Professional Documents
Culture Documents
Textbook Pet MR Imaging A Case Based Approach 1St Edition Rajesh Gupta Ebook All Chapter PDF
Textbook Pet MR Imaging A Case Based Approach 1St Edition Rajesh Gupta Ebook All Chapter PDF
https://textbookfull.com/product/spine-imaging-a-case-based-
guide-to-imaging-and-management-1st-edition-gupta/
https://textbookfull.com/product/clinical-imaging-of-spinal-
trauma-a-case-based-approach-1st-edition-zoran-rumboldt-editor/
https://textbookfull.com/product/hammertoes-a-case-based-
approach-emily-a-cook/
https://textbookfull.com/product/a-case-based-approach-to-
emergency-psychiatry-1st-edition-maloy/
Imaging Gliomas After Treatment A Case based Atlas 2nd
Edition Tommaso Scarabino
https://textbookfull.com/product/imaging-gliomas-after-treatment-
a-case-based-atlas-2nd-edition-tommaso-scarabino/
https://textbookfull.com/product/management-of-lymphomas-a-case-
based-approach-1st-edition-jasmine-zain/
https://textbookfull.com/product/sharing-cities-2020-a-case-
based-approach-iris-wang/
https://textbookfull.com/product/biomechanics-a-case-based-
approach-second-edition-sean-p-flanagan/
https://textbookfull.com/product/thyroid-cancer-a-case-based-
approach-2nd-edition-giorgio-grani/
Rajesh Gupta · Robert Matthews
Lev Bangiyev · Dinko Franceschi
Mark Schweitzer
PET/MR Imaging
A Case-Based Approach
123
PET/MR Imaging
Rajesh Gupta • Robert Matthews
Lev Bangiyev • Dinko Franceschi
Mark Schweitzer
PET/MR Imaging
A Case-Based Approach
Rajesh Gupta Robert Matthews
Department of Radiology Department of Radiology
Stony Brook University Hospital Stony Brook University Hospital
Stony Brook, NY, USA Stony Brook, NY, USA
Mark Schweitzer
Department of Radiology
Stony Brook University Hospital
Stony Brook, NY, USA
vii
viii Foreword
Technical Challenges
Attenuation
Spatial Resolution
Conclusion
Simultaneous PET and MRI technology is still relatively new to the clinic and
has not yet reached full acceptance, in part due to its high cost but also due to
limited large-scale prospective validation studies. The initial phase of adoption
focused on clinical feasibility and the degree to which it was equivalent to
PET/CT for detecting lesions. In the following years, PET/MRI developed to
a stage where it is superior to PET/CT for some malignancies [17, 18] and has
evolved into non-oncologic clinical applications such as assessment of neuro-
degenerative diseases. However, cultural and historical obstacles remain in the
routine clinical adoption of PET/MR imaging. Cancer specialists have consid-
erable training and experience with PET/CT, but not necessarily in the com-
plex language of MRI, its benefits, variety of imaging sequences and contrast
mechanisms, and its limitations such as new types of artifacts to be inter-
preted. This book is an attempt to introduce the nuances of PET/MR imaging
to oncologists, radiologists, and other specialized physicians who are already
familiar with PET/CT. Our hope is that a deeper understanding of PET/MRI,
including its advantages and disadvantages, by practicing physicians will help
place this new technology in the most effective role in patient care.
References
1. Bensinger SJ, Christofk HR. New aspects of the Warburg effect in cancer cell biology.
Semin Cell Dev Biol. 2012;23:352–61.
2. Metser U, Even-Sapir E. Increased (18)F-fluorodeoxyglucose uptake in benign, nonphysi-
ologic lesions found on whole-body positron emission tomography/computed tomogra-
phy (PET/CT): accumulated data from four years of experience with PET/CT. Semin Nucl
Med. 2007;37:206–22.
3. Wechalekar K, Sharma B, Cook G. PET/CT in oncology—a major advance. Clin
Radiol. 2005;60:1143–55.
4. Kelloff GJ, Hoffman JM, Johnson B, Scher HI, Siegel BA, Cheng EY, et al. Progress
and promise of FDG-PET imaging for cancer patient management and oncologic drug
development. Clin Cancer Res. 2005;11:2785–808.
5. Fahey F, Stabin M. Dose optimization in nuclear medicine. Semin Nucl Med.
2014;44:193–201.
6. Xia T, Alessio AM, De Man B, Manjeshwar R, Asma E, Kinahan PE. Ultra-low dose
CT attenuation correction for PET/CT. Phys Med Biol. 2012;57:309–28.
7. Vaska P, Cao T. The state of instrumentation for combined positron emission tomogra-
phy and magnetic resonance imaging. Semin Nucl Med. 2013;43:11–8.
