¹⁸F-FDG PET/CT vs. PET/MRI in Cancer Assessment

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 14, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 0.75
Procedures: 0.75
Head, Spine, and Musculoskeletal: 0.25
Neck and Chest: 0.25
Abdomen and Pelvis: 0.25

Magnetic Resonance Imaging: 0.75
Procedures: 0.75
Neurological: 0.25
Body: 0.25
Musculoskeletal: 0.25

Nuclear Medicine Technology: 1.00
Procedures: 1.00
Endocrine and Oncology Procedures: 1.00

Registered Radiologist Assistant: 1.00
Procedures: 1.00
Abdominal Section: 0.25
Thoracic Section: 0.25
Musculoskeletal and Endocrine Sections: 0.25
Neurological, Vascular, and Lymphatic Sections: 0.25

Sonography: 0.50
Procedures: 0.50
Abdomen: 0.25
Gynecology: 0.25

Radiation Therapy: 0.75
Patient Care: 0.75
Patient and Medical Record Management: 0.75

Outline

1. Introduction
2. Design of PET/MRI Systems
3. Operational Considerations
4. Clinical Indications for PET/MRI
   1. Head and Neck Cancer
   2. Lung Cancer and Pulmonary Lesions
   3. Gastrointestinal Cancer
   4. Gynecologic Cancer
   5. Breast Cancer
   6. Prostate Cancer
   7. Lymphoma
   8. Neuroendocrine Tumors
   9. Metastatic Bone Disease
   10. Pediatric Cancer
   11. Central Nervous System Tumors
   12. Mixed-Cancer Populations
5. Summary and Future Perspectives

Objectives

Upon completion of this course, students will:

1. identify the most important reason driving the success of PET/CT after integrated scanners became commercially available in 2000
2. describe the primary focus of studies comparing PET/MRI and ¹⁸F-FDG PET/CT
3. list the PET/MRI system designs that allow the individual modality components to be used independently
4. list the PET/MRI system designs that allow for reduced imaging time and the least amount of image misregistration
5. list the classes of tissue segmentation provided by MRI-based attenuation correction sequences
6. understand the prerequisites for clinical adoption of PET/MRI
7. identify the superiority of PET/MRI over PET/CT in prostate cancer
8. describe the role of CT and MRI as first-line imaging modalities according to NCCN guidelines
9. list the imaging modalities supported by NCCN guidelines for staging and restaging of head and neck cancer patients
10. recognize the stages of small cell lung cancer for which ¹⁸F-FDG PET/CT is appropriate for additional work-up
11. describe the size threshold of ¹⁸F-FDG-negative lung nodules that limits detection by PET/MRI
12. identify the recommended imaging modality for T-staging of esophageal cancer
13. identify the imaging modality that demonstrates the highest accuracy for N-staging of esophageal cancer
14. identify the first-line imaging modality listed by NCCN guidelines for liver metastases of colorectal cancer
15. list the imaging modalities used for initial diagnosis of uterine, ovarian, and cervical cancers
16. describe the clinical settings in which MRI is considered for staging of breast cancer patients
17. describe the use of PET/CT for staging of breast cancer
18. understand the application of multiparametric MRI in the evaluation of recurrent prostate cancer
19. list the PET tracers used in conjunction with PET/CT to identify sites of metastatic prostate cancer
20. describe the diagnostic modality of choice for lymphomas that are not routinely ¹⁸F-FDG-avid
21. compare the sensitivities of DWI, PET/MRI and PET/CT in the identification of ¹⁸F-FDG-avid nodal groups
22. identify the imaging technique that is considered the standard of care for assessing neuroendocrine tumor patients
23. compare the sensitivities of imaging modalities for the detection of early bone lesions and marrow-based metastases
24. describe the body region were lesion detection rates with PET/CT are slightly better than those with PET/MRI
25. identify the imaging modality that is considered to be the gold standard for imaging central nervous system cancer