I have financial relationships to disclose Research support from: Siemens Medical Solutions

Transkript

1 I have financial relationships to disclose Research support from: Siemens Medical Solutions

2 Nuklearmedizinische Klinik im Klinikum rechts der Isar der Technischen Universität München PET Imaging Tracers and Protocols for Routine Clinical Use Markus Schwaiger, Stephan Nekolla Technische Universität München Germany 2012 Annual ESC Congress, August München, Germany

3 PET Cardiology Applications and Protocols Clinical Measurements of Perfusion (Flow Reserve) Assessment of Tissue Viability Integrated Phenotyping of CAD Research Endothelial Function Plaque Imaging Molecular Imaging (HF, Innervation, Inflammation) Therapy Monitoring (Cell Therapy, HF)

4 Multimodal Cardiac Imaging Anatomy, Function and Molecular Tissue Characterisation Multimodal Imaging SPECT/CT, PET/CT, PET/MRI SPECT/CT PET/CT PET/MRI

5 PET/MRI (mmr Biograph)

6 mmr Biograph Simultaneous MRI and PET Acquisition Function and Viability

7 MR/CT/PET Examination 18 F-FDG PET/CT acquired with a Biograph16 PET/CT MRI acquired with 1.5 T (TR: 0.2 ms, TE: 0.7 ms) Attenuation Correction performed using a segmentation-based method. No AC CT AC MR AC Martinez; Nekolla et al

8 PET Tracer Molecular Imaging Probes Wester HJ, Clin Cancer Res HED,MIBG

9 SPECT PET Myocardial Perfusion Imaging Perfusion Tracer Tracer HWZ g - kev EF(%) Tl h 80, Tc-99m MIBI 6 h Tc-99m Tetrofosmin 6 h O-15 Water 2 min N-13 Ammonia 10min Rubidium sec F-18 Fluripidaz 119min

10 F-18 Flow tracer F-18 Fluripidaz Imaging Contrast myo/blood myo/liver myo/lung NH3 Stress 1.8± ± ±0.3 NH3 Rest 2.5± ± ±0.5 F-18 Fluripidaz S F-18 Fluripidaz R 5.8± ± ± ± ± ±1.5 Nekolla et al, Circulation

11 RA LA LV All slides TU München. No use without permission. Time Fluridipaz Perfusion Imaging Ischemia Model (120 sec occlusion) RV RA LV LA

12 Rubidium-82 Imaging Protocol 920MBq 82 Rb (rest) 140 ug/kg/min Adenosine over 5 min. Injection of 934MBq 82 Rb (stress) after 2.5 min Dynamic acquisitions Listmode Transmission Dynamic 10 min 6 min Dynamic 10 min i.v. 30 sec bolus 82 Rb ~1000 MBq Adenosine i.v. 30 sec bolus 82 Rb ~1000 MBq

13 82 Rb: Time activity curves Blood Rest Mean Tissue Rest Blood S1 Mean Tissue S Activity in Bq/ml MBF = 2.8 ml/min/g MBF = 0.8 ml/min/g Time / seconds

14 Quantitative Flow and Flow Reserve MBF Rest MBF Dipyridamole Flow Reserve MBF Rest Stress CFR LAD LCX Retention Model w. Extraction Correction RCA Global ml/min/g Bengel

15 Quantification of Flow Multimodal Imaging with PET/CT (O-15 water) Kajander, et al Circulation/2010

16 First simultaneous measurement of myocardial perfusion on whole-body PET/MR Hybrid MPI Protocol MRI Slice planning T1 map AC SR GRE Cine T1 map AC SR GRE LGE AC Adenosine Gd: 4mL/s 0.05mmol/kg Gd: 4mL/s 0.05mmol/kg Gd: 2mL/s 0.1 mmol/kg 13 NH 3 : 0.67mL/s 214±31 MBq in 20 ml 13 NH 3 : 0.67mL/s 214±31 MBq in 20 ml 0 min 60 min 15-min Listmode 15-min Listmode PET Zhang, Nekolla, Schwaiger

