slide1
Download
Skip this Video
Download Presentation
Text

Loading in 2 Seconds...

play fullscreen
1 / 26

Text - PowerPoint PPT Presentation


  • 159 Views
  • Uploaded on

IMAGING with RADIOPHARMACEUTICALS. Functional molecular specificity for disease detection and “follow-up” Durval C. Costa MD, MSc, PhD, FRCR Director Nuclear Medicine-Radiopharmacology Champalimaud Clinical Centre Champalimaud Foundation. Text. IMAGING clinical practice & research.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Text' - duane


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

IMAGING with RADIOPHARMACEUTICALS

Functional molecular specificity for

disease detection and “follow-up”

Durval C. Costa

MD, MSc, PhD, FRCR

Director

Nuclear Medicine-Radiopharmacology

Champalimaud Clinical Centre

Champalimaud Foundation

Text

slide2

IMAGING

clinical practice & research

slide3

IMAGES in MEDICINE

(resolution: spatial vs contrast/concentration)

Method

CT

MRI

MRSI

SPECT

PET

HFUS

Optical

Minimum Detectable

Size (Ø)

1 ~ 2 mm

1 ~ 2 mm

7 mm (~3 mm at 3T)

4 ~ 6 mm

3 ~ 5 mm

< 1 mm

0.02 mm

Minimum Detected

Molar Cells (n)

mM 400,000

400,000

1,000,000

pM500,000

pM300,000

100,000

1000

slide4

IMAGES with RADIOPHARMACEUTICALS

- Cellular functional Specificity -

Fluorodeoxyglucose (FDG) is phosphorylated to FDG-6-PO4 by hexokinase. Since the activity of glucose-6-phosphatase is negligible, FDG-6-phosphate is essentially trapped in tumor cells.

Unfortunately it is also trapped in activated macrophages.

Fluorothymidine (FLT) is phosphorylated by thymidine kinase to FLT-6-PO4 and accumulates in tumor cells.

It is described as a marker of cell proliferation.

Czernin J and Phelps ME.. Annu Rev Med, 2002; 53: 89-112.

slide5

IMAGES with RADIOPHARMACEUTICALS

clinical and research applications

  • Imaging and Molecular Medicine
        • Radiopharmaceuticals for DIAGNOSIS
        • Radiopharmaceuticals for THERAPY
        • Radiopharmaceuticals for ASSESSMENT and MONITORING response to THERAPY
        • Radioligands for R & D – new THERAPIES (pharmacokinetics and pharmacodynamics)
slide6

IMAGES with RADIOPHARMACEUTICALS

Case 01

74 y old man;

Radical prostatectomy 10 ys ago for carcinoma;

Bone Scintigraphy – multiple bone metastases;

ULTRASSOUN images – normal, i.e. sem no loco-regional recurrence;

17-July-2006

Alkaline Phosphatase 125 U/L (N 40-150)

Acid Phosphatase 4,3 U/L (N 0,0-6,5)

Prostatic fraction 0,6 U/L (N < 2,6)

PSA (prostate specific antigen) 0,33 ng/ml (N < 5)

Proteina C reactiva 0,4 ng/ml (N 0,0-0,5)

slide8

23-July-2007

2nd IODO-131 THERAPY

(7,4 GBq, i.e. 200 mCi)

IMAGES with RADIOPHARMACEUTICALS

Case 01

Pathology from biopsy – Thyroid carcinoma; Total Thyroidectomy;

13-November-2006

1st IODO-131 THERAPY

(7,4 GBq, i.e. 200 mCi)

slide9

PET-CT

camera

Gama

camera

Outpatient

Inpatient

Radiopharmaceuticals

Cyclotron

Generators

Radionuclides

Nuclear Reactor

RADIOPHARMACEUTICALS

NUCLEAR/MOLECULAR MEDICINE

Diagnosis

Therapy

slide10

RADIOPHARMACEUTICALS

NUCLEAR/MOLECULAR MEDICINE

Spatial resolution – detectable minimum lesion size!?

slide11

Function

Clinical Ratings

Time

RADIOPHARMACEUTICALS

Diagnose EARLY to IMPROVE Outcome!

slide12

RADIOPHARMACEUTICALS - PET

Cost-Savings BENEFIT analyses!

Ken A. Miles. An approach to demonstrating cost-effectiveness of diagnostic imaging modalities in Australia illustrated by positron emission tomography. Australasian Radiology, 2001; 45: 9-18.

slide13

RADIOPHARMACEUTICALS - PET

Cost-Savings BENEFIT analyses!

slide14

PET with FDG in ONCOLOGY

UTILITY in CLINICS

  • Diagnosis and “grading” of malignant disease
  • Definition of disease extent
      • staging and restaging
  • Identification and localisation of disease foci
    • unknown primary (paraneoplastic syndromes)
  • Evaluation and monitoring of response to therapy
  • Identification of recurrent disease in comparison with “raising” tumour markers and anatomic/structural changes (CT and MR)
  • Guide for biopsy
  • Therapy guidance and “management”
slide15

