the frontiers of medical imaging ferruccio fazio ibfm cnr, university of milano bicocca, h s....
TRANSCRIPT
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THE FRONTIERS OF MEDICAL IMAGING
FERRUCCIO FAZIOIBFM CNR, UNIVERSITY OF MILANO BICOCCA, H S. RAFFAELE, MILANO
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• X RAYS
• ULTRASOUND
• X RAYS COMPUTED TOMOGRAPHY CT
• MAGNETIC RESONANCE MR
• POSITRON EMISSION TOMOGRAPHY PET
IN VIVO MEDICAL IMAGING
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- Improved Temporal Resolution
- Wider Anatomical Coverage
- Improved Axial Resolution
HELICAL MULTI-SLICE CT
Solid State DetectorsUltra Fast Ceramics
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SINGLE-SLICE CT
1 sec/revolution
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HELICAL MULTI-SLICE CT16 SLICES
0.4 sec/revolution1.25 slice thickness1000 images/whole body study
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HELICAL MULTI-SLICE CTCARDIAC IMAGING
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MORPHOLOGY
FUNCTION
FLOW
CHEMICAL CONTENT
MR
BOLD
Gd PERFUSION
DIFFUSION/PERFUSION
MR ANGIOGRAPHY
MR SPECTROSCOPYin vivo
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MAGNETIC RESONANCE ANGIOGRAPHYFAST GRADIENT ECHO
MR ANGIOGRAPHY
DIGITAL ANGIOGRAPHY
Acute pulmonary embolism
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MAGNETIC RESONANCE
DIFFUSION/PERFUSION IMAGINGECHO PLANAR SEQUENCES
Acute trombosis of the left carotid artery.
T2
weighted image DIFFUSION
weighted image PERFUSION
weighted image
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DIFFUSION TENSOR IMAGING - FIBER TRACKING
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DIFFUSION TENSOR IMAGING – FIBER TRACKING
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POSITRON EMISSION TOMOGRAPHYPET
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CLINICAL PET IN ITALYTOTAL EXAMS/YEAR
Nr.
exa
ms
0
5000
10000
15000
20000
25000
30000
1999 2000 2001 2002
Year
0
50
100
150
200
250
1995 1996 1997 1998 1999 2000 2001 2002
Year
PE
T o
r P
ET
/CT
0
50
100
150
200
250
300
350
400
450
Tot
al P
ET
sca
nn
ers
PET/CTPETTotalExpon. (Total)
ESTIMATED PET - PET/CT
SCANNER UNITS WW
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18F-FDG WHOLE BODY PET18F-FDG WHOLE BODY PET
DIAGNOSIS
STAGING
RE-STAGING AND FOLLOW-UP
RADIOTHERAPY
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RADIOCHEMISTRY
INSTRUMENTATION HW/SW
PET + PROTEOMICS/FUNCTIONAL GENOMICS
ADVANCES IN PET IMAGING
NEW SCINTILLATION CRYSTALS
PET/CT
NEW TRACERS PET
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RADIOTRACERS PREPARED
AT HSR
[18F]FDG Glucose metabolism[18F]FESP D2 and 5-HT2 receptor antagonist
[15O]H2O Cerebral flow, Studi attivazione funzionale[13N]AMMONIA Myocardial flowm-[11C]hydroxyefedrine Adrenergic antagonist [11C]FLUMAZENIL Benzodiazepine receptor antagonist[11C]RACLOPRIDE Dopamine D2 receptor antagonist[11C]FE--CIT Dopamine reuptake inhibitor[11C]SCH23390 Dopamine D1 receptor antagonist[11C]CARAZOLOL Adrenergic 1/2 receptor antagonist[11C]MCN5652 Serotonin reuptake inhibitor[11C]MDL100907 Serotonin 5-HT2A receptor antagonist[11C]methylcoline Prostate Cancer[11C]FLUVOXAMINE Serotonin reuptake inhibitor[11C]CGP62349 GABAB antagonist [11C]isovaleroil-L-carnitine Cerebral metabolism[11C]PNU167760 Serotonin 5-HT1A receptor antagonist[11C] BISOPROLOL Adrenergic 1 antagonist [11C] ICI118551 Adrenergic 2 receptor antagonista [11C] OLANZAPINE Atypical Antipsychotic[11C] SB235753 Dopamine D4 receptor antagonist[11C] E2020 Muscarinic M2 receptor antagonist[11C] SCH442416 Adenosine A2A receptor antagonist[11C] PALMITATE Fatty acids metabolism[11C] A 84543 Nicotine 24 antagonist[11C] VC195 Peripheral Benzodiazepine[11C] VC193M Peripheral Benzodiazepine[11C] VC198M Peripheral Benzodiazepine[11C] WAY100635 Serotonin 5-HT1A receptor antagonist[11C]RN5 Adrenergic 1 receptor antagonist[11C] VA100 Opioid K1 receptor antagonist[11C] CARFENTANIL Opioid receptor agonist[11C] ZOFENOPRIL ACE inhibitor[18F]FLUORO CAPTOPRIL ACE inhibitor[11C] CNR1 1 adrenergic antagonist[11C] PK1113195 Peripheral Benzodiazepine[11C] F167 2 receptor antagonist[11C] PD60 dopamine D3 antagonist[11C] PD78 dopamine D3 antagonist
