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CLINICAL USE OF SPECT-CT IN BREAST & PROSTATE CANCERS Emerita A. Barrenechea, MD Department of Nuclear Medicine St Luke’s Medical Center St Luke’s Medical.

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Presentation on theme: "CLINICAL USE OF SPECT-CT IN BREAST & PROSTATE CANCERS Emerita A. Barrenechea, MD Department of Nuclear Medicine St Luke’s Medical Center St Luke’s Medical."— Presentation transcript:

1 CLINICAL USE OF SPECT-CT IN BREAST & PROSTATE CANCERS Emerita A. Barrenechea, MD Department of Nuclear Medicine St Luke’s Medical Center St Luke’s Medical Center & Veterans Memorial Medical Center Philippines

2 Introduction SPECT-CT: emerging dual-modality imaging technique with many established and potential clinical applications in the field of oncology. As with PET-CT, accurate co-registration of anatomical and functional data from combined SPECT-CT camera often provides complementary diagnostic information. Collection of both sets of imaging data in the same exam increases the likelihood of 1:1 mapping and improved diagnostic accuracy.

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4 SPECT Radiopharmaceuticals More specific More specific Longer half-lives allowing for delayed or increased imaging Longer half-lives allowing for delayed or increased imaging Like PET, extremely useful in determining organ or tissue function, which is augmented with anatomical correlation with CT scanning Like PET, extremely useful in determining organ or tissue function, which is augmented with anatomical correlation with CT scanning

5 SPECT-CT guided Bone Scintigraphy Bone scintigraphy is often used to detect possible areas of metastases, but the scans are so nonspecific that further radiological follow-up is always needed when abnormal uptake is present. Using the hybrid scanner, a patient undergoes SPECT imaging alone; if abnormality is detected, the patient remains on the table for a focused CT scan of the suspect region. Bone scintigraphy is often used to detect possible areas of metastases, but the scans are so nonspecific that further radiological follow-up is always needed when abnormal uptake is present. Using the hybrid scanner, a patient undergoes SPECT imaging alone; if abnormality is detected, the patient remains on the table for a focused CT scan of the suspect region.

6 Applications: Detection of primary or metastatic lesions Detection of primary or metastatic lesions Staging of malignant disease Staging of malignant disease Assessment of chemotherapy or radionuclide therapy Assessment of chemotherapy or radionuclide therapy Sentinel node identification Sentinel node identification Locating difficult lesions in oncology Locating difficult lesions in oncology

7 Clinical Applications in Oncology Endocrine tumors Endocrine tumors Lymphoscintigraphy Lymphoscintigraphy Lung cancer Lung cancer Brain tumors Brain tumors Bone scan Bone scan Liver perfusion studies Liver perfusion studies Liver hemangiomas Liver hemangiomas

8 Breast Cancer It is the most prevalent cancer worldwide in women. It is the most prevalent cancer worldwide in women. PET with FDG may be the most single sensitive imaging test to detect primary and systemic metastases but fails to detect microscopic disease smaller than 5- 10mm lesions as well as limited capabilities in axillary nodal evaluation where SPECT/CT lymphoscintigraphy is preferred PET with FDG may be the most single sensitive imaging test to detect primary and systemic metastases but fails to detect microscopic disease smaller than 5- 10mm lesions as well as limited capabilities in axillary nodal evaluation where SPECT/CT lymphoscintigraphy is preferred

9 Tc 99m Sestamibi Scintimammography

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11 Sentinel Node - Breast

12 Sentinel Node - Melanoma

13 Sentinel Node Mapping

14 Indications on planar lymphoscintigraphy for additional SPECT-CT Unusual lymphatic drainage patterns Extraaxillary drainage in breast cancer patients Extraaxillary drainage in breast cancer patients Drainage to more than one lymph node basin Drainage to more than one lymph node basin Drainage not to nearest lymph node basin Drainage not to nearest lymph node basin

15 Indications (cont’d) Lymphatic patterns difficult to interpret Sentinel lymph node close to injection site Sentinel lymph node close to injection site Deeply located sentinel lymph nodes Deeply located sentinel lymph nodesNon-visualization No lymphatic drainage on late planar images No lymphatic drainage on late planar images

