Abstract

The introduction of positron emission tomography/computed tomography (PET/CT), particularly with F-18 fluorodeoxyglucose, has transformed disease management, especially in oncology, marking a major breakthrough in nuclear medicine. Since its advent, PET/CT has been widely adopted as both a primary and complementary imaging modality. The functional data from PET, integrated with anatomical details from CT, has facilitated more effective disease management. Advancements in PET and CT technologies have enhanced imaging outcomes, but limitations of CT, such as inadequate soft tissue contrast and ionizing radiation exposure, remain. In response, PET/magnetic resonance imaging (MRI) has emerged, offering high tissue contrast and additional functional data, addressing CT’s shortcomings. However, PET/MRI introduces new challenges, including attenuation correction and signal issues in bone and lung imaging. Evaluating lung lesions is still challenging, though progress has been made with short echo time sequences. The distinct imaging characteristics and artifacts of MRI necessitate adaptation, requiring familiarity with various sequences and proper imaging protocols. The MRI component also introduces safety concerns that must be addressed with proper procedures and staff training. Additionally, the high cost of PET/MRI limits its availability to major research centers. Despite these challenges, PET/MRI represents a new milestone in nuclear medicine, generating excitement in the field. Ongoing developments are expected to address current issues, but understanding existing challenges and pitfalls is essential for accurate interpretation. This review discusses the general challenges, critical areas of concern, and potential pitfalls associated with PET/MRI.