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Research ArticleClinical Investigations

Systematic Comparison of the Performance of Integrated Whole-Body PET/MR Imaging to Conventional PET/CT for 18F-FDG Brain Imaging in Patients Examined for Suspected Dementia

Stefan Hitz, Cornelia Habekost, Sebastian Fürst, Gaspar Delso, Stefan Förster, Sibylle Ziegler, Stephan G. Nekolla, Michael Souvatzoglou, Ambros J. Beer, Timo Grimmer, Matthias Eiber, Markus Schwaiger and Alexander Drzezga
Journal of Nuclear Medicine June 2014, 55 (6) 923-931; DOI: https://doi.org/10.2967/jnumed.113.126813
Stefan Hitz
1Department of Nuclear Medicine, Technische Universität München, Munich, Germany
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Cornelia Habekost
1Department of Nuclear Medicine, Technische Universität München, Munich, Germany
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Sebastian Fürst
1Department of Nuclear Medicine, Technische Universität München, Munich, Germany
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Gaspar Delso
1Department of Nuclear Medicine, Technische Universität München, Munich, Germany
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Stefan Förster
1Department of Nuclear Medicine, Technische Universität München, Munich, Germany
2TUM Neuroimaging Center (TUM-NIC), Technische Universität München, Munich, Germany
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Sibylle Ziegler
1Department of Nuclear Medicine, Technische Universität München, Munich, Germany
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Stephan G. Nekolla
1Department of Nuclear Medicine, Technische Universität München, Munich, Germany
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Michael Souvatzoglou
1Department of Nuclear Medicine, Technische Universität München, Munich, Germany
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Ambros J. Beer
1Department of Nuclear Medicine, Technische Universität München, Munich, Germany
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Timo Grimmer
3Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
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Matthias Eiber
4Department of Radiology, Technische Universität München, Munich, Germany; and
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Markus Schwaiger
1Department of Nuclear Medicine, Technische Universität München, Munich, Germany
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Alexander Drzezga
1Department of Nuclear Medicine, Technische Universität München, Munich, Germany
5Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
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  • FIGURE 1.
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    FIGURE 1.

    Voxel-based group comparison reveals statistically significant differences in measured regional activity in AC (left) and NAC (right) data between PET/MR and PET/CT. For display, green was used for relatively higher measured PET signal in PET/MR than PET/CT (extent threshold in AC, T = 2.50, P < 0.05, false discovery rate–corrected; in NAC, T = 2.05, P < 0.05, false discovery rate–corrected), and red represented relatively higher measured PET signal in PET/CT (extent threshold in AC, T = 2.12, P < 0.05, false discovery rate–corrected; in NAC, T = 2.77, P < 0.05, false discovery rate–corrected).

  • FIGURE 2.
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    FIGURE 2.

    Percentage differences of values in different anatomic regions by ROI-based analysis. Error bars indicate SD.

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    FIGURE 3.

    Percentage differences of values in different anatomic regions by ROI-based analysis in data corrected for global differences. Error bars indicate SD. n.s. = no significant difference between PET/MR and PET/CT.

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    FIGURE 4.

    Patient 1 (PET/CT first): 3DSSPs generated by Neurostat after anatomic stereotactic normalization of same patient examined with PET/CT (A) and PET/MR (B). 3DSSPs of individual patient’s 18F-FDG PET data (upper) and pixelwise comparison of individual patient’s PET data to age-matched reference database, resulting in z score images (high z score = significantly reduced glucose metabolism; reference region: global mean) (lower). Compared with PET/CT, lower relative metabolic rate can be observed in frontoparietal portions of neocortex in PET/MR data on 3DSSP images (red arrows). On z score images, relatively stronger deviations from control are detected (green arrows) for PET/MR data.

