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Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
Perfusionsszintigraphie zur Diagnostik der Lungenembolie
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Perfusionsszintigraphie zur Diagnostik der Lungenembolie

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  • 1. M. Wissmeyer Department of Nuclear Medicine, University of Berne (Inselspital) PET/CT in Oncology: PETPET/CT in Oncology: PET Tracers other than FDGTracers other than FDG
  • 2. PET – Isotopes and Half LivesPET – Isotopes and Half Lives 15 O 2 Minutes 13 N 10 Minutes 11 C 20 Minutes 18 F 110 Minutes 68 Ga 68 Minutes
  • 3. PET - RadiopharmaceuticalsPET - Radiopharmaceuticals Aminoacids: 11 C-Methionine Proteinsynthesis: 18 F-Ethyltyrosine (FET) Proliferation: 11 C-Thymidine, 18 F- Fluorthymidine (FLT) Hypoxia: 18 F-Fluoromisonidazole Mineralisation (Skeleton): 18 F-Fluoride Cell Membranes: 11 C- or 18 F-Choline Fatty Acids: 11 C-Acetate APUD Cell System: 18 F-DOPA Receptor ligands: 68 Ga-Petpides (e.g. DOTA-TOC)
  • 4. Aminoacids:Aminoacids: 1111 C-MethionineC-Methionine Drawback: Short Halflife => Cyclotron onsite indispensable Transporter mediated Uptake No significant Metabolism in Proteinsynthesis Well established in Brain Tumours (positive Marker!)
  • 5. Aminoacids:Aminoacids: 1111 C-MethionineC-Methionine Sensitivity up to 91% for Gliomas (n=23) Jacobs AH et al., JNM 12/2005
  • 6. Aminoacids:Aminoacids: 1111 C-MethionineC-Methionine Methionine superior to FDG in Follow up of treated Gliomas Sensitivity 89%, Specificity 29%, Accuracy 72% (11%, 100%, 36%, respectively) Methionine FDG Pötzi et al., J Neurooncol 2007
  • 7. Aminoacids:Aminoacids: 1111 C-MethionineC-Methionine Promising in Monitoring Chemotherapy Galldiks et al., EJNMMI 05/2006
  • 8. Aminoacids:Aminoacids: 1111 C-MethionineC-Methionine Grosu et al., IJROBP 02/2006
  • 9. Aminoacids:Aminoacids: 1818 F-FETF-FET Halflife 110 Min. => Cyclotron onsite not required Transporter mediated Uptake No significant Metabolism in Proteinsynthesis Well established in Brain Tumours (positive Marker!)
  • 10. Aminoacids:Aminoacids: 1818 F-FETF-FET Gliomas: FET + MRI => Sensitivity 93%, Specificity 94% (n=26) Variable Uptake in Low Grade Gliomas => No SUV-Cutoff 1/3 of Astrozytoma Grade II => No FET Uptake (similar to 11 C- Methionine) Promising Tool in Detection of Recurrency Langen KJ et al., NMB 2006
  • 11. Aminoacids:Aminoacids: 1818 F-FETF-FET Gliomas: FET => Sensitivity 92%, Specificity 81%, Accuracy 92% (n=26) Significantly better than MRI alone in Assessment of Gliomas Pauleit D et al., Brain 2005
  • 12. Aminoacids:Aminoacids: 1818 F-FETF-FET High Value in Prediction of Prognosis of cerebral Gliomas Floeth FW et al., JNM 04/2007
  • 13. Aminoacids:Aminoacids: 1818 F-FETF-FET Poor Results in peripheral Tumours FDG (A) and FET (B) PET in Lymphoma (left) and Head and Neck Cancer (right) Pauleit D et al., JNM 2005
  • 14. Proliferation:Proliferation: 1818 F-FLTF-FLT Halflife 110 Min. => Cyclotron onsite not required Nucleosid Analogue (Pyrimidin) Uptake by passive Diffusion / facilitated Transport Cellular Trapping after Phosphorylation by Thymidinkinase
