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The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2022 March;66(1):15-30

DOI: 10.23736/S1824-4785.22.03434-3


lingua: Inglese

Positron emission tomography-magnetic resonance imaging as a research tool in musculoskeletal conditions

Tim van den WYNGAERT 1, 2, 3 , Stijn de SCHEPPER 1, 2, Filipe ELVAS 1, 2, Seyedeh S. SEYEDINIA 4, Mohsen BEHESHTI 4

1 Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium; 2 Faculty of Medicine and Health Sciences (MICA), University of Antwerp, Wilrijk, Belgium; 3 Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium; 4 Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria

Compared to positron emission tomography/computed tomography (PET/CT), the uptake of PET- magnetic resonance imaging (MRI) has been slow, even more so in clinical practice compared to the (pre-)clinical research setting. However, for applications in musculoskeletal (MSK) research, the combination of PET and MRI into a single modality offers attractive advantages over other imaging modalities. Most importantly, MRI has exquisite soft-tissue detail without the use of contrast agents or ionizing radiation, superior bone marrow visualization, and an extensive spectrum of distinct multiparametric assessment methods. In the preclinical setting, the introduction of PET inserts for small-animal MRI machines has proven to be a successful concept in bringing this technology to the lab. Initial hurdles in quantification have been mainly overcome in this setting. In parallel, a promising range of radiochemistry techniques has been developed to create multimodality probes that offer the possibility of simultaneously querying different metabolic pathways. Not only will these applications help in elucidating disease mechanisms, but they can also facilitate drug development. The clinical applications of PET/MRI in MSK are still limited, but encouraging initial results with novel radiotracers suggest a high potential for use in various MSK conditions, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and inflammation and infection. Further innovations will be required to bring down the cost of PET/MRI to justify a broader clinical implementation, and remaining issues with quality control and standardization also need to be addressed. Nevertheless, PET/MRI is a powerful platform for MSK research with distinct qualities that are not offered by other techniques.

KEY WORDS: Positron-emission tomography; Magnetic resonance imaging; Musculoskeletal system

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