High Spatial Resolution, Respiratory-Gated, T1-Weighted Magnetic Resonance Imaging of the Liver and the Biliary Tract During the Hepatobiliary Phase of Gadoxetic Acid–Enhanced Magnetic Resonance Imaging:

Breath-hold High-resolution T1-weighted Gradient Echo Liver MR Imaging with Compressed Sensing Obtained during the Gadoxetic Acid-enhanced Hepatobiliary Phase: Image Quality and Lesion Visibility Compared with a Standard T1-weighted Sequence

PURPOSE

To evaluate the feasibility of breath-hold (BH) high-resolution (HR) T1-weighted gradient echo hepatobiliary phase (HBP) imaging using compressed sensing (CS) in gadoxetic acid-enhanced liver MRI in comparison with standard HBP imaging using parallel imaging (PI).

METHODS

The study included 122 patients with liver tumors with hypointensity in the HBP who underwent both HR HBP imaging with CS and standard HBP imaging with PI. Two radiologists evaluated the liver edge sharpness, hepatic vessel conspicuity, bile duct conspicuity, image noise, and overall image quality, as well as the lesion conspicuity on HR and standard HBP imaging and the contrast-enhanced (CE) MR cholangiography (MRC) image quality reconstructed from HBP images. As a quantitative analysis, the SNR of the liver and the liver to lesion signal intensity ratio (LLSIR) were also determined.

RESULTS

The liver edge sharpness, hepatic vessel conspicuity, bile duct conspicuity, and overall image quality as well as the lesion conspicuity and the LLSIR on HR HBP imaging with CS were significantly higher than those on standard HBP imaging (all of P < 0.001). The image quality of CE-MRC reconstructed from HR HBP imaging with CS was also significantly higher than that from standard HBP imaging (P < 0.001). Conversely, the SNR of liver in standard HBP was significantly higher than that in HR HBP with CS (P < 0.001).

CONCLUSION

BH HR HBP imaging with CS provided an improved overall image quality, lesion conspicuity, and CE-MRC visualization when compared with standard HBP imaging without extending the acquisition time.

Kinetic analysis of cardiac dynamic 18F-Florbetapir PET in healthy volunteers and amyloidosis patients: A pilot study

Objectives

This study aimed to explore the potential of full dynamic PET kinetic analysis in assessing amyloid binding and perfusion in the cardiac region using 18F-Florbetapir PET, establishing a quantitative approach in the clinical assessment of cardiac amyloidosis disease.

Materials & methods

The distribution volume ratios (DVRs) and the relative transport rate constant (R1), were estimated by a pseudo-simplified reference tissue model (pSRTM2) and pseudo-Logan plot (pLogan plot) with kidney reference for the region of interest-based and voxel-wise-based analyses. The parametric images generated using the pSRTM2 and linear regression with spatially constrained (LRSC) algorithm were then evaluated. Semi-quantitative analyses include standardized uptake value ratios at the early phase (SUVREP, 0.5-5 min) and late phase (SUVRLP, 50-60 min) were also calculated.

Results

Ten participants [7 healthy controls (HC) and 3 cardiac amyloidosis (CA) subjects] underwent a 60-min dynamic 18F-Florbetapir PET scan. The DVRs estimated from pSRTM2 and Logan plot were significantly increased (HC vs CA; DVRpSRTM2: 0.95 ± 0.11 vs 2.77 ± 0.42, t'(2.13) = 7.39, P = 0.015; DVRLogan: 0.80 ± 0.12 vs 2.90 ± 0.55, t'(2.08) = 6.56, P = 0.020), and R1 were remarkably decreased in CA groups, as compared to HCs (HC vs CA; 1.08 ± 0.37 vs 0.56 ± 0.10, t'(7.63) = 3.38, P = 0.010). The SUVREP and SUVRLP were highly correlated to R1 (r = 0.97, P < 0.001) and DVR(r = 0.99, P < 0.001), respectively. The DVRs in the total myocardium region increased slightly as the size of FWHM increased and became stable at a Gaussian filter ≥6 mm. The secular equilibrium of SUVR was reached at around 50-min p.i. time.

Conclusion

The DVR and R1 estimated from cardiac dynamic 18F-Florbetapir PET using pSRTM with kidney pseudo-reference tissue are suggested to quantify cardiac amyloid deposition and relative perfusion, respectively, in amyloidosis patients and healthy controls. We recommend a dual-phase scan: 0.5-5 min and 50-60 min p.i. as the appropriate time window for clinically assessing cardiac amyloidosis and perfusion measurements using 18F-Florbetapir PET.

