Value of a Dixon-based MR/PET attenuation correction sequence for the localization and evaluation of PET-positive lesions

Eiber, Matthias; Martínez-Möller, Axel; Souvatzoglou, Michael; Holzapfel, Konstantin; Pickhard, Anja; Löffelbein, Dennys; Santi, Ivan; Rummeny, Ernst J.; Ziegler, Sibylle; Schwaiger, Markus; Nekolla, Stephan G.; Beer, Ambros J.

doi:10.1007/s00259-011-1842-9

Cited by 161 publications

(152 citation statements)

References 35 publications

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“…In PET-positive liver lesions coregistered PET and unenhanced MR images outperformed unenhanced PET/CT. These results are in line with those of Eiber et al [17] who used Dixon-based MR sequences (volumetric interpolated breath-hold examination) in comparison with a 20-mAs low-dose CT scan for anatomical correlation and delineation of PET-positive findings. However, there are important differences between the studies:…”

Section: Discussionsupporting

confidence: 81%

“…One metastatic lesion in the right adrenal was better visualized on CT than on MR images 3. Due to the small number of patients in the study by Eiber et al [17], the number of organ-specific lesions was not high enough for statistical analysis comparing low-dose CT and Dixon-MRI. Our larger and prospective study was able to provide statistically significant information.…”

Section: Discussionmentioning

confidence: 99%

“…in head and neck cancer, and has therefore a major impact on patient management [16]. Full coverage of the PET field of view (FOV) with a fast and robust MR pulse sequence is therefore necessary in oncology patients to provide anatomical correlation similar to that achieved with a low-dose CT scan [17]. Furthermore, this survey MR pulse sequence should ideally also provide data for anatomical MRbased attenuation correction (AC) of PET data equivalent to that provided by CT.…”

Section: Introductionmentioning

confidence: 99%

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Discrimination and anatomical mapping of PET-positive lesions: comparison of CT attenuation-corrected PET images with coregistered MR and CT images in the abdomen

Kuhn

Crook

Mader

et al. 2012

Eur J Nucl Med Mol Imaging

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Purpose PET/MR has the potential to become a powerful tool in clinical oncological imaging. The purpose of this prospective study was to evaluate the performance of a single T1-weighted (T1w) fat-suppressed unenhanced MR pulse sequence of the abdomen in comparison with unenhanced low-dose CT images to characterize PET-positive lesions. Methods A total of 100 oncological patients underwent sequential whole-body 18 F-FDG PET with CT-based attenuation correction (AC), 40 mAs low-dose CT and two-point Dixonbased T1w 3D MRI of the abdomen in a trimodality PET/CT-MR system. PET-positive lesions were assessed by CT and MRI with regard to their anatomical location, conspicuity and additional relevant information for characterization. Results From among 66 patients with at least one PETpositive lesion, 147 lesions were evaluated. No significant difference between MRI and CT was found regarding anatomical lesion localization. The MR pulse sequence used performed significantly better than CT regarding conspicuity of liver lesions (p<0.001, Wilcoxon signed ranks test), whereas no difference was noted for extrahepatic lesions. For overall lesion characterization, MRI was considered superior to CT in 40 % of lesions, equal to CT in 49 %, and inferior to CT in 11 %. Conclusion Fast Dixon-based T1w MRI outperformed lowdose CT in terms of conspicuity and characterization of PET-positive liver lesions and performed similarly in extrahepatic tumour manifestations. Hence, under the assumption that the technical issue of MR AC for whole-body PET examinations is solved, in abdominal PET/MR imaging the replacement of low-dose CT by a single Dixon-based MR pulse sequence for anatomical lesion correlation appears to be valid and robust.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Discrimination and anatomical mapping of PET-positive lesions: comparison of CT attenuation-corrected PET images with coregistered MR and CT images in the abdomen

Kuhn

Crook

Mader

et al. 2012

Eur J Nucl Med Mol Imaging

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“…In fused PET and MRI imaging, the results of Dixonbased MR imaging, a water/fat separation technique used for MR-based attenuation correction for PET/MRI, were evaluated for anatomical correlation of PET-positive lesions on a 3 T clinical scanner compared to low-dose CT [94]. No significant difference was found in anatomical localization for all PET-positive lesions in low-dose CT compared to Dixon-based MR [94].…”

Section: Methodological Considerationsmentioning

confidence: 99%

Whole-body PET/MRI in oncology: current status and clinical applications

Pace

Nicolai

Aiello

et al. 2013

Clin Transl Imaging

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In oncology, diagnostic imaging plays a major role in staging, therapy assessment and in the evaluation of tumor biology. Multimodality imaging, and more specifically positron emission tomography/computed tomography (PET/CT), has matured into an important imaging tool. The recent introduction of the integrated whole-body PET/ magnetic resonance imaging (MRI) represents the addition of a promising methodology in clinical practice. Combining the metabolic data of PET with the anatomical and functional information provided by MRI and fMRI may further improve the diagnostic value of each method alone. Although the literature is still limited, data indicate a potential advantage of PET/MRI over PET/CT in all the indications where MRI is superior to CT, as well as in the evaluation of tumor biology. Integrated PET/MRI might be performed in addition to the existing imaging modality in specific regions. Moreover, integrated PET/MRI is an alternative to PET/CT when a low radiation dose is required, i.e. in children and in repeated imaging. In the rapidly evolving field of diagnostic imaging, the role of a new modality should be accurately evaluated. Further studies are needed to test the diagnostic accuracy of PET/MRI in different oncology indications. Whether PET/MRI will replace PET/CT or be a complementary methodology and whether it represents true diagnostic progress remains to be evaluated, also taking into account economic considerations.

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“…Likewise, in a survey performed in 2014 among international SPECT/CT users, an overwhelming majority of respondents wanted to employ their SPECT/CT system as a SPECT system with attenuation correction and coarse anatomical localization rather than to implement closer integration of radiology-driven imaging perspectives [23]. Finally, one of the first clinical papers on PET/MR promoted the sufficiency of a Blow-signal^sequence, typically used for MR-based attenuation correction [24], synonymous to a lowdose CT scan, for the anatomical localization of the PET findings [25]. These are but a few examples of the disconnect between the diagnostic professions at the apogee of combined imaging, which coincides with the most deterring phase of interaction between the two professions (Table 1).…”

mentioning

confidence: 99%

Life is not black and white, nor just Shades of Gray

Beyer

Hicks

Freudenberg³

2018

Eur J Nucl Med Mol Imaging

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Value of a Dixon-based MR/PET attenuation correction sequence for the localization and evaluation of PET-positive lesions

Abstract: Dixon-based MR imaging for MR AC allows for anatomical allocation of PET-positive lesions similar to low-dose CT in conventional PET/CT. Thus, this approach appears to be useful for future MR/PET for body regions not fully covered by diagnostic MRI due to potential time constraints.

Cited by 161 publications

References 35 publications

Discrimination and anatomical mapping of PET-positive lesions: comparison of CT attenuation-corrected PET images with coregistered MR and CT images in the abdomen

Discrimination and anatomical mapping of PET-positive lesions: comparison of CT attenuation-corrected PET images with coregistered MR and CT images in the abdomen

Whole-body PET/MRI in oncology: current status and clinical applications

Life is not black and white, nor just Shades of Gray

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