Whole-Body [18F]-FDG-PET/MRI for Oncology: A Consensus Recommendation^[*]

Abstract

Combined PET/MR imaging (PET/MRI) was proposed for patient management in 2006 with first commercial versions of integrated whole-body systems becoming available as of 2010. PET/MRI followed the prior evolution of hybrid imaging as attested by the successful adoption of combined PET/CT and SPECT/CT since the early 2000 s. Today, around 150 whole-body PET/MRI systems have become operational worldwide. One of the main application fields of PET/MRI is oncologic imaging. Despite the increasing use of PET/MRI, little governance regarding standardized PET/MRI protocols has been provided to date. Standardization and harmonization of imaging protocols is, however, mandatory for efficient on-site patient management and multi-center studies. This document summarizes consensus recommendations on key aspects of patient referral and preparation, PET/MRI workflow and imaging protocols, as well as reporting strategies for whole-body [18F]-FDG-PET/MRI. These recommendations were created by early adopters and key experts in the field of PET, MRI and PET/MRI. This document is intended to provide guidance for the harmonization and standardization of PET/MRI today and to support wider clinical adoption of this imaging modality for the benefit of patients.

Citation Format

• Umutlu L, Beyer T, Grueneisen JS et al. Whole-Body [18F]-FDG-PET/MRI for Oncology: A Consensus Recommendation. Fortschr Röntgenstr 2019; 191: 289 – 297

Zusammenfassung

Nach initialen Plänen zur Einführung integrierter PET/MRT-Systeme im Jahre 2006 standen 2010 die ersten kommerziell erwerbbaren Scanner für die klinische Anwendung am Patienten zur Verfügung. Sie folgten damit früheren, bereits etablierten hybriden Bildgebungsmodalitäten, wie der PET/CT und SPECT/CT, bei denen der Vorteil einer kombinierten Analyse molekularer und anatomischer Parameter zur Beantwortung onkologischer Fragestellungen gezeigt werden konnte. Bis dato wurden weltweit ca. 150 PET/MRT-Systeme in Kliniken, Praxen und diversen Forschungsinstitutionen installiert. Anhand der aktuellen Studienlage lässt sich die onkologische Diagnostik weiterhin als Hauptanwendungsgebiet erkennen. Aufgrund der zunehmenden Anwendung der PET/MRT in der Patientenversorgung besteht nun die Notwendigkeit einer Anpassung der Arbeitsabläufe an die Anforderungen des klinischen Alltags sowie einer Standardisierung der Untersuchungsprotokolle an die spezifischen medizinischen Fragestellungen. In dem vorliegenden Manuskript werden Konsensempfehlungen für die Indikationsstellung und Vorbereitung des Patienten sowie die Durchführung und Interpretation einer PET/MRT-Untersuchung dargestellt. Darüber hinaus werden Untersuchungsprotokolle zur Anwendung der Ganzkörper [18F]-FDG-PET/MRT zusammengefasst. Diese Empfehlungen wurden durch Experten in den Bereichen der PET, MRT und PET/MRT-Bildgebung zusammengestellt. Sie sollen zur Standardisierung der [18F]-FDG-PET/MRT-Diagnostik onkologischer Patienten und zu einer breiteren klinischen Akzeptanz dieser Bildgebungsmodalität zum Wohle der Patienten beitragen.

Key words

PET/MRI - oncology - consensus recommendations - whole-body imaging - hybrid imaging

^* Published simultaneously in Nuklearmedizin 2019; DOI: 10.1055/a-0830-4453.

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