Skip to main content
Erschienen in:

Open Access 21.12.2021 | Editorial

Combined PET and MRI for the masses!

At least for the cardiac ones

verfasst von: Christoph Rischpler, Robert Seifert

Erschienen in: Journal of Nuclear Cardiology | Ausgabe 4/2022

download
DOWNLOAD
print
DRUCKEN
insite
SUCHEN
Hinweise

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About a decade ago, the dream of many nuclear physicians, radiologists, and even engineers came true and the first fully integrated, commercially available PET/MRI device was launched, leading to a large body of work investigating the synergy of these two imaging modalities.1 It did not take long for promising results to be published in oncological2 and also neurological fields of application.3 In cardiology, on the other hand, the integrated analysis of PET and MRI was initially mainly employed in research projects, either in clinical studies4,5 or case reports,6,7 albeit relatively numerous. The first real convincing clinical application was published in this very journal: a study was able to show the benefit of hybrid FDG PET/MRI in myocarditis patients.8 Since then, other clinically significant cardiac applications of combined PET and MRI imaging have been published. One that is particularly worth highlighting is a study of sarcoidosis patients with the clinical question of cardiac involvement.9,10 Here, combined PET and MR imaging has demonstrated its added value primarily by showing greater accuracy with combined analyses. Another very significant population of patients in whom added value of PET/MRI has been suggested is patients with cardiac tumors. It is understandable that in these patients, the most accurate imaging is highly desirable to avoid the frequent need for diagnosis by biopsy. Although the majority of myocardial tumors, approximately three-quarters, are benign, misdiagnosis can of course have fatal consequences. On the other hand, due to the high complication rate of the procedure, an unnecessary biopsy in a benign myocardial mass can also result in high morbidity and rarely even lethality. While there was a pilot study back in 2015 that looked at the value of integrated analysis of PET and MRI in the study of cardiac masses, the major shortcoming of that study was the small case number of 20 patients.11 Another study that was limited to FDG PET/CT came up with only 24 patients as well.12 However, in the highly interesting study by Aghayev et al published in the current issue of the JNC, more than three times as many patients were examined, resulting in a cohort of 72 patients.13 Furthermore, histological correlation was present in the majority of patients. Last but not least, the patients were followed-up and thus high-risk features regarding outcome could be investigated. In the current study, MRI was shown to achieve high sensitivity and specificity in differentiating benign vs. malignant cardiac tumors if 4 of 9 MRI features were positive (AUC 0.91). Individual MRI features showed significantly lower accuracy, with, interestingly, mere lesion size showing the highest accuracy. The inclined reader (particularly nuclear medicine physicians) may take some pride in the fact that a single, simple feature of PET, namely an SUVmax/blood pool ratio > 3, showed similar accuracy compared with the more complex MRI analysis (AUC 0.87). In the end, the integrated analysis of PET and MRI did not show a higher accuracy, but the authors could prove the added value in single complex cases. Outcome analysis also demonstrated that both MRI, by showing an infiltrative border, and PET, by showing focal extracardiac FDG uptake, may have prognostic significance. As promising as the results are, further questions remain unanswered: the PET analysis in the present study was relatively simplistic compared with the MRI analysis (maximal uptake in FDG PET vs 9 different features in MRI), so the question remains whether a more elaborate analysis of PET, e.g., using dynamic acquisition or additional parameters such as SUVpeak, SUVmean, radiomics of PET, metabolic tumor volume, can further increase diagnostic accuracy (Table 1).
Table 1
Comparison of the diagnostic performance of FDG PET vs. MRI in cardiac masses
Study
No. of patients
FDG PET
MRI
FDG PET + MRI
Rahbar et al. 12
24
100%/86%
Nensa et al. 11
20
100%/92%
100%/92%
100%/100%
Aghayev et al. 13
72
85%/88%
98%/84%
98%/84%
Given percentage values are sensitivity/specificity
Nevertheless, the study by Aghayev et al has shown one thing: an integrated PET and MRI analysis represents a promising diagnostic tool of cardiac masses and has the potential to become the clinical standard for this question. We therefore advocate "PET and MRI for cardiac masses!".

Disclosures

For this work, Dr. Seifert was partly supported by the University Medicine Essen Clinician Scientist Academy (UMEA). Dr. Rischpler reports a research grant from Pfizer, consultancy for Adacap and Pfizer, speaker honoraria from Adacap, Alnylam, BTG, GE Healthcare, Pfizer and Siemens Healthineers.
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
download
DOWNLOAD
print
DRUCKEN

Unsere Produktempfehlungen

e.Med Interdisziplinär

Kombi-Abonnement

Für Ihren Erfolg in Klinik und Praxis - Die beste Hilfe in Ihrem Arbeitsalltag

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf SpringerMedizin.de.

e.Med Innere Medizin

Kombi-Abonnement

Mit e.Med Innere Medizin erhalten Sie Zugang zu CME-Fortbildungen des Fachgebietes Innere Medizin, den Premium-Inhalten der internistischen Fachzeitschriften, inklusive einer gedruckten internistischen Zeitschrift Ihrer Wahl.

e.Med Radiologie

Kombi-Abonnement

Mit e.Med Radiologie erhalten Sie Zugang zu CME-Fortbildungen des Fachgebietes Radiologie, den Premium-Inhalten der radiologischen Fachzeitschriften, inklusive einer gedruckten Radiologie-Zeitschrift Ihrer Wahl.

