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MR-PET (Positron Emission Tomography) A WORLD OF KNOWLEDGE SMRT FOR MR TECHNOLOGISTS & RADIOGRAPHERS SECTION FOR MAGNETIC RESONANCE TECHNOLOGISTS OF THE INTERNATIONAL SOCIETY FOR MAGNETIC RESONANCE IN MEDICINE SMRT Home Study Educational Seminars VOLUME 18 • NUMBER 2 MR-PET (Positron Emission Tomography) Integrated PET/MR Harald H. Quick, Ph,D. Whole-Body Simultaneous Positron Emission Tomography (PET)-MR: Optimization and Adaptation of MRI Sequences Kathryn J. Fowler, M.D. Jon McConathy, M.D., Ph.D. Vamsi R. Narra, M.D.. Initial Experience of MR/PET in a Clinical Cancer Center Sasan Partovi, M.D. Mark R. Robbin, M.D. Oliver C. Steinbach, Ph.D. Andres Kohan, M.D. Christian Rubbert, M.D. Expert Reviewer: Jose L. Vercher-Conejero, M.D. Julia Lowe, B.S.,R.T.(R)(MR) FSMRT Jeffrey A. Kolthammer, Ph.D. SMRT Educational Seminars Editor: Peter Faulhaber, M.D. Anne Marie Sawyer, B.S., R.T.(R)(MR), FSMRT Raj Mohan Paspulati, M.D. Pablo R. Ros, M.D., MPH, Ph.D. Chair, SMRT Publications Committee: Vanessa Orchard, DCR(D), PGDip.(NucMed), M.Sc.(MRI) A Message from the SMRT Home Study Educational Seminars Publications Committee Editor, SMRT Educational Seminars, Home Study Program Chair, SMRT Publications Committee Vanessa Orchard, DCR(D), PGDip.(Nuc Med), Anne Marie Sawyer, B.S., R.T.(R)(MR), FSMRT M.Sc.(MRI) Home Study Program Lead Radiographer Lucas Center for Imaging Cardiac Imaging Centre Stanford University, Stanford, California, USA Golden Jubilee National Hospital T: +1 650 725 9697 Dunbartonshire, Glasgow, Scotland, UK E: [email protected] T: +0141 951 5187 E: [email protected] MR-PET (Positron Emission Tomography) March 2015 We are pleased to present the SMRT Home Study Educational Semi- imaging systems. They support this endeavor by saying “As the nar, Volume 18, Number 2: MR-PET (Positron Emission Tomography). newest hybrid imaging technology, simultaneous PET/MR combines This is the 68th accredited Home Study developed by the SMRT, exclu- these exciting areas of growth for radiology and nuclear medicine sively for SMRT members. The accredita- and further bridges the divide between tion is conducted by the SMRT acting as a anatomic and molecular imaging. PET/ RCEEM (Recognized Continuing Educa- MR can noninvasively provide molecu- tion Evaluation Mechanism) for the ARRT. lar, functional, and anatomic information Category A credits are assigned to each “Such PET/MR hybrid imaging in a single imaging session using FDG home study, which can be used to main- modality has potential and other PET tracers in conjunction with tain one’s ARRT advanced registry. SMRT state-of-the-art MRI.” diagnostic advantages in Home Studies Educational Seminars are In the third and final article that discusses also approved for AIR (Australian Institute cases where MR outperforms the initial experience at a clinical cancer of Radiography), NZIMRT (New Zealand CT (i.e., increased soft tissue center with MR/PET, the authors begin by Institute of Radiation Technology) and reminding us: “Staging, re-staging and contrast and reduced radiation CPD Now (The College of Radiographers, therapy monitoring are important steps United Kingdom) continuing professional dose) with clinical potential in in the management of oncologic patients. development (CPD) activities. All of these imaging management catego- oncology, neurology, cardiology Three peer-reviewed articles have been ries consist of a determination of the local chosen for this Home Study issue. As intro- and monitoring of early tumor extent, detection of adenopathy, duced in the first article by the authors, therapeutic success.” and secondary spread to their organs. “Initiated by the success story of hybrid MR/PET leverages the inherent strengths imaging by combining positron emission of both technologies and thereby opens tomography (PET) and computed tomog- new horizons in functional and molecular raphy (CT) in PET/CT, researchers have imaging.” pursued the technically challenging but diagnostically attractive idea A special thank you to Julia Lowe, B.S., R.T.(R)(MR) from Columbus, of integrating PET and MR imaging in one single system. Such PET/ Indiana, USA, for acting as the Expert Reviewer. Thanks also to Heidi MR hybrid imaging modality has potential diagnostic advantages Berns, M.S., R.T.