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THE FRONTIERS OF MEDICAL IMAGING FERRUCCIO FAZIO

THE FRONTIERS OF MEDICAL IMAGING FERRUCCIO FAZIO IBFM CNR, UNIVERSITY OF MILANO BICOCCA, H S. RAFFAELE, MILANO. IN VIVO MEDICAL IMAGING. X RAYS ULTRASOUND X RAYS COMPUTED TOMOGRAPHY CT MAGNETIC RESONANCE MR POSITRON EMISSION TOMOGRAPHY PET. HELICAL MULTI-SLICE CT.

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THE FRONTIERS OF MEDICAL IMAGING FERRUCCIO FAZIO

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  1. THE FRONTIERS OF MEDICAL IMAGING FERRUCCIO FAZIO IBFM CNR, UNIVERSITY OF MILANO BICOCCA, H S. RAFFAELE, MILANO

  2. IN VIVO MEDICAL IMAGING • X RAYS • ULTRASOUND • X RAYS COMPUTED TOMOGRAPHY CT • MAGNETIC RESONANCE MR • POSITRON EMISSION TOMOGRAPHY PET

  3. HELICAL MULTI-SLICE CT Solid State Detectors Ultra Fast Ceramics - Improved Temporal Resolution - Improved Axial Resolution - Wider Anatomical Coverage

  4. SINGLE-SLICE CT 1 sec/revolution

  5. HELICAL MULTI-SLICE CT 16 SLICES 0.4 sec/revolution 1.25 slice thickness 1000 images/whole body study

  6. HELICAL MULTI-SLICE CT CARDIAC IMAGING

  7. BOLD Gd PERFUSION DIFFUSION/ PERFUSION MORPHOLOGY FUNCTION MR MR ANGIOGRAPHY FLOW CHEMICAL CONTENT MR SPECTROSCOPY in vivo

  8. MAGNETIC RESONANCE ANGIOGRAPHY FAST GRADIENT ECHO DIGITAL ANGIOGRAPHY MR ANGIOGRAPHY Acute pulmonary embolism

  9. MAGNETIC RESONANCE DIFFUSION/PERFUSION IMAGINGECHO PLANAR SEQUENCES T2 weighted image DIFFUSION weighted image PERFUSION weighted image Acute trombosis of the left carotid artery.

  10. DIFFUSION TENSOR IMAGING - FIBER TRACKING

  11. DIFFUSION TENSOR IMAGING – FIBER TRACKING

  12. POSITRON EMISSION TOMOGRAPHY PET

  13. 30000 250 450 25000 400 PET/CT PET 200 Total 350 Expon. (Total) 20000 300 150 Nr. exams 250 PET or PET/CT 15000 Total PET scanners 200 100 10000 150 100 50 5000 50 0 0 0 1995 1996 1997 1998 1999 2000 2001 2002 1999 2000 2001 2002 Year Year ESTIMATED PET - PET/CT SCANNER UNITS WW CLINICAL PET IN ITALY TOTAL EXAMS/YEAR

  14. 18F-FDG WHOLE BODY PET • DIAGNOSIS • STAGING • RE-STAGING AND FOLLOW-UP • RADIOTHERAPY

  15. ADVANCES IN PET IMAGING RADIOCHEMISTRY INSTRUMENTATION HW/SW PET + PROTEOMICS/FUNCTIONAL GENOMICS NEW TRACERS PET  NEW SCINTILLATION CRYSTALS PET/CT