17 First simultaneous measurement of myocardial perfusion on whole-body PET/MR Acquisition of first-pass DCE ( AIF and myocardium seperated) 5.94 x 5.94 x 10 mm 3 TI/TE=5/0.63ms 1.98 x 1.98 x 8mm 3 TI /TE = 100/1.05ms AIF slice Apical Slice Mid-Ventrical Slice Basal Slice 12.5ms 150ms 325ms 500ms Nonselective 90 o pulse train Nonselective 90 o pulse train Nonselective 90 o pulse train Nonselective 90 o pulse train 1. Gatehouse PD et al J Magn Reson Imaging. 2004; 20(1): Xue H et al Med Image Comput Comput Assist Interv. 2009;12:741-9.

18 MR Perfusion [ml/min/g] MR Perfusion [ml/min/g] First simultaneous measurement of myocardial perfusion on whole-body PET/MR PET/MRI MPI Midventricular Slice 3 MidLV (slice average) Identity Line 3,5 MidLV (6 segments) 2, ,5 1,5 1 0,5 y = 0.49x R² = ,5 1 0,5 y = 0.44x R² = PET Perfusion [ml/min/g] 0 0 0,5 1 1,5 2 2,5 3 3,5 PET Perfusion [ml/min/g] Zhang, Nekolla, Schwaiger

19 ml/min/g Flow Reserve First simultaneous measurement of myocardial perfusion on whole-body PET/MR Global Myocardial Perfusion ( 3 slices) 3 2,5 PET MR 3,5 3 PET MR 2 1,5 1 2,5 2 1,5 1 0,5 0,5 0 REST STRESS 0 Zhang, Nekolla, Schwaiger

20 Imaging Parameters of Viability Viable Non-viable Residual Perfusion / Reserve (SPECT/PET) Contractile Reserve (ECHO/MRI/SPECT/PET) Oxidative Metabolism (PET,MRS) Glucose Utilization (PET, MRS) Membrane Integrity (SPECT) GD-DTPA Enhancement (MRI/CT) Apoptosis / Myosin Antibody (SPECT)

21 Injection 18 F-FDG ( MBq) PET/MR-Protocol (viability/clamp) Injection 13 N-ammonia (350 MBq) Gd (0.1 x BW) 13 N PET / MR PERFUSION (Rest) Injection Gd (0,3 x BW) 13 N PET / MR LATE ENHANCEMENT Insulin- Glucose-Clamp PET VIABILITY MR - SCOUT (axial, coronal, sagittal) - CINE (2Ch, 4Ch, Shax) 18 F-FDG PET Native MR

22 PET/MR: 6 days post MI LCE MRI Corr. FDG PET Glucose/Insulin Clamp

23 PET/MR: 6 days post MI

24 Tissue Viability/ Inflammation Fasted FDG Imaging 4 days after Myocardial Infarction Ripschler et al

25 Metabolic Memory FDG 5 Days after Acute Ischemic Event A B C D Takotsubo Ibrahim, Nekolla,Ripschler

26 PET/CT/MR Multimodal Cardiac Imaging Applications in Nuclear Cardiology Clinical Multimodal phenotyping of CAD Assessment of tissue viability / necrosis Integrated plaque imaging (?) Research Crossvalidation of imaging methods (i.e. perfusion) Molecular imaging (innervation,receptors,inflammation) Monitoring therapy i.e.cell therapy /cell migration

27 Acknowledgements Ambros Beer Alexander Drzezga Michael Souvatzoglou Iina Laitinen Isabel Dregely Sebastian Fürst Stephan Nekolla Sybille Ziegler Axel Martinez- Möller Sandra v Marwick Hans Jürgen Wester Sebastian Fürst Petra Watzlowik Shelley HuaLei Zhang, Christoph Rischpler, Carmel Hayes, Florian Gaertner, Gitti Dzewas Coletta Kruschke Sylvia Schachoff