31-1-214 Klinik for Klinisk Fysiologi, Nuklearmedicin & PET Sidehoved / Sidefod. Indføj Sted og dato i PET/ - fysik, forskning, klinik Adam Espe Hansen, PET/-fysiker Klinik for Klinisk Fysiologi, Nuklearmedicin & PET Rigshospitalet, København DRS årsmøde, Videnskabeligt møde for DSKFNM Odense, 31. januar 214 7. patient undersøgelser i 213 8. PET skanninger 2 cyklotroner & radiokemi 5 PET/CT, 1 PET/HRRT, 1 PET/ PET/CT og dyreskannere PET/: Doneret af John og Birte Meyer Fonden Første skanninger februar 212 9 undersøgelser indtil januar 214 The vision of simultaneous PET/ Combined PET/ designs Fusion of PET functional imaging, with anatomic imaging Combination of PET functional imaging with functional imaging Reduction of patient dose by replacing CT with I Simultaneity for reducing / studying physiologic effects Vendor Year Systems TOF-PET Integration Philips 21 1-15 Yes Co-planar Siemens 211 >4 No Simultaneous GE 214 (?) (3) Yes Simultaneous PET A E Hansen Co-planar Simultaneous Integrated PET/ Tekniske udfordringer m Siemens Biograph 6 cm bore size Standard PET detectors do not work in a magnetic field PET: : APD detectors 3 Tesla magnet Performance: Delso et al., JNM (211) 1
Bq/ml Truncation Truncation Restored Restored 31-1-214 PET is a quantitative technique - IF all the necessary corrections are applied, including: Deadtime Geometry, Normalization Randoms subtraction Attenuation and scatter Decay Calibration factor from counts to Bq/ml PET attenuation correction from DWFS: 4-class tissue segmentation of Water Air Fat Lungs (post-processing) VIBE-Dixon In phase Out of phase Water Fat Martinez-Möller, JNM (29) -map 8 4 Non-corrected Attenuation corrected PET og FOV MLAA correction of truncation STIR FDG PET + MLAA FOV: 5 cm x 5 cm -map AC-PET -map AC-PET PET FOV : 26 cm x 59 cm MLAA: Maximum Likelihood Estimation of Attenuation and Activity Nuyts, IEEE-TMI (212) Extension of Field-Of-View Spin-echo sequence Gradients are used to compensate for field inhomogeneities Frequency direction only Metal artefakter i PET/CT & PET/ CT μ-map PET (/CT) PET (/) A E Hansen Keller S et al. MAGMA (213) 2
Front Back m SUVmax 31-1-214 Korrektion af metal artefakter ved inpainting PET/ receive coils (integrated system) original inpaint PET (/) -map No AC 16 channel Head/Neck coil CT of bed for attenuation corr. - Optimized with respect to PET attenuation - Attenuation by fixed coils (*) are included in PET reconstruction - Avaliable m coils: *Head/Neck (16 channels) *Head coil (12 channels) *Spine (24 channels) Body-flex (6 channels) 5 *Breast (4 channels) Special-purpose (4 channels) CN Ladefoged, FL Andersen, SH Keller, J Löfgren, AE Hansen, S Holm, L Højgaard, T Beyer; EJNMMI (213) Attenuation by surface coils Up to 15% error due to body-flex coil Body-Flex coil Validation of FDG-PET/ imaging in gynecological cancer compared to standard clinical FDG-PET/CT 25 PET(/CT) 2 y = 1,427x -,877 R² =,983 15 1 PET(/) 5 5 1 15 2 25 PET/CT SUVmax (non TrueX) Tellmann, Med Phys (211); MacDonald, Med Phys (212) Paulus, A E Hansen Med Phys (212); Paulus, Med Phys (212) J Löfgren, EANM 212 Recent PET/ to PET/CT comparisons (1) University College London: Al-Nabahani et al., JNM (214) 5 oncology patients, 227 tracer-avid lesions, 225 identified on PET/CT, 227 identified on PET/ by 3 independent observers. 5/5 patients had improvement in local staging with PET/ imaging, compared with PET/CT. Recent PET/ to PET/CT comparisons (2) Technische Universität München: Eiber et al., JNM (214) 119 patients, bone metastases evaluated with FDG-PET. 98 lesions, 9 malignant, (85/9) [PET/CT], (84/9) [PET/1], (86/9) [PET/2] were correctly classified. bone lesions normal bone 3