  16. [18F]FDG Glucose metabolism [18F]FESP D2 and 5-HT2 receptor antagonist [15O]H2O Cerebral flow, Studi attivazione funzionale [13N]AMMONIA Myocardial flow m-[11C]hydroxyefedrine Adrenergic antagonist [11C]FLUMAZENIL Benzodiazepine receptor antagonist [11C]RACLOPRIDE Dopamine D2 receptor antagonist [11C]FE-b-CIT Dopamine reuptake inhibitor [11C]SCH23390 Dopamine D1 receptor antagonist [11C]CARAZOLOL Adrenergic b1/b2 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 b1 antagonist [11C] ICI118551 Adrenergic b2 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 a2b4 antagonist [11C]VC195 Peripheral Benzodiazepine [11C]VC193M Peripheral Benzodiazepine [11C]VC198M Peripheral Benzodiazepine [11C] WAY100635 Serotonin 5-HT1A receptor antagonist [11C]RN5 Adrenergic a1 receptor antagonist [11C] VA100 Opioid K1 receptor antagonist [11C] CARFENTANIL Opioid m receptor agonist [11C] ZOFENOPRIL ACE inhibitor [18F]FLUORO CAPTOPRIL ACE inhibitor [11C] CNR1 a1 adrenergic antagonist [11C] PK1113195 Peripheral Benzodiazepine [11C] F167 s2 receptor antagonist [11C] PD60 dopamine D3 antagonist [11C] PD78 dopamine D3 antagonist RADIOTRACERS PREPARED AT HSR

  17. [18F]FDG-PET [11C]Choline-PET [99mTc]MDP B.P. 65 yrs PSA: 1,9 ng/ml PROSTATE CANCER

  18. 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 

  19. ADVANCES IN PET IMAGING RADIOCHEMISTRY INSTRUMENTATION HW/SW PET + PROTEOMICS/FUNCTIONAL GENOMICS NEW TRACERS PET  NEW SCINTILLATION CRYSTALS PET/CT

  20. FUTURE DEVELOPMENTS IN PET CURRENT DETECTORS: BGO, GSO, LSO • NEW DETECTORS with: • SMALLER SIZE (2-3 mm) • GOOD ENERGY RESOLUTION • DEPTH OF INTERACTION INFORMATION SANDWICH OF DETECTORS • FASTER DETECTORS for • HIGH COUNT RATE CAPABILITY • TIME OF FLIGHT INFORMATION

  21. ADVANCES IN PET IMAGING RADIOCHEMISTRY INSTRUMENTATION HW/SW PET + PROTEOMICS/FUNCTIONAL GENOMICS NEW TRACERS PET  NEW SCINTILLATION CRYSTALS PET/CT

  22. PET PET – [18F]FDG LACK OF ANATOMICAL INFORMATION

  23. PET CT PET/CT PET – [18F]FDG ANATOMICAL INFORMATION

  24. PET/CT CT PET

  25. 18F-FDG PET/CT HSR MILANO

  26. PET/CT - APPLICATIONS • ANATOMICAL LOCALIZATION OF PET FUNCTIONAL IMAGES • PET/CT GUIDED RADIOTHERAPY TREATMENT PLANNING

  27. METABOLICALLY AIMED RADIOTHERAPY (MART) CT PET TREATMENT PLAN CT BASED PET/CT BASED

  28. METABOLLICALLY AIMED RADIOTHERAPY MART PET/CT GUIDED RADIOTHERAPY PLANNING PET/CT VOLUME DEFINITION OPTIMIZED TREATMENT

  29. TOMOTHERAPY LUNG SIMULATION MD Anderson Houston

  30. TREATMENT UNDER RESPIRATION CONTROL 4D PET/CT Respiration control during PET/CT Target volume with precise motion information

  31. METABOLLICALLY AIMED RADIOTHERAPY MART PET GUIDED IMRT/TOMOTHERAPY IMPROVED TUMOR/NON TUMOR RADIATION DOSE HYPO-FRACTIONATION 30-40  5-10 fractions

  32. ADVANCES IN PET IMAGING RADIOCHEMISTRY INSTRUMENTATION HW/SW PET + PROTEOMICS/FUNCTIONAL GENOMICS NEW TRACERS PET  NEW SCINTILLATION CRYSTALS PET/CT

  33. 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

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