Review ArticlesClinical Use of Integrated Positron Emission Tomography-Magnetic Resonance Imaging for Dementia PatientsShepherd, Timothy M. MD, PhD; Nayak, Gopi K. MDAuthor Information Department of Radiology, New York University Langone Medical Center, New York, NY. Address correspondence to Timothy M. Shepherd, MD, PhD, Department of Radiology, New York University Langone Medical Center, 660 First Ave Rm 226, New York, NY 10016 (e-mail: firstname.lastname@example.org). Received 7 October, 2019 Accepted 17 October, 2019 Support: T.S. received research support from the National Institute of Aging (NIH 1K23 AG048622-01). The authors report no conflicts of interest. Topics in Magnetic Resonance Imaging: December 2019 - Volume 28 - Issue 6 - p 299–310 doi: 10.1097/RMR.0000000000000225 Buy Metrics Abstract Combining magnetic resonance imaging (MRI) with 2-deoxy-2-18F-fluoro-D-glucose positron emission tomography (FDG-PET) data improve the imaging accuracy for detection of Alzheimer disease and related dementias. Integrated FDG-PET-MRI is a recent technical innovation that allows both imaging modalities to be obtained simultaneously from individual patients with cognitive impairment. This report describes the practical benefits and challenges of using integrated FDG-PET-MRI to support the clinical diagnosis of various dementias. Over the past 7 years, we have performed integrated FDG-PET-MRI on >1500 patients with possible cognitive impairment or dementia. The FDG-PET and MRI protocols are the same as current conventions, but are obtained simultaneously over 25 minutes. An additional Dixon MRI sequence with superimposed bone atlas is used to calculate PET attenuation correction. A single radiologist interprets all imaging data and generates 1 report. The most common positive finding is concordant temporoparietal volume loss and FDG hypometabolism that suggests increased risk for underlying Alzheimer disease. Lobar-specific atrophy and FDG hypometabolism patterns that may be subtle, asymmetric, and focal also are more easily recognized using combined FDG-PET and MRI, thereby improving detection of other neurodegeneration conditions such as primary progressive aphasias and frontotemporal degeneration. Integrated PET-MRI has many practical benefits to individual patients, referrers, and interpreting radiologists. The integrated PET-MRI system requires several modifications to standard imaging center workflows, and requires training individual radiologists to interpret both modalities in conjunction. Reading MRI and FDG-PET together increases imaging diagnostic yield for individual patients; however, both modalities have limitations in specificity. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.