不同示蹤劑PETCT在前列腺癌診斷中應用課件

1、不同示蹤劑PET/CT在前列腺癌診斷中的應用第1頁，共34頁。2放射性核素示蹤技術(shù) 是核醫(yī)學的基本技術(shù)！第2頁，共34頁。前列腺癌MRI T1骨顯像18F-FDG患者男性，72歲。尿頻、尿急2年。近來全身酸痛，直腸指診未觸及結(jié)節(jié)，PSA 6ng/ml骨顯像首先發(fā)現(xiàn)全身成骨轉(zhuǎn)移符合線路SPECT第3頁，共34頁。Positron Emitting Isotopes18F T110 minutes11C T20 minutes13N T10 minutes15OT2 minutesNotice how short the half-lives are that means that most of

2、 these tracers have to be produced close to the scanner. At the moment, only 18F compounds can be transported第4頁，共34頁。PET RadiotracersMetabolismGlucoseAminoacids Nucleotides Fatty acidsAcetateBlood FlowBlood VolumeHypoxiaDrug kinetics/metabolismNeuroreceptorsDopamine (pre and post synaptic)Serotonin

3、eOpiateBenzodiazepineThe positron emitting isotope can be incorporated into a variety of tracers. What tracer is used, depends on the physiological process being studied.第5頁，共34頁。The PET scanner consists of rings of paired detectors that detect these gamma rays第6頁，共34頁。CholineFDGPMSAAcetateFDHTNaFPC

4、aRadiotracers used in PCa 99mTc-MDP 、PSA 單抗、18F-FLT、18F-FMAU、anti-18F-FACBC 、18F-FMISO 第7頁，共34頁。FDG PET/CT The role of fluorodeoxyglucose (FDG)-PET scanning in men with suspected recurrent prostate cancer is controversial . Some early reports concluded that PET is of limited utility overall, particu

5、larly for men with a low serum PSA or PSA velocity In contrast, others suggest that PET is useful in imaging local recurrences , osseous metastases , or nodal and soft tissue lesions .第8頁，共34頁。2015-6-15PSA 4.622015-11-13PSA 17第9頁，共34頁。第10頁，共34頁。2015-02-152015-07-08PSA 0.87PSA 9.8第11頁，共34頁。2015-7-21第

6、12頁，共34頁。第13頁，共34頁。前列腺癌根治性切除術(shù)后，內(nèi)分泌治療后，肝轉(zhuǎn)移PSA 4.5第14頁，共34頁。前列腺癌術(shù)后復發(fā)PSA 1.2第15頁，共34頁。第16頁，共34頁。Choline PET/CTa Tool for Identifying Early Recurrence第17頁，共34頁。第18頁，共34頁。In a large cohort of patients, the feasibility of 11C-choline PET/CT for detecting the sites of metastatic disease in PCa patients wit

7、h BCR was confirmed. The PSA level was the main predictor of a positive scan with 1.16 ng/mL as the optimal cut-off value. In the majority of positive scans oligometastatic disease, potentially treatable with salvage therapies, was observed.第19頁，共34頁。18F-Choline PET/CT-response assessment第20頁，共34頁。A

8、cetate PET/CT第21頁，共34頁。第22頁，共34頁。PSMA PET/CTa Technique for Detecting Very Early Recurrence第23頁，共34頁。第24頁，共34頁。第25頁，共34頁。第26頁，共34頁。18F-FDHT PET/CT“Glycolysis/AR Concordant” phenotype“AR Predominant” phenotype第27頁，共34頁。NaF PET/CT第28頁，共34頁。Modified the following bullet“Newer technology using 18F-NaF a

9、s the tracer for a PET scan or hybrid imaging bone scans can be used as a diagnostic staging study”.These tests appear to have greater sensitivity than bone scan. However , there is controversy about how the results of 18F-NaF PET bone scan should be acted upon since all phase3 clinical trials to da

10、te have used progression criteria on bone scans.第29頁，共34頁。The Prostate Cancer Radiographic Assessments for Detection of Advanced Recurrence (RADAR) Working Group recommends using 18F-NaFPET/CTfor skeletal assessment in biochemical recurrence as an initial scan with PSA 5ng/mLor for doubling of PSA a

11、fter a prior negative scan.Crawford ED, Stone NN, Yu EY, et al. Challenges and recommendations for early identification of metastatic disease in prostate cancer. Urology 2014; 83:664.第30頁，共34頁。Which metabolicimaging, besidesbonescanwith 99mTc-phosphonates, for detecting and evaluatingbone metastases

12、 inprostaticcancerpatients? An open discussion.Q J Nucl Med Mol Imaging. 2015 , 59(4):381-399. 第31頁，共34頁。Radioimmunoimaging, RIIFusion imaging of 111In-PSA MoAb SPECT RII with MRI檢出：前列腺癌原發(fā)灶及精囊轉(zhuǎn)移精囊轉(zhuǎn)移精囊轉(zhuǎn)移前列腺癌原發(fā)病灶第32頁，共34頁。核醫(yī)學未來PET及核素診治SNMMI image of the year - theranostic drug unites imaging and therapy for prostate cancerPET image shows prostate cancer patients successful respons