Dr. J. Bomanji

PET-MR Project
Dr. J. Bomanji
Head of Department and Clinical Lead
Dept of Nuclear Medicine
UCLH NHS Foundation Trust
253 Euston Road
London NW1 2BU

The Institute
of Nuclear Medicine
Lead Innovation;
Contribute sustainable value for
patients and society;
Network nationally and
internationally
Patients experience
is first priority;
Latest technology
PET-MR
To remain the UK’s
leading Institute for
Nuclear Medicine –
in Clinical Service,
Research and
Education
Quality service
Research
Education
Align services and innovation objectives;
Adapt service configuration to market needs;
Develop staff to full potential; Maintain financial viability;
Support highest standards in service outcomes and audit

PET-MR PROJECT
Nuclear Medicine
• Sept 2009: space in Macmillan Cancer Centre
(PET/CT) no PET-MR machine available
• Feb 2010: PET-MR machine available from Siemens
• June 2010: MCC space reconfigured
• July 2010: Trustees offer to buy and pay for PET/MR
machine installation
• Sept 2010: Visit to Erlangen, Siemens Factory

PET-MR PROJECT
Business Case (Nov-Dec 2010)
Tom Wright & Martin Lerner
Assumptions
• Approximately 8 patients/day
• Price Tariff similar to a PET/CT/MRI (£ 1500/-)
• Replace machine in 7yrs (Capital gift)
• Clinical Indications: unclear
Time: 60% Clinical, 40% Research
Seed money of ~ £1.2 million required from
CBRC (Research)

PET-MR PROJECT
• Approximately a £6 million project
• Dec 2010, Business case submitted for Board
Approval.
• Dec 2010, Trustees place order
• Feb 2011, Board of Directors ratify programme
• Time-lines:
• Sept 2011, Machine delivery
• Jan 2012, Building handover
• April 2012, Clinical patients

PET-MR PROJECT
Management (Nuc Med)
• FUNDING: Tom Wright
• DESIGN: Wendy Waddington
• INSTALLATION: Wendy Waddington
• COMPLIANCE: Wendy Waddington
• RECRUITMENT: TW, WW, JB, S.Punwani
• CLINICAL WORK FLOW: Caroline Townsend/
Medics
• RESEARCH: Prof A. Groves, Dr. S. Punwani
(Themes: Oncology, Neurology, Cardiology)

• Radiology
PET-MR PROJECT
PARTNERS
• Clinicians
• Medical Physics
• The Centre for Advanced Biomedical Imaging
• The Centre for Medical Image Computing

PET-MR PROJECT
A Big Thank You to
UCLH Trustees
Sir Robert Naylor (CEO)
Dr. Geoff Bellingham (MD)
Prof. Mark Emberton
Martin Lerner
All members of Management/ IT
SKANSKA

PET-MR Imaging
CLINICAL and RESEARCH THEMES
• Oncology
• Neurology
• Cardiology
• Infection/Inflammation

Biograph mMR
The world’s only simultaneous, wholebody
molecular MR

two is now one.
Resulting in…
– One exam
– One room
– One whole-body
solution
– For shorter exams
– Easier scheduling
– And faster results

PET-MR Project
Potential applications, now a reality.
Neurodegenerative disease
Head/Neck cancers
Cardiac evaluation
Liver metastasis
Clinicians have proposed
a vast range of
applications where PET-
MR will make a
difference.
Colorectal cancers
Prostate cancer
Whole-body oncology
Pediatric* oncology
Bone metastasis
Bone and soft tissue lesions
* MR scanning has not been established as safe for imaging fetuses and infants under two years of age. The responsible physician must evaluate the benefit of
the MRI examination in comparison to other imaging procedures.

ONCOLOGY
Lung cancer
PET/MRI fusion
images show
vascular invasion.

Breast
• Breast imaging at 3T represent the ultimate
potential of MR imaging (4mm lesion size).
• Imagine the potential of looking at glucose
metabolism (PET), receptor status of tumour (PET)
and the tumour oxygenation levels (MRI).
• PET--MRI: The potential in breast cancer ?
• Not for primary diagnosis,
• monitor response to conventional and novel therapies.

SUPRAGLOTTIC
PARAGANGLIOMA

SUPRAGLOTTIC
PARAGANGLIOMA

T2 fat suppressed
VAGINAL paraganglioma

CARDIOLOGY
Short axis Cardiac MR, Rb-82 and contrast
MR (using an IR-FLASH pulse sequence)

NEUROLOGY
Non-Tumourumor
Tumor
?
?
Demyelinating lesion
Demyelinating lesion
Protoplasmatic astrocytoma WHO II
?
?
Brain abscess
Glioblastoma WHO IV
Dept. of Nuclear Medicine • University of Munich

PET-MR with Gallium-68- DOTATATE
For Meningioma
Radiotherapy Planning

Malignant Meningiomas
• Combining PET Ga-DOTATATE (SS2)
receptor imaging with MRS in
meningiomas to monitor response to
therapy
• Note elevated Alanine at 1.48ppm is a
signature of meningiomas

MR Spectroscopy
• Proton MRS can be performed in 10-15
min & can be added to conventional MR
protocols.
• PET--MRS indications:
• Epilepsy
• Tumours (serial monitoring of response to
relevant therapies)

PET--MRS EPILEPSY
• Blood oxygenation level dependent
(BOLD) Dynamic MR imaging technique
that acquires images of the brain during
stimulus and also rest.
• Complemented by reduced metabolic
(FDG) activity in epilepticogenic focus.

EPILEPSY
LESSON: The area of hypometabolism is far greater than the area
of seizure onset, possibly reflection propagation of seizure activity
as well as the functional deficit area.
Aim of surgery:
• To resect focus without causing functional deficits.
To do
• Strategies that tailor resection extent to regional
hypometabolism may warrant further evaluation

Alzheimers Disease
PET Tracers
F-18-fluorodeoxyglucose (FDG)
Amyloid tracers
•florbetapir, (previously known as AV-45)
•flutemetamol ,
•florbetaben (previously known as AV-1)
•

73 year old female; MMSE 28.
Subject and spouse concerned but memory tests normal.
18 months later – amnestic MCI
Asymptomatic
AD

[ 18 F]-AV1/ZK
Alzheimer’s Disease
80 year old male
MMSE 26
Healthy Elderly Control

Von Hippel Lindau Syndrome

Orthopedic applications
• The new 3T scanner can pick up minute
orthopaedic detail and subtle signs of injury.
• Combine this strength with a F-18 PET which
reflects an increase in osteoblastic activity
secondary to bone injury, bruising and repeated
biomechanical stress.

MALIGNANT PIGMENTED
VILLONODULAR SYNOVITIS

PET-MR Project
Questions: What is the big deal about PET-MR
Radical new hybrid technology
First in UK Apart from Germany 1 st in Europe (worldwide 7machines)
UK Clinical and Diagnostic service on map
UK Translational Research on map

PET-MR Project
Does it improve outcome and quality?
• To early to give an answer
Does it improves safety?
• Yes! Reduced radiation dose
Does it improves patience experience?
• Yes! reduce patient journey, one stop shop

PET-MR Project
Does it improves cost efficiency?
• To early to answer.
• A decade ago we were in the same place with PET/CT
which is now established

THANK YOU