10 years of PET/MR: Looking back for a moment
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¨t Mu ¨ nchen, School of Medicine, Department of Nuclear Medicine, Technische Universita Munich, Germany ¨ r Herz-Kreislauf-Forschung e.V.), Partner Site Munich Heart DZHK (Deutsches Zentrum fu Alliance, Munich, Germany
Received Aug 21, 2020; accepted Aug 21, 2020 doi:10.1007/s12350-020-02358-z
Time flies and this holds true even in these remarkable days. Almost 10 years ago, the first fully integrated clinical PET/MR capable of truly simultaneous measurements was installed in our department. I would like to use this opportunity and reflect on a few (and really not all) things which preceded it and what I experienced: on the introduction of the PET/CT, the concepts we envisioned beforehand, the lessons we learned, and what a summary could be after almost a decade working with one of the most complex and most expensive systems in non-invasive medical imaging. It goes without saying that this is a very personal perspective. Introduced with substantial marketing fanfare and quite some engineering efforts, the ‘‘beast’’ as I used to call it went from a well-kept secret to an amazing technical achievement made available to the medical imaging community. Having this said, let me rapidly limit the scope: the hardware was truly amazing but the ‘‘software’’ was not quite ready. The hyphens indicate that not only the computer software running on the ‘‘beast’’ had its issues but also the ‘‘software’’ of the team running it. In principle, we were very well prepared. I had the privilege to join Markus Schwaiger’s group in 1993: back then, we were able to establish rather rapidly one of the very early centers in Europe running a clinical PET service—and gratefully receiving considerable support from colleagues based all over the world. The integration of sequentially acquired cardiac PET and cardiac MRI was actually a focus starting very early; the validation of MRI’s capabilities to assess perfusion1 and
Reprint requests: Stephan G. Nekolla, PhD, School of Medicine, Department of Nuclear Medicine, Technische Universita¨t Mu¨nchen, Munich, Germany; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright 2020 The Author(s)
viability2 was actually completed just before the clinical introduction of the first hybrid imaging systems, SPECT/ CT and PET/CT. This transition to hybrid systems was actually a watershed moment: it ended the dominance of ‘‘single bed position’’ procedures scanning the heart or the brain (both fitted well into the PET scanners axial field of view and allowed routinely dynamic or gated acquisitions) (Figure 1). Oncological imaging was back then rather limited due to time constraints. This changed dramatically with the PET/CT and the simple fact that the CT scan replaced the time-consuming transmission scan—basically the conditio sine qua non to generate attenuation corrected and thus quantitative images. The increase in scanner sensitivity by going from 2D to 3D acquisitions and increasingly powerful scanner hardware enabled whole-body scan times in the order of 15 to 20 minutes. This introduce
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