Hybrid cardiac imaging using PET/MRI: a joint position statement by the European Society of Cardiovascular Radiology (ESCR) and the European Association of Nuclear Medicine (EANM)

Abstract

Positron emission tomography (PET) and magnetic resonance imaging (MRI) have both been used for decades in cardiovascular imaging. Since 2010, hybrid PET/MRI using sequential and integrated scanner platforms has been available, with hybrid cardiac PET/MR imaging protocols increasingly incorporated into clinical workflows. Given the range of complementary information provided by each method, the use of hybrid PET/MRI may be justified and beneficial in particular clinical settings for the evaluation of different disease entities. In the present joint position statement, we critically review the role and value of integrated PET/MRI in cardiovascular imaging, provide a technical overview of cardiac PET/MRI and practical advice related to the cardiac PET/MRI workflow, identify cardiovascular applications that can potentially benefit from hybrid PET/MRI, and describe the needs for future development and research. In order to encourage its wide dissemination, this article is freely accessible on the European Radiology and European Journal of Hybrid Imaging web sites. Key Points• Studies and case-reports indicate that PET/MRI is a feasible and robust technology.• Promising fields of application include a variety of cardiac conditions. • Larger studies are required to demonstrate its incremental and cost-effective value.• The translation of novel radiopharmaceuticals and MR-sequences will provide exciting new opportunities.

Improving the CT (140 kVp) to PET (511 keV) conversion in PET/MR hardware component attenuation correction

“…Since its introduction in 2010, simultaneous positron emission tomography/magnetic resonance (PET/MR) has found its way into various clinical applications ranging from neuro to pediatric and cardiac to whole‐body applications in oncology 1–4 . Recent studies also work towards the integration of PET/MR hybrid imaging into the concept of radiation therapy planning 5,6 .…”

Assessment of sympathetic reinnervation after cardiac transplantation using hybrid cardiac PET/MRI: A pilot study

“…Hybrid cardiac PET/MRI is a relatively novel imaging technique that provides the opportunity to obtain deep insights into myocardial composition; however, its clinical value has yet to be evaluated. 17 To date, most PET/MRI studies using [ 18 F]FDG have focused on myocardial infarction or on the assessment of inflammation in the case of cardiac sarcoidosis. 18,19 Nonetheless, LGE by MRI and missing or elevated [ 18 F]FDG uptake often represent the same pathophysiological imaging targets, such as myocardial infarction or necrosis in the case of myocarditis.…”

Diagnostik und Therapie der kardialen Sarkoidose

“…Eine fortgeschrittene Perfusionsbildgebung mittels der PET (z. B. Rubidium-82 oder N-13-Ammonia-PET) erlaubt eine hochaufgelöste Perfusionsanalyse mit der Möglichkeit der absoluten Quantifizierung des Blutflusses, jedoch sind diese Techniken nur an wenigen Standorten verfügbar [58].…”

“…Kardiale MRT "versus" PET oder kardiale MRT "mit" PET Prinzipiell kann sowohl mit der kardialen MRT als auch mit den o. a. nuklearmedizinischen Verfahren eine myokardiale Inflammationsdiagnostik, eine Narbendiagnostik als auch eine Perfusionsdiagnostik durchgeführt werden. Insofern stellt sich heutzutage zunehmend die Frage, a) welchen diagnostischen Stellenwert diese beiden nichtinvasiven Ansätze im Vergleich haben und b) ob die kombinierte Anwendung von PET/MRT-Untersuchungen mittels moderner Hybrid-Bildgebung diagnostische Vorteile bietet [58].…”