xSPECT – Advances in Nuclear Medicine · Department of Nuclear Medicine. LMU Munich Mandatory...

Department of Nuclear MedicineUniversity Hospital of Munich

chairman: Prof. Dr. med. P. Bartenstein

xSPECT – Advances in Nuclear Medicine27. Ulusal Nükleer Tıp Kongresi

01. – 05. Nisan 2015, Adana, Turkey

Harun IlhanDepartment of Nuclear MedicineUniversity Hospital of MunichMarchioninistr. 15, 81377 Munich, GermanyEmail: harun.ilhan@med.uni-muenchen.de

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Nuclear Medicine and Theranostic

Department of Nuclear MedicineLMU Munich

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

What is „theranostics“?

Department of Nuclear MedicineLMU Munich

Combination of therapy and diagnostic

Therapeutic procedure or product followed by diagnostic procedure(e.g. drug efficacy for patients with specific diseases)

Diagnostic procedure followed by therapeutic procedure(e.g. imaging procedure for therapy indication)

Tumor characterization by specific radiopharmaceuticals

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Personalized medicine

Department of Nuclear MedicineLMU Munich

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Theranostics example

Department of Nuclear MedicineLMU Munich

Diagnostic Ga-68 DOTA TATE PET for patient evaluation for Peptide-Receptor-Radionuclide-Therapy with Lu-177 DOTA TATE

68Ga-DOTATATE

177Lu

HOH2C

OH

HN

O

S

HN

O

OH

HN

S

HN

O

HN

O

HN

OH

O

NH

NH

O

O

HN

NH2

O

N

N

N

N

COOHHOOC

HOOC

90Y68Ga

HOH2C

OH

HN

O

S

HN

O

OH

HN

S

HN

O

HN

O

HN

OH

O

NH

NH

O

O

HN

NH2

O

N

N

N

N

COOHHOOC

HOOC

90Y

68Ga-DOTATATE

90Y-DOTATATE177Lu-DOTATATE

177LuHOH2C

OH

HN

O

S

HN

O

OH

HN

S

HN

O

HN

O

HN

OH

O

NH

NH

O

O

HN

NH2

O

N

N

N

N

COOHHOOC

HOOC

90Y68Ga

177Lu

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

2005

4509 FDG803 Ga-TATE583 FET282 FEC

84 Alzheimercomp. 69 FDOPA50 DMFP/FP

8 Ga-PSMA .6389 total

PET Radiopharmaceuticals 2005 and 2013

2490 FDG122 FET

54 Choline2666 total

2005

2013

FDG93,40%

FET4,58%

Cholin2,03%

FDG70,57%

FET9,13%

Ga-TATE12,57%

FEC4,43%

FDOPA1,08%

DMFP0,67%

FP0,11%

Ga-PSMA0,13%

F-18 AlzComp1,31%

Department of Nuclear MedicineLMU Munich

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Do we need scintigraphy in this situation?

Department of Nuclear MedicineLMU Munich

Increasing demand for SPECT

Number of scintigraphic investigations at theDepartment of Nuclear Medicine, LMU Munich 2006 - 2013

years

Num

bero

fInv

estig

atio

ns

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Relevance of Molecular Imaging and SPECT

Department of Nuclear MedicineLMU Munich

EANM 2007 Statistics Survery: Σ 7.5 x 106 per year

Installed cameras:PET and PET/CT: 503SPECT Cameras: 4250

0,0E+00

5,0E+05

1,0E+06

1,5E+06

2,0E+06

2,5E+06

Ske

leta

l

Endo

crin

e

Myo

card

Oth

ers

Lun

g

PET

+P

ET/C

T

Ren

al

In-Vivo Diagnostic Procedures in the USA

Delbeke and Segall; J Nucl Med 2011Status of and trends in Nuclear Medicine in the United States:

Total: 17 x 106 per yearPET/CT and PET: 1.5 x 106 per year

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Relevance of SPECT

Department of Nuclear MedicineLMU Munich

www.eanm.org – Technopolis report summary

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Relevance of SPECT

Department of Nuclear MedicineLMU Munich

www.eanm.org – Technopolis report summary

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Relevance of SPECT

Department of Nuclear MedicineLMU Munich

www.eanm.org – Technopolis report summary

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Advantages of SPECT imaging

Department of Nuclear MedicineLMU Munich

Installed camera basis

Logistics(Availability of kits, radiopharmaceutical production and distribution)

