An innovative hybrid imaging protocol for whole-body ¹⁸F-FDG-PET/MRI in cardio-oncology: a proof-of-concept study

Early identification of cardiac involvement in oncology patients is critical but challenging. To date, no validated protocol integrates dedicated cardiac magnetic resonance imaging (CMR) within routine whole-body (WB) ¹⁸F-FDG PET/MRI examinations.

This proof-of-concept study evaluated the feasibility and effectiveness of a novel hybrid imaging protocol combining CMR and WB ¹⁸F-FDG PET/MRI for oncology patients.

Fifteen patients with suspected or confirmed multiple myeloma (MM) were enrolled. All participants scheduled for oncologic ¹⁸F-FDG PET/MRI underwent an integrated protocol incorporating dedicated CMR sequences prior to WB PET/MRI. The CMR sequences included cine imaging, native T1 and T2 mapping, and feature-tracking to assess cardiac structure, function, and tissue characteristics. Feasibility, safety, and the prevalence of clinically relevant cardiac abnormalities were evaluated.

The protocol was successfully completed in all participants without adverse events, enabling comprehensive cardiac and oncologic assessment within an average procedure time of 115 min (cumulative scanning time 65.5 ± 9.8 min). Clinically relevant cardiac abnormalities were identified in 4 patients (27%), including reduced left ventricular ejection fraction, concentric hypertrophy, and increased myocardial ¹⁸F-FDG uptake.

This study demonstrates the feasibility of a novel, time-efficient, integrated ¹⁸F-FDG PET/MRI protocol combining oncologic staging with comprehensive cardiac assessment in a single examination. This approach serves as an ideal strategy for cardio-oncology, bridging the gap between cancer treatment and cardiac care.