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Correlation of Simultaneously Acquired Diffusion-Weighted Imaging and 2-Deoxy-[18F] fluoro-2-D-glucose Positron Emission Tomography of Pulmonary Lesions in a Dedicated Whole-Body Magnetic Resonance/Positron Emission Tomography System

Schmidt, Holger PhD*†; Brendle, Cornelia MD*; Schraml, Christina MD*; Martirosian, Petros PhD; Bezrukov, Ilja Dipl-Inform†§; Hetzel, Jürgen MD*; Müller, Mark MD; Sauter, Alexander MD*†; Claussen, Claus D. MD*; Pfannenberg, Christina MD*; Schwenzer, Nina F. MD*

doi: 10.1097/RLI.0b013e31828d56a1
Original Articles

Objective Hybrid whole-body magnetic resonance/positron emission tomography (MR/PET) systems are a new diagnostic tool enabling the simultaneous acquisition of morphologic and multiple functional data and thus allowing for a diversified characterization of oncological diseases.

The aim of this study was to investigate the image and alignment quality of MR/PET in patients with pulmonary lesions and to compare the congruency of the 2 functional measurements of diffusion-weighted imaging (DWI) in MR imaging and 2-deoxy-[18F] fluoro-2-D-glucose (FDG) uptake in PET.

Materials and Methods A total of 15 patients were examined with a routine positron emission tomography/computer tomography (PET/CT) protocol and, subsequently, in a whole-body MR/PET scanner allowing for simultaneous PET and MR data acquisition. The PET and MR image quality was assessed visually using a 4-point score (1, insufficient; 4, excellent). The alignment quality of the rigidly registered PET/CT and MR/PET data sets was investigated on the basis of multiple anatomic landmarks of the lung using a scoring system from 1 (no alignment) to 4 (very good alignment). In addition, the alignment quality of the tumor lesions in PET/CT and MR/PET as well as for retrospective fusion of PET from PET/CT and MR images was assessed quantitatively and was compared between lesions strongly or less influenced by respiratory motion. The correlation of the simultaneously acquired DWI and FDG uptake in the pulmonary masses was analyzed using the minimum and mean apparent diffusion coefficient (ADCmin and ADCmean) as well as the maximum and mean standardized uptake value (SUVmax and SUVmean), respectively. In addition, the correlation of SUVmax from PET/CT data was investigated as well. On lesions 3 cm or greater, a voxelwise analysis of ADC and SUV was performed.

Results The visual evaluation revealed excellent image quality of the PET images (mean [SD] score, 3.6 [0.5]) and overall good image quality of DWI (mean [SD] score of 2.5 [0.5] for ADC maps and 2.7 [0.5] for diffusion-weighted images, respectively). The alignment quality of the data sets was very good in both MR/PET and PET/CT without significant differences (overall mean [SD] score of MR/PET, 3.8 [0.4]; PET/CT 3.6 [0.5]). Also, the alignment quality of the tumor lesions showed no significant differences between PET/CT and MR/PET (mean cumulative misalignment of MR/PET, 7.7 mm; PET/CT, 7.0 mm; P = 0.705) but between both modalities and a retrospective fusion (mean cumulative misalignment, 17.1 mm; P = 0.002 and P = 0.008 for PET/CT and MR/PET, respectively). Also, the comparison of the lesions strongly or less influenced by respiratory motion showed significant differences only for the retrospective fusion (21.3 mm vs 11.5 mm, respectively; P = 0.043). The ADCmin and SUVmax as measures of the cell density and glucose metabolism showed a significant reverse correlation (r = −0.80; P = 0.0006). No significant correlation was found between ADCmean and SUVmean (r = −0.42; P = 0.1392). Also, SUVmax from the PET/CT data showed significant reverse correlation to ADCmin (r = −0.62; P = 0.019). The voxelwise analysis of 5 pulmonary lesions each showed weak but significant negative correlation between ADC and SUV.

Conclusions Examinations of pulmonary lesions in a simultaneous whole-body MR/PET system provide diagnostic image quality in both modalities. Although DWI and FDG-PET reflect different tissue properties, there may very well be an association between the measures of both methods most probably because of increased cellularity and glucose metabolism of FDG-avid pulmonary lesions. A voxelwise DWI and FDG-PET correlation might provide a more sophisticated spatial characterization of pulmonary lesions.

Supplemental Digital Content is available in the text.

From the *Department of Radiology, Diagnostic and Interventional Radiology, †Department of Radiology, Preclinical Imaging and Radiopharmacy, Laboratory for Preclinical Imaging and Imaging Technology of the Werner Siemens Foundation, ‡Department of Radiology, Diagnostic and Interventional Radiology, Section on Experimental Radiology, Eberhard Karls University; §Max Planck Institute for Intelligent Systems; and ∥Department of Radiology, Nuclear Medicine, Eberhard Karls University, Tübingen, Germany.

Received for publication May 8, 2012; and accepted for publication, after revision, February 14, 2013.

Conflicts of interest and sources of funding: none declared.

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Reprints: Cornelia Brendle, MD, Department of Radiology, Diagnostic and Interventional Radiology, Eberhard Karls University, Hoppe-Seyler-St 3, 72076 Tübingen, Germany. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.