Literatur
1.
Zurück zum Zitat Delso G, Fürst S, Jakoby B, et al. Performance measurements of the Siemens mMR integrated whole-body PET/MR scanner. J Nucl Med 2011;52:1914‐22.CrossRef Delso G, Fürst S, Jakoby B, et al. Performance measurements of the Siemens mMR integrated whole-body PET/MR scanner. J Nucl Med 2011;52:1914‐22.CrossRef
2.
Zurück zum Zitat Drzezga A, Souvatzoglou M, Eiber M, et al. First clinical experience with integrated whole-body PET/MR: Comparison to PET/CT in patients with oncologic diagnoses. J Nucl Med 2012;53:845‐55.CrossRef Drzezga A, Souvatzoglou M, Eiber M, et al. First clinical experience with integrated whole-body PET/MR: Comparison to PET/CT in patients with oncologic diagnoses. J Nucl Med 2012;53:845‐55.CrossRef
3.
Zurück zum Zitat Hitz S, Habekost C, Fürst S, et al. Systematic comparison of the performance of integrated whole-body PET/MR imaging to conventional PET/CT for 18F-FDG brain imaging in patients examined for suspected dementia. J Nucl Med 2014;55:923‐31.CrossRef Hitz S, Habekost C, Fürst S, et al. Systematic comparison of the performance of integrated whole-body PET/MR imaging to conventional PET/CT for 18F-FDG brain imaging in patients examined for suspected dementia. J Nucl Med 2014;55:923‐31.CrossRef
4.
Zurück zum Zitat Rischpler C, Langwieser N, Souvatzoglou M, et al. PET/MRI early after myocardial infarction: Evaluation of viability with late gadolinium enhancement transmurality vs. 18F-FDG uptake. Eur Heart J Cardiovasc Imaging 2015;16:661‐9.PubMed Rischpler C, Langwieser N, Souvatzoglou M, et al. PET/MRI early after myocardial infarction: Evaluation of viability with late gadolinium enhancement transmurality vs. 18F-FDG uptake. Eur Heart J Cardiovasc Imaging 2015;16:661‐9.PubMed
5.
Zurück zum Zitat Rischpler C, Dirschinger RJ, Nekolla SG, et al. Prospective evaluation of 18F-fluorodeoxyglucose uptake in postischemic myocardium by simultaneous positron emission tomography/magnetic resonance imaging as a prognostic marker of functional outcome. Circ Cardiovasc Imaging 2016;9:e004316.CrossRef Rischpler C, Dirschinger RJ, Nekolla SG, et al. Prospective evaluation of 18F-fluorodeoxyglucose uptake in postischemic myocardium by simultaneous positron emission tomography/magnetic resonance imaging as a prognostic marker of functional outcome. Circ Cardiovasc Imaging 2016;9:e004316.CrossRef
6.
Zurück zum Zitat Rischpler C, Nekolla SG, Kossmann H, et al. Upregulated myocardial CXCR4-expression after myocardial infarction assessed by simultaneous GA-68 pentixafor PET/MRI. J Nucl Cardiol 2016;23:131‐3.CrossRef Rischpler C, Nekolla SG, Kossmann H, et al. Upregulated myocardial CXCR4-expression after myocardial infarction assessed by simultaneous GA-68 pentixafor PET/MRI. J Nucl Cardiol 2016;23:131‐3.CrossRef
7.
Zurück zum Zitat Goedel A, Hoellein A, Rischpler C, Götze K. B-lymphoblastic lymphoma: A heartening diagnosis. Eur Heart J Cardiovasc Imaging 2015;16:116.CrossRef Goedel A, Hoellein A, Rischpler C, Götze K. B-lymphoblastic lymphoma: A heartening diagnosis. Eur Heart J Cardiovasc Imaging 2015;16:116.CrossRef
8.
Zurück zum Zitat Nensa F, Kloth J, Tezgah E, et al. Feasibility of FDG-PET in myocarditis: Comparison to CMR using integrated PET/MRI. J Nucl Cardiol 2018;25:785‐94.CrossRef Nensa F, Kloth J, Tezgah E, et al. Feasibility of FDG-PET in myocarditis: Comparison to CMR using integrated PET/MRI. J Nucl Cardiol 2018;25:785‐94.CrossRef
9.
Zurück zum Zitat Vita T, Okada DR, Veillet-Chowdhury M, et al. Complementary value of cardiac magnetic resonance imaging and positron emission tomography/computed tomography in the assessment of cardiac sarcoidosis. Circ Cardiovasc Imaging 2018;11:e007030.CrossRef Vita T, Okada DR, Veillet-Chowdhury M, et al. Complementary value of cardiac magnetic resonance imaging and positron emission tomography/computed tomography in the assessment of cardiac sarcoidosis. Circ Cardiovasc Imaging 2018;11:e007030.CrossRef
10.
Zurück zum Zitat Dweck MR, Abgral R, Trivieri MG, et al. Hybrid magnetic resonance imaging and positron emission tomography with fluorodeoxyglucose to diagnose active cardiac sarcoidosis. JACC Cardiovasc Imaging 2018;11:94‐107.CrossRef Dweck MR, Abgral R, Trivieri MG, et al. Hybrid magnetic resonance imaging and positron emission tomography with fluorodeoxyglucose to diagnose active cardiac sarcoidosis. JACC Cardiovasc Imaging 2018;11:94‐107.CrossRef
11.
Zurück zum Zitat Nensa F, Tezgah E, Poeppel TD, et al. Integrated 18F-FDG PET/MR imaging in the assessment of cardiac masses: A pilot study. J Nucl Med 2015;56:255‐60.CrossRef Nensa F, Tezgah E, Poeppel TD, et al. Integrated 18F-FDG PET/MR imaging in the assessment of cardiac masses: A pilot study. J Nucl Med 2015;56:255‐60.CrossRef
12.
Zurück zum Zitat Rahbar K, Seifarth H, Schäfers M, et al. Differentiation of malignant and benign cardiac tumors using 18F-FDG PET/CT. J Nucl Med 2012;53:856‐63.CrossRef Rahbar K, Seifarth H, Schäfers M, et al. Differentiation of malignant and benign cardiac tumors using 18F-FDG PET/CT. J Nucl Med 2012;53:856‐63.CrossRef
Metadaten
Titel
Combined PET and MRI for the masses!
At least for the cardiac ones
verfasst von
Christoph Rischpler
Robert Seifert
Publikationsdatum
21.12.2021
Verlag
Springer International Publishing
Erschienen in
Journal of Nuclear Cardiology / Ausgabe 4/2022
Print ISSN: 1071-3581
Elektronische ISSN: 1532-6551
DOI
https://doi.org/10.1007/s12350-021-02881-7

