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Arab Health 2011: PET/CT Imaging in Urology

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Clinical indications for PET/CT and Molecular imaging in patients with urologic conditions, primarily prostate and renal cancer.

Publicada em: Saúde e medicina

Arab Health 2011: PET/CT Imaging in Urology

  1. 1. Clinical Indications for PET.CT Imaging in UrologyThomas F. Heston, MD, FACNM, FASNC, FAAFP
  2. 2. Why PET/CT Works:The Warburg Effect● Normal Cells ● Low rate of glycolysis ● Aerobic metabolism● Most Cancer Cells ● High rate of glycolysis ● Anaerobic metabolism
  3. 3. Imaging Glycolysis: 18-F FDG
  4. 4. Imaging the glycolisis: Positron Emission Tomography 511 γ e+ e- 511 γ
  5. 5. Imaging the Warburg Effect: Why it Works
  6. 6. The Warburg Effect: Cancer Types● Nearly all solid tissue tumors ● Lung ● Colon ● Breast● Notable Exceptions ● Slow growth: prostate cancer (use 18F-fluoride) ● Mucinous: BAC ● Early Disease: tumors < 0.5 cm
  7. 7. Urological Tumors: limited value● Renal mass: C● Renal cell carcinoma: C (M-staging)● Testicular Cancer: C ● Useful in stage II germ cell tumors ● Useful for identifying recurrence ● Most useful in seminomas● Bladder cancer: C● Prostate cancer: D
  8. 8. 18-F FDG PET/CT Works Because:● Tumor cells have increased glycolysis● O-18 enriched water bombarded by protons ---> F-18 ---> 18F-FDG● FDG hits a metabolic dead end● PET images 18F positron emissions● CT allows anatomic localization
  9. 9. Imaging the Warburg Effect: Normal vs Abnormal
  10. 10. Normal PET/CT
  11. 11. Abnormal PET/CT
  12. 12. Prostate Cancer
  13. 13. Prostate Cancer: FDG Schöder H, Larson SM. Positron emission tomography for prostate, bladder, and renal cancer. Semin Nucl Med. 2004 Oct;34(4):274-92. Review. PubMed PMID: 15493005
  14. 14. C-11 choline vs F-18 FDG Schöder H, Larson SM. Positron emission tomography for prostate, bladder, and renal cancer. Semin Nucl Med. 2004 Oct;34(4):274-92. Review. PubMed PMID: 15493005
  15. 15. Prostate Cancer: FDG vs MDP Initial: FDG positive, MDP positive (panel A and C-left) 6-months later post- therapy: FDG negative, MDP no/little change (panel B and C-right)Schöder H, Larson SM. Positron emission tomography for prostate, bladder, andrenal cancer. Semin Nucl Med. 2004 Oct;34(4):274-92. Review. PubMed PMID:15493005
  16. 16. F-18 NaF vs Tc-99m MDP● PET/CT more accurate ● Sensitivity: 90% vs 80% ● Specificity: 95%+ vs 90%● PET/CT more comfortable ● Shorter uptake time ● Shorter scan time
  17. 17. PET/CT vs SPECT http://www.cms.gov/mcd/publiccomment_popup.asp?comment_id=19917
  18. 18. Dual Tracer Acquisition 10:1 FDG/NaF Acquisition Soft + Bone + (breast CA)Bridges RL, Wiley CR, Christian JC, Strohm AP. An introduction to Na(18)F bone scintigraphy: basic principles,advanced imaging concepts, and case examples. J Nucl Med Technol. 2007 Jun;35(2):64-76
  19. 19. Dual Tracer Acquisition
  20. 20. Dual Tracer Fusion Single CT aquisition, Single FDG acquisition, Single F-18 acquisitionBridges RL, Wiley CR, Christian JC, Strohm AP. An introduction to Na(18)F bone scintigraphy: basic principles,advanced imaging concepts, and case examples. J Nucl Med Technol. 2007 Jun;35(2):64-76
  21. 21. PET/CT in Prostate Cancer:Conclusions● Workup: in selected patients only● Restaging in pts with PSA relapse ● Nodal disease ● Osseous disease ● Dual FDG / NaF imaging
  22. 22. Renal Cell Carcinoma
  23. 23. Renal Cell Carcinoma: Staging Tumor extension into the right renal vein and inferior vena cavaSchöder H, Larson SM. Positron emission tomography for prostate, bladder, andrenal cancer. Semin Nucl Med. 2004 Oct;34(4):274-92. Review. PubMed PMID: 15493005
  24. 24. PET/CT in Renal CellCarcinoma: Conclusions● FDG excreted by the urinary tract● Indications ● Staging high risk patients for metastatic disease ● When other imaging is non-diagnostic
  25. 25. Research Studies
  26. 26. PET/CT vs Bone Scan - 1● 44 pts with high risk prostate cancer ● Gleson score >= 8 or PSA >= 20 ng/mL● Prevalence: 52% with bony mets● Gold Standard ● All imaging results including MRI & CT ● Biopsy in selected cases ● Clinical follow-upEven-Sapir E, Metser U, Mishani E, Lievshitz G, Lerman H, Leibovitch I. The detection of bone metastasesin patients with high-risk prostate cancer: 99mTc-MDP Planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT. J Nucl Med. 2006 Feb;47(2):287-97.
  27. 27. PET/CT vs Bone Scan - 2Even-Sapir E, Metser U, Mishani E, Lievshitz G, Lerman H, Leibovitch I. The detection of bone metastasesin patients with high-risk prostate cancer: 99mTc-MDP Planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT. J Nucl Med. 2006 Feb;47(2):287-97.
  28. 28. PET/CT vs Bone Scan - 3 Bone Scan PET/CT ScanEven-Sapir E, Metser U, Mishani E, Lievshitz G, Lerman H, Leibovitch I. The detection of bone metastasesin patients with high-risk prostate cancer: 99mTc-MDP Planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT. J Nucl Med. 2006 Feb;47(2):287-97.
  29. 29. FDG PET/CT vs MDP Bone Scan - 1● 70 pts with a variety of cancers with bone mets● Per Patient Basis: PET/CT 97% vs BS 86% sensitivity● Per Lesion Basis: PET/CT 92% vs BS 70% sensitivity● Incidental Findings: in 24 patients, organ metastases were found and in 7/7 pts with unknown primary, the primary was foundOzülker T, Küçüköz Uzun A, Ozülker F, Ozpaçac T. Comparison of (18)F-FDG-PET/CT with (99m)Tc-MDPbone scintigraphy for the detection of bone metastases in cancer patients. Nucl Med Commun. 2010Jun;31(6):597-603.
  30. 30. FDG PET/CT vs MDP Bone Scan - 2 MDP - Equivocal PET/CT - DefiniteOzülker T, Küçüköz Uzun A, Ozülker F, Ozpaçac T. Comparison of (18)F-FDG-PET/CT with (99m)Tc-MDPbone scintigraphy for the detection of bone metastases in cancer patients. Nucl Med Commun. 2010Jun;31(6):597-603.
  31. 31. Questions? Tawam Molecular Imaging Centre
  32. 32. Thank You!

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