Comparisons of Hepatobiliary Phase Imaging Using Combinations of Parallel Imaging and Variable Degrees of Compressed Sensing With Use of Parallel Imaging Alone

OBJECTIVE

This study aimed to compare the image quality in the hepatobiliary phase images of gadoxetic acid-enhanced liver magnetic resonance imaging using parallel imaging (PI) and compressed sensing (CS) reconstruction, using variable CS factors with the standard method using the PI technique.

METHODS

In this study, 64 patients who underwent gadoxetic acid-enhanced liver magnetic resonance imaging at 3.0 T were enrolled. Hepatobiliary phase images were acquired 6 times using liver acquisition with volume acceleration (LAVA) and CS reconstruction with 5 CS factors 1.4, 1.6, 1.8, 2.0, and 2.5 (LAVA-CS 1.4, 1.6, 1.8, 2.0, and 2.5) and standard LAVA (LAVA-noCS). For objective analysis, the signal intensity ratios (SIRs) of the liver-to-spleen (SIRliver/spleen), liver-to-portal vein (SIRliver/portal vein), and liver-to-fat (SIRliver/fat) were estimated. For subjective analysis, 2 radiologists independently evaluated the quality of all the images.

RESULTS

The objective analysis demonstrated no significant difference in all evaluation parameters of all the images. Subjective analysis revealed that the scores of all evaluation items were higher for LAVA-noCS images than for LAVA-CS images, and only LAVA-CS 1.4 did not significantly differ from LAVA-noCS in all evaluation items (P = 1.00 in 2 readers).

CONCLUSIONS

A CS factor of 1.4 in the hepatobiliary phase image with combined PI and CS can reduce the scan time without degrading the image quality compared with the standard method.

A two-stage cardiac PET and late gadolinium enhancement MRI co-registration method for improved assessment of non-ischemic cardiomyopathies using integrated PET/MR

PURPOSE

Respiratory motion causes mismatches between PET images of the myocardium and the corresponding cardiac MR images in cardiac integrated PET/MR. The mismatch may affect the attenuation correction and the diagnosis of non-ischemic cardiomyopathies. In this study, we present a two-stage cardiac PET and MR late gadolinium enhancement (LGE) co-registration method, which seeks to improve diagnostic accuracy of non-ischemic cardiomyopathies via better image co-registration using an integrated whole-body PET/MR system.

METHODS

The proposed PET and LGE two-stage co-registration method was evaluated through comparison with one-stage direct co-registration and no-registration. One hundred and ninety-one slices of LGE and forty lesions were studied. Two trained nuclear medicine physicians independently assessed the displacement between LGE and PET to qualitatively evaluate the co-registration quality. The changes of the mean SUV in the normal myocardium and the LGE-enhanced lesions before and after image co-registration were measured to quantitatively evaluate the accuracy and value of image co-registration.

RESULTS

The two-stage method had an improved image registration score (4.93 ± 0.89) compared with the no-registration method (3.49 ± 0.84, p value < 0.001) and the single-stage method (4.23 ± 0.81, p value < 0.001). Furthermore, the two-stage method led to increased SUV value in the myocardium (3.87 ± 2.56) compared with the no-registration method (3.14 ± 1.92, p value < 0.001) and the single-stage method (3.32 ± 2.16, p value < 0.001). The mean SUV in the LGE lesion significantly increased from 2.51 ± 2.09 to 2.85 ± 2.35 (p value < 0.001) after the two-stage co-registration.

CONCLUSION

The proposed two-stage registration method significantly improved the co-registration between PET and LGE in integrated PET/MR imaging. The technique may improve diagnostic accuracy of non-ischemic cardiomyopathies via better image co-registration.

REGISTERED NO

DF-2020-085,2020.04.30.

Compressed sensing for breath-hold high-resolution hepatobiliary phase imaging: image noise, artifact, biliary anatomy evaluation, and focal lesion detection in comparison with parallel imaging

PURPOSE

To assess image quality, performance for biliary anatomy diagnosis, and focal lesion detection rate of breath-hold high-resolution 3D T1-weighted hepatobiliary phase imaging using compressed sensing (CS HBP) compared to standard HBP using conventional parallel imaging.