(R)(MR), FSMRT, Chair of the SMRT RCEEM Ad-hoc in cases where MR outperforms CT (i.e., increased soft tissue con- committee from Coralville, Iowa, USA, and all those who participate on trast and reduced radiation dose) with clinical potential in oncology, this committee by reviewing the Home Studies Educational Seminars neurology, cardiology and monitoring of early therapeutic success.” for accreditation. Finally, many thanks to Kerry Crockett, Associate What follows is an intriguing and detailed description of this recently Executive Director, ISMRM/SMRT, Mary Keydash, Publications Director, introduced hybrid-imaging modality. Linda O-Brown, SMRT Coordinator, Sally Moran, Director of Electronic The authors of the second article continue to expand on the tech- Communications and the entire staff in the Berkeley, California, USA, nology of MR-PET but with more specific information regarding the office of the ISMRM and SMRT, for their insight and long hours spent adaptation and optimization of imaging software given the challenges supporting these educational symposia. of hardware modifications required to merge these two complex Page 2 SMRT Educational Seminar Volume 18, Number 2: MR-PET (Positron Emission Tomography) MR-PET (Positron Emission Tomography) ISMRM SECTION FOR MAGNETIC RESONANCE TECHNOLOGISTS Home Study Educational Seminars VOLUME 18 • NUMBER 2 Educational Objectives Continued from Whole-Body Simultaneous Positron Integrated PET/MR Emission Tomography (PET)-MR: Optimization and • Discuss the history behind the development of Adaptation of MRI Sequences PET/MR; • Review the development of PET/MR scan • Review the technical considerations of an protocols and selection of scan parameters; integrated PET/MR system; • List whole body anatomically focused • Describe the attenuation correction (AC) and protocol trees; and motion correction (MC) software; • Show imaging examples including MRI, PET • Review the clinical applications including and merged data acquired simultaneously. oncology, neurology, pediatric and cardiovascular; Initial Experience of MR/PET in a • Explain the workflow of the hybrid imaging Clinical Cancer Center modality, artifacts, quantification and • Review the pre-MR Conditional cardiac standardization; and device era; • Show imaging examples including MRI, PET • Describe the technology and workflow and merged data acquired simultaneously. considerations in a sequential MR/PET system; Whole-Body Simultaneous Positron • Review the opportunities and challenges of Emission Tomography (PET)-MR: MR/PET; Optimization and Adaptation of MRI • Describe the clinical oncologic applications Sequences including head and neck cancer, lung cancer, • Discuss the technologic challenges involved genitourinary cancer, and rectal cancer; in integrating PET and MR; • Explain the importance of low-dose oncologic • Review the attenuation correction (AC) and imaging in the pediatric population; and its importance for generation of accurate PET • Show imaging examples including MRI, PET data; and merged data acquired sequentially. • Describe optimization of MR sequences for whole body PET/MR including body imaging at 3T; (continued next column) NZIMRT APPROVED CPD ACTIVITY Expert Reviewer SMRT Home Studies, Online Electronic Studies & Online Video Studies Credits: 6.25 points per module Julia Lowe, B.S.,R.T.(R)(MR) FSMRT Valid: 2015 South Central Indiana Local SMRT Chapter Columbus, IN USA ENDORSED BY THE COLLEGE OF RADIOGRAPHERS - UNITED KINGDOM Credit levels according to SMRT certificate - Valid 2015 CoR Assessment: A combined programme covering a wide range of clinical applications and current issues in MR imaging. May support outcomes 1-13, 18 and 19 of CPD Now Page 3 SMRT Educational Seminar Volume 18, Number 2: MR-PET (Positron Emission Tomography) CME JOURNAL OF MAGNETIC RESONANCE IMAGING 39:243–258 (2014) Review Integrated PET/MR Harald H. Quick, Ph.D.* ReprintedIntegrated with permission from PET/MR the ISMRM Journal of Magnetic Resonance Imaging: Volume 39: 243–258, © 2014 with permission from 2014 Wiley Periodicals, Inc. Harald H. Quick, PhD* ers have pursued the technically challenging but Integrated whole-body PET/MR hybrid imaging combines excellent soft tissue contrast and various functional imag- diagnostically attractive idea of integrating PET and ing parameters provided by MR with high sensitivity and MR imaging in one single system (1–3). Such PET/ quantification of radiotracer metabolism provided by posi- MR hybrid imaging modality has potential diagnostic tron emission tomography (PET). While clinical evaluation advantages in cases where MR outperforms CT (i.e., now is under way, integrated PET/MR demands for new increased soft tissue contrast and reduced radiation technologies and innovative solutions, currently subject dose) with clinical potential in oncology, neurology, to interdisciplinary research. Attenuation correction of cardiology and monitoring of early therapeutic suc- human soft tissues and of hardware components has to cess (4, 5). Integration of MR and PET, however, is be MR-based to maintain quantification of PET imaging technically demanding; standard PET detectors could because computed tomography (CT) attenuation informa- not be placed in the isocenter of an MRI scanner tion is missing.
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