PET CT-1.pptx

It's all about principal and clinical applications of PET scan

1. PRINCIPLES & APPLICATIONS OF PET - CT

2. PET/CT Medical Imaging Technique Both systems in one Gantry Aquired image combined into a coregistered image Functional imaging by PET Anatomical imaging by CT-Scanner 2 By Eng. Abdulkader Helwan

3. PET/CT Combines the functional information with the anatomical detail Accurate anatomical registration Higher diagnostic accuracy than PET or CT alone 3 By Eng. Abdulkader Helwan

4. 4 By Eng. Abdulkader Helwan

5. Fused PET/CT images

6. PET Stands for positron emission tomography Machine that can image biological and chemical activities F o r e x : imag i n g b r ain activity when the r e is a scary event Active part of brain can’t be imaged using x-ray of only CT It can be imaged using PET 7 By Eng. Abdulkader Helwan

7. Principles of PET Inject a radioactive tracer bind with glucose The active part of brain absorbs it more than other inactive parts The radioactive tracer is: Fluorine-18-deoxyglucose (FDG), a radionuclide labeled glucose analogue is injected into the organ that would be imaged 8 By Eng. Abdulkader Helwan

8. PET tracer: FDG Fluoro d eoxy g lucose is a glucose analog. Its full chemical name is 2-fluoro-2-deoxy-D-glucose , commonly abbreviated to FDG. Radioactive fluoride atom produced in a cyclotron is attached to a molecule of glucose. The FDG molecule is absorbed by various tissues just as normal glucose would be. 9 By Eng. Abdulkader Helwan

9. FDG CH 2 HO HO HO O OH 18 F C H 2 HO HO HO O O H OH glucose 2-deoxy-2-(F-18) fluro-D-glucose Most widely used PET tracer Glucose utilization Taken up avidly by most tumours It is absorbed by various tissues as normal glucose would be. 9 By Eng. Abdulkader Helwan

10. Figure 3. Uptake of FDG. FDG is a glucose analog that is taken up by metabolically active cells by means of facilitated transport via glucose transporters (Glut) in the cell membrane. Kapoor V et al. Radiographics 2004;24:523-543 ©2004 by Radiological Society of North America

11. FDG Metabolism FDG FDG -6-P Rad i o - act i v e Glucose 18 F-FDG Radioactive Glucose 18 F-FDG X Glucose Glucose Glucose G l uc ose - 6- Pho s pha te Unlike glucose, FDG is trapped 11

12. PET Radiopharmaceuticals Nuclide Half-life Tracer Application O-15 2 mins Water Cerebral blood flow C-11 20 mins Methionine Tumour protein synthesis N-13 10 mins Ammonia Myocardial blood flow F-18 110 mins FDG Glucose metabolism Ga-68 68 min DOTANOC Neuroendocrine imaging Rb-82 72 secs Rb-82 Myocardial perfusion 12

13. Positron and Photons Emission Kapoor V et al. Radiographics 2004;24:523-543 ©2004 by Radiological Society of North America

14. Annihilation Reaction The positron annihilates with an electron to release energy in the form of coincident photons : 15

15. Coincidence Detection 16

16. Figure 5. Photograph (frontal view) of a hybrid PET-CT scanner shows the PET ring detector system (red ring). Kapoor V et al. Radiographics 2004;24:523-543 ©2004 by Radiological Society of North America 17

17. CRYSTALS USED IN PET BaF 2 – Barium Flourid e (0.8ns) BGO – Bismuth Germinate Oxide (300ns) LSO – Lutetium Orthosilicate (40ns) GSO – Gadolineum Orthosilicate (60ns) YLSO – Yttrium Lutetium Orthosilicate (40ns) 17

18. Data Acqusition The detection of photon pairs by opposing crystals create one event (LOR) Millions of this event will be stored within sinograms and used to reconstruct the image Spatial resolution is determined by the size of the crystal and their separation and is typically 3-5mm 22

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22. Interpretation of Images PET provides images of quantitative uptake of the radionuclide injected that can give the concentration of radiotracer activity in kilobecquerels per milliliter . Methods for assessment of radiotracer uptake – visual inspection standardized uptake value (SUV) glucose metabolic rate 30

23. SUV Standardized Uptake Value The SUV is a semiquantitative assessment of the radiotracer uptake from a static (single point in time) PET image. Malignant tumors have an SUV of greater than 2.5–3.0, whereas normal tissues such as the liver, lung, and marrow have SUVs ranging from 0.5 to 2.5. The SUV of a given tissue is calculated with the following formula:

24. Limitations of PET/CT FDG is not cancer specific and will accumulate in any areas of high rates of metabolism and glycolysis. Therefore, increased uptake can be expected in all sites of hyperactivity at the time of FDG administration (e.g. muscles and nervous system tissues); at sites of active inflammation or infection 28

25. The distribution of FDG within a normal individual (MIP). 31

26. Physiologic FDG uptake

27. Figure 17b. Kapoor V et al. Radiographics 2004;24:523-543 ©2004 by Radiological Society of North America

28. Figure 18. Non-small cell lung carcinoma in a 78-year-old man with enlarged hilar and mediastinal lymph nodes. Kapoor V et al. Radiographics 2004;24:523-543 ©2004 by Radiological Society of North America

29. Figure 20. Large cell lung cancer in a 54-year-old woman. Kapoor V et al. Radiographics 2004;24:523-543 ©2004 by Radiological Society of North America

30. Identification of distant metastatic disease Top Tip Evidence suggests that the removal of a solitary adrenal deposit at the time of resection of the lung primary results in an increased life expectancy. Liver, adrenal, brain and bony deposits are common with lung cancer but many of the lesions are undetected in the course of conventional staging

31. ASSESSMENT OF TREATMENT RESPONSE Pretherapy and post therapy studies showing a complete metabolic response to therapy.

32. PET in Neurology The Active Human Brain

33. Hypo metabolism in left temporal lobe secondary to epilepsy

34. THANK YOU new ideas make work interesting 40