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EUROPEAN CONGRESS OF RADIOLOGY 2013 | www.myESR.orgRadiologists gatherto contemplate thefuture of MR/PETBy Mélisande RougerSaturday, March 9,08:30–10:00NH 8:MR/PET:a marriage made inheaven or hell?The field of possibilities offered by MR/PET is excitingbut remains unclear. Only a few machines are availableworldwide and very little information exists about this newhybrid modality. Research is ongoing, but it is still too earlyto produce results. Always at the forefront of innovation, theECR will feature a special New Horizons Session to presentdelegates with the prospects, potential and requirementsof MR/PET in neurological and oncologic imaging, nextMarch in Vienna.MR/PET is a completely new technology, introduced about two years ago. As such, it requiresclinical evaluation and raises many questions regarding its value, explained session chairmanProfessor Bernd Hamm, director of the Institute of Radiology at the Charité University Hospitalin Berlin.“The questions are: in which indication will we have a benefit, and how big will these benefitsbe? In other words, is MR/PET just a very expensive new toy without real medical benefits or doesit offer completely new diagnostic insights that would improve the treatment of patients?” he said.Sequential imaging of both modalities already provides very good morphological and metabolicinformation. MR is considered to have the best contrast resolution in cross-sectional imaging; itprovides a lot of anatomical detail, and offers the option of measuring parameters of perfusion,cell density and metabolism, while PET allows the study of metabolic changes with sensitivityin the picomolar range. The information from MR and PET images is highly valuable in manyfields, including oncologic, cardiovascular and neurological imaging.So why would a combination of MR with PET be of value? Many arguments speak in favourof such a union. One such argument is that it could improve tumour detection, by allowing thevisualisation of a lesion through both morphological and metabolic images with unrivalledsensitivity. Professor Heinz-Peter Schlemmer, head of the radiology department at the GermanCancer Research Centre, has worked extensively on comparative studies with whole-body MRand PET/CT for the detection of solid tumours. He found that, while all modalities are useful forthis task, depending on the particular tumour entities, MR and PET have the highest accuracy.“Interestingly the important information came either from MR or PET studies, but CT wasoften not that relevant. We thought that the combination of PET and MR would be ideal to detectand typify tumours. Locally, the tumour can be imaged with the best anatomical resolution byMR, and in addition you have this metabolic and membrane receptor information about cellsfrom PET, so together you increase your sensitivity and specificity for tumour detection andcharacterisation,” he said.30ECR 2013 | Preliminary Programme EdiciÓn Invierno
www.myESR.org | EUROPEAN CONGRESS OF RADIOLOGY 2013Professor Bernd Hamm from Berlin,Germany, will chair the New HorizonsSession on MR/PET.Professor Heinz-Peter Schlemmerfrom Heidelberg, Germany, willtalk about the role of MR/PET inoncologic imaging.The combination of morphological, functional and metabolic information proves useful atevery step of cancer imaging. It enables radiologists to detect and characterise tumours veryaccurately, by showing tumour size, infiltrative pattern and growth potential. It is very good forlocal staging, distant metastatic staging, treatment monitoring, and follow-up.“For instance in patients with pole melanoma, we use FDG PET/CT with glucose to assesstumour spread. MR is very important to detect tumour spread in the brain, liver and bone marrowand PET allows us to see tumours early, particularly in lymph nodes. If you put it all together, youobtain very precise information about tumour spread, which you can use not only for therapyfollow-up, but also for early detection,” Schlemmer said. MR/PET could also be used for patientswith other types of solid tumour, e.g. breast and prostate tumours, he suggested.Another argument in favour of MR/PET is that it generates very low levels of radiation. Thiscould be particularly important for repeated imaging during therapy monitoring and follow-upas well as imaging of young patients, for instance young men with testicular cancer.Having all the information in one examination represents a significant time-saver, whichmeans that treatment could be started or modified earlier. It would also prove more comfortableand less stressful for patients, who wouldn’t have to wait for another examination or new results.It might also be easier to put in place an MR/PET machine than merge sequential imagingat a later stage. “In principle, you could do a PET/CT first and then an MR examination; sophisticatedsoftware would process and merge the images. It might work that way, but in dailypractice it sounds unlikely because it is too complex and time consuming, whereas having anMR/PET machine would allow you to have all the information in 45 minutes without furtherpost-processing,” he said.If the clinical benefits prove to be worthwhile, MR/PET could be useful in imaging tumourentities, despite the difficulties, he predicted. “According to my experience, it would be worth it,but it would also be quite complex. PET and MR are the most sophisticated imaging modalities,and both require a lot of expertise. To have it all in one machine, you would need even greaterexpertise to interpret the images. You would need to know a lot about PET and MR, and aboutoncology and treatment. But once the expertise is there, it could offer a very fast and comprehensiveassessment for detection and staging of tumours as well as therapy monitoring,” said Schlemmer,who trained in physics before becoming a medical doctor.Working with MR/PET means working closely with physicists, radiopharmacists, oncologistsand, naturally, nuclear doctors, especially for making diagnoses. The level of cooperation betweenradiologists and nuclear physicists demanded by hybrid modalities might require more than just aninterest in the other’s discipline; it might require further subspecialisation. Only the future will tell.Preliminary Programme EdiciÓn Invierno | ECR 2013 31
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