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

Background: 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.

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.