不同示踪剂PETCT在前列腺癌诊断中应用课件.ppt

1、不同示踪剂不同示踪剂PET/CT在前列在前列腺癌诊断中的应用腺癌诊断中的应用第1页，共34页。2放射性核素示踪技术放射性核素示踪技术是是核医学的基本技术核医学的基本技术！第2页，共34页。MRI T1骨显像骨显像18F-FDG患者男性，患者男性，72岁。岁。尿频、尿急尿频、尿急2年。近来年。近来全身酸痛，直肠全身酸痛，直肠指诊未触及结节，指诊未触及结节，PSA 6ng/ml骨显像首先发现全身成骨转移骨显像首先发现全身成骨转移符合线路符合线路SPECT第3页，共34页。Positron Emitting Isotopes18F T110 minutes11C T20 minutes13N T10

2、 minutes15OT2 minutesNotice how short the half-lives are that means that most of these tracers have to be produced close to the scanner.At the moment,only 18F compounds can be transported第4页，共34页。PET Radiotracers Metabolism Glucose Aminoacids Nucleotides Fatty acids Acetate Blood Flow Blood VolumeHy

3、poxiaDrug kinetics/metabolismNeuroreceptorsDopamine(pre and post synaptic)SerotonineOpiateBenzodiazepineThe positron emitting isotope can be incorporated into a variety of tracers.What tracer is used,depends on the physiological process being studied.第5页，共34页。The PET scanner consists of rings of pai

4、red detectors that detect these gamma rays第6页，共34页。CholineFDGPMSAAcetateFDHTNaFPCaRadiotracers used in PCa 99mTc-MDP、PSA 单抗、单抗、18F-FLT、18F-FMAU、anti-18F-FACBC、18F-FMISO 第7页，共34页。FDG PET/CT The role of fluorodeoxyglucose(FDG)-PET scanning in men with suspected recurrent prostate cancer is controversi

5、al.Some early reports concluded that PET is of limited utility overall,particularly 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页，共34页。2015-6-15PSA 4.622015-11-13PSA 17第9

6、页，共34页。第10页，共34页。2015-02-152015-07-08PSA 0.87PSA 9.8第11页，共34页。2015-7-21第12页，共34页。第13页，共34页。前列腺癌根治性切除术后，前列腺癌根治性切除术后，内分泌治疗后，肝转移内分泌治疗后，肝转移PSA 4.5第14页，共34页。前列腺癌术后复发前列腺癌术后复发PSA 1.2第15页，共34页。第16页，共34页。Choline PET/CTa Tool for Identifying Early Recurrence第17页，共34页。第18页，共34页。In a large cohort of patients,th

7、e feasibility of 11C-choline PET/CT for detecting the sites of metastatic disease in PCa patients with 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 treatabl

8、e with salvage therapies,was observed.第19页，共34页。18F-Choline PET/CT-response assessment第20页，共34页。Acetate PET/CT第21页，共34页。第22页，共34页。PSMA PET/CTa Technique for Detecting Very Early Recurrence第23页，共34页。第24页，共34页。第25页，共34页。第26页，共34页。18F-FDHT PET/CT“Glycolysis/AR Concordant”phenotype“AR Predominant”phenot

9、ype第27页，共34页。NaF PET/CT第28页，共34页。Modified the following bullet“Newer technology using 18F-NaF as 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

10、results of 18F-NaF PET bone scan should be acted upon since all phase3 clinical trials to date have used progression criteria on bone scans.第29页，共34页。The Prostate Cancer Radiographic Assessments for Detection of Advanced Recurrence(RADAR)Working Group recommends using 18F-NaF PET/CT for skeletal ass

11、essment in biochemical recurrence as an initial scan with PSA 5 ng/mL or for doubling of PSA after 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页，共34页。Which metabolic ima

12、ging,besides bone scan with 99mTc-phosphonates,for detecting and evaluating bone metastases in prostatic cancer patients?An open discussion.Q J Nucl Med Mol Imaging.2015,59(4):381-399.第31页，共34页。Radioimmunoimaging,RIIRadioimmunoimaging,RIIFusion imaging of 111In-PSA MoAb SPECT RII with MRI检出：前列检出：前列腺

13、癌原发灶腺癌原发灶及精囊转移及精囊转移精囊转移精囊转移精囊转移精囊转移前列腺癌前列腺癌原发病灶原发病灶第32页，共34页。核医学未来核医学未来PET及核素诊治及核素诊治SNMMI image of the year-theranostic drug unites imaging and therapy for prostate cancerPET image shows prostate cancer patients successful response to PSMA-617 endoradiotherapy德国海德堡大学医院和德国癌德国海德堡大学医院和德国癌症研究中心症研究中心 68Ga-PSMA-617第33页，共34页。CholineFDGPSMAAcetateFDHTNaFPCaprecision medicine 99mTc-MDP、PSA 单抗、单抗、18F-FLT、18F-FMAU、anti-18F-FACBC、18F-FMISO 第34页，共34页。