Development of new camera types / reconstruction algorithms

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

PET vs. SPECT in clinical oncology

Department of Nuclear MedicineLMU Munich

Mandatory requirements for the future:

adequate radiopharmaceuticals

development in camera systems and reconstruction methods

Inferiority of SPECT in terms of spatial resolution and quantification

However, due to availability, costs, logistics SPECT might be the better choice

Siemens Symbia Intevo

the world`s first xSPECT system

„see the unseen“

„quantify the difference“

„adapt the lowest dose“

„double the throughput“

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

PET vs. SPECT in clinical oncology

Department of Nuclear MedicineLMU Munich

Mandatory requirements for the future:

adequate radiopharmaceuticals

development in camera systems and reconstruction methods

Inferiority of SPECT in terms of spatial resolution and quantification

However, due to availability, costs, logistics SPECT might be the better choice

Siemens Symbia Intevo

the world`s first xSPECT system

„see the unseen“

„quantify the difference“

„adapt the lowest dose“

„double the throughput“

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Radiopharmaceuticals for theranostic approaches

Department of Nuclear MedicineLMU Munich

I-131

I-131 MIBG

Ga-68 / Lu-177 somatostatine receptor ligands

Ga-68 / Lu-177 PSMA

Y-90 Ibritumomab

Y-90 Microspheres

Ra-223 Dicholride

Sm-153 EDTMP

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Radiopharmaceuticals for theranostic approaches

Department of Nuclear MedicineLMU Munich

I-131

I-131 MIBG

Ga-68 / Lu-177 somatostatine receptor ligands

Ga-68 / Lu-177 PSMA

Y-90 Ibritumomab

Y-90 Microspheres

Ra-223 Dicholride

Sm-153 EDTMP

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Department of Nuclear MedicineLMU Munich

Somatostatine-receptor ligands for therapy and diagnostics

HOH2C

OH

HN

O

S

HN

O

OH

HN

S

HN

O

HN

O

HN

OH

O

NH

NH

O

O

HN

NH2

O

N

N

N

N

COOHHOOC

HOOC

90Y

68Ga-DOTATATE

90Y-DOTATATE177Lu-DOTATATE

HOH2C

OH

HN

O

S

HN

O

OH

HN

S

HN

O

HN

O

HN

OH

O

NH

NH

O

O

HN

NH2

O

N

N

N

N

COOHHOOC

HOOC

90Y

177Lu

68Ga

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Neuroendocrine Tumors

Department of Nuclear MedicineLMU Munich

DOTATATE-PET Conventional Octreotide-scintigraphy

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Relevance of quantification and dosimetry

Department of Nuclear MedicineLMU Munich

Courtesy Juri Ruf; Dept. of Nuclear Medicine, Univ. Freiburg

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Neuroendocrine Tumors

Department of Nuclear MedicineLMU Munich

60yr patient, NET of the pancreas with lymphnode and hepatic filiaeGa-68 DOTATATE PET/CT prior to therapy and after 2 cycles

2 x therapywith 7400 MBq

177Lu-DOTATATE

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

RESULTS – 177LU-DOTATATE

310 patients1

CR 2%, PR 28%, MR 16%

SD 35%

PD 20%

Median TTP 40 months

Median survival

46 months

Significant improvement of QoLin 50 patients2

1 Kwekkeboom et al., JCO 20082 Teunissen et al., JCO 2004

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

0

25

50

75

100

125

150

175

200

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

ther

apie

s

year

DOTA-TATE therapies / year

Department of Nuclear MedicineLMU Munich

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

PRRT THERAPY AND THERAPY MONİTORİNG

177Lu-DOTATATEPRRT

Planar dynamicscintigraphy

Therapy

Planar + SPECT

Blood samplesUrine

72h p.i.

Planar + SPECT

Blood samples

Planar + SPECT

Blood samples

Planar + SPECT

Blood samples

24h p.i. 48h p.i.1h p.i.Diagnostic

PET/CT

Department of Nuclear MedicineLMU Munich

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Neuroendocrine Tumors

Department of Nuclear MedicineLMU Munich

38yr female patient, NET of the ileum with liver and spleen metastases

Currently undergoing 3rd cycle of Lu-177-DOTATATE treatment

Day 0 Day 1 Day 2 Day 3

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Lu-177-DOTATATE SPECT/CT: xSPECT Reconstruction

Department of Nuclear MedicineLMU Munich

upper energy window (both available)currently no quantitation available (at our site)

Day 0 Day 1 Day 2 Day 3Day 0 Day 1

Day 2 Day 3

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Lu-177-DOTATATE SPECT/CT: LMU-Reconstruction

Department of Nuclear MedicineLMU Munich

DOSE ESTIMATIONS„manual“ method

Day 0 Day 1 Day 2 Day 3Day 0

SPECT/CT (day 0)

SPECT/CT (day 3)

SPECT/CT (day 0)

SPECT/CT (day 3)

Spleen met. Liver met.

