1. Molecular Imaging “101” The Role of Molecular Imaging in Cancer Briefing and Roundtable Washington, DC July 22, 2008 Martin G. Pomper, MD, PhD Russell H. Morgan Department of Radiology and Radiological Science Johns Hopkins University

2. PAST PRESENT “FUTURE” Molecular NM, PET, SPECT, MRS, optical, PET/MRIcontrast-enhancedMRI/US/CTHybridPET/CT, SPECT/CT, PET/MR Functionalangiography, doppler US, NM, MRI, PET Anatomic plain films, CT, MRI, US The evolution of diagnostic imaging

3. What is molecular imaging? What is molecular imaging? “Viewing” the Body’s Biological Processes  Uses imaging technologies to assess biological activity in the body  Shows what cells are doing and how they are functioning over time  Different than x-rays or CT scans that show anatomical pictures of the body’s organs and tissues  Changes in physiology and biochemistry occur prior to changes in anatomy

4. Why is molecular imaging important?  Enables early detection and/or identification of changes occurring in tissue  Enables changes in individual patient management in real time (personalized medicine)  Facilitates drug development  Allows researchers to explore new ways to manage and treat illnesses  Serves as a noninvasive diagnostic and monitoring tool

6. Molecular imaging modalities PET/CT SPECT/CT MR Spectroscopy Optical Imaging Targeted ultrasound

7. + - 180 o 511 kev 18 FDG Radiotracer Positron emission tomography: PET PET-CT image

8. How is molecular imaging relevant to cancer patient care? Imaging cellular and molecular phenomena in vivo Patient selection by genotype Diagnostic and therapeutic agents combine as “theranostics” D. Artemov S. Gambhir M. Harisinghani malignant metastasis

9. Molecular imaging and cancer S. Gambhir U. Mahmood Nuclear: [ 18 F]FHBG for tracking T cells Optical: Activatable fluorescence for intestinal adenoma P. Van Zijl MR: Amide proton transfer imaging to assess brain tumor characteristics Nuclear: PSMA imaging for prostate cancer J. Babich

10. What is the state of molecular imaging now?  ~90 % of clinical molecular imaging is PET and SPECT  Optical, other modalities on the horizon  Nanoparticles, bacteria, new probes used to image critical cancer processes (cell death, tumor proliferation, angiogenesis, hypoxia) on the horizon  Reporter-probe pairs are being generated for molecular-genetic imaging