Simultaneous PET/MRI for the evaluation of hemato-oncological diseases with lower extremity manifestations

Objectives: The study purpose is the evaluation of patients, suffering from hemato-oncological disease with complications at the lower extremities, using simultaneous PET/MRI. Methods: Until now two patients (chronic active graft-versus-host-disease [GvHD], B-non Hodgkin lymphoma [B-NHL]) before and after therapy were examined in a 3-Tesla-BrainPET/MRI hybrid system following F-18-FDG-PET/CT. Simultaneous static PET (1200 sec.) and MRI scans (T1WI, T2WI, post-CA) were acquired. Results: Initial results show the feasibility of using hybrid PET/MRI-technology for musculoskeletal imaging of the lower extremities. Simultaneous PET and MRI could be acquired in diagnostic quality. Before treatment our patient with GvHD had a high fascia and muscle FDG uptake, possibly due to muscle encasement. T2WI and post gadolinium T1WI revealed a fascial thickening and signs of inflammation. After therapy with steroids followed by imatinib the patient’s symptoms improved while, the muscular FDG uptake droped whereas the MRI signal remained unchanged. We assume that fascial elasticity improved during therapy despite persistance of fascial thickening. The examination of the second patient with B-NHL manifestation in the tibia showed a significant signal and uptake decrease in the bone marrow and surrounding lesions in both, MRI and PET after therapy with rituximab. The lack of residual FDG-uptake proved superior to MRI information alone helping for exclusion of vital tumor. Conclusions: Combined PET/MRI is a powerful tool to monitor diseases requiring high soft tissue contrast along with molecular information from the FDG uptake