Kompaktes Leitlinien-Wissen Innere Medizin (Link öffnet in neuem Fenster)

Mit medbee Pocketcards schnell und sicher entscheiden.
Leitlinien-Wissen kostenlos und immer griffbereit auf ihrem Desktop, Handy oder Tablet.

Neu im Fachgebiet Kardiologie

Auf einen Myokardinfarkt folgt häufig eine Herzinsuffizienz

Ein erneuter Myokardinfarkt sowie die Entwicklung einer Herzinsuffizienz sind wesentliche Komplikationen nach einem akuten Myokardinfarkt. Eine US-amerikanische Studie zeigt insbesondere ein hohes Risiko für die Entwicklung einer Herzinsuffizienz auf, von der nahezu ein Viertel der Patienten betroffen war.

Nach Herzinfarkt zurück ans Steuer: Braucht es ein befristetes Fahrverbot?

Wann sollten sich Menschen nach überstandenem Myokardinfarkt wieder ans Steuer eines Autos setzen dürfen? Eine Studie aus Kanada liefert aktuelle Daten zur Wahrscheinlichkeit kardial bedingter plötzlicher Kontrollverluste als Basis für entsprechende Empfehlungen.

Vorhofflimmern, Bluthochdruck und mehr: Das waren die Top-News 2024

Ablation, Vorhofohr-Verschluss und Antikoagulation bei Vorhofflimmern, TAVI bei asymptomatischer Aortenstenose – nicht nur dazu brachten Studien 2024 neue Erkenntnisse. Leitlinien-Updates etwa zum Hypertonie-Management gab es auch.

Hochsensitive Tests auf kardiale Troponine T und I nicht gleichwertig

Ob beim Verdacht auf einen NSTEMI ein hochsensitiver Test auf kardiales Troponin T oder I zum Einsatz kommt, hat laut einer Sekundäranalyse der APACE-Studie Konsequenzen für die Genauigkeit von Diagnose und Prognose. 

EKG Essentials: EKG befunden mit System (Link öffnet in neuem Fenster)

In diesem CME-Kurs können Sie Ihr Wissen zur EKG-Befundung anhand von zwölf Video-Tutorials auffrischen und 10 CME-Punkte sammeln.
Praxisnah, relevant und mit vielen Tipps & Tricks vom Profi.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.