8. Cho ZH, Son YD, Kim HK, Kim KN, Oh SH, Han JY, et al. A fusion PET-MRI system
with a high-resolution research tomograph-PET and ultra-high field 7.0 T-MRI for the
molecular-genetic imaging of the brain. Proteomics. 2008;8:1302–23.
9. Zaidi H, Ojha N, Morich M, Griesmer J, Hu Z, Maniawski P, et al. Design and per-
formance evaluation of a whole-body ingenuity TF PET-MRI system. Phys Med Biol.
2011;56:3091–106.
10. Delso G, Fürst S, Jakoby B, Ladebeck R, Ganter C, Nekolla SG, et al. Performance
measurements of the Siemens mMR integrated whole-body PET/MR scanner. J Nucl
Med. 2011;52:1914–22.
11. Grant AM, Deller TW, Khalighi MM, Maramraju SH, Delso G, Levin CS. NEMA
NU 2–2012 performance studies for the SiPM-based ToF-PET component of the GE
SIGNA PET/MR system. Med Phys. 2016;43:10.
12. Surti S. Update on time-of-flight PET imaging. J Nucl Med. 2015;56:
98–105.
13. Kinahan PE, Hasegawa BH, Beyer T. X-ray-based attenuation correction for posi-
tron emission tomography/computed tomography scanners. Semin Nucl Med.
2003;33:166–79.
14. Ladefoged CN, Hansen AE, Keller SH, Holm S, Law I, Beyer T, et al. Impact of incor-
rect tissue classification in Dixon-based MR-AC: fat-water tissue inversion. EJNMMI
Phys. 2014;1:101.
15. Ladefoged CN, Law I, Anazodo U, St. Lawrence K, Izquierdo-Garcia D, Catana C,
et al. A multi-centre evaluation of eleven clinically feasible brain PET/MRI attenuation
correction techniques using a large cohort of patients. Neuroimage. 2016;147:346–59.
16. Rezaei A, Defrise M, Bal G, Michel C, Conti M, Watson C, et al. Simultaneous recon-
struction of activity and attenuation in time-of-flight PET. IEEE Trans Med Imaging.
2012;31:2224–33.
17. Heusch P, Nensa F, Schaarschmidt B, Sivanesapillai R, Beiderwellen K, Gomez B,
et al. Diagnostic accuracy of whole-body PET/MRI and whole-body PET/CT for TNM
staging in oncology. Eur J Nucl Med Mol Imaging. 2015;42:42–8.
18. Sher AC, Seghers V, Paldino MJ, Dodge C, Krishnamurthy R, Krishnamurthy R, et al.
Assessment of sequential PET/MRI in comparison with PET/CT of pediatric lymphoma:
a prospective study. AJR. Am J Roentgenol. 2016;206:623–31.
Preface
xiii
Acknowledgements
xv
Contents
Part I Musculoskeletal
Case 1 Recurrent High-Grade Sarcoma . . . . . . . . . . . . . . . . . . . . . 3
Rajesh Gupta
Case 2 Bone Metastases from Lung Cancer . . . . . . . . . . . . . . . . . . 5
Rajesh Gupta
Case 3 Benign Notochordal Remnant . . . . . . . . . . . . . . . . . . . . . . . 7
Rajesh Gupta
Case 4 Ewing Sarcoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Apar Gupta
Case 5 Multiple Myeloma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Rajesh Gupta
Case 6 Osteomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Rajesh Gupta
Case 7 Malignant Soft Tissue Myxofibrosarcoma . . . . . . . . . . . . . 17
Rajesh Gupta
Case 8 Vertebral Body Hemangioma. . . . . . . . . . . . . . . . . . . . . . . . 19
Rajesh Gupta
Case 9 Therapy-Induced Marrow Changes. . . . . . . . . . . . . . . . . . . 21
Rajesh Gupta
Case 10 Benign Spinal Cord Compression . . . . . . . . . . . . . . . . . . . . 25
David Pouldar and Robert Matthews
Case 11 Prostate Cancer with F-18 Sodium Fluoride. . . . . . . . . . . . 27
Ana M. Franceschi and Robert Matthews
Case 12 Tarlov Cyst. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Rajesh Gupta
Case 13 Cellulitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Rajesh Gupta
Case 14 Degenerative Spine: Modic Type I Changes. . . . . . . . . . . . 35
Rajesh Gupta and Robert Matthews
xvii
xviii Contents
Part II Chest
Case 26 Pulmonary Sarcoidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Kavitha Yaddanapudi
Case 27 Cardiac Metastasis from Renal Cell Carcinoma . . . . . . . . 65
Kavitha Yaddanapudi and Robert Matthews
Case 28 Breast Cancer (Invasive Ductal Carcinoma). . . . . . . . . . . . 67
Elham Safaie
Case 29 Benign Thymic Rebound Hyperplasia. . . . . . . . . . . . . . . . . 69
Rajesh Gupta
Case 30 Pulmonary Infarct. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Kavitha Yaddanapudi
Case 31 Mediastinal Lymphoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Rajesh Gupta
Case 32 Inflammatory Breast Cancer. . . . . . . . . . . . . . . . . . . . . . . . 75
Elham Safaie
Case 33 Benign Loculated Pleural Effusion . . . . . . . . . . . . . . . . . . . 77
Kavitha Yaddanapudi
Contents xix