METHODS

This retrospective study assessed consecutive 125 patients who underwent CS HBP and standard HBP between November 2019 and July 2020. Optimized resolution and scan time for CS HBP were 1 × 1.4 × 1 mm³ and 15 s, while those for standard HBP were 1.3 × 1.8 × 3 mm³ and 16 s. Two independent radiologists evaluated qualitative indices on the clarity of liver margin, visibility of the hepatic vessel and bile duct, image noise, and artifact on a 5-point scale. Biliary anatomy, confidence for biliary anatomy diagnosis, expected number of bile duct openings, and number of focal lesions were assessed. Wilcoxon signed-rank test, Pearson chi-square test, and sensitivity for focal lesion were used for statistical analysis. Intraclass correlation coefficient (ICC) and Cohen's kappa (κ) were used to determine inter-observer agreement.

RESULTS

CS HBP showed significantly better liver edge sharpness and bile duct visualization, but greater subjective image noise and non-respiratory artifacts compared to standard HBP. CS HBP showed higher number of concordantly assigned biliary anatomy across readers (86 vs. 80), indicating greater inter-observer agreement for biliary anatomy (κ, 0.67 vs. 0.45) and the number of bile duct openings (ICC, 0.860 vs. 0.579) with significantly higher diagnostic confidence (4.70-4.74 vs. 3.96-4.55; p = 0.002). Both readers identified more focal lesions in CS HBP than in standard HBP (88.2% and 84.5% vs. 66.3% and 73.4%).

CONCLUSION

Breath-hold high-resolution CS HBP was a feasible clinical sequence providing superior liver edge sharpness, bile duct visualization, and focal lesion detection rate compared to standard HBP despite higher noise and artifact. Due to improved spatial resolution, CS HBP yielded a higher inter-observer agreement and confidence for the biliary anatomy diagnosis.

Comparison of image quality of subtracted and nonsubtracted breath hold VIBE and free breathing GRASP in the evaluation of renal masses

OBJECTIVE

To compare the image quality of subtracted and nonsubtracted images obtained using volumetric interpolated breath-hold exam (VIBE) and free breathing T1 weighted Golden-angle Radial Sparse Parallel (GRASP).

METHODS

We retrospectively evaluated 27 consecutive patients who underwent MRI for the evaluation of renal masses. Contrast enhanced VIBE and free breathing GRASP imaging were performed, and subtraction images generated. Two radiologists performed quantitative and qualitative evaluations of image quality of nonsubtracted and subtracted data sets. Statistical analysis was performed using the Wilcoxon signed-rank test, paired t-test and kappa statistics.

RESULTS

VIBE images scored statistically higher for the following parameters in the coronal and axial plane: sharpness, streak artifact, image noise, and overall image quality for standard and subtracted images (all P values P < 0.001). GRASP images had significantly less subtraction artifact in the coronal (P = 0.042) plane with a similar trend in the axial plane (P = 0.079). Interreader Kappa values for qualitative images scores were fair to good (0.23-0.71). Quantitative subtracted GRASP images had significant less subtraction artifact compared to VIBE in the anterior-posterior (3.9 mm SD 2.6 mm versus 5.8 mm SD 3.6 mm, P = 0.010), and craniocaudal direction (4.4 mm SD 2.9 mm versus 7.0 mm SD 5.3 mm, P = 0.010); a trend was seen in the left-right direction (2.6 mm SD 1.4 mm versus 4.0 mm SD 3.9 mm, P = 0.084).

CONCLUSION

VIBE images have significantly better image quality than free breathing GRASP images, however free breathing GRASP images have significantly less subtraction artifact.

Perianal fistula mapping at 3 T: volumetric versus conventional MRI sequences

AIM

To evaluate volumetric contrast-enhanced three-dimensional T1-weighted (CE 3D T1) turbo spin-echo (TSE) with variable flip angle (SPACE), CE 3D T1 volumetric interpolated breath-hold examination (VIBE) sequences with conventional CE-two-dimensional (2D)-T1 and 2D-T2-weighted imaging (WI) sequences in assessing perianal fistulas.

