1. HYBRID IMAGING

2.  Combination  Nuclear medicine  Radiology  PET/CT  Positron emission tomography  Computed tomography  SPECT/CT  Single photon emission tomography  Computed tomography  PET/MRI

3. 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 18 0 511 keV   18 F

4. PET/CT scanner

5. 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)

6. Imaging technique  Application of radiofarmaka  Oral preparation  1000 ml 2,5% manitol  CT data acquisition  PET data acquisition  7 positions per 3 min

7. 2,5% mannitol Oral preparation

8. Postprocessing fusion CT + PET Multiple colorectal cancer

9. 18 F-fluorodeoxyglucose plasmacell transportphosphorylationglycolysis glucose 18 F-FDG 18 F-FDG-6-P glucose-6-P glycolysis glucose 18 F-FDG

10. 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

11. staging  Bronchogenic carcinoma  Head and neck tumours  Lymfoma  Melanoblastoma

12. BRCA

13. BRCA

14. Cerebral lymphoma

15. Hodgkin disease

16. Therapy strategy Sarcoma tendinis Achill. Leiomyosarkoma Synovial sarcoma

17. Restaging  Therapy response effect  Definitive  In the middle between cycles

18. Oropharyngeal cancer 18 months after

19. Early after surgery 3 months later

20. Cervical cancer Before th After th myom myom Ca Ca

21. Grading  the assesment of the biologic activity  More dedifferenciated – higher FDG uptake

22. Low-grade astrocytoma

23. Anaplastic oligodendroglioma

24. Fever of unknown origin M. Hodgkin

25. Blastic turnover of the osteomyelofibrosis

26. Microscopic polyarteritis

27. 18 F-fluorothymidine  replication DNA = cellular proliferation  Fast dividing cells  Tumors  Bone marrow  Germinative zones of lymph nodes  Therapy monitoring – RT, CHT

28. indications

29. 18 F-natriumfluoride  Bone turnover  fluoroapatite  Osteoblastic activity  Osteoplastic bone metastases  Ca prostate  Ca breast  Ca lungs  Bony tumors

30. Indications