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B.P. 65 yrsPSA: 1,9 ng/ml
PROSTATE CANCER
[11C]Choline-PET[18F]FDG-PET [99mTc]MDP
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TRACERS for TUMOR CHARACTERIZATION
• Glucose metabolism [18F]FDG
• Membrane function [11C]Choline
• Proliferation [18F]FLT
[18F]FMISO
• Hypoxia [18F]FAZA
[64Cu]ATSM
• Apoptosis [18F]Annexin V
• Angiogenesis [18F]NGR-peptide
• Neuroendocrine tumors [110In]Octreotate
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RADIOCHEMISTRY
INSTRUMENTATION HW/SW
PET + PROTEOMICS/FUNCTIONAL GENOMICS
ADVANCES IN PET IMAGING
NEW SCINTILLATION CRYSTALS
PET/CT
NEW TRACERS PET
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SANDWICH OF DETECTORS
FASTER DETECTORS for • HIGH COUNT RATE CAPABILITY• TIME OF FLIGHT INFORMATION
NEW DETECTORS with:• SMALLER SIZE (2-3 mm)• GOOD ENERGY RESOLUTION • DEPTH OF INTERACTION INFORMATION
FUTURE DEVELOPMENTS IN PET
CURRENT DETECTORS: BGO, GSO, LSO
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RADIOCHEMISTRY
INSTRUMENTATION HW/SW
PET + PROTEOMICS/FUNCTIONAL GENOMICS
ADVANCES IN PET IMAGING
NEW SCINTILLATION CRYSTALS
PET/CT
NEW TRACERS PET
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PET
PET – [18F]FDG
LACK OF ANATOMICAL INFORMATION
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PET CT PET/CT
PET – [18F]FDG
ANATOMICAL INFORMATION
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PET CT
PET/CT
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HSR MILANO
18F-FDG PET/CT
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PET/CT - APPLICATIONS
• ANATOMICAL LOCALIZATION OF PET FUNCTIONAL IMAGES
• PET/CT GUIDED RADIOTHERAPY TREATMENT PLANNING
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METABOLICALLY AIMED RADIOTHERAPY (MART)
CT PET
CT BASED PET/CT BASED
TREATMENT PLAN
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OPTIMIZED TREATMENT
PET/CTVOLUME DEFINITION
PET/CT GUIDED RADIOTHERAPY
PLANNING
METABOLLICALLY AIMED RADIOTHERAPYMART
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LUNG SIMULATION
TOMOTHERAPY
MD Anderson Houston
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4D PET/CTRespiration control during PET/CT
Target volume with precise motion information
TREATMENTUNDER
RESPIRATION CONTROL
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HYPO-FRACTIONATION30-40 5-10 fractions
PET GUIDED IMRT/TOMOTHERAPY
IMPROVED TUMOR/NON TUMOR RADIATION DOSE
METABOLLICALLY AIMED RADIOTHERAPYMART
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RADIOCHEMISTRY
INSTRUMENTATION HW/SW
PET + PROTEOMICS/FUNCTIONAL GENOMICS
ADVANCES IN PET IMAGING
NEW SCINTILLATION CRYSTALS
PET/CT
NEW TRACERS PET
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THE PROTEOMICS OF PET:IDENTIFICATION OF NEW TUMOR MARKERS
• At present, tumor markers (CEA, PSA ....) are inadequate for early diagnosis and restaging
• Functional proteomics (on human tumor specimens) may identify new markers
• The new markers identified can be validated for assessemnt of early diagnosis or follow-up (re-staging)
Patients selection criteria for PET and current tracers (FDG, Choline)
Development of new radiotracers for PET imaging