  • 15. Proliferation:Proliferation: 1818 F-FLTF-FLT Promising Results cerebral Gliomas: Primary Diagnosis Saga T et al., Clin Nucl Med 2006
  • 16. Proliferation:Proliferation: 1818 F-FLTF-FLT Promising Results cerebral Gliomas: Suspected Recurrence Saga T et al., Clin Nucl Med 2006
  • 17. Proliferation:Proliferation: 1818 F-FLTF-FLT Early Assessment of Therapy Reponse: Malignant Lymphoma Mouse Model Lymphoma Treated with Chemotherapy (n=10) Immunotherapy (CD20 mAB; n=10) Radioimmunotherapy (90 Y-CD20 (Zevalin); n=10) FLT detects Tumour Response earlier than morphologic Imaging Buck AK et al., EJNMMI 2007, in press
  • 18. Proliferation:Proliferation: 1818 F-FLTF-FLT Significant Impact on Target Volumes in RT in rectal Cancer (Patel DA et al., TCRT 02/2007)  Drawbacks in Lymph Node Imaging in Primary Head and Neck Cancer (Troost EGC et al., JNM 2007)
  • 19. Hypoxia:Hypoxia: 1818 F-MisonidazoleF-Misonidazole Halflife 110 Min. => Cyclotron onsite not required Presence of hypoxic Tissue Predicts Outcome of RT Hypoxia => Increased Tumour Aggressivity => Decreased Response to Therapy => Poor Outcome Most published Results in Head and Neck Cancer Impact on Target Volume Definition in RT
  • 20. Hypoxia:Hypoxia: 1818 F-MisonidazoleF-Misonidazole Outcome in Head and Neck Cancer: FDG vs. F-MISO Rajendran JG et al., Clin Cancer Res 09/2006
  • 21. Hypoxia:Hypoxia: 1818 F-MisonidazoleF-Misonidazole F-MISO Uptake during RT in Head and Neck Cancer Eschmann SM et al., Radiotherapy and Oncology 2007; in press
  • 22. Hypoxia:Hypoxia: 1818 F-MisonidazoleF-Misonidazole Dose Painting Using F-MISO Information Thorwarth D et al., IJROBP 2007
  • 23. Mineralisation:Mineralisation: 1818 F-FluorideF-Fluoride Halflife 110 Min. => Cyclotron onsite not required Significantly higher Bone Uptake than 99m Tc-Phosphonates Blood Clearance faster than 99mTc-Phosphonates => Higher Contrast Planar Scintigraphy more available than PET-Scanners
  • 24. Mineralisation:Mineralisation: 1818 F-FluorideF-Fluoride Bone Scan vs. Fluoride PET Schirrmeister H et al., JCO 1999
  • 25. Mineralisation:Mineralisation: 1818 F-FluorideF-Fluoride Normal Bone Scan vs. Pathologic Fluoride PET Schirrmeister H et al., JCO 1999
  • 26. Mineralisation:Mineralisation: 1818 F-FluorideF-Fluoride Pathologic Bone Scan vs. Extensive Metastases in Fluoride PET Schirrmeister H et al., JCO 1999
  • 27. Cell Membranes:Cell Membranes: 1111 C- /C- / 1818 F-CholineF-Choline 11 C-Choline: Halflife 20 Min. => Cyclotron onsite required 18 F-Choline: Halflife 110 Min. => Cyclotron onsite not required First Results for a Variety of Tumours Most Studies in Prostate Cancer Ongoing multicentric Trial on Choline PET/CT in initial Staging of Prostate Cancer
  • 28. Cell Membranes:Cell Membranes: 1111 C- /C- / 1818 F-CholineF-Choline 11 C-Choline vs. FDG in various Tumours Tian M et al., EJNMMI 2004
  • 29. Cell Membranes:Cell Membranes: 1111 C- /C- / 1818 F-CholineF-Choline 11 C-Choline vs. FDG in various Tumours Tian M et al., EJNMMI 2004
