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We report our initial clinical experience for image quality and diagnostic performance of a digital PET prototype scanner with time-of-flight (DigitalTF), compared with an analog PET scanner with time-of-flight (GeminiTF PET/CT).Twenty-one oncologic patients, mean age 58 y, first underwent clinical (18)F-FDG PET/CT on the GeminiTF. The scanner table was then withdrawn while the patient remained on the table, and the DigitalTF was inserted between the GeminiTF PET and CT scanner. The patients were scanned for a second time using the same PET field of view with CT from the GeminiTF for attenuation correction. Two interpreters reviewed the 2 sets of PET/CT images for overall image quality, lesion conspicuity, and sharpness. They counted the number of suggestive (18)F-FDG-avid lesions and provided the TNM staging for the 5 patients referred for initial staging. Standardized uptake values (SUVs) and SUV gradients as a measure of lesion sharpness were obtained.The DigitalTF showed better image quality than the GeminiTF. In a side-by-side comparison using a 5-point scale, lesion conspicuity (4.3 ± 0.6), lesion sharpness (4.3 ± 0.6), and diagnostic confidence (3.4 ± 0.7) were better with DigitalTF than with GeminiTF (P0.01). In 52 representative lesions, the lesion maximum SUV was 36% higher with DigitalTF than with GeminiTF, lesion-to-blood-pool SUV ratio was 59% higher, and SUV gradient was 51% higher, with good correlation between the 2 scanners. Lesions less than 1.5 cm showed a greater increase in SUV from GeminiTF to DigitalTF than those lesions 1.5 cm or greater. In 5 of 21 patients, DigitalTF showed an additional 8 suggestive lesions that were not seen using GeminiTF. In the 15 restaging patients, the true-negative rate was 100% and true-positive rate was 78% for both scanners. In the 5 patients for initial staging, DigitalTF led to upstaging in 2 patients and showed the same staging in the other 3 patients, compared with GeminiTF.DigitalTF provides better image quality, diagnostic confidence, and accuracy than GeminiTF. DigitalTF may be the most beneficial in detecting small tumor lesions and disease staging.

Introduction Despite advances in the diagnosis and treatment of breast cancer, it remains a major cause of morbidity and mortality. In the United States, approximately 232,000 new cases of breast cancer and 40,000 cancer deaths were expected in 2013, and 1 in 8 women will develop breast cancer in her lifetime. Currently, mammography is the primary method of breast cancer screening; however, extensive controversy exists regarding the timing, frequency, and schedule of such screening. Mammography has its limitations, with reported sensitivities ranging from30%-96% and is influenced bymultiple factors, including age and breast tissue density. Given the known limitations of mammography, alternative modalities have been explored to aid in the diagnosis of breast cancer, including dynamic contract-enhanced magnetic resonance tomography (DCE-MRI), whole-breast ultrasound, andmolecular breast imaging using positron emission tomography (PET). Fluorodeoxyglucose (FDG)-PET/computed tomography (CT) has been used in patients with breast cancer as a tool to diagnose breast cancer as well as to detect metastasis and recurrence. This article reviews the current state of DCE-MRI and FDG-PET/CT in patients with breast cancer and then delves into the potential utilization of PET/MRI (Figs. 1-3).

BACKGROUND AND PURPOSE: MR imaging and PET/CT are integrated in the work-up of head and neck cancer patients. The hybrid imaging technology 18 F-FDG-PET/MR imaging combining morphological and functional information might be attractive in this patient population. The aim of the study was to compare whole-body 18 F-FDG-PET/MR imaging and 18 F-FDG-PET/CT in patients with head and neck cancer, both qualitatively in terms of lymph node and distant metastases detection and quantitatively in terms of standardized uptake values measured in 18 F-FDG-avid lesions. MATERIALS AND METHODS: Fourteen patients with head and neck cancer underwent both whole-body PET/CT and PET/MR imaging after a single injection of 18 F-FDG. Two groups of readers counted the number of lesions on PET/CT and PET/MR imaging scans. A consensus reading was performed in those cases in which the groups disagreed. Quantitative standardized uptake value measurements were performed by placing spheric ROIs over the lesions in 3 different planes. Weighted and unweighted κ statistics, correlation analysis, and the Wilcoxon signed rank test were used for statistical analysis. RESULTS: κ statistics for the number of head and neck lesion lesions counted (pooled across regions) revealed interreader agreement between groups 1 and 2 of 0.47 and 0.56, respectively. Intrareader agreement was 0.67 and 0.63. The consensus reading provided an intrareader agreement of 0.63. For the presence or absence of metastasis, interreader agreement was 0.85 and 0.70. The consensus reading provided an intrareader agreement of 0.72. The correlations between the maximum standardized uptake value in 18 F-FDG-PET/MR imaging and 18 F-FDG-PET/CT for primary tumors and lymph node and metastatic lesions were very high (Spearman r = 1.00, 0.93, and 0.92, respectively). CONCLUSIONS: In patients with head and neck cancer, 18 F-FDG-PET/MR imaging and 18 F-FDG-PET/CT provide comparable results in the detection of lymph node and distant metastases. Standardized uptake values derived from 18 F-FDG-PET/MR imaging can be used reliably in this patient population.