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Lu-177-DOTATATE SPECT/CT: LMU-Reconstruction

Department of Nuclear MedicineLMU Munich

DOSE ESTIMATIONS

Day 0 Day 1 Day 2 Day 3Day 0

Organ Dose[Gy]

T1/2[h]

Tumor (spleen) 15.2 77.7

Tumor (liver) 10.5 65.7

Kidney (left) 4.2 72.2

Kidney (right) 4.5 61.5

Bone marrow 0.04 9.1 (0.5 fast)

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Radiopharmaceuticals for theranostic approaches

Department of Nuclear MedicineLMU Munich

I-131

I-131 MIBG

Ga-68 / Lu-177 somatostatine receptor ligands

Ga-68 / Lu-177 PSMA

Y-90 Ibritumomab

Y-90 Microspheres

Ra-223 Dichloride

Sm-153 EDTMP

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Radiopharmaceuticals for theranostic approaches

Department of Nuclear MedicineLMU Munich

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Glu-NH-CO-NH-Lys-(Ahx)-[68Ga(HBED CC)]

68Ga-PSMA in clinical routine

„bench to bedside“

6/2012first patient data from Afshar-Oromieh, et al. in Heidelberg:[68Ga]Gallium-labelled PSMA ligand as superior PET tracer for the diagnosis of prostate cancer: comparison with 18F-FECHAfshar-Oromieh A, Haberkorn U, Eder M, Eisenhut M, Zechmann CM.Eur J Nucl Med Mol Imaging. 2012 Jun;39(6):1085-6

since 12/2013clinical routine at our institution

Department of Nuclear MedicineLMU Munich

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

CLİNİCAL TRANSLATİON

0 20 40 600

1

2

3

4 Tumor

TumorBackground

Background

time after injection [min]

% ID

/ g [68Ga]HBED-CC-

conjugate

[68Ga]Reference

Preclinical : LNCaPXenografts

Patient:recurrent prostate cancer

68Ga-PSMA

18F-choline

Department of Nuclear MedicineLMU Munich

Courtesy Uwe Haberkorn, Dept. of Nuclear MedicineUniversity Hospital Heidelberg

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Tracer-Uptake in human studies

Department of Nuclear MedicineLMU Munich

Courtesy Uwe Haberkorn, Dept. Nuclear MedicineUniversity Hospital Heidelberg

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Ga-68 PSMA PET / CT in metastatic prostate cancer

Department of Nuclear MedicineLMU Munich

high uptake in bone and soft tissue metastases

therapy option with Lu-177 labelled ligands

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Ga-68 PSMA PET / CT and Lu-177-PSMA therapy

Department of Nuclear MedicineLMU Munich

Ga-68 PSMA Lu-177 PSMA

Male, 54 y, 84 kg, prostate-CA, 1 x 223Ra, 1st cycle of 177Lu-PSMA (3.7 GBq)

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Lu-177-PSMA wholebody planar images

Department of Nuclear MedicineLMU Munich

68Ga-PSMAPET/CT

177Lu-PSMA WB planar

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Lu-177-PSMA quantitative SPECT/CT: LMU-reconstruction

Department of Nuclear MedicineLMU Munich

PET/CT LMU-Recon of SPECT & SPECT/CT (Siemens Symbia T1)

Day 1 Day 2 Day 3(68Ga-PSMA) Day 0

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Lu-177-PSMA quantitative SPECT/CT: LMU-reconstruction

Department of Nuclear MedicineLMU Munich

SPECT/CT (day 0)

SPECT w/ ext. CT (day 3)

SPECT/CT (day 0)

SPECT w/ ext. CT (day 3)

Spine met. Rib met.