Part IV Genitourinary
Case 76 Cervical Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Rajesh Gupta
Case 77 Simple Renal Cysts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Rajesh Gupta
Case 78 Mature Cystic Ovarian Teratoma . . . . . . . . . . . . . . . . . . . . 181
Rajesh Gupta
Case 79 Papillary Urothelial Neoplasm of the Bladder,
Low Malignant Potential . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Rajesh Gupta
Case 80 Adrenal Adenoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Rajesh Gupta
Case 81 Invasive Cancer of the Vulva . . . . . . . . . . . . . . . . . . . . . . . . 187
Rajesh Gupta
Case 82 Physiological FDG Uptake in the Uterus and Ovary. . . . . 189
Jerrin Varghese and Amit Gupta
Case 83 Renal Cell Carcinoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Robert Matthews
Case 84 Urinoma: Urinary Fistula. . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Rajesh Gupta
Case 85 Endometrial Polyps and Tamoxifen-Associated
Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Rajesh Gupta
Case 86 Prostate Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Rajesh Gupta
Case 87 Colovaginal Fistula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Rajesh Gupta
Case 88 Seroma: Post-Operative . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Rajesh Gupta
xxii Contents
Part VI Neuroradiology
Case 112 High-Grade Glioma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Anuj Rajput, Michael Goodman, and Lev Bangiyev
Case 113 Alzheimer’s Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Ana M. Franceschi, Michael J. Hoch, and Timothy M.
Shepherd
Case 114 Pituitary Adenoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Jingyu Zhou
Case 115 Oligodendroglioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Michael J. Hoch, Ana M. Franceschi, and Timothy M.
Shepherd
Case 116 Vascular Dementia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Priya Sharma and Rajesh Gupta
Case 117 Tumor Progression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Anuj Rajput, Michael Goodman, and Lev Bangiyev
Case 118 Meningioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Priya Sharma and Rajesh Gupta
Case 119 Mesial Temporal Lobe Sclerosis. . . . . . . . . . . . . . . . . . . . . 295
Ana M. Franceschi, Michael J. Hoch, and Timothy M.
Shepherd
Case 120 Brain Abscess. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
James Bai and Lev Bangiyev
Case 121 Glioblastoma Recurrence with Negative FDG PET. . . . . 301
Anuj Rajput, Michael Goodman, and Lev Bangiyev
Case 122 Logopenic Primary Progressive Aphasia. . . . . . . . . . . . . . 305
Michael J. Hoch, Lev Bangiyev, and Timothy M.
Shepherd
xxiv Contents
xxv
xxvi Contributors
xxvii
Part I
Musculoskeletal
Case 1
Recurrent High-Grade
Sarcoma
Rajesh Gupta
History Discussion
A 74-year-old female with left lower leg sar- Sarcomas are malignant cancers that arise from
coma, treated by below-knee amputation, has a mesenchymal origins. They can arise in the mus-
new palpable lump at the stump, concerning for cle, bone, fat, or connective tissue. Sarcomas
recurrence (Fig. 1.1). most often present as a mass. There are various
histopathological subtypes which manifest as
different clinical presentations and diagnoses. It
Diagnosis is important to assess the grade of the tumor as it
impacts staging, prognostic, and treatment
Recurrent high-grade sarcoma implications.
MR imaging is the primary modality of
choice to evaluate sarcomas, especially those
Findings arising in the soft tissues. MR can reliably iden-
tify tumor depth beneath fascial planes, tumor
• Moderately well-circumscribed lesion at the size, growth, and internal signal characteristics.
medial aspect of the left stump which has low Generally, high-grade tumors show isointense
signal on T1-weighted images and intermedi- signal on T1-weighted images, heterogeneously
ate signal on T2-weighted images (arrows). high signal on T2-weighted images, and hetero-
• Post-contrast image demonstrates heteroge- geneous enhancement on post gadolinium
neously avid contrast enhancement, mostly images. Poorly defined tumor margin and peri-
peripheral (arrowheads). tumoral contrast enhancement on MRI indicate a
• PET/MR fusion images show heterogeneous more invasive and aggressive tumor implying a
abnormal FDG uptake within this soft tissue higher-grade pathology.
