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. 2014 Mar 15;7(3):640-8.
eCollection 2014.

Hybrid PET/MR imaging in two sarcoma patients - clinical benefits and implications for future trials

Sasan Partovi  1 , Andres A Kohan  1 , Lisa Zipp  2 , Peter Faulhaber  1 , Christos Kosmas  1 , Pablo R Ros  1 , Mark R Robbin  1
Affiliations

Hybrid PET/MR imaging in two sarcoma patients - clinical benefits and implications for future trials

Sasan Partovi et al. Int J Clin Exp Med. .

Abstract

PET/MRI is an evolving hybrid imaging modality which combines the inherent strengths of MRIs soft-tissue and contrast resolution and PETs functional metabolic capabilities. Bone and soft-tissue sarcoma are a relatively rare tumor entity, relying on MRI for local staging and often on PET/CT for lymph node involvement and metastatic spread evaluation. The purpose of this article is to demonstrate the successful use of PET/MRI in two sarcoma patients. We also use these patients as a starting point to discuss how PET/MRI might be of value in sarcoma. Among its potential benefits are: superior TNM staging than either modality alone, decreased radiation dose, more sensitive and specific follow-up and better assessment of treatment response. These potentials need to be investigated in future PET/MRI soft-tissue sarcoma trials.

Keywords: FDG; PET/CT; PET/MRI; molecular hybrid imaging; sarcoma.

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Figures

Figure 1
Figure 1
Initial PET/CT done during radiation therapy shows spread of the disease beyond the primary tumor. Increased uptakes are noticeable in the head, upper right lung, upper left abdominal quadrant and right psoas (D). Uptake in the descending colon was interpreted as physiologic. Axial CT (A), PET (B) and fusion (C) images show in more detail the lesion described in the psoas, which is slightly noticeable in the CT image (A) as a less hypodense structure inside the psoas and presents homogeneous FDG uptake in the PET image (B).
Figure 2
Figure 2
Coronal CT reconstruction (A) and coronal T2w (B) fused with their corresponding PET in the contiguous image (row A and B), reveals the higher soft-tissue resolution of MRI, allowing the identification of healthy muscle (arrow) that is displaced by the heterogeneous tumor. Axial T2w (C and D) fused with the corresponding PET (row C) and the DWI (row D) show the discrepant findings described in the text. Direct comparison of the PET MIPs shows the successful performance of PET/MRI and the MR based attenuation correction map.
Figure 3
Figure 3
Axial T2w (A), STIR (B), DWI (C) and ADC (D) and the fusion of these images with the corresponding PET shows integration of the PETs functional capabilities with MRIs local assessment of the recurrence (arrow heads). Notice the peri-articular muscle uptake (arrows) which can be discarded as physiological due to the normal appearance of that area in STIR, DWI and ADC images (arrows). Direct comparison of PET MIPs allows recertification of the successful performance of the MR based attenuation correction map.
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