HYBRID IMAGINGHYBRID IMAGING

HYBRID IMAGINGHYBRID IMAGING Combination Combination

Nuclear medicineNuclear medicine Radiology Radiology

PET/CTPET/CT Positron emission tomographyPositron emission tomography Computed tomographyComputed tomography

SPECT/CTSPECT/CT Single photon emission tomographySingle photon emission tomography Computed tomographyComputed tomography

PET/MRIPET/MRI

e-

e+

Beta plus decayBeta plus decay Nucleus reach of protonsNucleus reach of protons Proton is transformed to neutronProton is transformed to neutron Emission of positron and neutrinoEmission of positron and neutrino Periodical table shift to the left by one sitePeriodical table shift to the left by one site

18F to18O18F to18O Positron is living only few msPositron is living only few ms Annihilation of the matterAnnihilation of the matter Interaction of electron and positronInteraction of electron and positron Gamma raysGamma rays

2 quanta E – 511 keV 2 quanta E – 511 keV Unique energyUnique energy Angle180oAngle180o

180

511 keV

511 keV18F

PET/CT scannerPET/CT scanner

RadiopharmaceuticalsRadiopharmaceuticals 18F halftime110 min18F halftime110 min

18FDG – fluorodeoxyglucose18FDG – fluorodeoxyglucose 18FLT – fluorothymidine 18FLT – fluorothymidine Na18FNa18F 18F-Estradiol, 18F-methionin, 18F-DOPA, 18F-cholin18F-Estradiol, 18F-methionin, 18F-DOPA, 18F-cholin

68Ga halftime 68 min68Ga halftime 68 min DOTA derivatesDOTA derivates somatostatine analogasomatostatine analoga

11C halftime 20 min11C halftime 20 min 11C-acetate, 11C-cholin 11C-acetate, 11C-cholin

13N (9 min), 15O (123 s), 82Rb (78 s)13N (9 min), 15O (123 s), 82Rb (78 s)

Imaging techniqueImaging technique Application of radiofarmakaApplication of radiofarmaka Oral preparationOral preparation

1000 ml 2,5% manitol1000 ml 2,5% manitol CT data acquisitionCT data acquisition PET data acquisitionPET data acquisition

7 positions per 3 min7 positions per 3 min

2,5% mannitol2,5% mannitol

Oral preparationOral preparation

Postprocessing fusion CT + Postprocessing fusion CT + PETPET

Multiple colorectal cancerMultiple colorectal cancer

1818F-fluorodeoxyglucoseF-fluorodeoxyglucose

plasma cell

transport phosphorylation glycolysis

glucoseglucose

1818F-FDGF-FDG 1818F-FDG-6-PF-FDG-6-P

glucose-6-Pglucose-6-Pglycolysis

glucoseglucose

1818F-FDGF-FDG

1818FDG-PET/CTFDG-PET/CT

Increased uptakeIncreased uptake Tumorous tissues with increased glycolytic activityTumorous tissues with increased glycolytic activity Inflammatory reactionInflammatory reaction

Physiological uptakePhysiological uptake brainbrain Brown fatty tissueBrown fatty tissue Stripped musclesStripped muscles Kidneys Kidneys Sallivary glandsSallivary glands

stagingstaging Bronchogenic carcinomaBronchogenic carcinoma Head and neck tumoursHead and neck tumours Lymfoma Lymfoma MelanoblastomaMelanoblastoma

BRCABRCA

BRCABRCA

Cerebral lymphomaCerebral lymphoma

Hodgkin diseaseHodgkin disease

Therapy strategyTherapy strategySarcoma tendinis Achill.Sarcoma tendinis Achill. LeiomyosarkomaLeiomyosarkoma Synovial sarcomaSynovial sarcoma

RestagingRestaging Therapy response effectTherapy response effect

DefinitiveDefinitive In the middle between cyclesIn the middle between cycles

Oropharyngeal cancerOropharyngeal cancer

18 months after

Early after Early after surgerysurgery

3 months later3 months later

Cervical cancerCervical cancer

Before thBefore th After thAfter th

myommyom

myommyom

CaCaCaCa

GradingGrading the assesment of the biologic activitythe assesment of the biologic activity More dedifferenciated – higher FDG More dedifferenciated – higher FDG

uptakeuptake

Low-grade astrocytomaLow-grade astrocytoma

Anaplastic oligodendrogliomaAnaplastic oligodendroglioma

Fever of unknown originFever of unknown origin

M. Hodgkin M. Hodgkin

Blastic turnover of the osteomyelofibrosisBlastic turnover of the osteomyelofibrosis

Microscopic polyarteritisMicroscopic polyarteritis

1818F-fluorothymidineF-fluorothymidine replication DNA = cellular proliferationreplication DNA = cellular proliferation

Fast dividing cellsFast dividing cells Tumors Tumors Bone marrowBone marrow Germinative zones of lymph nodesGerminative zones of lymph nodes Therapy monitoring – RT, CHTTherapy monitoring – RT, CHT

indicationsindications

1818F-natriumfluorideF-natriumfluoride Bone turnoverBone turnover

fluoroapatitefluoroapatite Osteoblastic activityOsteoblastic activity Osteoplastic bone metastasesOsteoplastic bone metastases

Ca prostateCa prostate Ca breastCa breast Ca lungsCa lungs

Bony tumorsBony tumors

Indications Indications