Multimodal comparisons of QSM and PET in neurodegeneration and aging

•Quantitative susceptibility mapping (QSM) provides tissue composition information.•Iron contributes to neurodegeneration and is a main driver of QSM signal.•PET reflects protein aggregation and cellular changes in neurodegenerative disease.•Associations of QSM and PET may reflect role of iron in neurodegeneration.•Iron deposition with neuroinflammation contributes to these associations. Quantitative susceptibility mapping (QSM) has been used to study susceptibility changes that may occur based on tissue composition and mineral deposition. Iron is a primary contributor to changes in magnetic susceptibility and of particular interest in applications of QSM to neurodegeneration and aging. Iron can contribute to neurodegeneration through inflammatory processes and via interaction with aggregation of disease-related proteins. To better understand the local susceptibility changes observed on QSM, its signal has been studied in association with other imaging metrics such as positron emission tomography (PET). The associations of QSM and PET may provide insight into the pathophysiology of disease processes, such as the role of iron in aging and neurodegeneration, and help to determine the diagnostic utility of QSM as an indirect indicator of disease processes typically evaluated with PET. In this review we discuss the proposed mechanisms and summarize prior studies of the associations of QSM and amyloid PET, tau PET, TSPO PET, FDG-PET, 15O-PET, and F-DOPA PET in evaluation of neurologic diseases with a focus on aging and neurodegeneration.