METHODS AND MATERIALS

Twenty-three patients with perianal fistula were included in this prospective study and underwent pelvic magnetic resonance imaging (MRI) at 3 T including fat-supressed CE 3D T1 SPACE, CE 3D T1 VIBE, axial and coronal 2D-T1WI together with 2D-T2WI sequences in the axial and coronal planes. Acquisition times were recorded. Performance of each sequence was evaluated in terms of image quality, presence of artefacts, lesion conspicuity, fistula type, presence of abscess, visibility of internal orifice, and number of internal orifices. Results were compared with post-surgical findings defined as the reference standard.

RESULTS

Both CE 3D T1 VIBE and CE 3D T1 SPACE were the best sequences to determine fistula type and in terms of image quality, artefacts, and determining locations of internal orifices. The number of internal orifices was detected correctly in 23 (100%) patients for CE 3D T1 SPACE and CE 3D T1 VIBE sequences, in 17 (73.9%) patients on CE-T1WI, and in seven (30.4%) patients on 2D-T2WI. Lesion conspicuity was higher for CE 3D T1 SPACE and CE 3D T1 VIBE sequences compared to the 2D sequences (p<0.05). The overall acquisition time for each 3D sequence was shorter compared to the 2D sequences combined.

CONCLUSION

CE 3D T1 SPACE and CE 3D T1 VIBE sequences may outperform conventional 2D sequences in the evaluation of perianal fistulas in terms of visibility and number of internal orifices with a shorter scanning time.

Pseudo-random Trajectory Scanning Suppresses Motion Artifacts on Gadoxetic Acid-enhanced Hepatobiliary-phase Magnetic Resonance Images

Purpose:

Hepatobiliary-phase (HBP) MRI with gadoxetic acid facilitates the differentiation between lesions with and without functional hepatocytes. Thus, high-quality HBP images are required for the detection and evaluation of hepatic lesions. However, the long scan time may increase artifacts due to intestinal peristalsis, resulting in the loss of diagnostic information. Pseudo-random acquisition order disperses artifacts into the background. The aim of this study was to investigate the clinical applicability of pseudo-random trajectory scanning for the suppression of motion artifacts on T₁-weighted images including HBP.

Methods:

Our investigation included computer simulation, phantom experiments, and a clinical study. For computer simulation and phantom experiments a region of interest (ROI) was placed on the area with motion artifact and the standard deviation inside the ROI was measured as image noise. For clinical study we subjected 62 patients to gadoxetic acid-enhanced hepatobiliary-phase imaging with a circular- and a pseudo-random trajectory (c-HBP and p-HBP); two radiologists graded the motion artifacts, sharpness of the liver edge, visibility of intrahepatic vessels, and overall image quality using a five-point scale where 1 = unacceptable and 5 = excellent. Differences in the qualitative scores were determined using the two-sided Wilcoxon signed-rank test.

Results:

The image noise was higher on the circular image compared with pseudo-random image (101.0 vs 60.9 on computer simulation image, 91.2 vs 67.7 on axial, 95.5 vs 86.9 on reformatted sagittal image for phantom experiments). For clinical study the score for motion artifacts was significantly higher with p-HBP than c-HBP imaging (left lobe: mean 3.4 vs 3.2, P < 0.01; right lobe: mean 3.6 vs 3.4, P < 0.01) as was the qualitative score for the overall image quality (mean 3.6 vs 3.3, P < 0.01).

Conclusion:

At gadoxetic acid-enhanced hepatobiliary-phase imaging, p-HBP scanning suppressed motion artifacts and yielded better image quality than c-HBP scanning.

High spatial resolution navigated 3D T1-weighted hepatobiliary MR cholangiography using Gd-EOB-DTPA for evaluation of biliary anatomy in living liver donors

PURPOSE

To determine the feasibility of high-resolution navigated three-dimensional (3D) T1-weighted hepatobiliary MR cholangiography (Nav T1 MRC) using Gd-EOB-DTPA for biliary visualization in living liver donors and to assess added value of 3D T1-weighted hepatobiliary MRCs in improving the confidence and diagnostic accuracy of biliary anatomy in complementary to T2-weighted MRCs.

METHODS

Twenty-nine right liver donors underwent 3D T2 MRC, 2D T2 MRC, breath-hold T1-weighted hepatobiliary MRC (BH T1 MRC), and Nav T1 MRC. Two readers independently reviewed and compared 3D/2D MRC set, added BH T1 MRC set, and added Nav T1 MRC set for biliary diagnostic accuracy and confidence. For each MRC, biliary segments visualization and image quality were scored.

