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Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Nuklearnomedicinsko oslikavanje demencija
Ratimir Petrović
SPECT
Doktorski studij "BIOMEDICINA I ZDRAVSTVO“Granski predmet:Neurobiologija starenjaVoditelj:Prof. dr. sc. Goran Šimić
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Produkcija radionuklida u ciklotronu
Isporuka doze
PET je najskuplja i najkompleksnija metoda nuklearnomedicinskog
oslikavanja
• Sinteza radiofarmaka• Sterilizacija
Transport u “vruću stanicu”
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
18F +
-
p
511 keV
511 keV
e+
e-
18F ->
18O + e
+ + v + Energija (635 keV)
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
SPECT
• Single Photon Emission Computerised Tomography
• prikaz regionalnog cerebralnog protoka
• 99-mTc-HMPAO - radiofarmak “prvog prolaza”
• korelira s regionalnom neuronalnom aktivnošću
• relativno jeftin i dobavljivALI
– nije moguća kvantitativna analiza
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
PET vs. SPECT
• Bolja rezolucija• Biološki korisni
izotopi – 11C, 13N, 15O, 18F
• Kvantitativan (b+)• Kratko poluvrijeme
raspada T1/2
• Vrlo skup• Ciklotron
• Slabija rezolucija• Kompleksne i
velike molekule• Manje kvantitativan• Duže poluvrijeme
raspada• Lako dobavljiv• Ne tako skup• Nepotrebna
posebna oprema za produkciju izotopa
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Konvencionalni PET radionuklidi
15O 13N 11С 18F18F
2,04 min
9,96 min
20,4 min
109,8 min
Jedino 18F-radiofarmaci mogu biti transportirani na
veće udaljenosti od proizvodnog pogona
(ciklotrona)
• 96.9% + • Emax 0.635 MeV
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Trenutačno se u laboratorijima širom svijeta ispituje oko
•81 neurotransmiterska molekula prikladna za SPECT scintigrafije
i
•163 neurotransmiterskih molekula prikladnih za scintigrafije PET-om
( .... i svaki dan se otkrivaju nove molekule)
(vlastiti podaci dobijeni revizijom devedeset recentnih članaka)
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
1818Fluoro-2-deoFluoro-2-deoksiksi-D-glukoza-D-glukoza
HO
O
OH
OH
18F
OH
PLAZMA TKIVO
FDG FDG FDG–6–P
glukoza glukoza glukoza–6–P
CO2 + H2O[18F]–FDG
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Poredba PET-a
i SPECT-a
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Koregistracija slike
1: Tehnička ispravnost i položaj
2: Opći pregled velikih struktura
3: Globalni nivo metabolizma
4: Fokalna kortikalna metabolička patologija (hiper ili hipo) ... i poredba s očekivanom distribucijom radiofarmaka
5. Pojava tipičnih metaboličkih obrazaca !
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
ProgresivProgresivnini PET PET ObrasciObrasci
PariParijjetaletalnini/Temporal/Temporalnini± Frontal± Frontalnini
hipohipoometaboliometabolizamzam
PredominantPredominantno frontalnino frontalnihipohipometabolimetabolizazamm
AmetaboliAmetabolizazam Bam Bazzalalnihnih GangliGanglijja a
(Huntington(Huntingtonovaova bolestbolest))
ObrazacObrazac::
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
StacionarniStacionarni PET PET ObrasciObrasci
NormalNormalniniMetaboliMetabolizazamm
GlobalGlobalniniHHiipometabolipometabolizazamm
FoFokkalalniniHHiipometabolipometabolizazam m
ObrazacObrazac::
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Uredan PET mozga – 18F-FDG
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Organic Brain Syndrome
Degenerative disorders:
Alzheimer’s dementia, Creutzfeldt-Jakob disease, Huntington disease, Multiple Sclerosis (MS), Normal pressure hydrocephalus, Pick’s disease
Cardiovascular disorders:
Arrhythmias – may cause some types of OBS, Cardiac infections (endocarditis, myocarditis, etc.) -- may sometimes cause OBS, Hypertensive brain injury, Multi-infarct dementia, Stroke, Transient Ischaemic Attack (TIA)
Trauma-induced brain injury:
Chronic subdural haematoma, Concussion, Intracerebral haemorrhage, Subarachnoid haemorrhage, Respiratory conditions -- may cause or aggravate OBS, Hypoxia (decreased oxygen in the body), Hypercapnia (increased carbon dioxide levels in the body)
Infections:
Any acute or chronic infection, Septicaemia (presence in the bloodstream of toxic by-products caused by infection), Meningitis, Encephalitis
Drug and alcohol related conditions:
Intoxication, drug abuse or alcohol use, Long-term effects of alcohol, Wernicke-Korsakoff syndrome, Alcohol withdrawal state, Withdrawal from drugs (especially sedative-hypnotics and corticosteroids)
Parkinson’s disease
Other conditions that may be related to organic brain syndrome include: depression, neuroses, and psychoses of various types, which may occur simultaneously with the OBS.
Metabolic Causes
Endocrine disorders
Addison’s disease, Cushing’s disease, Diabetic nephropathy, Diabetic ketoacidosis, Insulinoma or hypoglycemia, Hypoparathyroidism, Hyperparathyroidism, Hypothyroidism, Thyrotoxicosis, Pheochromocytoma
Metabolic disorders
Acid/base disorders of any type, Fluid electrolyte disorders of any type, Hyponatremia, Hypercalcemia, Kidney failure with uremia, Liver disease, Porphyria
Nutritional disorders
Vitamin B-1 deficiency, Vitamin B-12 deficiency, Pellagra, Protein-calorie malnutrition
Different causes of Dementia
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Proces starenja
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
PET – smanjenje u nakupljanju neurotransmitera tijekom procesa starenja
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
PET, 18F-FDG Tipičan prikaz Alheimerove bolesti – parijetotemporalni hipometabolizam
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
PET – Progresija Alheimerove demencijePET – Progresija Alheimerove demencije
UredanUredan Rani stadijRani stadij Kasni stadijKasni stadij Dijete Dijete
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Alzheimerova demencija – umjerena i teška forma
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Pickova demencija
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Rani stadij frontotemporalne demencije
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Frontotemporalna demencija
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Vaskularna demencija
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Lewy body demencija
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Huntingtonova demencija
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Novi radiofarmaci
PET - FDG
PET - PIB
NordbergLancet Neurology2004
PET - Pittsburgh Compound-B (PIB), omogućava kvanitativnu procjenu depozita amiloida
Uredan AD
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