31-1-214 18 F-FDG, PET/ versus PET/CT in brain % difference, PET/ versus PET/CT in brain PET/CT T=17 min kbq/ml 37 22 HU 124 PET/ 17 min PET/CT PET(/) DWFS - PET(/CT) CT 1 PET(/CT) CT -124 CT % kbq/ml 3 22 µ cm -1 1.5-1 % -2 % PET/ T= -3 % Spatial bias of PET from PET/? Normalized to global mean=1.6 DWFS µ -map -4 % Radial fejl i estimeret PET(/) aktivitet Evaluering af attenuations korrektion, hjerner Opsamling, attenuations korrektion: Studie med 19 patienter, PET/ og PET/CT, randomiseret rækkefølge Regional fejl ses i alle patienter Fejl skyldes manglende knogle i attenuations billede Fejlen kan rettes hvis CT fra PET/CT bruges til attenuationskorrektion af PET(/) Knogle attenuation kan ikke negligeres i hjernen Her-og-nu løsning: lavdosis CT til alle PET/ hjerner spoler: løst, implementeret af leverandør (for faste spoler, ikke for fleksible overflade spoler) For lille Field-Of-View: løst, implementeret af leverandør Metal artefakter: løst, implementeret af Siemens (for hofte proteser) / Rigshospitalet løsning (for dental artefakter) Kranie knogler: ikke løst, nødløsning med CT implementeret på Rigshospitalet Anvendelse af PET/ på Rigshospitalet PET/ Rigshospitalet år 1-2 Region Tracer 9 undersøgelser indtil januar 214 18 godkendte etiske protokoller 4
31-1-214 Examples of PET tracers First PET/I of carotid arteries C11-PiB: b-amyloid deposits FET: amino acid turnover CT C11-PiB FET FDG-PET/CT FDG-PET/ PET/ yields same quantification as PET/CT but superior delineation of the vasculature. NaF: uptake in bone NaF FDG: glucose turn-over FDG PET/ seems apt in the study of early atherosclerosis. Ripa RS et al.. Am J Nucl Med 213 Diffusion Weighted Imaging FDG-PET and DWI/ADC Cancer tissue Normal tissue Low Apparent diffusion coefficient (ADC) High Apparent diffusion coefficient (ADC) Koh, Collins, AJR (27) Kjaer A, et al., MAGMA (213) PET/ with DWI versus PET/CT in head/neck PET funktion + anatomi, hoved/hals PET/CT PET/ FDG-PET PET/ fusion STIR CT FDG-PET T2w PET/ T2w DWI b=8 DWI ADC PET/ ADC assessment T2stir cor T1w cor Dixon W God anatomisk overensstemmelse ml. PET og I /J. Löfgren, data from study by J. Rasmussen, B.M. Fischer et al. J. Rasmussen, B.M. Fischer et al. 5
31-1-214 [11C]-PiB T1w T2w FLAIR FET-PET og flow i glioblastom : T1w : FLAIR PET/ T2* SWI Diffusion Hippocampal Vol : T2w FET-PET : ASL Patient suspected of Alzheimers disease (F, 72 Y) Comprehensive one-stop shopping identifying multiple risk factors for dementia - 3 min examination / Ian Law, VA Larsen Amino acid turnover Blood flow PET/ til pædiatriske undersøgelser 13-årig pige henvist til PET/CT obs. Infektion, ukendt primær tumor? (dissemineret rhabdomyosarcoma) PET/ sparer CT stråledosis Klinisk brug af PET/ på Rigshospitalet 23 kliniske PET/ hjerne undersøgelser [PiB: 12; FDG: 145; FET:73] (nogle kun PET beskrevet) Stor klinisk relevans af FDG-PET/ til demens (3-4 PET/CT us årligt); PiB; FET; 15 O-H 2 til diamox test Uden for hjernen: 3 beskrivelser på projekt pt, hvor PET/ været brugt som supplement i diagnosen [NaF, sarkomer, børn, ] Klinisk relevans: sarkomer, cervix cancer, hoved/hals cancer, børn, patienter med gentagne undersøgelser (lymfomer) PET MIP PET/ T2 STIR T1 TSE PET /Johan Löfgren, Helle Hjorth Johannesen, Lise Borgwardt Copenhagen PET/I next step the first simultaneous, whole-body PET/I & hyperpolarizer 6
31-1-214 Hyperpolariseret 13 C Hyperpolarized 13 C-pyruvate in prostate cancer -synlig isotop Hyppighed af isotop Forekomst i biologisk væv 1 H 99,99 % 63 % 13 C 1,1 %,13 % Dyreforsøg: 13C-pyruvate til laktat produktion 13C-bicarbonat til måling af extracellulær ph 13C-fumarat til malat produktion som nekrose markør Hyperpolarisator: lav temperatur, højt magnetfelt: Polarisering op 1. til 1. gange! 1 st human study, performed at UCSF Nelson SJ et al. Sci Transl Med 213 Tak til The John and Birte Meyer foundation Sidehoved / Sidefod. Indføj Sted og dato i Liselotte Højgaard Andreas Kjær Sune Keller Flemming Andersen Thomas Levin Klausen Thomas Beyer Søren Holm Claes Ladefoged Helle Hjorth Johannesen Johan Löfgren Ian Law Jacob Rasmussen Malene Fischer Camilla Bardram Johnbeck Julie Bjerglund Rasmus Ripa Otto Henriksen Lise Borgwardt Sarah Teuber Henriksen Jakup Poulsen Marianne Federspiel Karin Stahr Annika Loft Anne Kiil Bertelsen Henrik Larsson Vibeke Andrée Larsen Jan Ardenkjær-Larsen 7