  • 30. Cell Membranes:Cell Membranes: 1111 C- /C- / 1818 F-CholineF-Choline 18 F-Choline in Prostate Cancer: Diagnosis of Relapse Cimitan M et al., EJNMMI 2006
  • 31. Cell Membranes:Cell Membranes: 1111 C- /C- / 1818 F-CholineF-Choline 18 F-Choline in Prostate Cancer: Diagnosis of Relapse Cimitan M et al., EJNMMI 2006
  • 32. Cell Membranes:Cell Membranes: 1111 C- /C- / 1818 F-CholineF-Choline 18 F-Choline in Prostate Cancer: Own Experience G.G., 62y; mediastinal LN Metastasis
  • 33. Fatty Acids:Fatty Acids: 1111 C-AcetateC-Acetate Halflife 20 Min. => Cyclotron onsite required Increased Uptake in slowly growing Tumours Potential Advantage in FDG negative Tumours Most Evidence in Prostate Cancer and Myocardial Imaging First Studies in Adenocarcinoma of the Lung
  • 34. Fatty Acids:Fatty Acids: 1111 C-AcetateC-Acetate Acetate PET/CT in recurrent Prostate Cancer Albrecht S et al., EJNMMI 2007
  • 35. APUD Cell System:APUD Cell System: 1818 F-DOPAF-DOPA Halflife 110 Min. => Cyclotron onsite not required Katecholamine Metabolite Analogue Active Uptake in APUD Cells Decarboxylation => No further Metabolism => Accumulation Well established in Neuro-Imaging and 111 In-Octreotide negative neuroendocrine Carcinomas
  • 36. APUD Cell System:APUD Cell System: 1818 F-DOPAF-DOPA F-DOPA vs. 111 In-Octreotide in GEP Tumours Ambrosini V et al., Nucl Med Commun 2007
  • 37. APUD Cell System:APUD Cell System: 1818 F-DOPAF-DOPA F-DOPA vs. FDG PET/CT in GEP Tumours Nanni C et al., EJNMMI 2006
  • 38. APUD Cell System:APUD Cell System: 1818 F-DOPAF-DOPA F-DOPA vs. FDG PET in Medullary Thyroid Carcinoma Beuthien-Baumann B et al., EJNMMI 2007
  • 39. APUD Cell System:APUD Cell System: 1818 F-DOPAF-DOPA 111 In-Octreotide vs. 18 F-DOPA in typical Carcinoid B.L., f, 70y; Liver and mesenteric LN Metastases
  • 40. Receptor Ligands:Receptor Ligands: 6868 Ga-PeptidesGa-Peptides Halflife 68 Min. Generator Product Synthesis of Radiopharmaceutical onsite Peptides: Somatostatin Analogues Linked to Somatostatin Receptors of Neuroendocrine Tumours High Specificity für Somatostatine Receptor Subtypes II and V First Results: Sensitivity and Accuracy much higher than for 111 In-Octreotide
  • 41. Receptor Ligands:Receptor Ligands: 6868 Ga-PeptidesGa-Peptides Results of a valuable Clinical Trial (n=84) Gabriel M et al., JNM 2007
  • 42. Receptor Ligands:Receptor Ligands: 6868 Ga-PeptidesGa-Peptides Own Experience: 111 In-Octreotide vs. DOTATOC PET/CT W.P., 61y, m, Pancreatic NET, multiple Metastases; Courtesy Dr. M. Hofmann
  • 43. Receptor Ligands:Receptor Ligands: 6868 Ga-PeptidesGa-Peptides Own Experience W.P., 61y, m, Pancreatic NET, multiple Metastases; Courtesy Dr. M. Hofmann
  • 44. ConclusionsConclusions Variety of promising PET Tracers besides FDG Data limited mostly due to small Size of Cohorts 11 C labelled Tracers restricted to Centers with Cyclotron onsite Growing Field of 18 F labelled Tracers 68 Ga as new promising Generator Product in Neuroendocrine Tumours

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