Perfusion dynamics play a vital role in delivering essential nutrients and oxygen to tissues while removing metabolic waste products. Imaging techniques such as magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) use contrast agents to visualize perfusion and clearance patterns; however, each technique has specific limitations. Hybrid PET/MRI combines the quantitative power and sensitivity of PET with the high functional and anatomical detail of MRI and holds great promise for precision in molecular imaging. However, the development of dual PET/MRI probes has been hampered by challenging synthesis and radiolabeling. Here, we present a novel PET/MRI probe, [18F][Gd(FL1)], which exhibits excellent stability comparable to macrocyclic MRI contrast agents used in clinical practice. The unique molecular design of [18F][Gd(FL1)] allows selective and expeditious radiolabeling of the gadolinium chelate in the final synthetic step. Leveraging the strengths of MRI and PET signals, the probe enables quantitative in vivo mapping of perfusion and excretion dynamics through an innovative voxel-based analysis. The diagnostic capabilities of [18F][Gd(FL1)] were demonstrated in a pilot study on healthy mice, successfully detecting early cases of unilateral renal dysfunction, a condition that is typically challenging to diagnose. This study introduces a new approach for PET/MRI and emphasizes a streamlined probe design for practical synthesis and improved diagnostic accuracy.

Cluster of Excellence iFIT Image Guided and Functionally Instructed Tumor Therapies Eberhard Karls University Tübingen 72076 Tübingen Germany

Faculty of Science Department of Organic Chemistry Charles University Praha 2 Albertov 6 12800 Prague Czech Republic

German Cancer Consortium Im Neuenheimer Feld 280 Heidelberg 69120 Germany

Institute for Engineering Electronics and Analytics Research Center Jülich GmbH Wilhelm Johnen Str 52428 Jülich Germany

Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences Flemingovo náměstí 542 2 160 00 Prague 6 Czech Republic

Nuclear Physics Institute of the CAS Řež 130 250 68 Řež Czech Republic

Werner Siemens Imaging Center Department of Preclinical Imaging and Radiopharmacy Eberhard Karls University Tübingen Röntgenweg 13 1 72076 Tübingen Germany

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