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Clinical PET and PET/CT, 2nd Edition presents a valuable overview of the basic principles and clinical applications of PET and PET/CT. Emphasis is placed on.
Table of contents
The facility also offers equipment for the remote synthesis of carbon and fluorine labeled radiopharmaceuticals:. The area, staffed full-time by radiologists credentialed to interpret both PET and CT scans, allows for greater diagnostic accuracy in interpretation and more convenient one-to-one consultations with the oncologist.
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The PET experts offer consultation services to investigators to discuss specific research objectives and the appropriate PET imaging protocol. Consultations include guidance in experimental design, development, validation, and implementation of methodology in the interpretation of study data. Please contact Dr. James Mountz for more information or to set up an appointment regarding your clinical imaging studies.
Search for:. Some tracers are made available through pre-made cassettes that are mounted and used locally with standardized synthesizer production units. There has been a focus on establishing tracers labeled with fluorine for clinical use, while the more versatile isotope carbon has been put to use for labeling tracers in academic projects and drug development. Recently, the use of generator-based radioisotope production has seen renewed interest with the clinical introduction of galliumbased labeling of somatostatin analogs.
Some long-lived isotopes are currently considered for clinical PET imaging.
Positron emission tomography - Wikipedia
When large molecules, such as antibodies and fragments thereof, are radiolabeled with isotopes of sufficiently long half-lives they could potentially be used with PET imaging many hours after injection, at a time when only the tracer bound to the specific target remains in the tissue. Radiotracers in clinical use with PET can be categorized in several different ways, depending on labeling, access and biological mechanisms of uptake, etcetera.
One useful biological denominator is whether the tracer identifies processes that are highly specific or integrative. Highly specific probes bind to a singular target, such as a receptor or enzyme. Such probes are typically used for imaging of upstream targets that are unique expressed in association with a certain disease. An integrative probe identifies a general biological activity that is common for several parallel processes in the organism, such as protein synthesis, energy metabolism or tissue perfusion.
Table 2 provides a list of some tracers that have been found clinically useful in our centre, an academic institution with a strong focus on radiochemistry development, or have been made commercially available elsewhere. There are several examples of specific tracers already in clinical use. Figure 4 shows [ 11 C]hydroxytryptophan uptake in two very small bone metastases in a patient with a known carcinoid tumor. The converting enzyme 5-hydroxytryptophan decarboxylase is highly expressed in the majority of tumors with neuroendocrine origin.
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As such, focal uptake of this tracer in the bones can only be explained by metastases from a neuroendocrine tumor. With experience, a tool like this sometimes obviates the need for additional histopathology and the referring doctor moves directly towards relevant therapy. As the field of molecular imaging grows, there will be a need for continuous specialization and training for many different types of experts. The amount of information potentially available for evaluating and making treatment decisions for a single patient will require teams of specialists. Clinically, the imaging expert will move from mainstream radiology focusing on morphology and structure towards a situation where imaging with multiple tracers is available on top of a daunting amount of radiological imaging tools.
Radiochemists are working in the interface of innovation and regulatory demands that tend to increase over time. The major cost for a full scale molecular imaging centre is related to radiochemistry, including cyclotron services, which need to be taken into account early during planning. There is a definitive lack of radiochemists with skills in the area of tracer development and many more are needed for the field to continue to grow.
Some tracers used for diagnosis in oncology in one PET Center. Numerous PET tracers have been investigated for clinical utility worldwide. For a few of these there are at least some evidences for patient benefit, supporting routine use in selected patient groups. This collage shows a number of the tracers in clinical routine use locally at the PET Centre of Uppsala University hospital.
From top left to bottom right: [ 18 F]-FDG is the universal tracer for evaluating the growth pattern and aggressiveness of a tumor. It is primarily used for brain tumor imaging,[ 30 ] but is also used as a last resort when trying to locate a parathyroid tumor [ 31 ]as shown in the image.
