Your SlideShare is downloading. ×
 
 
 
 
 
                  
 
                  
                       
                       
S
            
         ...
Simultaneous PET-MRI e A one stop shop
multi-modality imaging: Hype or a hope?
Amarnath Jena a,*
, Sangeeta Taneja a
, Gau...
individual imaging in interpretation are bottle necks and need
to be understood while considering such an option either du...
Apollohospitals:http://www.apollohospitals.com/
Twitter:https://twitter.com/HospitalsApollo
Youtube:http://www.youtube.com...
Upcoming SlideShare
Loading in...5
×

Simultaneous PET-MRI – A one stop shop multi-modality imaging: Hype or a hope?

122

Published on

Although the concept of hybrid imaging has been around for many years, in last few decades it has transformed from visual comparison of anatomical and functional images to software based image fusion, and currently integrated imaging systems have become the standard of care. The concept of PET-CT (Positron emission tomography-Computerized tomography) was introduced by David Townsend in 1998 and a decade after its prototype introduction; PET-CT has become the modality-of-choice for variety of clinical indications in oncology.

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
122
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Transcript of "Simultaneous PET-MRI – A one stop shop multi-modality imaging: Hype or a hope?"

  1. 1.                                                                                                   S                                      Simultane multi-mo        eous PET odality im T-MRI - A maging: H      A one stop Hype or a p shop hope?
  2. 2. Simultaneous PET-MRI e A one stop shop multi-modality imaging: Hype or a hope? Amarnath Jena a,* , Sangeeta Taneja a , Gaurav Katiyal b , Nipun Choudhry c a Sr. Consultant, Nuclear Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India b Sr. Manager Operation, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India c Dy. Chief Medical Administrator (Academics), Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110076, India a r t i c l e i n f o Article history: Received 23 May 2014 Accepted 28 June 2014 Available online xxx Keywords: PET Mutiple myeloma Gynaecological malignancy Although the concept of hybrid imaging has been around for many years, in last few decades it has transformed from visual comparison of anatomical and functional images to software based image fusion, and currently integrated imaging systems have become the standard of care. The concept of PET-CT (Positron emission tomography-Computerized tomography) was introduced by David Townsend in 1998 and a decade after its prototype introduction; PET-CT has become the modality- of-choice for variety of clinical indications in oncology. The idea of integrating PET with MRI into a single imaging platform has grown in the recent years due to the power of MRI for tissue characterization, microstructural appraisal and functional assessment, together with new PET tracers designed to target specific metabolic processes, now catalyzed by the clinical success of integrated PET-CT scanners, new photodetector technologies for PET, the growth of the field of bio molecular imaging and an increasing appreciation for the power of multimodality whole body imaging, simultaneous PET-MRI system has finally started to find its feet in the clin- ical setting. THE TECHNOLOGY: In fact putting “PET electronics” inside a high field 3T magnet system and made to work with no interference on their individual function whatsoever is a technological marvel in the present era and a big potential boost to patient management. The avalanche photodiode is the heart of this development and the successful clinical use of the prototype Whole body Simultaneous PET-MRI. Virtually it combines the capability of both super powers in medical imaging, each one having their roles well established in clin- ical routine. It is apt to conceptualize the power of the com- bed. Fully integrated Whole body and Simultaneous acquisition PET-MRI system, provided by Siemens, received a CE mark and FDA approval for customer purchase in 2011. The technique uniquely allows the PET component of PET-MRI to acquire PET data during the Whole body MR imaging making it a single study, single session. Unlike this, the PET and MRI fusion imaging is possible by getting the PET images from a PET-CT study and fusing it off line with Whole body MR im- ages done elsewhere as a separate study. Accuracy of result, examination time, double scheduling and ownership of * Corresponding author. Tel.: þ91 9811072952. E-mail address: drjena2002@yahoo.com (A. Jena). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/apme a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e2 Please cite this article in press as: Jena A, et al., Simultaneous PET-MRI e A one stop shop multi-modality imaging: Hype or a hope?, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.07.007 http://dx.doi.org/10.1016/j.apme.2014.07.007 0976-0016/Copyright © 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
  3. 3. individual imaging in interpretation are bottle necks and need to be understood while considering such an option either due to availability or other concerns. Among some fifty facilities all over the world that have since installed this new technology, Indraprastha Apollo hospitals Delhi is the 14th unit and, as of today the first and only clinical site in South Asia to have this system. THE PET SUITE representing the epitome of molecular imaging services is a visionary concept of House of Di- agnostics and Apollo management, where two of the most advanced molecular imaging facilities in the present era viz. PET-CT and PET-MRI are put under one roof. PET Suite is of- fering diagnostic capabilities of highest standards through a team of experienced Radiology and Nuclear Medicine spe- cialists, imaging physicists, biomedical engineers, nurses and technologists. The PET-CT is the new 128 slice OptisoHD Bio- graph mCT-X from Siemens with technologies including Time of Flight and High-Definition PET 21.8 cm Zl FOV ensuring fast and precise images which enable precise measurements of metabolic processes