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Positron emission tomography/magnetic resonance in musculoskeletal disorders: proper sequences and workflow optimization

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Abstract

Magnetic resonance imaging (MRI) represents a gold standard imaging for detection of oncologic and non-oncologic musculoskeletal disorders (MSK), owing to its high soft tissue contrast. Positron Emission Tomography (PET) was proven to be clinically useful in MSK, owing to its early detection of metabolic disfunction and its high accuracy for monitoring therapy response. With hybrid PET/MRI system, simultaneous availability of both morphologic and metabolic features could potentially enhance the diagnostic accuracy in MSK. Some technical issue should be overcome for best imaging quality: specific MR sequences for accurate visualization of cortical bone and bone marrow involvement, such as zero-time echo (ZTE) or µ time echo (µTE) sequences, that were shown to provide valuable attenuation coefficients for the bone, which leads to accurate quantitative analysis of bone and extra-bone tissues; implementation of novel attenuation map, owing to the presence of flexible coils in the field of view, additional sequences to reduce artifacts derived from metal implants. Workflow consideration should be addressed to the choice of proper sequences able to answer the clinical demand or the research purpose. Redundant information provided by useless sequences, which could prolong the whole scan time and increase the discomfort of the patient, should be avoided.

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Fig. 1
Fig. 2

Adopted from Sonni et al. [26]

Fig. 3

Adopted from MacKay et al.

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Funding

The authors report no involvement in the research by the sponsor that could have influenced the outcome of this work.

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Authors and Affiliations

  1. TracerGLab, Dipartimento di Diagnostica per Immagini, Radioterapia ed Ematologia, Unità di Medicina Nucleare, UOC Medicina Nucleare, Fondazione Policlinico Agostino Gemelli IRCCS, 00168, Rome, Italy

    Daniele Antonio Pizzuto

  2. Dipartimento di Diagnostica per Immagini, Radioterapia ed Ematologia, UOC Radiologia Diagnostica ed Interventistica, Fondazione Policlinico Agostino Gemelli IRCCS, 00168, Rome, Italy

    Lucio Calandriello

  3. UOC di Ortopedia e Traumatologia, Dipartimento di Scienze Dell’invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy

    Ivan De Martino

  4. Medipass S.P.a. Dipartimento di Diagnostica per Immagini, Radioterapia ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Agostino Gemelli IRCCS, 00168, Rome, Italy

    Maria Luisa De Micheli

  5. Medipass S.P.a. Servizio Integrativo PET TC, Radiofarmacia Fondazione Policlinico Agostino Gemelli IRCCS, 00168, Rome, Italy

    Marco De Summa

  6. TracerGLab, Dipartimento di Diagnostica per Immagini, Radioterapia ed Ematologia, Unità di Medicina Nucleare, UOC Medicina Nucleare, Fondazione Policlinico Agostino Gemelli IRCCS, 00168, Rome, Italy

    Salvatore Annunziata

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Contributions

DAP and S have given substantial contributions to the conception or the design of the manuscript, LC, IDeM, MLDeM, MDeS to acquisition, analysis and interpretation of the data. All authors have participated to drafting the manuscript, DAP revised it critically. All authors read and approved the final version of the manuscript. All authors contributed equally to the manuscript and read and approved the final version of the manuscript.

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Correspondence to Daniele Antonio Pizzuto.

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Pizzuto, D.A., Calandriello, L., De Martino, I. et al. Positron emission tomography/magnetic resonance in musculoskeletal disorders: proper sequences and workflow optimization. Clin Transl Imaging 12, 253–261 (2024). https://doi.org/10.1007/s40336-023-00611-2

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