The tracer is used to detect tumors of adrenocortical origin. Because of the specificity of the tracer, the very intense uptake in the millimeter-sized spinal lesions is highly suspicious for bone metastasis.
The use of FDG is likely to increase as evidence amounts regarding new indications. Similarly, a number of tracers for general biological activity have been made available in countries where regulatory authorities accept the use of radiopharmaceuticals on the referring doctor's discretion. A range of proprietary tracers are currently in late phase clinical trials with the aim of making them commercially available.
Some of these will indicate an evolution in terms of diagnostic accuracy, compared to less advanced technologies. On the other hand, if no commercial entities document and manufacture tracers or kits for tracer production for more widespread access, the new tracers cannot be introduced into general guidelines. Regulatory authorities are currently regarding radiopharmaceuticals along the same line as therapeutic drugs, in spite of the fact that PET tracers are injected in amounts of a few micrograms, often at a single occasion.
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Some authorities now suggest a trend towards scrutinizing the barriers for approval of compounds that are given in trace amounts. In conclusion, clinical PET is increasingly impacting health care and helps stratify individual patient treatments. The use of FDG continues to grow, many other PET tracers are in small-scale use in academic centers and some are approaching a potential market authorization and more widespread use.
Journal of nuclear medicine. AJR American journal of roentgenology. Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. The New England Journal of Medicine. Palmetto GBA. Weber WA. Assessing tumor response to therapy. Hutchings M, Barrington SF. Evaluation of different normalization procedures for the calculation of the standardized uptake value in therapy response monitoring studies.
Nuclear Medicine Communications. Seminars in Nuclear Medicine. European Journal of Radiology. Nuclear Medicine and Biology. Velikyan I. Positron emitting [68Ga]Ga-based imaging agents: chemistry and diversity. Med Chem. Lubberink M, Herzog H. Clinical pharmacology and therapeutics. Whole-body 11 Chydroxytryptophan positron emission tomography as a universal imaging technique for neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and computed tomography. The Journal of clinical endocrinology and metabolism. Simplified quantification of myocardial flow reserve with flurpiridaz F validation with microspheres in a pig model.
Imaging brain amyloid in Alzheimer's disease with Pittsburgh Compound-B. Ann Neurol. Amyloid imaging in the differential diagnosis of dementia: review and potential clinical applications. Alzheimers Res Ther. The risk of exaggerated risk aversion-a life and death struggle for molecular imaging.
Genotoxic hazard of radiopharmaceuticals in humans: chemical and radiation aspects coupled to microdosing. Eur J Clin Pharmacol. Critical Path Initiative. Herholz K, Ebmeier K. Clinical amyloid imaging in Alzheimer's disease. Lancet Neurol. Skeletal PET with 18F-fluoride: applying new technology to an old tracer. Evaluation of 11C-methionine PET as a surrogate endpoint after treatment of grade 2 gliomas.
Journal of Neuro-Oncology. High success rate of parathyroid reoperation may be achieved with improved localization diagnosis. World J Surg. Pheochromocytomas: detection with 11C hydroxyephedrine PET. Simultaneous quantification of myocardial perfusion, oxidative metabolism, cardiac efficiency and pump function at rest and during supine bicycle exercise using C-acetate PET - a pilot study.
Treatment response External radiation therapy dose Developing clinical molecular Click on the image to enlarge. Tracer Diagnostic relevance of uptake mechanism General biological activity downstream markers [ 18 F]-fluorodeoxyglucose The signal is proportional to glucose uptake and phosphorylation.
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Glucose is the major carbon donor for energy production and replenishment of macromolecule production in many organs and many cancers. Initial uptake is proportional to blood flow. Retention is due to intracellular trapping as [ 11 C]-acetyl-CoA, which is converted to [ 11 C]-CO 2 in oxidative metabolism or consumed in liponeogenesis. Useful in investigations of cardiac physiology and for detection of some cancers, mainly prostate carcinoma. Signal is proportional to proliferative activity in several cancer types, including astrocytomas and lung cancer.