RESULTS

Both BH T1 MRC and Nav T1 MRC improved accuracy and specificity in biliary diagnosis when added to 3D/2D T2 MRC-alone set, though without statistical significance (R1, 82.8% to 93.1%; R2, 82.8% to 89.7%). The added Nav T1 MRC set showed the highest diagnostic confidence with both readers. Both readers scored Nav T1 MRC with the highest visualization scores for branching ducts and overall ducts.

CONCLUSION

Combining T1-weighted hepatobiliary MRCs to 3D/2D T2 MRC set improved accuracy for biliary anatomy diagnosis; time-efficient BH T1 MRC in axial and coronal planes should be considered as a key MRC sequence complementary to T2 MRCs. Given excellent biliary visualization and superior diagnostic confidence, Nav T1 MRC in selected subjects with breath-hold difficulties and inconclusive or complex biliary variations may assist in reaching a correct biliary diagnosis.

Two-Dimensional Spoiled Gradient-Recalled Echo Magnetic Resonance Imaging of the Liver Using Respiratory Navigator-Gating Techniques

OBJECTIVE

We assessed the feasibility of T1-weighted 2-dimensional spoiled gradient-recalled (2D SPGR) acquisition in steady-state imaging of the liver with various respiratory navigator gating techniques.

METHODS

A total of 12 healthy volunteers underwent in-phase and out-of-phase 2D SPGR imaging of the liver during breath-holding and free-breathing. Four techniques for respiratory navigation, 2 conventional navigator techniques and 2 self-navigator techniques, were used for free-breathing imaging.

RESULTS

Good navigator waveforms were obtained in conventional navigation, whereas fluctuations were evident in self navigation. All of the 4 navigator-based methods provided better images in terms of background signals and visual image quality compared with images obtained with no respiratory control. However, differences remained in comparison with breath-holding. Superiority of self-navigation to conventional navigation was not shown.

CONCLUSIONS

Navigator-gating techniques improved 2D SPGR images of the liver acquired during free-breathing, suggesting feasibility and beneficial effects, although navigator-based images were still inferior to breath-hold images.

Lung morphology assessment of cystic fibrosis using MRI with ultra-short echo time at submillimeter spatial resolution

OBJECTIVES

We hypothesized that non-contrast-enhanced PETRA (pointwise encoding time reduction with radial acquisition) MR (magnetic resonance) sequencing could be an alternative to unenhanced computed tomography (CT) in assessing cystic fibrosis (CF) lung structural alterations, as well as compared agreements and concordances with those of conventional T1-weighted and T2-weighted sequences.

MATERIAL AND METHODS

Thirty consecutive CF patients completed both CT and MRI the same day. No contrast injection was used. Agreement in identifying structural alterations was evaluated at the segmental level using a kappa test. Intraclass correlation coefficients (ICC) and Bland-Altman analysis were used to assess concordances and reproducibility in Helbich-Bhalla disease severity scoring.

RESULTS

Agreement between PETRA and CT was higher than that of T1- or T2-weighted sequences, notably in assessing the segmental presence of bronchiectasis (Kappa = 0.83; 0.51; 0.49, respectively). The concordance in Helbich-Bhalla scores was very good using PETRA (ICC = 0.97), independently from its magnitude (mean difference (MD) = -0.3 [-2.8; 2.2]), whereas scoring was underestimated using both conventional T1 and T2 sequences (MD = -3.6 [-7.4; 0.1]) and MD = -4.6 [-8.2; -1.0], respectively). Intra- and interobserver reproducibility were very good for all imaging modalities (ICC = 0.86-0.98).

CONCLUSION

PETRA showed higher agreement in describing CF lung morphological changes than that of conventional sequences, whereas the Helbich-Bhalla scoring matched closely with that of CT.

KEY POINTS

• Spatial resolution of lung MRI is limited using non-ultra-short TE MRI technique • Ultra-short echo time (UTE) technique enables submillimeter 3D-MRI of airways • 3D-UTE MRI shows very good concordance with CT in assessing cystic fibrosis • Radiation-free 3D-UTE MRI enables the Helbich-Bhalla scoring without a need for contrast injection.

Single-breath-hold thin-slice gadoxetic acid-enhanced hepatobiliary MR imaging using a newly developed three-dimensional fast spoiled gradient-echo sequence

PURPOSE

To prospectively evaluate the efficacy of a new three-dimensional gradient-echo sequence (Turbo LAVA) that uses undersampled k-space acquisition combined with a two-dimensional parallel imaging technique for hepatobiliary MRI.

