HYBRID IMAGING
Combination Nuclear medicine Radiology PET/CT Positron emission tomography Computed tomography SPECT/CT Single photon emission tomography Computed tomography PET/MRI
e-e- e+e+ Beta plus decay Nucleus reach of protons Proton is transformed to neutron Emission of positron and neutrino Periodical table shift to the left by one site 18F to18O Positron is living only few ms Annihilation of the matter Interaction of electron and positron Gamma rays 2 quanta E – 511 keV Unique energy Angle180o keV 18 F
PET/CT scanner
Radiopharmaceuticals 18F halftime110 min 18FDG – fluorodeoxyglucose 18FLT – fluorothymidine Na18F 18F-Estradiol, 18F-methionin, 18F-DOPA, 18F-cholin 68Ga halftime 68 min DOTA derivates somatostatine analoga 11C halftime 20 min 11C-acetate, 11C-cholin 13N (9 min), 15O (123 s), 82Rb (78 s)
Imaging technique Application of radiofarmaka Oral preparation 1000 ml 2,5% manitol CT data acquisition PET data acquisition 7 positions per 3 min
2,5% mannitol Oral preparation
Postprocessing fusion CT + PET Multiple colorectal cancer
18 F-fluorodeoxyglucose plasmacell transportphosphorylationglycolysis glucose 18 F-FDG 18 F-FDG-6-P glucose-6-P glycolysis glucose 18 F-FDG
18 FDG-PET/CT Increased uptake Tumorous tissues with increased glycolytic activity Inflammatory reaction Physiological uptake brain Brown fatty tissue Stripped muscles Kidneys Sallivary glands
staging Bronchogenic carcinoma Head and neck tumours Lymfoma Melanoblastoma
BRCA
BRCA
Cerebral lymphoma
Hodgkin disease
Therapy strategy Sarcoma tendinis Achill. Leiomyosarkoma Synovial sarcoma
Restaging Therapy response effect Definitive In the middle between cycles
Oropharyngeal cancer 18 months after
Early after surgery 3 months later
Cervical cancer Before th After th myom myom Ca Ca
Grading the assesment of the biologic activity More dedifferenciated – higher FDG uptake
Low-grade astrocytoma
Anaplastic oligodendroglioma
Fever of unknown origin M. Hodgkin
Blastic turnover of the osteomyelofibrosis
Microscopic polyarteritis
18 F-fluorothymidine replication DNA = cellular proliferation Fast dividing cells Tumors Bone marrow Germinative zones of lymph nodes Therapy monitoring – RT, CHT
indications
18 F-natriumfluoride Bone turnover fluoroapatite Osteoblastic activity Osteoplastic bone metastases Ca prostate Ca breast Ca lungs Bony tumors
Indications