Presentation on theme: "CLINICAL USE OF SPECT-CT IN BREAST & PROSTATE CANCERS"— Presentation transcript:
1CLINICAL USE OF SPECT-CT IN BREAST & PROSTATE CANCERS Emerita A. Barrenechea, MDDepartment of Nuclear MedicineSt Luke’s Medical Center& Veterans Memorial Medical CenterPhilippines
2IntroductionSPECT-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.
4SPECT Radiopharmaceuticals More specificLonger half-lives allowing for delayed or increased imagingLike PET, extremely useful in determining organ or tissue function, which is augmented with anatomical correlation with CT scanning
5SPECT-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.
6Applications: Detection of primary or metastatic lesions Staging of malignant diseaseAssessment of chemotherapy or radionuclide therapySentinel node identificationLocating difficult lesions in oncology
8Breast Cancer 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
14Indications on planar lymphoscintigraphy for additional SPECT-CT Unusual lymphatic drainage patternsExtraaxillary drainage in breast cancer patientsDrainage to more than one lymph node basinDrainage not to nearest lymph node basin
15Indications (cont’d) Lymphatic patterns difficult to interpret Sentinel lymph node close to injection siteDeeply located sentinel lymph nodesNon-visualizationNo lymphatic drainage on late planar images
16SPECT-CT Imaging: Breast Cancer A = AnteriorB = L LateralNo lymphaticdrainage 4hrsC = Axillary Sentinel Node
17SPECT-CT Imaging: Breast Cancer ® Axillary sentinel nodeNo lymphatic drainage® Internal Mammary sentinel node
18SPECT-CT Imaging: Breast Cancer 2nd Echelon LNInt Mam LN
19SPECT-CT Imaging: Breast Cancer Axillary LNInt Mam LNSLN Breast
21Adenosylcobalamin:New radiopharmaceutical under investigation for use in SPECT-CTIndium111 DTP adenosylcobalamin (Vit B12 analogue)Action: Vitamin B12 involved in methylation reactions important in Krebs’ cycle, thymidine production required for DNA synthesis. These processes are increased in metabolically active tissues like cancers
22Ductal Breast Carcinoma in 4 Women using Adenosylcobalamin
23Prostate CancerProstate cancer: leading form of cancer for men, and leading cause of cancer-related deaths.Slow growing, but lethal once it has metastasized.Indium111 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
24ProstaScint Agent: Indium111 ProstaScint Half-life: 2.8 days For assessment of nodal metastasesDetection of occult metastatic disease in post-prostatectomy patients
26Prostate CA: Widespread Osseous Metastases Interpretation dependent on pattern of tracer distribution according to expected physiology or pathophysiology
27Prostate CA with Degenerative Joint Disease Highly sensitive for metabolic increases in osteoblastic activityPoorly specific:also accumulates in inflammation or areas of hypervascularization
28SPECTUseful in localizing lesions in complex bony structures such as the skull, vertebral column, or pelvisProstate CA with neck pains revealed to be of degenerative origin
29SPECTTypical 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 matrixEven with CT correlation, however, the characteristics of Tc99m HDP or MDP limits the study
31ConclusionSPECT-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.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.
32ConclusionBoth 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.
33Thank you for youe attention Thank you for your attention.