DOSE ESTIMATION„manual“ method

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Lu-177-PSMA quantitative SPECT/CT: LMU-reconstruction

DOSE ESTIMATION

Department of Nuclear MedicineLMU Munich

Organ Dose[Gy]

T1/2[h]

Tumor (rib) 7.6 93.6

Tumor (spine) 5.7 67.8

Kidney (left) 2.3 30.4

Kidney (right) 2.2 31.8

Bone marrow 0.04 6.4 (0.5 fast)

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Relevance of quantification / dosimetry

Department of Nuclear MedicineLMU Munich

Patient selection

Selection of radionuclide

Therapy monitoring and response

Correlation with clinical outcome

Current issues:

calibration

time and labour

manually co-registration

segmentation of relevant organ structures

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Relevance of Absolute Quantificatione.g. Samarium-153 EDTMP

Department of Nuclear MedicineLMU Munich

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

12.12.2013 (pretherapy) 30.04.2014 (after 6 cycles Ra-223)

Therapy response following Ra-223 therapy in metastatic prostate cancer

PSA (ng/ml):Pre-therapy: 239After 6 cycles: 16,6Follow-up 3 months after 6th cycle: 9,98

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Differentiation of benign and malignant lesions

62 year old female

Breast cancer 1998

s/p ablatio mammae

s/p radiotherapy

s/p pulmonary metastasis and lungresection

CT scan in outside clinic with suspectedmetastasis of the R. inferior ossis pubisand the sacroiliac joint

Department of Nuclear MedicineLMU Munich

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Patient example – pelvis – Flash 3D

Focal activity in the ischial tuberosity without explicit CT-correlate

benign? malignant?

Department of Nuclear MedicineLMU Munich

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Patient example – pelvis – MRI scan

Tendinitis of the flexor muscle insertion in the ischial tuberosity

No signs for malignancy

Department of Nuclear MedicineLMU Munich

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Patient example – pelvis – xSPECT

distinct focal activity; differential diagnosis, however, remains difficult

less overestimation as compared to Flash 3D

Department of Nuclear MedicineLMU Munich

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Patient example – pelvis – xSPECT

Absolute quantification of uptake as a reference standard?

Department of Nuclear MedicineLMU Munich

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Animal models – further research

Department of Nuclear MedicineLMU Munich

Siemens Intevo

170 MBq Tc-99m-DPD

SPECT parameters xSPECT bone recon 256 matrix, 64 views, 30 sec

CT parameters 16 slices 0,75 mm

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

NAME DER EİNRİCHTUNG.KANN AUCH 2 ZEİLİG SEİN

THANK YOU VERY MUCHFOR YOUR ATTENTİON!

Department of Nuclear MedicineLMU Munich

Harun IlhanDepartment of Nuclear MedicineOncology WorkgroupLMU MunichMarchioninistr. 15, 81377 MunichTel: +4989 / 7095-4646Fax: +4989 / 7095-7646Email: harun.ilhan@med.uni-muenchen.de

Special thanks to:Meltem Yorulmaz, Siemens MedicalMehmet Aycin, Siemens MedicalHans Vija, Siemens Medical

Peter Bartenstein, LMU MunichGuido Böning, LMU MunichAndreas Delker, LMU MunichTechnichal staff LMU MunichHans Vija, Siemens MedicalJuri Ruf, Univ. FreiburgUwe Haberkorn, Univ. Heidelberg

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Patient 9

63 year old male

suspected stress shielding

total hip prosthesis left 2009

s/p tibia fracture left

s/p foot ancle fracture right

Department of Nuclear MedicineLMU Munich

tracer accumulation around prosthesis stem sign for loosening

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Patient 9 – xSPECT vs. Flash 3D

Department of Nuclear MedicineLMU Munich

tracer accumulation as a sign for prosthesis loosening Flash 3D seems „diffuse“, whereas xSPECT is clearyl located around the prosthesis stem

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Patient 7

65 year old male

prostate cancer

s/p thoracal spine osteosynthesis

s/p prosthesis right hip

severe pain in lumbal spine

Department of Nuclear MedicineLMU Munich

tracer accumulation in lumbal spine malignant? inflammation? fracture?

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Patient 7 – lumbal spine – Flash 3D

upper and lower end plate deformity in lumbal vertebra

s/p fracture (osteoporotic)

diagnose only in awareness of CT

Department of Nuclear MedicineLMU Munich

NAME DER EİNRİCHTUNGKANN AUCH 2 ZEİLİG SEİN

KLINIKUM DER UNIVERSITÄT MÜNCHEN®

Patient 7 – lumbal spine – xSPECT

confirmation of diagnose

all relevant information included in xSPECT

Department of Nuclear MedicineLMU Munich