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

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Abstract

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.

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Authors and Affiliations

  1. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Jad S. Husseini, William E. Palmer, Pedram Heidari, Umar Mahmood & Onofrio A. Catalano

  2. Division of Nuclear Medicine, Department of Radiology, School of Medical Sciences,, State University of Campinas, Campinas, Brazil

    Bárbara Juarez Amorim

  3. Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Angel Torrado-Carvajal, Ciprian Catana & Bruce Rosen

  4. Medical Image Analysis and Biometry Laboratory, Universidad Rey Juan Carlos, Madrid, Spain

    Angel Torrado-Carvajal

  5. Department of Radiology, NYU Langone Health, New York, NY, USA

    Vinay Prabhu

  6. Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    David Groshar

  7. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany

    Lale Umutlu

  8. Department of Nuclear Medicine, University Hospital Essen, Essen, Germany

    Ken Herrmann

  9. Department of Nuclear Medicine, Hospital Universitario Madrid Sanchinarro, Madrid, Spain

    Lina García Cañamaque

  10. Department of Nuclear Medicine, CETIR-ERESA, University of Barcelona, Barcelona, Spain

    José Ramón García Garzón

  11. Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan

    Tiffany Ting-Fang Shih

  12. Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel

    Jacob Sosna

  13. Department of Nuclear Medicine, Hospital São Lucas of Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil

    Cristina Matushita

  14. Department of Nuclear Medicine, Quanta Diagnóstico Nuclear, Curitiba, Brazil

    Juliano Cerci

  15. Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil

    Marcelo Queiroz

  16. Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, Hospital Clinicas, University of São Paulo, Ribeirão Prêto, Brazil

    Valdair Francisco Muglia

  17. Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School. University of São Paulo (USP), Ribeirão Prêto, Brazil

    Marcello H. Nogueira-Barbosa

  18. Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands

    Ronald J. H. Borra & Thomas C. Kwee

  19. Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Andor W. J. M. Glaudemans

  20. Department of Clinical and Experimental Medicine, University of Padova, Padua, Italy

    Laura Evangelista

  21. Department of Radiology and Nuclear Medicine, Università Suor Orsola Benincasa di Napoli, Naples, Italy

    Marco Salvatore

  22. Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy

    Marco Salvatore, Alberto Cuocolo & Andrea Soricelli

  23. Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy

    Alberto Cuocolo

  24. Department of Movement and Wellness Sciences, Parthenope University of Naples, Naples, Italy

    Andrea Soricelli

  25. Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria

    Christian Herold

  26. Department of Radiology, University of Rome “La Sapienza”, Rome, Italy

    Andrea Laghi

  27. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Marius Mayerhoefer

  28. Department of Radiology, Stanford University, Stanford, CA, USA

    Heike E. Daldrup-Link

Authors
  1. Jad S. Husseini
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  2. Bárbara Juarez Amorim
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  3. Angel Torrado-Carvajal
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  4. Vinay Prabhu
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  6. Lale Umutlu
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  7. Ken Herrmann
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  8. Lina García Cañamaque
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  10. William E. Palmer
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  13. Jacob Sosna
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  14. Cristina Matushita
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  15. Juliano Cerci
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  16. Marcelo Queiroz
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  17. Valdair Francisco Muglia
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  18. Marcello H. Nogueira-Barbosa
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  19. Ronald J. H. Borra
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  20. Thomas C. Kwee
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  21. Andor W. J. M. Glaudemans
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  22. Laura Evangelista
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  23. Marco Salvatore
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  24. Alberto Cuocolo
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  25. Andrea Soricelli
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  26. Christian Herold
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  27. Andrea Laghi
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  28. Marius Mayerhoefer
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  29. Umar Mahmood
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  30. Ciprian Catana
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  31. Heike E. Daldrup-Link
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  32. Bruce Rosen
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  33. Onofrio A. Catalano
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Contributions

All authors contributed to the study conception and design. The first draft of the manuscript was written by Jad S Husseini and Onofrio A Catalano and all authors commented on versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Onofrio A. Catalano.

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Conflict of interest

A Torrado-Carvajal declares no conflicts of interest. The work by Dr. Torrado-Carvajal was partially supported by Young Reserchers R&D Project Ref M2166 (MIMC3-PET/MR) financed by Community of Madrid and Rey Juan Carlos University. Dr. Umutlu receives speaker and consultant payments from Bayer Healthcare and Siemens Healthcare, and research funds from Siemens. Dr. Herrmann has received personal fees from Bayer, Sofie Biosciences, SIRTEX, Adacap, Curium, Endocyte, IPSEN, Siemens Healthineers, GE Healthcare, and Amgen; non-financial support from ABX; personal fees from grants; and personal fees from BTG, outside the submitted work. Dr. Queiroz received research support from GE Healthcare. Dr. Herold is a member of scientific advisory board of Siemens Healthineers. He is also a recipient of grants/research support from Siemens Healthineers, Bayer Healthcare, Bracco (through contract with his University). Dr. Laghi has received honoraria for invited lectures from Bracco, GE Healthcare, Bayer, Guerbet and Merck. Dr. Mayerhoefer has received speaker honoraria from Bristol Myers Squibb and Siemens (paid to him), and research support from Siemens Healthineers (paid to his institution). Dr. Mahmood is a cofounder/shareholder, consultant, and grant recipient of CytoSite Biopharma. Dr. Catana has ongoing relationships with Siemens Healthineers in the domain of PET/MRI hardware and software development. Dr. Daldrup-Link receives research support from the Andrew McDonough B+ Foundation and from the Sarcoma Foundation. Dr. Rosen did not receive any personal support. However, the Martinos center receives research support from Siemens Healthineers and GE Healthcare. Dr. Catalano has been a consultant for Siemens Healthineers and IBM and receives research support from Bayer. He is a recipient of an IBM fellowship. The Martinos center receives research support from Siemens Healthineers and GE Healthcare. J Husseini, B Juarez Amorim, V Prabhu, D Groshar, L. García Cañamaque, J. García Garzón, W. Palmer, P. Heidari, T. Ting-Fang Shih, J. Sosna, C. Matushita, J. Cerci, V. Muglia, M. Nogueira-Barbosa, R. Borra, T. Kwee, A. Glaudemans, L. Evangelista, M. Salvatore, A. Cuocolo, and A. Soricelli declare no competing interests.

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This article is part of the Topical Collection on Oncology - Muskoskeletal

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Husseini, J.S., Amorim, B.J., Torrado-Carvajal, A. et al. An international expert opinion statement on the utility of PET/MR for imaging of skeletal metastases. Eur J Nucl Med Mol Imaging 48, 1522–1537 (2021). https://doi.org/10.1007/s00259-021-05198-2

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