PET-MRI

After radiosurgery concurrent with nivolumab in 59-year-old patient with melanoma BM (patient 1; Supplemental Tables 3 and 5), F-18 FET PET at follow-up 12 weeks after treatment initiation (bottom row) shows significant decrease of metabolic activity (TBRmean, ?28%) compared with baseline (top row), although MRI changes were consistent with progression according to iRANO criteria. Reduction of metabolic activity was associated with stable clinical course over 10 mo. CE = contrast-enhanced. Image created by N. Galldiks et al., Research Center Juelich, Juelich, Germany.

Pre-treatment (A-C) and post-treatment (D-F) images after eight cycles of systemic FOLFIRINOX and consolidative chemoradiation. Baseline CA 19-9 was 145 U/ml. Pre-treatment whole body axial fused PET/MRI showed FDG avid lesion in body of pancreas (arrow, A) with SUVmax 7.1 and SUVgluc 8.0. Lesion was hypo-enhancing on axial contrast-enhanced T1-weighted (T1W) MR image (arrow, B) from focused abdominal PET/MRI and on CT (arrow, C). Pre-treatment CT tumor volume was 10.3 cm3. Post-treatment whole body axial fused PET/MRI showed complete metabolic response (arrow D) with SUVmax 1.9 and SUVgluc 1.9. Lesion was indistinct on axial contrast-enhanced T1W MRI (arrow, E) and CT (arrow, F), and there was upstream pancreatic parenchymal atrophy. Post-treatment CT tumor volume was 0.46 cm3. There was normalization of CA 19-9. Relative change in SUVmax (ΔSUVgluc) was -73%, and relative change in SUVgluc (ΔSUVgluc) was -76%. Based on change in tumor size, response was categorized as partial response per RECIST. Relative change in tumor volume (ΔTvol) was -96%. Pathology showed major pathologic response (College of American Pathologists score 1.) Images courtesy of American Roentgen Ray Society (ARRS), American Journal of Roentgenology (AJR)

Adult male with decades of right neck pain, discomfort and tightening following birth injury. The patient had failed multiple standard therapeutic maneuvers before presenting for 18F-FDG PET/MR imaging. Images shows abnormally elevated FDG uptake (white arrows; SUVmax = 1.2) observed in a linear pattern in the space in the posterolateral right neck, between the oblique capitis inferior and the semispinalis capitis muscles, where the greater occipital nerve resides. By comparison, the same region on the contralateral, asymptomatic side of the neck has an SUVmax = 0.7. This result encouraged a surgeon to explore the area. The surgeon ultimately found a collection of small arteries wrapped around the nerve in this location. The small arteries underwent lysis by the surgeon and the patient reported tremendous relief of symptoms. (A) Coronal thick slab MIP of 18F-FDG PET. (B) Axial LAVA FLEX MRI through the cervical spine. (C) Axial PET at the same slice as the axial MRI. (D) Fused axial PET/MRI. Image courtesy of Cipriano, et al., Stanford University, CA.

Image courtesy of MR Solutions.

David Schultz, M.D., Ph.D.

Tc-99m MDP bone scan (left) is negative for osseous lesions. NaF/FDG PET/MRI (right and second slide) confirms absence of bone metastases, but shows liver metastases. Image courtesy of Stanford University.