16 SPECT-CT Imaging: Breast Cancer A = Anterior B = L Lateral No lymphatic drainage 4hrs C = Axillary Sentinel Node

17 SPECT-CT Imaging: Breast Cancer No lymphatic drainage ® Axillary sentinel node ® Internal Mammary sentinel node

18 SPECT-CT Imaging: Breast Cancer Int Mam LN 2 nd Echelon LN

19 SPECT-CT Imaging: Breast Cancer Axillary LN Int Mam LN SLN Breast

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21 Adenosylcobalamin: New radiopharmaceutical under investigation for use in SPECT-CT New radiopharmaceutical under investigation for use in SPECT-CT Indium 111 DTP adenosylcobalamin (Vit B 12 analogue) Indium 111 DTP adenosylcobalamin (Vit B 12 analogue) Action: Vitamin B 12 involved in methylation reactions important in Krebs’ cycle, thymidine production required for DNA synthesis. These processes are increased in metabolically active tissues like cancers

22 Ductal Breast Carcinoma in 4 Women using Adenosylcobalamin

23 Prostate Cancer Prostate cancer: leading form of cancer for men, and leading cause of cancer-related deaths. Slow growing, but lethal once it has metastasized. Indium 111 Capromab Pendetide (ProstaScint) imaging is indicated for staging and recurrence detection as well as for metastases. Interpretation without correlated structural information becomes challenging as the radiopharm demonstrates non-specific uptake in the normal vasculature, bowel, bone marrow and prostate gland

24 ProstaScint Agent: Indium 111 ProstaScint Agent: Indium 111 ProstaScint Half-life: 2.8 days Half-life: 2.8 days For assessment of nodal metastases For assessment of nodal metastases Detection of occult metastatic disease in post-prostatectomy patients Detection of occult metastatic disease in post-prostatectomy patients

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26 Prostate CA: Widespread Osseous Metastases Interpretation dependent on pattern of tracer distribution according to expected physiology or pathophysiology Interpretation dependent on pattern of tracer distribution according to expected physiology or pathophysiology

27 Prostate CA with Degenerative Joint Disease Highly sensitive for metabolic increases in osteoblastic activity Highly sensitive for metabolic increases in osteoblastic activity Poorly specific: Poorly specific: also accumulates in inflammation or areas of hypervascularization

28 SPECT Useful in localizing lesions in complex bony structures such as the skull, vertebral column, or pelvis Useful in localizing lesions in complex bony structures such as the skull, vertebral column, or pelvis Prostate CA with neck pains revealed to be of degenerative origin Prostate CA with neck pains revealed to be of degenerative origin

29 SPECT Typical bone scan agents like Tc-99m MDP or HDP are taken up by osteoblasts in bone formation and chemoabsorbed in the hydroxyapatite mineral component of the osseous matrix Typical bone scan agents like Tc-99m MDP or HDP are taken up by osteoblasts in bone formation and chemoabsorbed in the hydroxyapatite mineral component of the osseous matrix Even with CT correlation, however, the characteristics of Tc 99m HDP or MDP limits the study Even with CT correlation, however, the characteristics of Tc 99m HDP or MDP limits the study

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31 Conclusion SPECT-CT imaging in breast, prostate and other cancers has been proven effective through SPECT-CT imaging in breast, prostate and other cancers has been proven effective through improved specificity and diagnostic confidence helping to guide conventional management and assess suitability for targeted therapy. combines anatomic and functional techniques to allow accurate localization of tumors, increased detection of recurrent and metastatic disease, and exclusion of physiologic uptake. SPECT-CT combines anatomic and functional techniques to allow accurate localization of tumors, increased detection of recurrent and metastatic disease, and exclusion of physiologic uptake.

32 Conclusion Both functional and morphologic information can be obtained in a single imaging session. Both functional and morphologic information can be obtained in a single imaging session. With SPECT-CT, it is now possible to have the “best of both worlds”, providing functional information on lesions within an adequate anatomic context. With SPECT-CT, it is now possible to have the “best of both worlds”, providing functional information on lesions within an adequate anatomic context.

33 Thank you for youe attention Thank you for your attention.


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