Magentic Resonance/positron emission tomography (PET) has been introduced recently for imaging of clinical patients. This hybrid imaging technology combines the inherent strengths of MRI with its high soft-tissue contrast and biological sequences with the inherent strengths of PET, enabling imaging of metabolism with a high sensitivity. In this article, we describe the initial experience of MR/PET in a clinical cancer center along with a review of the literature. For establishing MR/PET in a clinical setting, technical challenges, such as attenuation correction and organizational challenges, such as workflow and reimbursement, have to be overcome. The most promising initial results of MR/PET have been achieved in anatomical areas where high soft-tissue and contrast resolution is of benefit. Head and neck cancer and pelvic imaging are potential applications of this hybrid imaging technology. In the pediatric population, MR/PET can decrease the lifetime radiation dose. MR/PET protocols tailored to different types of malignancies need to be developed. After the initial exploration phase, large multicenter trials are warranted to determine clinical indications for this exciting hybrid imaging technology and thereby opening new horizons in molecular imaging. J. Magn. Reson. Imaging 2014;39:768–780. © 2013 Wiley Periodicals, Inc.

PET/MRI is a new hybrid modality which is increasingly being used in clinical settings, although both clinical evaluation and technical optimization are still an ongoing process. Initial experience with this new imaging device proves promising for oncologic applications. Other clinical indications in the field of cardiac imaging and neuroimaging are also being explored. This article aims to review the current status of PET/MRI and its value in oncologic applications, and summarizes our own preliminary experience in this field.

Splenosis is defined as the heterotopic autotransplantation of splenic tissue because of a ruptured spleen due to trauma or surgery. It is a benign and incidental finding, although imaging tests may sometimes orient toward malignancy simulating renal tumors, abdominal lymphomas, endometriosis, among other. We report the case of a 42-year old male in whom a MRI was performed after a study due to abdominal pain. Multiple enlarged lymph nodes were observed in the abdomen, suggestive of lymphoproliferative disease. As an important background, splenectomy was carried out due to abdominal trauma at age 9. After several studies, it was decided to perform a (99m)Tc-labeled heat-damaged red blood cell scintigraphy that showed multiple pathological deposits distributed throughout the abdomen, and even the pelvis, being consistent with splenosis.

Introduction Imaging plays an important role in the diagnosis and management of lung cancer, which is the leading cause of cancer-related death in the world. Radiography is often the initial modality of diagnosis, but detection depends on the size and density of nodules. The sensitivity of detection may be improved by using the dual-energy subtraction technique, which generates a soft tissue reconstruction that is free of overlapping chest wall and bony structures, or by using tomosynthesis. Computed tomography (CT) has become the established modality for the screening, diagnosis, and staging of lung cancers. Radiation and the use of potentially nephrotoxic contrast media are the risk factors associated with it. Magnetic resonance imaging (MRI) does not involve radiation, but its use in lung cancer is limited by intrinsic low proton spin density, magnetic field inhomogeneities, and motion artifacts from cardiac and respiratory motion. However, novel sequences show potential in the evaluation of lung cancer. Positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG-PET) is useful in determining the metabolic activity of the lung tumor. False-negative results are seen in small tumors and in bronchoalevolar carcinoma, whereas falsepositive findings are seen in cases of infection or inflammation. The hybrid imaging modality of PET/CT is now the standard of care in the staging of lung cancers, combining the morphologic information of CT with the metabolic information of PET. PET/MRI is a novel hybrid imaging technology that involves the fusion of 2 powerful imaging modalities: PET and MRI. MRI provides tissue characterization capabilities

Evaluate the performance of PET/MRI at tissue interfaces with different attenuation values for detecting lymph node (LN) metastases and for accurately measuring maximum standardised uptake values (SUVmax) in lung cancer patients.Eleven patients underwent PET/CT and PET/MRI for staging, restaging or follow-up of suspected or known lung cancer. Four experienced readers determined the N stage of the patients for each imaging method in a randomised blinded way. Concerning metastases, SUVmax of FDG-avid LNs were measured in PET/CT and PET/MRI in all patients. A standard of reference was created with a fifth experienced independent reader in combination with a chart review. Results were analysed to determine interobserver agreement, SUVmax correlation between CT and MRI (three-segment model) attenuation correction and diagnostic performance of the two techniques.Overall interobserver agreement was high (κ = 0.86) for PET/CT and substantial (κ = 0.70) for PET/MRI. SUVmax showed strong positive correlation (Spearman's correlation coefficient = 0.93, P 0.001) between the two techniques. Diagnostic performance of PET/MRI was slightly inferior to that of PET/CT, without statistical significance (P 0.05).PET/MRI using three-segment model attenuation correction for LN staging in lung cancer shows a strong parallel to PET/CT in terms of SUVmax, interobserver agreement and diagnostic performance.•F18-FDG PET/MRI shows similar performance to F18-FDG PET/CT in lung cancer N staging. •PET/MRI has substantial interobserver agreement in N staging. •A three-segment model attenuation correction is reliable for assessing the mediastinum.