PET with FDG in ONCOLOGY

Overall results – sensitivity and specificity

  • Sensitivity - 84% (based on 18 402 patient studies)
  • Specificity - 88% (based on 14 264 patient studies)
  • Average management change across all aplications
      • 30% (based on 5 062 patients)
  • Sensitivity range 84% - 87%
  • Specificity range 88% - 93%
  • Accuracy range 87% - 90%

Gambhir SJ, Czernin J, Schwimmer J, et al. A Tabulated Summary of the FDG PET Literature. J Nucl Med, 2001; 42: 1S-93S. [www.snm.org]

slide16

SCC

Oral cavity

FDG +ve

FET +ve

FDG +ve

FET -ve

RADIOPHARMACEUTICALS

Distinction between TUMOUR and inflammation

21 consecutive pts (3 women and 18 men, age range 41 to 80 y) with suspected squamous head and neck cancer.

FDG

Fluorodeoxyglucose

FET

O-(2-[18F]fluoroethyl)-L-tyrosine

Chronic

inflammation

Pauleit D, Zimmermann A, Stoffels G, et al. J. Nucl Med, 2006; 47: 251-261.

slide17

RADIOPHARMACEUTICALS

The future requests planning … measures and ACTION

11C

18F

3H

15O

Molecular Chemistry

Cyclotron and “Production Facility”

slide18

FDG

AC

RADIOPHARMACEUTICALS

The future requests planning … measures and ACTION

13 of 22 pts with serum PSA > 3ng/mL had positive AC PET findings.

Only 1 of 24 pts with serum PSA ≤ 3ng/mL had positive findings.

11C-Acetate

77-y-old man with PSA relapse and serum PSA value of 10.5 ng/mL 8 y after radical prostatectomy and 5 y after salvage external-beam radiation therapy. Histologic diagnosis showed Gleason score of 8 at surgery. CT scan negative.

Oyama N, et al. J Nucl Med, 44 (4): 549-555; 2003

slide19

RADIOPHARMACEUTICALS

… differential diagnosis of DEMENTIA

AD

FTD

Accuracy = 0.778

(Exatidão = 0.778)

Accuracy = 0.875

(Exatidão = 0.875)

slide20

RADIOPHARMACEUTICALS

… labelling β-Amyloid pathology “in vivo”.

18F-florbetapir

(18FAV-45)

18F-flutemetamol

(18FGE067)

18F-florbetaben

(18F-BAY94-9172)

Benzothiazole11C - 6-OH-BTA-1

(also known as 11C - PIB)

Binds to Aβ 1-40 and Aβ 1-42 fibrils

Stilbene11C -SB-13

99Tcm-MAMA-chrysamine G

(analog of Congo red)

Labels Aβ 10-43

slide21

RADIOPHARMACEUTICALS - positive markers of disease … labelling β-Amyloid pathology “in vivo”.

11C-PIB

N-Methyl-11C-2-(4´-methylamino-phenyl)-6-hydroxy-benzothiazole or 11C-6-OH-BTA-1

Average radiochemical yield - 20%; Synthesis time - 45 min; Radiochemical purity - 98%.

Ng S, et al. J Nucl Med 2007; 48: 547-552.

slide22

KS, 62 y old male; bil. tremor, rigity, akinesia, no falls,

no visual hallucinations

H & Y=3.0; MMSE=27/30; CAMCOG=101/107

123I-FP-CIT

123I-IBZM

dopamine D2

post-synaptic

receptor

marker

pre-synaptic

transporter

marker

R

Idiopathic Parkinson’s Disease (IPD)

RADIOPHARMACEUTICALS

… imaging neuropathology “in vivo”.

INM

slide23

A D

N V

E T

Drug induced

parkinsonism

IPD

DLB

Schizophrenia + PD

RADIOPHARMACEUTICALS

… imaging neuropathology “in vivo”.

AD= Alzheimer’s disease; DLB= dementia with Lewy bodies; ET= Essential benign tremor; IPD= idiopathic Parkinson’s disease; NV= normal volunteer

INM

INM

slide24

Coronary angiography confirms LMS occlusion (A), with patent RCA (B), right-to-left collateral circulation (C) and normal LV contractile function (D)

RADIOPHARMACEUTICALS

… in Nuclear Cardiology – Myocardial Viability

slide25

RADIOPHARMACEUTICALS

… in Nuclear Cardiology – Myocardial Viability

Patologias associadas

Toxic Autonomous Adenoma

of the THYROID

Multiple pulmonary emboli

slide26

Endocrinology

Hyperthyroidism

Ca Thyroid

IODINE-131

Pheochromocytoma

Paraganglioma

Carcinoid

IODINE-131 - mIBG

Intracavitary

Synovectomy

(microspheres)

YTTRIUM-90

Resistent PAIN

Ca Prostate

Possibly others

STRONTIUM-89

SAMARIUM-153

RADIOPHARMACEUTICALS

… therapeutic APPLICATIONS

ad