In our institute, we are currently the only facility in Hungary performing PET/MRI examinations. The combination of PET diagnostics with MRI represents a revolution in 3D diagnostics. PET/MRI is a hybrid imaging technology capable of acquiring and overlaying both MRI morphological and functional data along with PET functional content. The radioactive isotopes used for the examination, marked with glucose molecules (18F-FDG and FDOPA), are produced in our own radiopharmaceutical laboratory using a Siemens Eclipse cyclotron.

What you need to know about PET/MRI examinations

MRI: Magnetic Resonance Imaging
PET: Positron Emission Tomography

During an MRI examination, highly detailed and excellent tissue-resolution images are obtained using a strong magnetic field and radiofrequency waves. These images can be captured in any plane of the examined body part. Certain structures and pathological conditions can be more effectively distinguished compared to other imaging techniques. This capability makes MRI examinations widely applicable in various disorders such as cancerous diseases, inflammatory processes, circulatory disorders, injuries, and neurological conditions. MRI can also be used to examine nearly every body region, including the brain and spine, joints, bones, muscles, abdominal and pelvic organs, breasts, thoracic organs, and the cardiovascular system.

During a PET examination, the distribution and accumulation of radioactively labeled glucose molecules (18F-FDG), administered intravenously, are measured. Cells and tissues with accelerated metabolism, differing from the norm, show increased glucose utilization, which can indicate pathological conditions or diseases. The administered radiopharmaceutical (18F-FDG) entails radiation exposure for both you and your surroundings. However, due to its short half-life, its radioactivity decreases by approximately half in about 2 hours and is completely eliminated from the body within the following 24 hours.

The combination of PET diagnostics with MRI represents a revolution in 3D diagnostics. PET/MRI is a hybrid imaging technology capable of simultaneous acquisition and overlaying of MRI morphological and functional data along with PET functional content.

The PET/MRI machine in our institute operates at a magnetic field strength of 3 Tesla, making it twice as powerful as commonly used equipment for human diagnostics. This increased power allows us to obtain higher spatial resolution images with finer structures, better contrast, and a higher signal-to-noise ratio, all without extending the examination time. It also enables faster imaging in examinations where temporal resolution is important, such as contrast-enhanced angiography, cardiac and brain perfusion studies, functional brain imaging, and diffusion tensor imaging of the brain. This maintains image quality (signal-to-noise ratio) and resolution.

IMPORTANT INFORMATION BEFORE PET/MRI EXAMINATION!

We would like to inform you that there is a constant magnetic field in the MRI machine and examination room, making it necessary to conduct examinations under specific conditions. Please carefully review our MRI information before the examination.

The MRI machine generates a very strong magnetic field, which is why the examination should be considered carefully, as it can be contraindicated for individuals with certain metal, electrical, magnetic, or mechanical implants, devices, or objects. Such metal implants include items like pacemakers, implanted defibrillators, brain or other aneurysm clips, artificial eyes, implanted hearing aids, bullets, shrapnel, metal fragments, artificial heart valves, implanted joint prosthetics, artificial limbs, orthopedic metal materials (screws, plates, nails, wires).

Requirements for MRI Examination

Referral:

A specialist referral is required to participate in the MRI examination. If your physician deems the examination necessary, they will arrange the appointment at our institute and inform you accordingly.

For privately funded MRI examinations, our institute offers fee-based options if they are medically justified. In such cases, please contact our customer service at the central phone number to receive information about the procedure, cost, and possible payment methods for the MRI examination.

Preparing for an MRI Examination

General:

• You can eat and drink normally before the examination, including water and mineral water, unless contrast agent administration is required for the examination. In that case, please refrain from eating for 3 hours before the examination.
• You can take your medicines as usual.
• Metal objects on your body or clothing can interfere with the MRI examination and pose a safety risk. We provide a lockable cabinet for storing metal objects. We provide a lockable cabinet for storing metal objects. Please place all metal objects in the designated locker before entering the MRI examination room. These can include hearing aids, signaling devices, mobile phones, keys, glasses, hairpins or headbands, jewelry (including body piercings), watches, safety pins, paper clips, bank cards, coins, pens, pocket knives, steel-toed shoes, tools, loosely attached metal items, clothing with metal decorations, metal buttons, or zippers, bras.

In case of diabetes:

If you have diabetes, please inform our staff upon registration!

• It is important to maintain blood sugar levels between 4 - 11 mmol/L, as high blood sugar levels can alter the uptake and utilization of isotopically labeled sugars in organs/tissues/cells. If your blood sugar level measured right before the examination is above 8 mmol/L (144 mg/dl), due to the altered glucose metabolism pattern, it might be necessary to postpone the examination to another day.
• In the case of IDDM (insulin-dependent diabetes mellitus), you can administer insulin in the usual way, you can eat (you can eat foods with a reduced carbohydrate content, which means half the usual amount of carbohydrates). You must appear for the examination within 3 hours after the administration of the insulin (the radiopharmaceutical can be administered 4 hours later). If you need to inject insulin several times a day, take the injector and insulin with you with food.
• In case of NIDDM (non-insulin-dependent - "pill" diabetes mellitus), do not take metformin-containing medicines (Adimet, Avandamet, Competact, Eucreas, Gluformin, Janumet, Maformin, Meforal, Meglucon, Merkformin, Metfogamma, Metformin, Metrivin, Stadamet, Velmetia) 48 hours before the examination. Other oral antidiabetic medication should be taken, but food should be avoided! Please always bring your diabetes medication with you.

In case of pregnancy:

• In case of pregnancy or suspicion of pregnancy, the examination cannot be performed (except based on prior consultation with the medical team).

