THE FRONTIERS OF MEDICAL IMAGING

FERRUCCIO FAZIOIBFM CNR, UNIVERSITY OF MILANO BICOCCA, H S. RAFFAELE, MILANO

• X RAYS

• ULTRASOUND

• X RAYS COMPUTED TOMOGRAPHY CT

• MAGNETIC RESONANCE MR

• POSITRON EMISSION TOMOGRAPHY PET

IN VIVO MEDICAL IMAGING

- Improved Temporal Resolution

- Wider Anatomical Coverage

- Improved Axial Resolution

HELICAL MULTI-SLICE CT

Solid State DetectorsUltra Fast Ceramics

SINGLE-SLICE CT

1 sec/revolution

HELICAL MULTI-SLICE CT16 SLICES

0.4 sec/revolution1.25 slice thickness1000 images/whole body study

HELICAL MULTI-SLICE CTCARDIAC IMAGING

MORPHOLOGY

FUNCTION

FLOW

CHEMICAL CONTENT

MR

BOLD

Gd PERFUSION

DIFFUSION/PERFUSION

MR ANGIOGRAPHY

MR SPECTROSCOPYin vivo

MAGNETIC RESONANCE ANGIOGRAPHYFAST GRADIENT ECHO

MR ANGIOGRAPHY

DIGITAL ANGIOGRAPHY

Acute pulmonary embolism

MAGNETIC RESONANCE DIFFUSION/PERFUSION IMAGING

ECHO PLANAR SEQUENCES

Acute trombosis of the left carotid artery.

T2 weighted image

DIFFUSIONweighted image

PERFUSION weighted image

DIFFUSION TENSOR IMAGING - FIBER TRACKING

DIFFUSION TENSOR IMAGING – FIBER TRACKING

POSITRON EMISSION TOMOGRAPHYPET

CLINICAL PET IN ITALYTOTAL EXAMS/YEAR

Nr.

exa

ms

0

5000

10000

15000

20000

25000

30000

1999 2000 2001 2002Year

0

50

100

150

200

250

1995 1996 1997 1998 1999 2000 2001 2002

Year

PET

or

PET

/CT

0

50

100

150

200

250

300

350

400

450

Tot

al P

ET

scan

ners

PET/CTPETTotalExpon. (Total)

ESTIMATED PET - PET/CT

SCANNER UNITS WW

18F-FDG WHOLE BODY PET

DIAGNOSIS

STAGING

RE-STAGING AND FOLLOW-UP

RADIOTHERAPY

RADIOCHEMISTRY

INSTRUMENTATION HW/SW

PET + PROTEOMICS/FUNCTIONAL GENOMICS

ADVANCES IN PET IMAGING

NEW SCINTILLATION CRYSTALS

PET/CT

NEW TRACERS PET

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

B.P. 65 yrsPSA: 1,9 ng/ml

PROSTATE CANCER

[11C]Choline-PET[18F]FDG-PET [99mTc]MDP

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

RADIOCHEMISTRY

INSTRUMENTATION HW/SW

PET + PROTEOMICS/FUNCTIONAL GENOMICS

ADVANCES IN PET IMAGING

NEW SCINTILLATION CRYSTALS

PET/CT

NEW TRACERS PET

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

RADIOCHEMISTRY

INSTRUMENTATION HW/SW

PET + PROTEOMICS/FUNCTIONAL GENOMICS

ADVANCES IN PET IMAGING

NEW SCINTILLATION CRYSTALS

PET/CT

NEW TRACERS PET

PET

PET – [18F]FDG

LACK OF ANATOMICAL INFORMATION

PET CT PET/CT

PET – [18F]FDG

ANATOMICAL INFORMATION

PET CT

PET/CT

HSR MILANO

18F-FDG PET/CT

PET/CT - APPLICATIONS

• ANATOMICAL LOCALIZATION OF PET FUNCTIONAL IMAGES

• PET/CT GUIDED RADIOTHERAPY TREATMENT PLANNING

METABOLICALLY AIMED RADIOTHERAPY (MART)

CT PET

CT BASED PET/CT BASED

TREATMENT PLAN

OPTIMIZED TREATMENT

PET/CTVOLUME DEFINITION

PET/CT GUIDED RADIOTHERAPY

PLANNING

METABOLLICALLY AIMED RADIOTHERAPYMART

LUNG SIMULATION

TOMOTHERAPY

MD Anderson Houston

4D PET/CTRespiration control during PET/CT

Target volume with precise motion information

TREATMENTUNDER

RESPIRATION CONTROL

HYPO-FRACTIONATION30-40 5-10 fractions

PET GUIDED IMRT/TOMOTHERAPY

IMPROVED TUMOR/NON TUMOR RADIATION DOSE

METABOLLICALLY AIMED RADIOTHERAPYMART

RADIOCHEMISTRY

INSTRUMENTATION HW/SW

PET + PROTEOMICS/FUNCTIONAL GENOMICS

ADVANCES IN PET IMAGING

NEW SCINTILLATION CRYSTALS

PET/CT

NEW TRACERS PET

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