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Vol. 74. Issue 4.
Pages 303-311 (April 2021)
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Vol. 74. Issue 4.
Pages 303-311 (April 2021)
Original article
DOI: 10.1016/j.rec.2020.06.034
Additional value of hybrid PET/MR imaging versus MR or PET performed separately to assess cardiovascular disease
Valor adicional de la tecnología híbrida de PET/RM frente a la RM y la PET en la enfermedad cardiovascular
Patricia Barrioa,, Beatriz López-Melgara,, Ana Fidalgoa, M. José Romero-Castroa, Andrea Moreno-Arciniegasa,b, Caroline Fieldc, Marjorie Garcerantc, Leydimar Anmad Shihadeha, Belén Díaz-Antóna,d, Santiago Ruiz de Aguiare, Lina García Cañamaquec,, Leticia Fernández-Frieraa,b,d,f,,
Corresponding author

Corresponding author: Departamento de Cardiología, HM Hospitales, Avda. de Montepríncipe 25, 28660 Boadilla del Monte, Madrid, Spain.
a Unidad de Imagen Cardiaca, Departamento de Cardiología, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Madrid, Spain
b Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
c Departamento de Medicina Nuclear, HM Hospitales, Madrid, Spain
d Departamento de Medicina, Universidad CEU San Pablo, Madrid, Spain
e Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
f Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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Tables (3)
Table 1. Magnetic resonance and positron emission tomography parameters of patients in the coronary and noncoronary groups
Table 2. Distribution of segmental abnormalities, late enhancement, and 18F-FDG uptake detected by PET/MR in the coronary patient group, evaluated by segment (n=323 segments)
Table 3. Usefulness of the PET/MR diagnosis compared with the diagnostic performance of MR or PET separately, evaluated by patient
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Additional material (1)
Introduction and objectives

Hybrid positron emission tomography (PET) and magnetic resonance (MR) imaging is an emerging technology in the diagnosis of cardiovascular disease; however, there have been no reports of its use in the national clinical setting. Our objective was to evaluate the additional value of integrated PET/MR systems compared with MR and PET performed separately in this setting.


We prospectively included 49 patients, 30 to assess myocardial viability (coronary group) and 19 to assess inflammatory, infectious, and tumoral diseases (noncoronary heart disease group). All patients underwent cardiac 18F-fluorodeoxyglucose PET/MR. PET/MR studies included attenuation correction sequences, followed by simultaneous cardiac PET and cardiac MR acquisition, with protocols adapted to the clinical indication (cine, tissue characterization and/or late enhancement imaging).


Most (87.8%) PET/MR studies were initially interpretable. Use of PET/MR improved diagnosis vs PET or MR performed separately in 42.1% of coronary cases and 88.9% of noncoronary cases. PET/MR enabled reclassification of 87.5% of coronary cases initially classified as showing inconclusive results on MR or PET and 70% of noncoronary cases.


In our series, multimodality PET/MR technology provided additional diagnostic value in some patients with cardiovascular disease compared with MR and PET performed separately, especially in cases of noncoronary heart disease and in those with inconclusive results on MR or PET. In our experience, the main benefits of PET/MR include the possibility of simultaneous acquisition, the in vivo integration of anatomical/functional/metabolic aspects, and the interaction of different experts in imaging modalities.

Introducción y objetivos

Los sistemas híbridos de tomografía por emisión de positrones (PET) y resonancia magnética (RM) son una tecnología prometedora para el diagnóstico por imagen, pero su aplicación cardiovascular en nuestro entorno clínico es desconocida. Nuestro objetivo es evaluar el valor de los equipos integrados de PET/RM frente a la RM y la PET por separado.


Se incluyó prospectivamente a 49 pacientes, 30 para valoración de viabilidad miocárdica (grupo coronario) y 19 para estudio de enfermedad inflamatoria, infecciosa y tumoral (grupo no coronario), a los que se realizó una PET/RM cardiaca con 18F-fluorodesoxiglucosa, incluyendo secuencias de corrección de atenuación y, simultáneamente a la PET, secuencias de cine, caracterización tisular o realce tardío de RM, según indicación clínica.


El 87,8% de los estudios de PET/RM fueron inicialmente interpretables. La PET/RM mejoró el diagnóstico en el 42,1% de los pacientes del grupo coronario respecto a la PET o la RM por separado, y en el 88,9% del grupo no coronario. De los casos no concluyentes según la RM o la PET, la PET/RM reclasificó a estudio diagnóstico al 87,5% de los pacientes del grupo coronario y el 70% de los del no coronario.


En nuestra serie, la tecnología multimodal de PET/RM añade valor diagnóstico en algunos pacientes con enfermedad cardiovascular, sobre todo en enfermedad no coronaria y con hallazgos no concluyentes por RM o PET, y complementa cada técnica por separado. Los principales beneficios incluyen la adquisición simultánea, la integración de imágenes anatómicas, funcionales y metabólicas y la interacción entre distintos profesionales expertos en imagen.

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