Clinical applications of PET/MRI for evaluation of cardiovascular disease

Learning Objectives 1. To review diagnostic performance of PET/MRI for diagnosis, staging, prognostication, and response assessment of cardiovascular disease. 2. To discuss new and evolving horizons related to PET/MRI and their potential in the management of cardiovascular disease.

By clinical introduction of PET/MRI, new opportunities are available to evaluate cardiovascular diseases. Combination of PET and MRI has made it possible to take advantage of both modalities with superior diagnostic and lesion detection due to improvement in soft tissue contrast resolution, multi-planar image capability and functional imaging of MRI. Overall, PET/MRI can offer multi-parametric structural, functional, and molecular assessment of myocardial function and viability, atherosclerosis, pericarditis, cardiomyopathy, myocarditis, vasculitis, and other cardiovascular pathologies. Diversity of MRI pulse sequences and multiple available PET radiotracers make PET/MRI a useful tool for assessment of cardiovascular structure and function. In this review, we discuss these topics: 1. Advantages of PET/MRI relative to PET/CT for evaluation of cardiovascular diseases a. Improved assessment of myocardial tissue composition, thickness, motion, and perfusion b. Improved assessment of vascular structure and flow c. Decreased radiation dose 2. Clinical applications of PET/MRI for evaluation of patients with cardiovascular disease a. Cardiac and pericardiac tumors b. Cardiomyopathy c. Myocarditis d. Atherosclerosis e. Vasculitis f. Assessment of effects of cellular and gene therapies