Slide 1:THE FRONTIERS OF MEDICAL IMAGING FERRUCCIO FAZIO IBFM CNR, UNIVERSITY OF MILANO BICOCCA, H S. RAFFAELE, MILANO


Slide 2:X RAYS ULTRASOUND X RAYS COMPUTED TOMOGRAPHY CT MAGNETIC RESONANCE MR POSITRON EMISSION TOMOGRAPHY PET IN VIVO MEDICAL IMAGING


Slide 3:- Improved Temporal Resolution - Wider Anatomical Coverage - Improved Axial Resolution HELICAL MULTI-SLICE CT Solid State Detectors Ultra Fast Ceramics


Slide 4:SINGLE-SLICE CT 1 sec/revolution


Slide 5:HELICAL MULTI-SLICE CT 16 SLICES 0.4 sec/revolution 1.25 slice thickness 1000 images/whole body study


Slide 6:HELICAL MULTI-SLICE CT CARDIAC IMAGING


Slide 7:MORPHOLOGY FUNCTION FLOW CHEMICAL CONTENT MR MR ANGIOGRAPHY MR SPECTROSCOPY in vivo


Slide 8: MAGNETIC RESONANCE ANGIOGRAPHY FAST GRADIENT ECHO MR ANGIOGRAPHY DIGITAL ANGIOGRAPHY Acute pulmonary embolism


MAGNETIC RESONANCE DIFFUSION/PERFUSION IMAGINGECHO PLANAR SEQUENCES :MAGNETIC RESONANCE DIFFUSION/PERFUSION IMAGINGECHO PLANAR SEQUENCES Acute trombosis of the left carotid artery. T2 weighted image DIFFUSION weighted image PERFUSION weighted image


Slide 10:DIFFUSION TENSOR IMAGING - FIBER TRACKING


Slide 11:DIFFUSION TENSOR IMAGING – FIBER TRACKING


Slide 12:POSITRON EMISSION TOMOGRAPHY PET


Slide 13:CLINICAL PET IN ITALY TOTAL EXAMS/YEAR ESTIMATED PET - PET/CT SCANNER UNITS WW


Slide 14:18F-FDG WHOLE BODY PET DIAGNOSIS STAGING RE-STAGING AND FOLLOW-UP RADIOTHERAPY


Slide 15:RADIOCHEMISTRY INSTRUMENTATION HW/SW PET + PROTEOMICS/FUNCTIONAL GENOMICS ADVANCES IN PET IMAGING NEW SCINTILLATION CRYSTALS PET/CT NEW TRACERS PET 


Slide 16:RADIOTRACERS PREPARED AT HSR [18F]FDG Glucose metabolism [18F]FESP D2 and 5-HT2 receptor antagonist [15O]H2O Cerebral flow, Studi attivazione funzionale [13N]AMMONIA Myocardial flow m-[11C]hydroxyefedrine Adrenergic antagonist [11C]FLUMAZENIL Benzodiazepine receptor antagonist [11C]RACLOPRIDE Dopamine D2 receptor antagonist [11C]FE-b-CIT Dopamine reuptake inhibitor [11C]SCH23390 Dopamine D1 receptor antagonist [11C]CARAZOLOL Adrenergic b1/b2 receptor antagonist [11C]MCN5652 Serotonin reuptake inhibitor [11C]MDL100907 Serotonin 5-HT2A receptor antagonist [11C]methylcoline Prostate Cancer [11C]FLUVOXAMINE Serotonin reuptake inhibitor [11C]CGP62349 GABAB antagonist [11C]isovaleroil-L-carnitine Cerebral metabolism [11C]PNU167760 Serotonin 5-HT1A receptor antagonist [11C] BISOPROLOL Adrenergic b1 antagonist [11C] ICI118551 Adrenergic b2 receptor antagonista [11C] OLANZAPINE Atypical Antipsychotic [11C] SB235753 Dopamine D4 receptor antagonist [11C] E2020 Muscarinic M2 receptor antagonist [11C] SCH442416 Adenosine A2A receptor antagonist [11C] PALMITATE Fatty acids metabolism [11C] A 84543 Nicotine a2b4 antagonist [11C] VC195 Peripheral Benzodiazepine [11C] VC193M Peripheral Benzodiazepine [11C] VC198M Peripheral Benzodiazepine [11C] WAY100635 Serotonin 5-HT1A receptor antagonist [11C]RN5 Adrenergic a1 receptor antagonist [11C] VA100 Opioid K1 receptor antagonist [11C] CARFENTANIL Opioid m receptor agonist [11C] ZOFENOPRIL ACE inhibitor [18F]FLUORO CAPTOPRIL ACE inhibitor [11C] CNR1 a1 adrenergic antagonist [11C] PK1113195 Peripheral Benzodiazepine [11C] F167 s2 receptor antagonist [11C] PD60 dopamine D3 antagonist [11C] PD78 dopamine D3 antagonist


