The development of integrated positron emission tomography (PET)/magnetic resonance imaging (MRI) scanners opened a new scenario for cancer diagnosis, treatment, and follow-up. Multimodal imaging combines functional and morphological information from different modalities, which, singularly, cannot provide a comprehensive pathophysiological overview. Molecular imaging exploits multimodal imaging in order to obtain information at a biological and cellular level; in this way, it is possible to track biological pathways and discover many typical tumoral features. In this context, nanoparticle-based contrast agents (CAs) can improve probe biocompatibility and biodistribution, prolonging blood half-life to achieve specific target accumulation and non-toxicity. In addition, CAs can be simultaneously delivered with drugs or, in general, therapeutic agents gathering a dual diagnostic and therapeutic effect in order to perform cancer diagnosis and treatment simultaneous. The way for personalized medicine is not so far. Herein, we report principles, characteristics, applications, and concerns of nanoparticle (NP)-based PET/MRI CAs. modality allows gathering all the necessary morphological and functional information, the combination of two or more imaging techniques, also called multimodal imaging or hybrid imaging, can offer synergistic advantages over any modality alone [11], overcoming its drawbacks and strengthening the peculiarities. The traditional approach was directed to the integration of a structural imaging modality (CT, MRI) with a functional highly sensitive imaging modality (PET/SPECT). Thus, firstly, PET/CT and SPECT/CT were introduced in clinical settings. The first PET/CT scanner was developed in 1998 by Townsend and colleagues [12] and was commercialized in 2001. It consists of a PET component independent from CT, and a single bed moves axially into the scanner while the patient sequentially performs CT and PET scans [13]. To date, PET/CT scanners completely replaced standalone PET scanners [14], exploiting anatomical reference and attenuation estimation from CT data. The success of PET/CT scanners inspired the feasibility of a PET/MRI scanner [15]. Three different configuration options were developed over the years [16]: the first consists of a sequential acquisition, similarly to PET/CT, where the patient undergoes firstly a MRI scan and later a PET scan; even if the MRI and PET components must be minimally modified, two consecutive acquisitions are performed without simultaneity. Temporal mismatches between PET metabolic data and MRI morphological information such as patient motion are the main weak points [7]. Nearly 15 years ago, some researchers working in preclinical settings analyzed the possibility of integrating a modified PET scanner into an MRI system. In Tubingen, Germany, an MRI-compatible PET scanner was inserted into a 3T clinical MRI scanner [8]; this system is suitable for preclinical studies or human brain imaging. The third option considers a first fully integrated whole-body PET/MRI sys...

Positron emission tomography (PET) provides spatially localized information about brain metabolism and function and innovative tracers have extended this potential to the study of neuroinflammation (NI), an important process in the pathophysiology of several neurological disorders. However, PET is limited by low spatial resolution. Conversely, Magnetic Resonance Imaging (MRI) affords high-resolution information about brain anatomy and metabolism which can complement PET-related information as well as aid in post-processing of PET data. For sequentially acquired MR/PET data, anatomical correspondence is often capped by the limited structural detail afforded by PET, and the assumption that no significant changes in subject state has occurred between sessions. Hybrid PET/MRI offers the unique opportunity to overcome these limitations by providing access to temporal and spatial cross-modal alignment/synchronization, hence opening novel avenues for exploiting multivariate and multiparametric information regarding brain structure and function. While, the clinical applicability and impact on diagnostic accuracy of PET/MRI in neurological disorders is still under investigation, the study of NI, a complex processes mediated by multiple metabolic pathways and hence likely characterized by different biomarkers, represents an opportunity to characterize the added value of joint MRI-PET techniques in a clinical context. This would in turn offer improved diagnostic and prognostic tools in several neurological disorders in which NI is a key mediator. This review aims at summarizing the current state as well as future potential of using hybrid PET/MRI for characterizing NI phenomena, both in terms of technical challenges and clinical relevance.

Glial activation characterizes most neurodegenerative and psychiatric diseases, often anticipating clinical manifestations and macroscopical brain alterations. Although imaging techniques have improved diagnostic accuracy in many neurological conditions, often supporting diagnosis, prognosis prediction and treatment outcome, very few molecular imaging probes, specifically focused on microglial and astrocytic activation, have been translated to a clinical setting. In this context, hybrid positron emission tomography (PET)/magnetic resonance (MR) scanners represent the most advanced tool for molecular imaging, combining the functional specificity of PET radiotracers (e.g., targeting metabolism, hypoxia, and inflammation) to both high-resolution and multiparametric information derived by MR in a single imaging acquisition session. This simultaneity of findings achievable by PET/MR, if useful for reciprocal technical adjustments regarding temporal and spatial cross-modal alignment/synchronization, opens still debated issues about its clinical value in neurological patients, possibly incompliant and highly variable from a clinical point of view. While several preclinical and clinical studies have investigated the sensitivity of PET tracers to track microglial (mainly TSPO ligands) and astrocytic (mainly MAOB ligands) activation, less studies have focused on MR specificity to this topic (e.g., through the assessment of diffusion properties and T2 relaxometry), and only few exploiting the integration of simultaneous hybrid acquisition. This review aims at summarizing and critically review the current state about PET and MR imaging for glial targets, as well as the potential added value of hybrid scanners for characterizing microglial and astrocytic activation.