Summary: Use of the unique hybrid imaging system Biograph mMR in the clinical setting is on the rise. A great example is the University Hospital of Leipzig where all examinations conducted in children with oncological problems requiring whole-body hybrid imaging are performed exclusively using Biograph mMR.
Applications in PET-MR: Biograph mMR is the scanner of choice for pediatric oncology at the University Hospital of Leipzig
Sponsored by: Siemens Healthcare
Pediatric oncology is a special discipline in medicine engaged with diagnosis and
treatment of children with cancer. As one of the most challenging
disciplines, it also requires extraordinary caution and quality in
imaging. In this field, the University Hospital of Leipzig in Leipzig,
Germany, took big steps forward thanks to the use of Biograph mMR. It
was installed in the fall of 2011 under the supervision of Osama Sabri,
MD, PhD, director and chairman of the department of nuclear medicine,
University Hospital Leipzig, and spokesman of the local positron
emission tomography-magnetic resonance program. “Shortly after the
Biograph mMR was taken into operation, all examinations conducted in
children with oncological problems requiring whole-body hybrid imaging
in our institution have been performed exclusively using PET/MR,”
explained Franz Wolfgang Hirsch MD, PhD, the chair of pediatric
radiology at the University Hospital of Leipzig.
By developing Biograph mMR, Siemens succeeded in fully integrating 2
modalities, with different functional methodologies that provide
complementary information for the diagnosis and understanding of
disease, such as cancers. While MR imaging delivers precise structural
images of the body’s internal organs, PET shows metabolic activity in
the human body. With Biograph mMR, it is now possible to scan once and
acquire both MR and PET images simultaneously. Whole-body exams as well
as exams of specific body regions are possible.
Siemens introduced the integrated MR and PET system in late 2010. Today, with
close to 50 systems worldwide, Biograph mMR is now avail- able in the
clinical setting. Since September 2011, the innovative system has been
in use in Leipzig. The physicians have been pleased with how well the
new hybrid system has been running. “Being such a complex system, in our
initial experience, PET/MR has turned out to be an unexpectedly
stable and reliable hybrid imaging modality, which generates a
complementary diagnostic study,” said Bernhard Sattler, MD, PhD, lead
medical physicist of the department of nuclear medicine. “The evaluation
in the system in a clinical and research setting revealed very
promising results that we were able to publish, and which is still
One of the main reasons to perform pediatric examinations (Figure 1-3) on
the new hybrid system is the low radiation exposure. In particular,
there is no exposure to ionizing radiation emitted from the MR part of
Biograph mMR. “In a diagnostic setting, it is likely that the radiation
expo- sure from a PET/MR scan is significantly lower than the current
gold standard of hybrid PET imaging. It is also important to consider
that children with oncological diseases often require multiple hybrid
imaging investigations,” said Regine Kluge, MD, PhD, vice chair of the
department of nuclear medicine.
Another unique feature of Biograph mMR is the true simultaneous acquisition of
the MR and PET data. In comparison to sequential solutions, simultaneity makes a big difference. “The advantage of this technical
solution is that the acquisition of PET and MR data synchronously allows
true simultaneous registration of morphological and metabolic
processes that follow the same timeline, resulting in a significantly
improved coregistration of the 2 modalities. Moreover due to the fact
that the patient only needs to undergo an imaging exam once, the burden
from anesthesia—often required for small children—can also be reduced,”
commented Henryk Barthel, MD, PhD, who is the assistant medical director
of the PET-MR program.
Simultaneous MR and PET examination has also become standard in pediatric oncology
at other institutions. “Our mission is to move toward a more
personalized treatment of that tumor. We think we can develop a better
biopsy by using these combined structural assessments, which you can get
with PET and MR in a simultaneous acquisition,” stated Robert C.
McKinstry, III, MD, PhD, radiologist-in-chief, St. Louis Children’s Hospital, professor of radiology and pediatrics, and director, Center for
Clinical Imaging Research, Mallinckrodt Institute of Radiology,
Washington University, St. Louis, Mo.
The Center for Modern Diagnostics (CEMODI) in Bremen, Germany, was the
first private installation worldwide of Biograph mMR, and doctors there
have been using the scanner in the clinical setting since late 2011.
Markus Lentschig, MD, CEMODI, said, “We at CEMODI were motivated to
acquire a molecular MR system so that we could offer a procedure with as
little radiation exposure as possible. This is especially important for
frequent follow-up exams and younger patients.”
The University Hospital of Leipzig’s initial experience in children
suffering from multifocal, oncological diseases shows that a 60-minute
complete examination on the Biograph mMR provides all relevant
information for pediatric surgeons and pediatric oncologists (Figure 3).
This reduced time for the diagnostic procedure in the initial stages is
important for the following steps in therapy planning. “The advantages
show that in children with oncological diseases, combined PET/MR
including whole-body diffusion weighting demonstrates a new quality in
imaging and functional diagnostics,” concluded Dr. Sabri.
Sponsored by: Siemens Healthcare