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PET/MRI Technology

PET/MRI is a new imaging modality, where the camera (or detector) used to image the PET
has been engineered to fit and function within the bore of the MRI. This allows for the
simultaneous acquisition of both PET and MRI data while the patient is in the scanner.

PET (or positron emission tomography) is an imaging modality that is used to detect the
presence of a specific type of radiation (ie positrons). We take advantage of this, by labeling
small molecules with positron emitters. The most common approach is to label glucose
(sugar) with F18 (radioactive fluorine); this is termed FDG (fluorodeoxyglucose) to describe
the injected radiotracer. Since the late 1990s, FDG PET/CT has been the cornerstone of
oncologic imaging.

MRI (or magnetic resonance imaging) is a noninvasive tool for imaging that does not require
the use of ionizing radiation. MRI uses unique properties of magnetic fields and resonance to
image water protons in the body. This technique has developed into a powerful tool for
discriminating soft tissues within the body, and is now commonly used for numerous
applications.

In order to make PET/MRI feasible, significant technological hurdles had to be over


come. The major issue is with the PET detector itself. In PET/CT the crystals detect photons
by releasing electrons, which results in a cascade within a photomultiplier tube. This
technology does not function within a PET/MRI as the electrons would be displaced due to
the strong magnetic field. Therefore new detectors had to be engineered that can function
with high fidelity within a clinical 3.0T magnet. This was solved by using what is termed
silicon photomultipliers.

Numerous other engineering hurdles had to be developed as well, including solving


attenuation correction issues, preventing heating of the detectors, workflow considerations
and minimizing interplay between MR imaging and PET acquisition.
The PET/MRI installed at UCSF is a GE Healthcare Signa 3.0T time-of-flight PET/MRI. It
is the first clinical time-of-flight PET/MRI installed in the United States, and has unparalleled
imaging capabilities. It has a 60 cm bore, identical to the majority of 3.0T magnetics
available. The PET detectors are only 5 cm wide and narrow the bore of the original magnet
from 70 cm to 60 cm. The PET detector uses a 25 mm deep lutetium base scintillator with a
25 cm z-axis field of view for the PET detector. The detectors have a sensitivity of 21
cps/kBq. Every MR sequence that is available on our clinical 3.0T magnets is available on
the PET/MRI, meaning that there is no loss in MRI imaging when simultaneous acquisitions
are performed.

PET/MRI is a first-of-its-kind imaging technology approved by the FDA in November


2014. This combined technology is used for the diagnosis, staging and treatment of a variety
of conditions, including cancer, neurological, oncological and musculoskeletal diseases.
PET/MRI provides high-quality images while reducing patient exposure to radiation. Thomas
Hope, MD, assistant professor in residence at UCSF’s Department of Abdominal Imaging
and Nuclear Medicine, has been instrumental in both leading high-level research that
demonstrated the effectiveness of this technique, and then moving this new technology from
bench to bedside (from research labs to the patient-care environment.) Here, he addressed a
key benefit of this new technology -- reducing radiation exposure.

“The PET/MRI has the best PET detectors in modern imaging. That means we are able to use
a lower dose of injected radiotracers. Time of Flight (ToF) detectors, the first such equipped
PET/MRI available in the United States, provide improved images with lower doses of
radiation because of the heightened image sensitivity.”

Additionally, he explained, “With PET/MRI, there is no CT component, so there’s no


radiation. Instead of using radiation to make an image, the MRI uses varying magnetic
fields.”

“Reducing radiation is important to all patients, but especially pediatric patients because they
are more likely to develop secondary cancers throughout their lives,” said Dr. Hope. The
same concern is true among patients requiring repeat imaging because of the long-term nature
of their condition, such as lymphoma. “Because we don’t fully understand the risk of
radiation, it’s important to minimize it as much as possible.”

Thomas Hope, MD, is an assistant professor in residence in the Abdominal Imaging


and Nuclear Medicine sections at UCSF and the San Francisco Veterans Affairs
Medical Center. In 2007, he received his medical degree from Stanford University
School of Medicine and he completed a one-year internship at Kaiser Permanente,
San Francisco. From 2008-2012, Dr. Hope completed a residency in Diagnostic
Radiology at the University of California, San Francisco, followed by a clinical
fellowship in Body MRI and Nuclear Medicine from Stanford Medical Center in 2013.