including the assessment of neurological disease, cancerous tissue and cardiac blood flow. The Simul- taneous PET-MRI (Biograph mMR) houses a 3T MRI (Trio), Tim (102 Â 18) MQ gradient: 45 mT/m with Slew rate of 200 T/m/s, and PET: LSO crystal with avalanche photodiode (APD), Z FOV of 25.8 cm. Fully functional with (PET on) uninterfered func- tioning of routine imaging and advanced MR applications: proton MRS, DTI, fMRI, Perfusion (T1 DCE and T2*). BENEFITS: The clinical availability of hybrid Simultaneous PET-MRIsystemoffersarangeofpotential benefitsinoncologic, neurological, and cardiovascular applications. Over the last 1 year 4 months, over 800 cases (perhaps the largest series worldwide as on date) have been completed at this facility spanning variety of disciplines. One obvious benefit of simul- taneous acquisition that we observed is improved image registration which allows optimal anatomic localization of PET findings over MRI for confident reporting. Other advantages include, shorter overall imaging time, the ability to simulta- neously acquire many biologically relevant parameters improving diagnosis & assessing changing physiological/ pathophysiological processes, and that too with zero radiation dose as from CT (versus MRI) which is a special point of concern particularly for pediatric, young reproductive age women pop- ulation and cases requiring repeated follow ups requiring assessment of treatment response. Moreover with availability of PET-CT under the same roof, co relative and comparative imaging is being undertaken especially in cases such as lung carcinoma where a high-resolution CT scan scores over MR, providing comprehensive assessment and directing clinical management. Also the unique facility has immensely contrib- uted in defining the right and judicious use of the newly intro- duced PET-MRI in the arena of clinical diagnosis through comparative study with PET-CT on patients using both mo- dalitiesinabacktobackimagingsession:effectivelydonein100 cases during standardization of PET-MRI in this first Indian site. PET-MRI appears particularly useful in imaging patients with dementia and Alzheimer's disease because the combi- nation of high-resolution anatomical and perfusion MR in- formation along with FDG or Pittsburgh Compound B (PiB) PET during a single session can help us understand the patho- genesis and mechanism of Alzheimer's disease, and enable early diagnosis and drug development. It is also contributing immensely for brain pathologies such as epilepsy. Brain tumor evaluation that is now underway has been boosted using multiparametric mapping capitalizing on the simulta- neity of PET and MRI, hoping to provide a medical break- through by noninvasively diagnosing areas of recurrence and directing accurate site for biopsy/intervention and monitoring treatment effect. Other area now getting established is the standardization of MR based quantitation of PET indices using brain PET-MR as a lone modality reliable for clinical workup for dementia. Therapy planning in brain tumors by combining the metabolic information from PET with BOLD (blood oxygen- level dependence), fiber-tracking and diffusion weighted im- aging in a single session is a leap forward with the existing algorithms taking simultaneity of PET and MRI data available in a single session. For body oncology applications, simultaneous PET-MRI has been found to provide panoramic view of whole body, excel- lent tissue characterization, not possible with CT component of PET-CT, along with targeted molecular whole body PET imaging, proving unparalleled for head and neck carcinoma, breast and liver cancers, neuroendocrine tumors, gynecolog- ical cancer, prostate cancer and musculoskeletal tumors. Many longitudinal studies with interrelated parameters like glucose metabolism and neo-angiogenesis in cancer; plaque biology in atherosclerosis; fibrocyte turnover in collagen dis- ease under non oncology applications holds great promise with the availability of magnitudes of tissue parameters derived from molecular imaging (PET) and MRI. The field of cardiology poised to greatly benefit from PET- MR as the simultaneous acquisition allows accurate motion correction and will have a major role to play in the diagnosis of coronary artery disease, detection of hibernating myocardium in patients with congestive heart failure, congenital heart disease and precise estimation of ventricular volumes. In our experience, the clinical performance of Simulta- neous PET-MRI has been found to have a definite edge over PET-CT for comprehensive disease assessment in oncology practice viz; Head & Neck, Breast, Abdomen, Prostate, Multiple Myeloma, Gynecological malignancy both in staging/restag- ing/recurrence/therapy response settings, of course in many cases with an added information on lung from CT chest that is usually available as a preliminary test in cancer staging. It is truly a single stop shop in neuro imaging especially in brain cancer like glioma recurrence and neuro degenerative dis- eases like dementia. In most of the other clinical situations like infection evaluation, combined detection sensitivity of PET and MRI is found making an impact as a fast and comprehensive technique. The various advancements being made in the field of Dis- ease Specific Biological markers will further open newer ave- nues and bring greater insights into the disease. The role of PET/MRI in understanding the disease progression and assessment is likely to hugely contribute to the Clinical Management of our Patients. Conflicts of interest All authors have none to declare. a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e22 Please cite this article in press as: Jena A, et al., Simultaneous PET-MRI e A one stop shop multi-modality imaging: Hype or a hope?, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.07.007
  4. 4. Apollohospitals:http://www.apollohospitals.com/ Twitter:https://twitter.com/HospitalsApollo Youtube:http://www.youtube.com/apollohospitalsindia Facebook:http://www.facebook.com/TheApolloHospitals Slideshare:http://www.slideshare.net/Apollo_Hospitals Linkedin:http://www.linkedin.com/company/apollo-hospitals Blog:Blog:http://www.letstalkhealth.in/

×