenges Hardware implications Possible interference of the two systems APD (Avalache Photodiodes) instead of Photomultipliers Shielding of both Attenuation correction: Compensation for MRI hardware (coils, cables, etc) Compensation for system inherent artifacts (truncation, metal, respiratory, etc)
15 MR-PET: Attenuation Correction (MRAC) MR image for basic anatomical pilot and attenuation correction support for PET
16 MR-PET: MRAC Hardware Patient Table Head 8ch NV 16ch Cardiac 6ch Spine 15ch Cardiac 32ch posterior Breast 7ch
17 MR-PET Applications Oncologic Pediatrics (lower radiation exposure) Breast Imaging (lower dose staging) Rectum (staging), Liver Prostate, GYN and pelvis Head and Neck Soft tissue tumors Neuro-oncology (Tumor vs Treatment response) Neurologic (other than oncology): Degenerative diseases (Dementia, Epilepsy) Cardiac Contrast agents Beyond Gadolinium-DTPA, FDG
18 MRI-PET vs PET-CT in Oncology (PET-MRI) PET/CT PET/MR Oncology Colorectal Oncology Prostate Oncology Breast Oncology Gyn & Cervical Oncology Soft Tissue Tumours Oncology Head & Neck Oncology Pediatric Lymph Node Involvement
19 MR-PET: Next Steps Optimize image quality, artifact correction Accuracy of PET quantification (SUVs) Evaluate the effect of Gadolinium on MRAC Compare to standard-of-care PET/CT or SPECT/CT (NM) Determine the incremental value PET/MRI over standard-of-care imaging with CT and MRI Asses its time efficacy as compared to separate imaging studies Assess radiation dose reduction if PET-CT may be substituted with PET-MRI
20 MR-PET: Pearls to take Home MRI as dominant modality Will affect your life (Radiologist or NM MD) If MRI preferred to CT If MRI and PET-CT clinically appropriate Pediatrics and repeated imaging Not a replacement for PET-CT
21 Learning Objectives Define MR-PET technology Compare PET-CT with MR-PET Discuss MR-PET opportunities and challenges Review applications focusing in abdominal oncology
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