Whole-Body PET/MRI in Oncology

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after May 9, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Magnetic Resonance Imaging: 1.00
Patient Care: 0.50
Patient Interactions and Management: 0.50
Image Production: 0.50
Physical Principles of Image Formation: 0.25
Sequence Parameters and Options: 0.25

Nuclear Medicine Technology: 1.00
Patient Care: 0.50
Patient Interactions and Management: 0.50
Image Production: 0.25
Instrumentation: 0.25
Procedures: 0.25
Endocrine and Oncology Procedures: 0.25

Registered Radiologist Assistant: 1.00
Patient Care: 0.50
Pharmacology: 0.50
Procedures: 0.50
Abdominal Section: 0.25
Neurological, Vascular, and Lymphatic Sections: 0.25

Outline

1. Introduction
2. Workflow and Logistic Considerations
   1. Patient Preparation Before Examination
   2. In-Bed Patient Preparation
3. Optimization of PET/MRI Protocols for Oncologic Indications
   1. General Aspects
   2. Potential PET/MRI Protocols for Whole-Body Oncologic Staging
   3. Data Visualization and Analysis
   4. Possible Artifacts on PET/MRI
4. Conclusion

Objectives

Upon completion of this course, students will:

1. understand the positioning of the PET detector ring for simultaneous PET/MRI
2. know which vendors offer a trimodality PET/MRI system design
3. know which vendors position the PET and MRI systems in the same room
4. identify the indications for PET/MRI at a single bed position
5. list the patient preparation requirements for the ¹⁸F-FDG PET portion of a PET/MRI study
6. know the absolute contraindications for a PET/MRI study
7. identify the MRI coils capable of transmitting RF energy
8. identify the MRI coils capable of detecting signals from the body
9. identify the characteristics of the body coil in the MRI system
10. estimate the acquisition time per bed position for a simultaneous PET/MRI study
11. list the technical aspects of a PET/MRI study that require measurement of the patient’s current physiological state
12. list the tissue types that can be identified by the 2-point Dixon MRI sequence
13. understand the usefulness of the 2-point Dixon sequence for anatomic localization of PET-positive lesions
14. identify alternatives to the 2-point Dixon sequence for MRI attenuation correction
15. list the indications where partial PET/MRI body imaging and region of interest imaging is warranted
16. identify the MRI imaging sequence with the shortest acquisition time
17. identify the MRI imaging sequences performed with the patient holding their breath
18. recognize the MRI technique that is superior to ¹⁸F-FDG PET for detection of liver lesions smaller than 1 cm
19. list the indications for which true whole-body PET/MRI should be performed
20. list suggested techniques for overcoming the poor ability of MRI to detect small pulmonary nodules
21. understand the effect of metallic implants on MRI images
22. identify the body regions that can be affected by truncation of MRI datasets
23. recognize the technique that helps reduce misregistration during PET/MRI studies
24. understand the acquisition timing of MRI attenuation correction sequences
25. identify the tissues that are ignored by current PET/MRI attenuation correction methods
26. describe the reported SUV error rate from incorrect MRI-based attenuation correction
27. describe the effect on SUV from tissue misidentification on MRI attenuation correction sequences
28. identify the MRI system component responsible for spatial localization encoding of signals
29. describe the characteristics of isotropic voxels
30. list the MRI tissue saturation techniques used to nullify signal from fat