imaging of cancer · imaging of cancer •imaging is a key ... mostly omniscan and optimark ......
TRANSCRIPT
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Imaging of Cancer
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Imaging of Cancer
• Imaging is a key element of:
– Screening (e.g. lung cancer, breast cancer)
– Staging (has it spread locally? Metastasized?)
– Monitoring of treatment (Better or worse?)
– Recurrence (Has it come back?)
– Prognosis (What will happen?)
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The Main Imaging Devices
• Computed Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Ultrasound (US)
• Single Photon Emission Computed Tomography (SPECT)
• Positron Emission Tomography (PET)
• Optical Imaging
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The Main Imaging Devices
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Computed Tomography
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Advantages of CT
• Widely available
• Minimal prep (NPO, drink contrast)
• Very rapid (2-3 seconds neck to pelvis)
• High resolution
• Relatively inexpensive
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Disadvantages
• Radiation
• Often requires iv contrast media
– Allergic reactions (minimal)
– Kidney damage (only in high risk patients)
• Anatomic information only
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X-ray production
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Basics of CT
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CT projection
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Cross section of a CT Scanner
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“Spiral” CT
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“Volume” CT imaging
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Attenuation differences thru the body
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Radiation
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Contrast Media
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Iodinated Contrast
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Non ionic iodinated contrast
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CT
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MRI
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MRI Advantages
• No radiation
• Multiplanar
• Multiple contrast types:
– T1 weighting, T2 weighting
– Diffusion weighting
– Contrast enhanced MRI
– Spectroscopy
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MR Disadvantages
• Slower than CT
• More expensive
• Does not depict calcifications
• Safety issues
– Metallic objects become projectiles
– Incompatible with metallic implanted devices
• Pacemakers
• Cochlear implants
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MRI physics
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MR physics
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Summary
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Creating a MR Image
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Anatomy of an MRI
Vents outside
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Safety issues in MRI
Quench Pipe
Injector
Ear protection
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The Importance of MR Safety
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MRI Safety
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MRI Safety
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Oxygen tank
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Value of Contrast Media
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Gd reagents
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GD reagents
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Nephrogenic systemic sclerosis
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Nephrogenic Systemic Fibrosis (NSF)
• May 2006 Danish Medicine Agency reported 25 cases of NSF in patients in renal failure who received gadodiamide (~2m)
• Nov 2006 Loma Linda reported 12 (8 on dialysis) NSF patients receiving 0.2mmol/Kg gadodiamide within 2-8 weeks of injection
• Since then over 200 cases have been reported with all of the available contrast agents but mostly Omniscan and Optimark
• By 2013 almost no cases are reported
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Case of NSF
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Mechanism
• Gadolinium is highly toxic
• Patients with normal renal function excrete Gd-chelates within 24-48h
• Patients with abnormal renal function may take weeks to excrete the agent
• Dissociation of Gd from the chelate could deposit in soft tissues (documented) – Hugh et al. Tissue Gd conc .14-24 ng/mL
• Fibrosis is an inflammatory response to toxic Gd ion.
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Risk Factors
• Renal failure: – Dialysis
– Chronic renal failure (GFR <30cc/min)
• Dose – Double, triple (vs. half dose)
• Contrast agent – Omniscan>Optimark>Magnevist>Prohance>
• Alternative imaging? – Non con MRI
– CT, US, PET
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Residual Gd
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Ultrasound
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US advantages
• No radiation
• Real time
• Inexpensive
• Quick, little prep
• No injection
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US disadvantages
• Operator dependent
• What you see is all there is
• Difficult to quantify
• Limited access (lungs, brain, bone etc.)
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Ultrasound basics
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Fate of sound waves in body
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Liver metastases
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Ultrasound probes
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Ultrasound devices
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Ultrasound guided biopsy
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Ultrasound
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SPECT
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SPECT Advantages/Disadvantages
• Relatively inexpensive
• Broad experience
• Disadvantages
– Radiation exposure
– Preparation of imaging agent
– Nuclear Regulatory
– Scanning is slow, low resolution
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SPECT detectors
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Collimation
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SPECT imaging
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SPECT agents for cancer
• 99mTc MDP Bone Scan
• 99mTc Pertechnetate (thyroid, salivary gland)
• 201Thallium Chloride (parathyroid)
• 111Indium oxine (WBC labelling)
• 131Iodine (thyroid)
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Hybrid Imaging
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Safety
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Positron Emission Tomography
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PET:Advantages and Disadvantages
• Highly sensitive
• Metabolic information
• Better spatial resolution than SPECT
• Combined with CT
• _____________________________________
• Expense
• Regulatory
• Short half life
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PET
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Positron travel
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Positron travel
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Positron travel
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Positron travel
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Positron and Electron
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Annihilation
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Gamma rays
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Gamma ray orientation
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F-18 Deoxyglucose
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PET imaging
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PET-CT device
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Metastatic Breast Cancer
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Notable PET Agents
• Sodium Fluoride: Bone target
• Fluorothymidine: Cellular Proliferation
• Fluoroestadiol: Estrogen receptor
• Fluorocholine: Membrane Turnover
• Fluoromiso: Hypoxia
• Florbetaben: Amyloid (Alzheimers)
• Zirconium Herceptin: labeled antibody
• Zirconium Oxine: Cell labeling
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Image Correction
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PET Imaging
• Positron emission tomography (PET) has the advantages of : – High energy photon imaging
– High Sensitivity, Moderate Specificity
– The ability to correct for attenuation
– No need for collimation
– Resolution is still limited
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Summary
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Cancer Imaging
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Cancer Imaging
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Cancer Imaging
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General Guidelines
• Overall “workhorse” for oncology: CT
• Specialty cancers: brain, liver, prostate: MRI
• Problem solving (e.g cyst vs. solid): US
• Bone mets: SPECT
• Metabolic activity: PET
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Imaging of cancer