MATERIALS AND METHODS

Sixty patients underwent T1-weighted gadoxetic acid-enhanced hepatobiliary axial MRI during a single breath-hold using both Turbo LAVA (thickness/interval=1.6/0.8mm) and conventional three-dimensional gradient-echo (4/2mm; LAVA) sequences at 3T. Axial 4-mm-thick reformation was performed from Turbo LAVA images. Portal vein-to-liver contrast (PLC), bile duct-to-liver contrast (BLC), and lesion-to-liver contrast (LLC) were compared. Two radiologists independently assessed image quality using a five-point scale. Sagittal 4-mm-thick multiplanar reconstructions (MPR) were performed from both sequences and assessed together with directly obtained 4-mm-thick sagittal LAVA images in terms of sharpness. The paired t-test was used to compare PLC, BLC, and LLC. The Wilcoxon signed rank test was used to compare five-point scales.

RESULTS

The mean PLC (P<0.001), BLC (P<0.001), and LLC (P<0.005) were significantly higher for Turbo LAVA than for LAVA; the scores for image noise and sharpness were inferior (P=0.000 and 0.005) and superior (0.005 and 0.157) for Turbo LAVA. There were no significant differences in the scores for bile duct visualization, artifacts, fat suppression quality, overall quality, and focal lesion conspicuity. For sagittal images, MPR Turbo LAVA showed significantly better sharpness than MPR LAVA but showed significantly worse sharpness compared with directly obtained LAVA.

CONCLUSION

High-spatial-resolution single-breath-hold hepatobiliary MRI using Turbo LAVA was feasible. Diagnostic-quality MPR images can be obtained using this sequence.

Hypovascular hepatic nodules at gadoxetic acid-enhanced MRI: whole-lesion hepatobiliary phase histogram metrics for prediction of progression to arterial-enhancing hepatocellular carcinoma

PURPOSE

To explore whole-lesion histogram analysis of the hepatobiliary phase (HBP) defect in indeterminate hypovascular liver lesions for predicting progression to arterial-enhancing hepatocellular carcinoma (HCC).

METHODS

Twenty patients undergoing gadoxetic acid-enhanced MRI for HCC screening with 12° and 25° flip angle (FA) HBP acquisitions demonstrating an indeterminate lesion showing HBP hypointensity but no arterial enhancement were included. Volumes-of-interest were placed on HBP defects, from which histogram metrics were obtained. Associations between these metrics and progression to arterial-enhancing HCC on follow-up imaging were investigated. Lesions were also assessed for the presence of a signal abnormality on conventional sequences.

RESULTS

40% of lesions progressed to arterial-enhancing HCC; 60% were stable at ≥6 months follow-up. Neither T2-hyperintensity increased diffusion signal nor portal/equilibrium phase washout was different between progressing and nonprogressing lesions (p = 1.0). Among direct signal intensity-based measures (overall mean; mean of bottom 10th, 10-25th, and 25-50th percentiles), area-under-the-curve (AUC) for prediction of progression to arterial-enhancing HCC was consistently higher at 25° (range 0.619-0.657) than at 12° (range 0.512-0.548). However, at both FAs, the four measures with highest AUC were measures related to lesion texture and heterogeneity [standard deviation (SD), coefficient of variation (CV), skewness, and entropy], having AUC of 0.655-0.750 at 12° and 0.686-0.800 at 25. The metric with highest AUC at 12° was SD (AUC = 0.750) and at 25° was CV (AUC = 0.800).

CONCLUSION

Whole-lesion histogram HBP measures of indeterminate hypovascular liver lesions may help predict progression to arterial-enhancing HCC by reflecting greater lesion heterogeneity, particularly at higher FA. Larger studies are therefore warranted.

MR-PET of the body: Early experience and insights

MR-PET is a novel imaging modality that combines anatomic and metabolic data acquisition, allowing for simultaneous depiction of morphological and functional abnormalities with an excellent soft tissue contrast and good spatial resolution; as well as accurate temporal and spatial image fusion; while substantially reducing radiation dose when compared with PET-CT.

In this review, we will discuss MR-PET basic principles and technical challenges and limitations, explore some practical considerations, and cover the main clinical applications, while shedding some light on some of the future trends regarding this new imaging technique.