Improved Visualization of Lymphomatous Cardiac Involvement with Retrospective PET/MRI Fusion

HomeRadiology: Imaging CancerVol. 5, No. 6 Images in CancerFree AccessImproved Visualization of Lymphomatous Cardiac Involvement with Retrospective PET/MRI FusionJoshua G. Hunter , Mohamed Gad, Amit GuptaJoshua G. Hunter , Mohamed Gad, Amit GuptaAuthor AffiliationsFrom the Case Western Reserve University School of Medicine, Health Education Campus, 9501 Euclid Ave, Cleveland, OH 44106 (J.G.H.); Section of Cardiovascular Medicine, Baylor College of Medicine, Houston, Tex (M.G.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (A.G.).Address correspondence to J.G.H. (email: [email protected]).Joshua G. Hunter Mohamed GadAmit GuptaPublished Online:Oct 13 2023https://doi.org/10.1148/rycan.230073MoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In PET/MRI techniques have proved valuable in several oncologic imaging applications (1). While PET/MRI hardware remains prohibitively expensive in most clinical practice settings, software-based retrospective PET/MRI fusion represents a more accessible alternative (2,3). We present an example of the utility of software-based retrospective PET/MRI fusion for evaluation of a complex case of an oncologic patient with widespread lymphomatous involvement, including the heart.A 58-year-old male patient with history of refractory T-cell lymphoma presented to the emergency department with sudden, persistent chest pain. The patient’s electrocardiogram and troponin levels were unremarkable. Further, coronary angiography findings revealed no abnormalities, and cardiac stress testing demonstrated equivocal results. PET/CT scans from 2 weeks prior had been interpreted as stable multifocal disease, with fluorodeoxyglucose (FDG) uptake around the heart considered either physiologic or attributed to the widespread mediastinal involvement (Fig 1). In hopes of uncovering the cause of chest pain, cardiac MRI was performed and showed nonspecific thickening of the lateral left ventricular wall and the apical right ventricular wall with no discernible enhancement on the delayed postcontrast images (Fig 2A, 2B). Given the discordance between PET and MRI findings, software-based retrospective PET/MRI fusion was performed. These images provided improved depiction and anatomic correlation of cardiac FDG uptake, now interpreted as secondary to lymphomatous cardiac involvement (Fig 2C). This diagnosis helped to explain the patient’s symptoms and guide appropriate medical management.Figure 1: PET/CT fusion image in a 58-year-old male patient with history of refractory T-cell lymphoma presenting to the emergency department with sudden, persistent chest pain. At initial interpretation, left ventricular fluorodeoxyglucose uptake was considered physiologic (blue arrows). Two anterior foci of uptake were reported as part of the widespread mediastinal lymphomatous involvement, while a subtle focus of uptake near the right atrium was not commented upon (red arrows).Figure 1:Download as PowerPointFigure 2: Cardiac MRI and PET/MRI fusion images. (A) Four-chamber bright blood cine MR image shows nonspecific thickening of the lateral left ventricular wall and the apical right ventricular wall (blue arrows) with (B) no discernible enhancement on the delayed postcontrast image (blue arrows). (C) Retrospective PET/MRI fusion image demonstrates lymphomatous involvement related to MRI findings (blue arrows), along with additional neoplastic involvement in the basal right ventricle and interatrial septum (yellow arrows) that were not correctly identified at PET/CT or MRI alone.Figure 2:Download as PowerPointDisclosures of conflicts of interest: J.G.H. No relevant relationships. M.G. No relevant relationships. A.G. No relevant relationships.Keywords: PET/MRI, PET/CT, Lymphoma, Cardiac, MR ImagingAuthors declared no funding for this work.References1. Martin O, Schaarschmidt BM, Kirchner J, et al. PET/MRI Versus PET/CT for Whole-Body Staging: Results from a Single-Center Observational Study on 1,003 Sequential Examinations. J Nucl Med 2020;61(8):1131–1136. Crossref, Medline, Google Scholar2. Pirasteh A, Riedl C, Mayerhoefer ME, Giancipoli RG, Larson SM, Bodei L. PET/MRI for neuroendocrine tumors: a match made in heaven or just another hype? Clin Transl Imaging 2019;7(6):405–413. Crossref, Medline, Google Scholar3. Robertson MS, Liu X, Plishker W, et al. Software-based PET-MR image coregistration: combined PET-MRI for the rest of us! Pediatr Radiol 2016;46(11):1552–1561. Crossref, Medline, Google ScholarArticle HistoryReceived: May 25 2023Revision requested: June 30 2023Revision received: July 31 2023Accepted: Sept 13 2023Published online: Oct 13 2023 FiguresReferencesRelatedDetailsRecommended Articles Active Cardiac Sarcoidosis Imitating Cardiac MetastasesRadiology: Cardiothoracic Imaging2020Volume: 2Issue: 6Transthoracic Echocardiography: Pitfalls and Limitations as Delineated at Cardiac CT and MR ImagingRadioGraphics2017Volume: 37Issue: 2pp. 383-406Cardiac and Pericardial Neoplasms in Children: Radiologic-Pathologic CorrelationRadioGraphics2023Volume: 43Issue: 9Cardiac Outpouchings: Practical Approach to Normal Variants and Pathologic Conditions at CT and MRIRadioGraphics2023Volume: 43Issue: 5Hypertrophic Cardiomyopathy from A to Z: Genetics, Pathophysiology, Imaging, and ManagementRadioGraphics2016Volume: 36Issue: 2pp. 335-354See More RSNA Education Exhibits A Beginner’s Guide to Understanding Echocardiography with CT/MRI Correlation, Case-based Examples, and Emphasis on Blind SpotsDigital Posters2019Pearls and Pitfalls in Cardiac ImagingDigital Posters2022CT and MR Imaging of Cardiac Masses and Pseudomasses: A Case-based ReviewDigital Posters2019 RSNA Case Collection Atrial fibrillationRSNA Case Collection2020Tuberculous pericardial abscess RSNA Case Collection2022Partial anomalous pulmonary venous returnRSNA Case Collection2021 Vol. 5, No. 6 Metrics Altmetric Score PDF download