Vision 20/20: Simultaneous CT-MRI - Next chapter of multimodality imaging : Simultaneous CT-MRI

Summary Magnetic Resonance (MR) is an exceptionally powerful and versatile measurement technique. The basic structure of an MR experiment has remained nearly constant for almost 50 years. Here we introduce a novel paradigm, Magnetic Resonance Fingerprinting (MRF) that permits the non-invasive quantification of multiple important properties of a material or tissue simultaneously through a new approach to data acquisition, post-processing and visualization. MRF provides a new mechanism to quantitatively detect and analyze complex changes that can represent physical alterations of a substance or early indicators of disease. MRF can also be used to specifically identify the presence of a target material or tissue, which will increase the sensitivity, specificity, and speed of an MR study, and potentially lead to new diagnostic testing methodologies. When paired with an appropriate pattern recognition algorithm, MRF inherently suppresses measurement errors and thus can improve accuracy compared to previous approaches.

At the UMC Utrecht, The Netherlands, we have constructed a prototype MRI accelerator. The prototype is a modified 6 MV Elekta (Crawley, UK) accelerator next to a modified 1.5 T Philips Achieva (Best, The Netherlands) MRI system. From the initial design onwards, modifications to both systems were aimed to yield simultaneous and unhampered operation of the MRI and the accelerator. Indeed, the simultaneous operation is shown by performing diagnostic quality 1.5 T MRI with the radiation beam on. No degradation of the performance of either system was found. The integrated 1.5 T MRI system and radiotherapy accelerator allow simultaneous irradiation and MR imaging. The full diagnostic imaging capacities of the MRI can be used; dedicated sequences for MRI-guided radiotherapy treatments will be developed. This proof of concept opens the door towards a clinical prototype to start testing MRI-guided radiation therapy (MRIgRT) in the clinic.

Photon counting detectors (PCDs) with energy discrimination capabilities have been developed for medical x-ray computed tomography (CT) and x-ray (XR) imaging. Using detection mechanisms that are completely different from the current energy integrating detectors and measuring the material information of the object to be imaged, these PCDs have the potential not only to improve the current CT and XR images, such as dose reduction, but also to open revolutionary novel applications such as molecular CT and XR imaging. The performance of PCDs is not flawless, however, and it seems extremely challenging to develop PCDs with close to ideal characteristics. In this paper, the authors offer our vision for the future of PCD-CT and PCD-XR with the review of the current status and the prediction of (1) detector technologies, (2) imaging technologies, (3) system technologies, and (4) potential clinical benefits with PCDs.