An international expert opinion statement on the utility of PET/MR for imaging of skeletal metastases

• Published in: European journal of nuclear medicine and molecular imaging Vol. 48; no. 5; pp. 1522 - 1537
• Main Authors: Husseini, Jad S., Amorim, Bárbara Juarez, Torrado-Carvajal, Angel, Prabhu, Vinay, Groshar, David, Umutlu, Lale, Herrmann, Ken, Cañamaque, Lina García, Garzón, José Ramón García, Palmer, William E., Heidari, Pedram, Shih, Tiffany Ting-Fang, Sosna, Jacob, Matushita, Cristina, Cerci, Juliano, Queiroz, Marcelo, Muglia, Valdair Francisco, Nogueira-Barbosa, Marcello H., Borra, Ronald J. H., Kwee, Thomas C., Glaudemans, Andor W. J. M., Evangelista, Laura, Salvatore, Marco, Cuocolo, Alberto, Soricelli, Andrea, Herold, Christian, Laghi, Andrea, Mayerhoefer, Marius, Mahmood, Umar, Catana, Ciprian, Daldrup-Link, Heike E., Rosen, Bruce, Catalano, Onofrio A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2021; Springer Nature B.V
• Subjects: Cardiology; Computed tomography; Evaluation; Expert Testimony; Fluorine isotopes; Fluorodeoxyglucose F18; Guidelines; Humans; Imaging; Magnetic Resonance Imaging; Malignancy; Medical imaging; Medicine; Medicine & Public Health; Metastases; Metastasis; Nuclear Medicine; Oncology; Oncology – Muskoskeletal; Orthopedics; Positron emission; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiology; Radiopharmaceuticals; Research facilities; Soft tissues; Tomography; PET/MR; PET/MRI; MR; Osseous; Skeletal; PET; Metastases
• ISSN: 1619-7070; 1619-7089; 1619-7089
• DOI: 10.1007/s00259-021-05198-2

Background
MR is an important imaging modality for evaluating musculoskeletal malignancies owing to its high soft tissue contrast and its ability to acquire multiparametric information. PET provides quantitative molecular and physiologic information and is a critical tool in the diagnosis and staging of several malignancies. PET/MR, which can take advantage of its constituent modalities, is uniquely suited for evaluating skeletal metastases. We reviewed the current evidence of PET/MR in assessing for skeletal metastases and provided recommendations for its use.
Methods
We searched for the peer reviewed literature related to the usage of PET/MR in the settings of osseous metastases. In addition, expert opinions, practices, and protocols of major research institutions performing research on PET/MR of skeletal metastases were considered.
Results
Peer-reviewed published literature was included. Nuclear medicine and radiology experts, including those from 13 major PET/MR centers, shared the gained expertise on PET/MR use for evaluating skeletal metastases and contributed to a consensus expert opinion statement. [18F]-FDG and non [18F]-FDG PET/MR may provide key advantages over PET/CT in the evaluation for osseous metastases in several primary malignancies.
Conclusion
PET/MR should be considered for staging of malignancies where there is a high likelihood of osseous metastatic disease based on the characteristics of the primary malignancy, hight clinical suspicious and in case, where the presence of osseous metastases will have an impact on patient management. Appropriate choice of tumor-specific radiopharmaceuticals, as well as stringent adherence to PET and MR protocols, should be employed.