Patient shuttle table
fully integrated system, while it is
advantageous for the patient to receive
two scans simultaneously, you cannot
use the MR while the PE T scan is in
progress and vice versa. So if one of
the two examinations (usually MR)
takes substantially longer than PET, it
creates a financial problem, because
during that time you use a very
expensive PET/MR to just do MR.
For most institutions to be able to
afford an integrated PET/MR, they need
to use it clinically, at least part time.
This requires that some clinical PET/CT
studies can be done with PET/MR. We
have two PET/CT systems at the
hospital, and I will consider replacing
one with PET/MR once I know I can shift
a sizeable number of indications from
PET/CT to PET/MR without loss of
diagnostic accuracy. But as we
discussed, I can’t do that clinically
until I have proven that PET/MR is of
comparable clinical value to PE T/CT
in some major indications in oncology,
because 95% of my PET/CT exams
are for oncology.
However, we don’t know what
the future holds, and it appears we’ll
have a greater need for dementia
imaging, which needs both PET and
MR. Although we can perform PET
and MR separately, there may be
an advantage for the patient with an
integrated system because we often
have to sedate them. There is also the
comfort issue we discussed. However,
from a clinical standpoint, we can take
care of the patient just as well with
separate systems as with a fully
So where do we need PET/MR?
Potentially in dementia; we haven’t
proven its clinical value yet in oncology.
PE T/MR is a technology that is desperately
looking for a good clinical application.
I’m not saying integrated PET/MR isn’t
an interesting technology, but MR will
have to adapt to the pace of a PET
acquisition to function along with it.
I like to say, ‘ The wild horse MR has to
be tamed to trek along with the donkey
of PET.’ With PET/CT, we had to learn
how to run CT differently to conform
to PE T, and the same thing holds true
1. von Schulthess GK, Burger C. Integrating imaging modalities:
what makes sense from a workflow perspective? Eur J Nucl
Med Mol Imaging. 2010 May;37(5):980-90. Epub 2010 Feb 6.
Professor Gustav Konrad von Schulthess, MD, PhD, Hon. MD, is the Chairman of the Department of Medical Radiology at University Hospital Zurich. He
received his doctorate in physics from the Massachusetts Institute of Technology (MIT), his medical degree from Harvard Medical School, and an honorary doctor
of medicine from the University of Copenhagen. Prior to his current position, Prof. von Schulthess was the Chief Medical Officer at University Hospital Zurich.
Throughout his prestigious career, he has held numerous positions as a Professor, director, and co-director of nuclear medicine and MR departments in
Switzerland and the US. He has published over 210 peer-reviewed papers, five books, and 12 book chapters.
University Hospital Zurich is one of the largest and most important teaching hospitals in Europe. With its 40 divisions and institutes, the hospital is renowned
for its achievements in healthcare, research and teaching, as well as for compassionate care. It offers state-of-the-art treatment for a broad range of illnesses,
provided by a dedicated team of leading consultants of the highest international standing.