Timothy Michael Shepherd MD, PhD, Presenter: Nothing to Disclose

Kent P. Friedman MD, Abstract Co-Author: Speaker, Bayer AG Spreaker, Spectrum Pharmaceuticals, Inc

Christopher Glielmi PhD, Abstract Co-Author: Employee, Siemens AG

David Duane Faul PhD, Abstract Co-Author: Employee, Siemens AG

Kimberly Jackson, Abstract Co-Author: Nothing to Disclose

Yu-Shin Ding PhD, Abstract Co-Author: Nothing to Disclose

Fernando Boada, Abstract Co-Author: Nothing to Disclose

Orrin Devinsky, Abstract Co-Author: Nothing to Disclose

PET-MRI is a recent technologic innovation that has multiple practical advantages for patients and clinicians to obtain rapid, synergistic diagnostic workup of localization-related epilepsy, dementias and other neurologic disorders. PET-MRI also has enormous research potential. We describe our initial experiences integrating this technology into routine clinical care for patients with epilepsy.

Over the past 18 months, we have used a 3-T PET-MRI scanner (Biograph mMR, Siemens Healthcare) for imaging 49 patients with localization-related epilepsy (mean age 34 +/- 18 yrs, range 8-70 yrs). 18F-FDG was administered at the start of the MRI protocol (mean dose 8.6 +/- 2.2 mCi) for dynamic list-mode data acquisition and posthoc creation of static images. Attenuation correction maps are derived from a Dixon MRI sequence. The MRI protocol includes multiplanar diffusion, FLAIR, T2, 3D T1 and double-inversion recovery sequences.

Combining PET with MRI for epilepsy workup can benefit patients, referring physicians and diagnostic radiologists. We will show multiple examples where integrated PET-MRI studies has altered diagnosis, prognosis or redirected further workup. Subtle MRI findings often have been ruled in or out based on PET concordance, with several patients going on to surgery based on new PET-MRI findings. Conversely reader PET sensitivity is increased with MRI-directed searches, particularly in the coronal plane.

Integrated PET-MRI is now the imaging modality of choice for our epilepsy program and exerts a significant impact on patient care. Due to its enormous potential, we stopped using PET-CT in September 2013 and are now using this technology in 6-10 new patients per month.

Our initial experiences demonstrate that PET-MRI has enormous potential for clinical workup in patients with localization-related epilepsy.

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Shepherd, T, Friedman, K, Glielmi, C, Faul, D, Jackson, K, Ding, Y, Boada, F, Devinsky, O, Integrated PET-MRI for Clinical Epilepsy Patients: How We Do It.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14019052.html