Slide 17:B.P. 65 yrs PSA: 1,9 ng/ml PROSTATE CANCER [11C]Choline-PET [18F]FDG-PET [99mTc]MDP


TRACERS for TUMOR CHARACTERIZATION :TRACERS for TUMOR CHARACTERIZATION Glucose metabolism [18F]FDG Membrane function [11C]Choline Proliferation [18F]FLT [18F]FMISO Hypoxia [18F]FAZA [64Cu]ATSM Apoptosis [18F]Annexin V Angiogenesis [18F]NGR-peptide Neuroendocrine tumors [110In]Octreotate 


Slide 19:RADIOCHEMISTRY INSTRUMENTATION HW/SW PET + PROTEOMICS/FUNCTIONAL GENOMICS ADVANCES IN PET IMAGING NEW SCINTILLATION CRYSTALS PET/CT NEW TRACERS PET 


Slide 20:SANDWICH OF DETECTORS FASTER DETECTORS for HIGH COUNT RATE CAPABILITY TIME OF FLIGHT INFORMATION NEW DETECTORS with: SMALLER SIZE (2-3 mm) GOOD ENERGY RESOLUTION DEPTH OF INTERACTION INFORMATION FUTURE DEVELOPMENTS IN PET CURRENT DETECTORS: BGO, GSO, LSO


Slide 21:RADIOCHEMISTRY INSTRUMENTATION HW/SW PET + PROTEOMICS/FUNCTIONAL GENOMICS ADVANCES IN PET IMAGING NEW SCINTILLATION CRYSTALS PET/CT NEW TRACERS PET 


Slide 22:PET – [18F]FDG LACK OF ANATOMICAL INFORMATION


Slide 23:PET – [18F]FDG ANATOMICAL INFORMATION


Slide 24:PET CT PET/CT


Slide 25:HSR MILANO 18F-FDG PET/CT


Slide 26:PET/CT - APPLICATIONS ANATOMICAL LOCALIZATION OF PET FUNCTIONAL IMAGES PET/CT GUIDED RADIOTHERAPY TREATMENT PLANNING


Slide 27:METABOLICALLY AIMED RADIOTHERAPY (MART) CT PET CT BASED PET/CT BASED TREATMENT PLAN


Slide 28:OPTIMIZED TREATMENT PET/CT VOLUME DEFINITION PET/CT GUIDED RADIOTHERAPY PLANNING METABOLLICALLY AIMED RADIOTHERAPY MART


Slide 29:LUNG SIMULATION TOMOTHERAPY MD Anderson Houston


Slide 30:4D PET/CT Respiration control during PET/CT Target volume with precise motion information


Slide 31:HYPO-FRACTIONATION 30-40  5-10 fractions PET GUIDED IMRT/TOMOTHERAPY IMPROVED TUMOR/NON TUMOR RADIATION DOSE METABOLLICALLY AIMED RADIOTHERAPY MART


Slide 32:RADIOCHEMISTRY INSTRUMENTATION HW/SW PET + PROTEOMICS/FUNCTIONAL GENOMICS ADVANCES IN PET IMAGING NEW SCINTILLATION CRYSTALS PET/CT NEW TRACERS PET 


THE PROTEOMICS OF PET:IDENTIFICATION OF NEW TUMOR MARKERS :THE PROTEOMICS OF PET:IDENTIFICATION OF NEW TUMOR MARKERS At present, tumor markers (CEA, PSA ....) are inadequate for early diagnosis and restaging Functional proteomics (on human tumor specimens) may identify new markers The new markers identified can be validated for assessemnt of early diagnosis or follow-up (re-staging) Patients selection criteria for PET and current tracers (FDG, Choline) Development of new radiotracers for PET imaging