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    TABLE 1

    Patients’ Characteristics

    Patient no.SexAge (y)Examination sequenceTime interval (min) between PET/MR and PET/CT
    1M69PET/CT first34
    2F39PET/CT first36
    3M71PET/CT first46
    4F52PET/CT first35
    5M60PET/CT first33
    6M76PET/CT first70
    7F75PET/CT first33
    8F25PET/CT first48
    9F61PET/MR first40
    10F53PET/MR first40
    11F45PET/MR first37
    12M45PET/MR first29
    13F46PET/MR first41
    14F61PET/CT first29
    15F70PET/CT first26
    16M64PET/CT first37
    17F74PET/CT first37
    18M73PET/MR first25
    19F79PET/MR first50
    20M64PET/MR first42
    21F70PET/MR first22
    22F45PET/MR first22
    23F66PET/MR first34
    24F68PET/MR first44
    25F57PET/MR first32
    26F55PET/MR first40
    27F64PET/CT first44
    28M67PET/CT first30
    29F72PET/CT first40
    30M60PET/CT first25
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    TABLE 2

    Study Characteristics

    CharacteristicPET/CT firstPET/MR firstP
    n1614Not significant
    Patient median age (y)65.559Not significant
    Time between PET/MR and PET/CT37.69 ± 10.8535.57 ± 8.55Not significant
    Male73Not significant
    Female911Not significant
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    TABLE 3

    ROI Analysis

    Data typeBasal gangliaCerebellumFrontalOccipitalParietalPonsTemporalCentral
    AC data
     PET/MR AC1.04 ± 0.061.04 ± 0.050.98 ± 0.031.08 ± 0.051.03 ± 0.050.83 ± 0.050.95 ± 0.041.05 ± 0.04
     PET/CT AC0.96 ± 0.061.01 ± 0.051.02 ± 0.041.09 ± 0.091.08 ± 0.060.78 ± 0.080.95 ± 0.051.12 ± 0.04
     Difference between PET/CT and PET/MR−0.08−0.030.040.010.05−0.060.000.07
     % Difference PET/MR (PET/CT = 100%)8.663.01−4.08−0.86−4.497.48−0.11−6.33
     P (PET/CT vs. PET/MR)P < 0.001P < 0.001P < 0.001NSP < 0.001P < 0.001NSP < 0.001
    NAC data
     PET/MR NAC0.84 ± 0.090.97 ± 0.051.12 ± 0.051.16 ± 0.081.15 ± 0.070.62 ± 0.070.98 ± 0.041.16 ± 0.06
     PET/CT NAC0.78 ± 0.110.96 ± 0.051.12 ± 0.051.19 ± 0.091.18 ± 0.070.57 ± 0.070.99 ± 0.051.20 ± 0.07
     Difference between PET/CT and PET/MR−0.060.000.000.040.03−0.050.010.03
     % Difference PET/MR (PET/CT = 100%)7.410.130.36−3.34−2.488.13−0.85−2.68
     P (PET/CT vs. PET/MR)P < 0.001NSNSP < 0.001P < 0.001P < 0.001NSP < 0.001
    • Mean uptake values obtained by ROI analysis, normalized to individual global mean.

    • NS = no significant difference.

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Journal of Nuclear Medicine: 55 (6)
Journal of Nuclear Medicine
Vol. 55, Issue 6
June 1, 2014
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Systematic Comparison of the Performance of Integrated Whole-Body PET/MR Imaging to Conventional PET/CT for 18F-FDG Brain Imaging in Patients Examined for Suspected Dementia
Stefan Hitz, Cornelia Habekost, Sebastian Fürst, Gaspar Delso, Stefan Förster, Sibylle Ziegler, Stephan G. Nekolla, Michael Souvatzoglou, Ambros J. Beer, Timo Grimmer, Matthias Eiber, Markus Schwaiger, Alexander Drzezga
Journal of Nuclear Medicine Jun 2014, 55 (6) 923-931; DOI: 10.2967/jnumed.113.126813

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Systematic Comparison of the Performance of Integrated Whole-Body PET/MR Imaging to Conventional PET/CT for 18F-FDG Brain Imaging in Patients Examined for Suspected Dementia
Stefan Hitz, Cornelia Habekost, Sebastian Fürst, Gaspar Delso, Stefan Förster, Sibylle Ziegler, Stephan G. Nekolla, Michael Souvatzoglou, Ambros J. Beer, Timo Grimmer, Matthias Eiber, Markus Schwaiger, Alexander Drzezga
Journal of Nuclear Medicine Jun 2014, 55 (6) 923-931; DOI: 10.2967/jnumed.113.126813
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