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Perfusionsszintigraphie zur Diagnostik der Lungenembolie

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Perfusionsszintigraphie zur Diagnostik der Lungenembolie

  1. 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. 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. 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. 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. 5. Aminoacids:Aminoacids: 1111 C-MethionineC-Methionine Sensitivity up to 91% for Gliomas (n=23) Jacobs AH et al., JNM 12/2005
  6. 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. 7. Aminoacids:Aminoacids: 1111 C-MethionineC-Methionine Promising in Monitoring Chemotherapy Galldiks et al., EJNMMI 05/2006
  8. 8. Aminoacids:Aminoacids: 1111 C-MethionineC-Methionine Grosu et al., IJROBP 02/2006
  9. 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. 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. 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. 12. Aminoacids:Aminoacids: 1818 F-FETF-FET High Value in Prediction of Prognosis of cerebral Gliomas Floeth FW et al., JNM 04/2007
  13. 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. 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. 15. Proliferation:Proliferation: 1818 F-FLTF-FLT Promising Results cerebral Gliomas: Primary Diagnosis Saga T et al., Clin Nucl Med 2006
  16. 16. Proliferation:Proliferation: 1818 F-FLTF-FLT Promising Results cerebral Gliomas: Suspected Recurrence Saga T et al., Clin Nucl Med 2006
  17. 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. 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. 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. 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. 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. 22. Hypoxia:Hypoxia: 1818 F-MisonidazoleF-Misonidazole Dose Painting Using F-MISO Information Thorwarth D et al., IJROBP 2007
  23. 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. 24. Mineralisation:Mineralisation: 1818 F-FluorideF-Fluoride Bone Scan vs. Fluoride PET Schirrmeister H et al., JCO 1999
  25. 25. Mineralisation:Mineralisation: 1818 F-FluorideF-Fluoride Normal Bone Scan vs. Pathologic Fluoride PET Schirrmeister H et al., JCO 1999
  26. 26. Mineralisation:Mineralisation: 1818 F-FluorideF-Fluoride Pathologic Bone Scan vs. Extensive Metastases in Fluoride PET Schirrmeister H et al., JCO 1999
  27. 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. 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. 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. 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. 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. 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. 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. 34. Fatty Acids:Fatty Acids: 1111 C-AcetateC-Acetate Acetate PET/CT in recurrent Prostate Cancer Albrecht S et al., EJNMMI 2007
  35. 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. 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. 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. 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. 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. 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. 41. Receptor Ligands:Receptor Ligands: 6868 Ga-PeptidesGa-Peptides Results of a valuable Clinical Trial (n=84) Gabriel M et al., JNM 2007
  42. 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. 43. Receptor Ligands:Receptor Ligands: 6868 Ga-PeptidesGa-Peptides Own Experience W.P., 61y, m, Pancreatic NET, multiple Metastases; Courtesy Dr. M. Hofmann
  44. 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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