Improved Detection of Small Pulmonary Nodules Through Simultaneous MR/PET Imaging

A review of the role of MRI in diagnosis and treatment of early stage lung cancer

Despite magnetic resonance imaging (MRI) being a mainstay in the oncologic care for many disease sites, it has not routinely been used in early lung cancer diagnosis, staging, and treatment. While MRI provides improved soft tissue contrast compared to computed tomography (CT), an advantage in multiple organs, the physical properties of the lungs and mediastinum create unique challenges for lung MRI. Although multi-detector CT remains the gold standard for lung imaging, advances in MRI technology have led to its increased clinical relevance in evaluating early stage lung cancer. Even though positron emission tomography is used more frequently in this context, functional MR imaging, including diffusion-weighted MRI and dynamic contrast-enhanced MRI, are emerging as useful modalities for both diagnosis and evaluation of treatment response for lung cancer. In parallel with these advances, the development of combined MRI and linear accelerator devices (MR-linacs), has spurred the integration of MRI into radiation treatment delivery in the form of MR-guided radiotherapy (MRgRT). Despite challenges for MRgRT in early stage lung cancer radiotherapy, early data utilizing MR-linacs shows potential for the treatment of early lung cancer. In both diagnosis and treatment, MRI is a promising modality for imaging early lung cancer.

Magnetic Resonance Fingerprinting: Implications and Opportunities for PET/MR

Magnetic Resonance Imaging (MRI) can be used to assess anatomical structure, and its sensitivity to a variety of tissue properties enables superb contrast between tissues as well as the ability to characterize these tissues. However, despite vast potential for quantitative and functional evaluation, MRI is typically used qualitatively, in which the underlying tissue properties are not measured, and thus the brightness of each pixel is not quantitatively meaningful. Positron Emission Tomography (PET) is an inherently quantitative imaging modality that interrogates functional activity within a tissue, probed by a molecule of interest coupled with an appropriate tracer. These modalities can complement one another to provide clinical information regarding both structure and function, but there are still technical and practical hurdles in the way of the integrated use of both modalities. Recent advances in MRI have moved the field in an increasingly quantitative direction, which is complementary to PET, and could also potentially help solve some of the challenges in PET/MR. Magnetic Resonance Fingerprinting (MRF) is a recently described MRI-based technique which can efficiently and simultaneously quantitatively map several tissue properties in a single exam. Here, the basic principles behind the quantitative approach of MRF are laid out, and the potential implications for combined PET/MR are discussed.