Greg Freiherr, Industry Consultant

Greg Freiherr has reported on developments in radiology since 1983. He runs the consulting service, The Freiherr Group.

Blog | Greg Freiherr, Industry Consultant | August 11, 2011

Trump Card in the Deck of Hybrids

In the yesteryears of over-optimism, when medical imaging was in its heyday, magnetic resonance spectroscopy (MRS) was framed as a kind of digital phantom that would one day wrest the biopsy needle from the hands of oncologists. MRS, with its graphs and hard numbers characterizing the metabolites present in tissue, would illuminate the biochemical fingerprint of cancer.  

That pipe dream went up in smoke as the 20th century drew to a close, when MRS advocates were seen as victims of the da Vinci syndrome – that ideas, while reasonable, were not feasible because technology was not yet up to the task. The past decade, however, has swept much of the technological challenge aside. The adoption of 3T, which began in earnest midway through the last decade, along with the evolution of 1.5T scanners with the horsepower to do MRS, has put spectroscopy at the fingertips of many in routine clinical practice. Vendors offer training courses in its use. Yet, very little has changed.

Despite a cornucopia of MRS packages – some so easy even a gecko could run them – spectroscopy remains largely a research tool, driven by forward-thinking, forward-looking visionaries.  One reason is that long-repeated practices are hard to change…and needle biopsy is one of the longest. Another is that functional imaging, namely positron emission tomography/computed tomography (PET/CT), is widely available and its usage is still trending upward, albeit less so than a few years ago.

Given these incontrovertible facts, needle biopsy will likely remain the go-to procedure for definitively diagnosing cancer. And similarly, PET/CT will likely remain the modality of choice in diagnostic workup and patient followup after therapy.

Yet, a strong case can be made for routine use of MR spectroscopy in oncology, if for no other reasons than the convenience of the provider and better service to the patient. Virtually every oncology patient has at least one MR exam. With the right software and hardware in place, adding a six-minute sequence to the standard brain exam provides baseline numbers from healthy neighboring tissue while another six-minute sequence plumbs the nearby lesion, producing spectra that in many cases can distinguish healthy from malignant tissue.

Granted, these spectra will not supplant a needle biopsy. And the extra time and effort will not be reimbursed. Consequently, any additional costs to upgrade the scanner to support spectroscopy may be tough to justify. But this justification does not have to come from the need to generate revenue so much as to ensure its source. We are at a time when the value that radiology brings to medicine is being questioned. Tiny ultrasound scanners peek out from the shirt pockets of general practitioners; a 1980s rock band promotes digital radiography on a music video; CT scanners capable of every major radiological exam are going for well under a million dollars.

By contrast, MR spectroscopy remains firmly rooted in radiology. It’s fast. It’s relatively easy to understand – although its results take time to grasp. And its use demonstrates the commitment of radiologists to patient welfare, supplanting conventional thought, which is to judge therapeutic success on the basis of whether a lesion has grown or shrunk. The hard numbers derived from MRS could help determine whether a patient is responding just days after the start of therapy. Compare this instantaneity to the weeks or months that must pass before tumor growth or shrinkage is evident.

MR spectroscopy is the ultimate hybrid imaging technology, delivering both anatomical and functional imaging in a single exam. As such, it may not only be the most underplayed card in imaging’s deck, it could be trump.

Related Content

Magseed magnetic marker
Technology | Tumor Tracking Systems | July 20, 2018
Endomag, the surgical guidance company, received 510(k) clearance from the U.S.
Researchers Trace Parkinson’s Damage in the Heart
News | PET Imaging | July 17, 2018
A new way to examine stress and inflammation in the heart will help Parkinson’s researchers test new therapies and...
Siemens Healthineers Announces FDA Clearance of syngo.via VB30 Molecular Imaging Software
Technology | Nuclear Imaging | July 16, 2018
At the 2018 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI), June 23-26 in Philadelphia...
Ensuring that the FMDS for MRI safety is mounted outside Zone IV provides maximum early warning.

Ensuring that the FMDS for MRI safety is mounted outside Zone IV provides maximum early warning. (Images courtesy of Metrasens)

Feature | Magnetic Resonance Imaging (MRI) | July 03, 2018 | By Tobias Gilk
Nearly every job in the country is subject to certain health and safety regulations. Construction workers must wear...
Carestream DRX-Revolution Nano Mobile X-ray System

The Carestream DRX-Revolution Nano Mobile X-ray System.

Feature | Digital Radiography (DR) | July 03, 2018 | By Melinda Taschetta-Millane
The mobile digital radiography (DR) segment is the largest segment by product type in the global digital mobile DR...
SNMMI Image of the Year Highlights Theranostic Approach for Advanced Prostate Cancer

IMAGE OF THE YEAR: PSMA PET before and after lutetium-177 PSMA617 theranostics in 8 patients with metastatic prostate cancer who exhausted standard therapeutic options.

68Ga-PSMA11 PET maximum intensity projection (MIP) images at baseline and 3 months after 177Lu-PSMA617 in 8 patients with PSA decline ≥ 98 percent in a prospective phase II study. Any disease with SUV over 3 is in red. Credit: Michael Hofman, John Violet, Shahneen Sandhu, Justin Ferdinandus, Amir Iravani, Grace Kong, Aravind Ravi Kumar, Tim Akhurst, Sue Ping Thang, Price Jackson, Mark Scalzo, Scott Williams and Rodney Hicks, Peter MacCallum Cancer Centre, Melbourne, Australia.

News | PET Imaging | June 29, 2018
In the battle against metastatic castrate-resistant prostate cancer, studies have demonstrated a high response rate to...
MILabs Introduces Futuristic PET Capabilities on New VECTor6 System
Technology | PET Imaging | June 28, 2018
At the 2018 Society of Nuclear Medicine and Molecular Imaging (SNMMI) annual meeting, June 23-26, in Philadelphia,...
Philips North America and GE Healthcare Win IMV PET Imaging ServiceTrak Awards
News | PET Imaging | June 25, 2018
IMV, part of the Science and Medicine Group and a market research and business intelligence provider to the imaging...
New ASNC SPECT Imaging Guideline Addresses Advances in Myocardial Perfusion Imaging
News | SPECT Imaging | June 21, 2018
The American Society of Nuclear Cardiology (ASNC) has published an update to its 2010 guidelines for single photon...
Overlay Init