72 hours before the examination::

• Avoid heavy physical activities (exercise, gardening, horseback riding, sports, skiing, physical labor, etc.).
• Avoid consumption of high-carbohydrate foods and beverages (DO NOT consume: bread, pastries, sugary drinks, sweets, candies, chewing gum).

On the day of the examination:

• Wearing warm clothing is recommended - shivering can affect the results.
• Metal objects on clothing interfere with image quality, so please avoid wearing clothing with metal elements (zippers, clasps, sequins, hooks, metal buttons).
• Do not bring jewelry or valuables with you, remove piercings and body jewelry.
• If you have removable dentures containing metal, they must be removed for the examination, so please DO NOT glue them in.
• Avoid smoking.
• If you experience claustrophobia, you can bring a mild sedative with you to take before the examination.
• Breastfeeding mothers should collect enough breast milk for one day, as breastfeeding should be suspended for 24 hours after the examination, and expressed breast milk should be discarded.
• If you have a stoma, if it becomes full, the stoma bag should be emptied immediately before the examination. Please bring spare stoma bags in case of replacement.
• If you have urinary elimination issues (catheter - urinary bag or wearing diapers, pads), please empty and, if needed, replace them just before the examination. Please also bring spare equipment for replacements.

Risks and possible side effects of the PET/MRI examination:

• The PET/MRI examination itself is completely painless.
• The administered substance has no medicinal effect on the body, the procedure is harmless from the point of view of an allergic reaction.
• The radiation exposure to the body is similar to the radiation exposure of a contrast-enhanced CT scan performed on the same areas of the body in addition to the usual activity.
• Rarely, mild side effects such as nausea, vomiting, or diarrhea may occur after consuming oral contrast material diluted to provide a more accurate image of the gastrointestinal tract. We recommend that you consume the liquid in small quantities and slowly.

During the MRI Examination

Upon arrival, check in at the reception for data verification, registration, and filling out and signing the 'MRI Consent Form.' Adhere to your appointment time, as failure to do so may result in the inability to conduct the examination.

Bring the following documents with you:

• MRI examination referral
• Personal identification (ID) card
• Address card
• National Health Insurance Card (Taj kártya)
• Relevant previous medical records related to the examination (Image material from CT, MRI, ultrasound examinations performed at other institutes, as well as laboratory and final reports).
• Documentation, medical certificate, or any related documents regarding possible implanted medical devices.

The assessment of its current condition is carried out in a specially designated area. During this, a qualified staff member will review the documentation you have brought, make copies as necessary, and take your medical history based on the questions on the evaluation form. They will measure your weight and height and make sure there are no exclusion criteria for the study. After that, you will receive information about the further course of the investigation. Before administering the radiopharmaceutical, we always check your blood sugar level. If it exceeds 11 mmol/l, we cannot continue the test.

After the evaluation, the radiopharmaceutical (medicine) is injected.

If you have any questions, please address them to our colleagues before the administration of the radiopharmaceutical. After the injection, our colleagues will minimize close contact with you for their own radiation protection, although necessary assistance will still be provided.

After the injection, you will need to wait in complete rest for 45-60 minutes (time for the radiopharmaceutical to accumulate in cells). It is important that you avoid any physical or mental activity during this time, which means no talking, reading, walking, etc.

During the waiting period, you are allowed to empty your bladder, but once the waiting time is over, our qualified staff will ask you to go to a designated restroom to empty your bladder, change your pad, and, if needed, empty your stoma bag. This is necessary because the administered radiopharmaceutical is excreted through the kidneys into the bladder, and a full bladder hinders the assessment of pelvic abnormalities.

Please pay special attention not to contaminate the environment or yourself with urine. This is important both from a radiation protection perspective and for the interpretability of the images obtained during the examination.

For the exam, the radiographer will call you by name and go through the details of the 'MRI Consent Form'. Trust their guidance as they will be your point of contact during the examination.

During the examination, it is crucial not to move from the position set by the radiographer. Follow instructions accurately via the speaker system.

The duration of the examination varies depending on the type of exam (15-60 minutes). You will lie in the MRI machine, which is resembling a tunnel-like machine. Loud noises are normal. A camera at the end of the head monitors the entire examination.

If there is a problem with the pump in your hand, you can notify us and interrupt the test if necessary.

Post-PET/MRI Examination Instructions

In the 24 hours following the examination:

• We kindly ask you to avoid close physical contact during the 24 hours after the examination, such as hugging, sleeping together, using public transportation, and participating in communal events (e.g., cinema, theater).
• Take particular care to protect small children and pregnant women, keep them as far away as possible and stay in one place for the shortest time, if absolutely necessary.
• If you are breastfeeding, you must discard expressed breast milk in the 24 hours following the examination.
• It is recommended to drink plenty of fluids, which should be at least 2-3 liters.
• During a restroom use, please take care not to contaminate your surroundings or yourself with urine.
• Until the day following the examination, avoid close contact with pregnant women and young children.

Result of PET/MRI examination, finding:

• Examination results and reports are sent to the referring physician.
• You or your representative, based on a written authorization, can receive the results of the examination. In this case, we will inform you about the pickup time via phone.
• For your benefit, request the report from your treating physician and bring it for future examinations.
• In the case of privately funded examinations, the results will be sent to the provided email address within 24 hours or can be collected in person or by an authorized representative after notification.

In order to diagnose your disease more accurately, it may be necessary to inject intravenous contrast material, which cannot be detected during the (native) examination without contrast material, and certain changes can be evaluated more precisely. The administration of the contrast material depends on the examined region and the suspected disease.

The contrast material poses little danger, but it can cause allergic symptoms. Such e.g. bitter or metallic taste, temporary skin itching. A more serious reaction is very rare. We are prepared to prevent them!

If you experience symptoms described above, notify us immediately for assistance.

Thank you for your cooperation, which aids our work in your recovery.