nuclear medical applications

Technische Universität München

Nuklearmedizinische Klinik und Poliklinik

Klinikum rechts der Isar Technische Universität München


Klinikum rechts der Isar Technische Universität München Technische Universität München


Klinikum rechts der Isar


S. I. Ziegler

Nuclear Medical Applications






Radiopharmaceuticals

• Selection of the pharmaceutical according to the organ-

specific question

• Labelling of pharmaceuticals with radioactive isotopes

External detection possible

• Radiopharmaceuticals must not affect the metabolism

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Mechanisms of Tracer Imaging

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Mechanism Example

Distribution in a body compartment Blood pool scintigraphy, cystography

Leaking from the vascular

compartment

Gastrointestinal bleeding

Passive diffusion Distribution in the tissue along a concentration

gradient

Capillaries blocking Lung perfusion scintigraphy (Tracer Ø > 20 µm)

Adsorption Skeleton scintigraphy (Tc-99m-diphosponates on the

surface of hydroxylapatite)

Active transport Thyroid scintigraphy, MIBG-scintigraphy, FDG - and

AS-PET

Metabolic trapping FDG in cell because of selective blocking of glucose

Phagocytosis Liver, spleen and bone marrow scintigraphy Ø < 10µm

Receptor bond Selective binding of ligands and receptors e.g. in

tumours and brain

Antigen- antibody reaction Radioimmunoscintigraphy






Thyroid Scintigraphy with Tc-99m Pertechnetate

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normal result autonomous adenoma






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131I – Scintigraphy

metastatic

thyroid carcinoma






Basics of skeletal scintigraphy

• Binding of technetium-phosphate

complexes or fluorides to new built

bone matrix

• Examination of regional bone

conversion (“metabolism“)

skeletal metastases of a prostate carcinoma

-

HO P C P OH

O

OH

- -

O

OH

- -

H

OH

- -

-

HDP

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Typical Questions for Imaging

• Does a malignant tumor exist?

(differential diagnosis)

• How far has the disease spread?

(staging)

• Is the initiated therapy effective?

(therapy control)

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O

18 F

CH2OH

OH

hexokinase

GLUT-3

GLUT-5

O

HOCH 2

OH

OH

OH

18 F

GLUT-2,4,7

OH OH

G6-phosphate-

isomerase X

X

CH2OPO32-

GLUT-1

FDG-uptake depends on:

1. GLUT-expression

2. hexokinase-expression

tumor cell

[18F]FDG (2-[18F]Fluoro-2-Deoxy-Glucose)

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FDG PET of a Normal Person

Brain

Kidney

Bladder

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48 year old patient

malignant lymphoma

PET: Example FDG-PET

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FDG PET Gastric Carcinoma Responder

before CTx day14 3 months after CTx

Response prediction

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before CTx Day 14

Response-Vorhersage

FDG PET Gastric Carcinoma Non-Responder

3 months after CTx

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protein synthesis

amino acid transporter

tumor cell

transferase

protein degradation

proteins

NH 3 +

COO -

11 C H 3

S

O 18

F NH 3 +

COO -

X

[11C]Methionin / [18F]F-Ethyl-Tyrosine

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[18F]FDG-PET versus [11C]MET-PET

astocytoma, recurrence

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Comparison of methionine and the

amino acid analog FET

SUV 0 5 SUV 0 4

MRT (T1-Gd) MET-PET FET-PET

Residual tumor after partial resection of a glioblastoma

Weber, Wester et al. Eur J Nucl Med (2000) 15

MR/PET Simultaneous Acquisition


Bed Position 1

Bed Position 2

Bed Position 3

Clinical Example: Cervical Lymphoma


MR/PET Munich (TUM/LMU), funded by the DFG

Hybrid PET/MR imaging in oncology: treatment planning in patients with liver metastases

• increasingly aggressive treatment of localized liver metastases (partial liver resection, thermoablation, SIRT,…)

• only beneficial for the patient when metastases are limited to liver and exact extent of disease in the liver is known

• MRI for liver imaging, PET to rule out distant metastases

Liver imaging in HCC with MR-PET

DWI b 400 DWI ADC map

T2w fatsat MR-PET fusion MIP

Hybrid MR-PET in neurooncology

Courtesy Drzezga A, 2011






[F-18] fluoro-deoxyglucose (FDG) glucose metabolism

[O-15] water blood flow

[F-18] fluoroethyl-Tyrosine (FET) amino acid transport

[C-11] methionin amino acid transport and metabolism

[F-18] feoxy-fluoro-thymidin (FLT) proliferation

[F-18] fluoromisonidazol (FMISO) hypoxia

PET Substances for Oncology

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[O-15] water blood flow dementia, ischemia, stroke

[O-15] butanol blood flow

[F-18] FDG glucose metabolism

[F-18] FDOPA presynaptic

dopamine function

parkinson disease

[C-11] methionin amino acid transport

and metabolism

brain tumors

[C-11] flumazenil benzodiazepine-

receptor imaging

epilepsia

PET Substances for Neurology

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Drzezga et al., Nuklearmedizin TUM 2001

O-15 Water Activation Study

Activation of sensory and motor areas by itching

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Klinikum rechts der Isar Technische Universität München Technische Universität München

axial slices, normal result, caudal view

FDG Normal result (slice images)






transversal example slices, landmarks

ACPC-Linie

Automated definition of stereotactic axis

and landmarks (Neurostat, Univ. of Michigan, USA)

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right left

surface projection

Deviation from normal result

Metabolism in Brain (Normal Person)

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right left

100%

0%

5

0

Typical Alzheimer‘s Disease

surface projection

difference to normal result

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right left

100%

0%

5

0

Early Alzheimer‘s Disease surface projection

Difference to normal result

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100%

0%

axial slices, caudal view

Frontal Dementia

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Arrows: Hypometabolism






100%

0%

Arrows: Hypometabolism

5

0

difference to normal result

Frontal Dementia surface projection

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Nuclear cardiology

metabolism/myocardium vitality

pump function

Myocardial

perfusion experimental

methods:

- innervation

- cell-death

- gen expression

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Myocardium: Slice Images short axis vertical long axis horizontal long axis

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ECG-triggered myocardial perfusion

scintigraphy

Measurement of perfusion and function

ED

ES

automatic contour detection 3D-Movie

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hibernating

myocardium Scar

NH3

FDG

Myocardial Viability Diagnosis

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Radiation Exposure

Study Effective radiation

dose (mSv)

PET

18F-FDG (370 MBq) 7.0

13N-NH3 rest/stress (2 x 550 MBq) 2.2

82Rb rest/stress (2 x 740 MBq) 5.0

H215O rest/stress (2 x 740 MBq) 1.4

Transmission 68Ge rod source 0.06 – 0.13

Multislice CT

Calcium scoring 1.5 – 6.2

CT angiography 6.7 – 13.0

CT-based PET attenuation correction 0.23 – 5.66

Whole body CT 14

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nuclear medical applications

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