lesion along the distal portion of the tibial FDG PET imaging can reliably distinguish
stump consistent with recurrence. between low-grade and high-grade sarcomas by
Fig. 1.1 T1 TSE axial of stump (a), T2 TSE with fat sup- VIBE axial fusion (d), and PET/MR T1 VIBE sagittal
pression axial of stump (b), T1 GRE with fat suppression fusion of left knee (e)
post-gadolinium contrast axial of stump (c), PET/MR T1
the intensity of FDG uptake. FDG can detect main mass and distant metastases allowing for
small areas of high-grade differentiation in a complete evaluation in one study.
large mass helping to direct biopsy targets. FDG
PET is effectively used for sarcoma tumor stag-
ing and monitoring treatment response. Suggested Reading
Combined PET/MR provides excellent evalua-
tion of the sarcoma tumor and surrounding soft Eary JF, Conrad EU. Imaging in sarcoma. J Nucl Med.
2011;52:1903–13.
tissues, as well as provides functional metabolic Zhao F, Ahlawat S, Farahani SJ, Weber KL, Montgomery
activity to aid in accurate tumor grading and stag- EA, Carrino JA, et al. Can MR imaging be used to pre-
ing. It can detect satellite lesions away from the dict tumor grade in soft-tissue sarcoma? Radiology.
2014;272:192–201.
Case 2
Bone Metastases from
Lung Cancer
Rajesh Gupta
Fig. 2.1 STIR sagittal (a), Dixon T1-weighted out-of-phase sagittal (b), PET/MR Dixon T1-weighted out-of-phase
sagittal fusion (c), and PET sagittal (d)
out-of-
phase, in-phase image, fat-only, and allows for superior anatomic localization and
water-only images. Metastatic bone lesions functional assessment of malignant skeletal
replace the bone marrow and do not drop on lesions and their response to therapy.
opposed-phase imaging. Dixon-based whole-
body MRI has been shown to be specific and
more sensitive than bone scan in detecting bone Suggested Reading
metastases, especially in breast cancer.
Overall MRI and PET imaging are roughly Costelloe CM, Kundra V, Ma J, Chasen BA, Rohren
EM, Bassett RL Jr, et al. Fast Dixon whole-body
equal in sensitivity in detecting metastases. MRI for detecting distant cancer metastasis: a pre-
However, MRI has better resolution and can liminary clinical study. J Magn Reson Imaging.
detect smaller lesions, while PET has the capabil- 2012;35(2):399–408.
ity to effectively detect lesions on whole-body Heindel W, Gübitz R, Vieth V, Weckesser M, Schober O,
Schäfers M. The diagnostic imaging of bone metasta-
images. It can provide metabolic information ses. Dtsch Arztebl Int. 2014;111(44):741–7.
related to the aggressiveness of the lesion and can O’Sullivan GJ, Carty FL, Cronin CG. Imaging of
determine whether the lesion is active following bone metastasis: an update. World J Radiol.
treatment. The use of FDG in PET/MR imaging 2015;7(8):202–11.
Case 3
Benign Notochordal
Remnant
Rajesh Gupta
Updated editions will replace the previous one—the old editions will
be renamed.
1.D. The copyright laws of the place where you are located also
govern what you can do with this work. Copyright laws in most
countries are in a constant state of change. If you are outside the
United States, check the laws of your country in addition to the terms
of this agreement before downloading, copying, displaying,
performing, distributing or creating derivative works based on this
work or any other Project Gutenberg™ work. The Foundation makes
no representations concerning the copyright status of any work in
any country other than the United States.
• You pay a royalty fee of 20% of the gross profits you derive from
the use of Project Gutenberg™ works calculated using the
method you already use to calculate your applicable taxes. The
fee is owed to the owner of the Project Gutenberg™ trademark,
but he has agreed to donate royalties under this paragraph to
the Project Gutenberg Literary Archive Foundation. Royalty
payments must be paid within 60 days following each date on
which you prepare (or are legally required to prepare) your
periodic tax returns. Royalty payments should be clearly marked
as such and sent to the Project Gutenberg Literary Archive
Foundation at the address specified in Section 4, “Information
about donations to the Project Gutenberg Literary Archive
Foundation.”
• You comply with all other terms of this agreement for free
distribution of Project Gutenberg™ works.
1.F.
1.F.4. Except for the limited right of replacement or refund set forth in
paragraph 1.F.3, this work is provided to you ‘AS-IS’, WITH NO
OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED,
INCLUDING BUT NOT LIMITED TO WARRANTIES OF
MERCHANTABILITY OR FITNESS FOR ANY PURPOSE.
Please check the Project Gutenberg web pages for current donation
methods and addresses. Donations are accepted in a number of
other ways including checks, online payments and credit card
donations. To donate, please visit: www.gutenberg.org/donate.
Most people start at our website which has the main PG search
facility: www.gutenberg.org.