Transcript Document

Nuklearnomedicinsko oslikavanje
demencija
SPECT
Doktorski studij "BIOMEDICINA I
ZDRAVSTVO“
Granski predmet:
Neurobiologija starenja
Voditelj:
Prof. dr. sc. Goran Šimić
Ratimir Petrović
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
PET je najskuplja i najkompleksnija
metoda nuklearnomedicinskog
oslikavanja
Produkcija
radionuklida u
ciklotronu
Isporuka
doze
Transport u “vruću
stanicu”
• Sinteza
radiofarmaka
• Sterilizacija
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
c
511 keV
+
18F
p
e+
e511 keV
c
18
F
->
18
+
O + e + v + Energija (635 keV)
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
SPECT
• Single Photon Emission
Computerised Tomography
• prikaz regionalnog
cerebralnog protoka
• 99-mTc-HMPAO - radiofarmak
“prvog prolaza”
• korelira s regionalnom
neuronalnom aktivnošću
• relativno jeftin i dobavljiv
ALI
– nije moguća kvantitativna
analiza
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
PET
vs. SPECT
• Bolja rezolucija
• Biološki korisni izotopi
–
11C, 13N, 15O, 18F
• Kvantitativan (b+)
• Kratko poluvrijeme
raspada T1/2
• Vrlo skup
• Ciklotron
• Slabija rezolucija
• Kompleksne i velike
molekule
• Manje kvantitativan
• Duže poluvrijeme
raspada
• Lako dobavljiv
• Ne tako skup
• Nepotrebna posebna
oprema za produkciju
izotopa
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Konvencionalni PET radionuklidi
15O
13N
11С
18F
2,04
min
9,96
min
20,4
min
109,8
min
Jedino 18F-radiofarmaci
mogu biti transportirani na
veće udaljenosti od
proizvodnog pogona
(ciklotrona)
• 96.9% +
• Emax 0.635 MeV
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Trenutačno se u
laboratorijima širom
svijeta ispituje oko
•81 neurotransmiterska
molekula prikladna za
SPECT scintigrafije
i
•163 neurotransmiterskih
molekula prikladnih za
scintigrafije PET-om
( .... i svaki dan se
otkrivaju nove molekule)
(vlastiti podaci dobijeni
revizijom devedeset recentnih
članaka)
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
18Fluoro-2-deoksi-D-glukoza
PLAZMA
TKIVO
OH
FDG
FDG
glukoza
glukoza
FDG–6–P
O
OH
HO
glukoza–6–P
OH
18
F
[18F]–FDG
CO2 + H2O
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Poredba PET-a
i SPECT-a
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
1: Tehnička ispravnost i položaj
2: Opći pregled velikih struktura
3: Globalni nivo metabolizma
4: Fokalna kortikalna metabolička
patologija (hiper ili hipo) ... i poredba s
očekivanom distribucijom radiofarmaka
5. Pojava tipičnih metaboličkih obrazaca !
Koregistracija slike
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Progresivni PET Obrasci
Obrazac:
Parijetalni/Temporalni Predominantno frontalni Ametabolizam Bazalnih
± Frontalni
hipometabolizam
Ganglija
hipoometabolizam
(Huntingtonova bolest)
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Stacionarni PET Obrasci
Obrazac:
Normalni
Metabolizam
Globalni
Hipometabolizam
Fokalni
Hipometabolizam
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Uredan PET mozga – 18F-FDG
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Different causes of Dementia
Organic Brain Syndrome
Metabolic Causes
Degenerative disorders:
Endocrine disorders
Alzheimer’s dementia, Creutzfeldt-Jakob disease, Huntington disease,
Multiple Sclerosis (MS), Normal pressure hydrocephalus, Pick’s disease
Addison’s disease, Cushing’s disease, Diabetic
nephropathy, Diabetic ketoacidosis, Insulinoma or
hypoglycemia, Hypoparathyroidism,
Hyperparathyroidism, Hypothyroidism,
Thyrotoxicosis, Pheochromocytoma
Cardiovascular disorders:
Arrhythmias – may cause some types of OBS, Cardiac infections
(endocarditis, myocarditis, etc.) -- may sometimes cause OBS,
Hypertensive brain injury, Multi-infarct dementia, Stroke, Transient
Ischaemic Attack (TIA)
Trauma-induced brain injury:
Chronic subdural haematoma, Concussion, Intracerebral haemorrhage,
Subarachnoid haemorrhage, Respiratory conditions -- may cause or
aggravate OBS, Hypoxia (decreased oxygen in the body), Hypercapnia
(increased carbon dioxide levels in the body)
Metabolic disorders
Acid/base disorders of any type, Fluid electrolyte
disorders of any type, Hyponatremia,
Hypercalcemia, Kidney failure with uremia, Liver
disease, Porphyria
Infections:
Nutritional disorders
Any acute or chronic infection, Septicaemia (presence in the
bloodstream of toxic by-products caused by infection), Meningitis,
Encephalitis
Vitamin B-1 deficiency, Vitamin B-12 deficiency,
Pellagra, Protein-calorie malnutrition
Drug and alcohol related conditions:
Intoxication, drug abuse or alcohol use, Long-term effects of alcohol,
Wernicke-Korsakoff syndrome, Alcohol withdrawal state, Withdrawal
from drugs (especially sedative-hypnotics and corticosteroids)
Parkinson’s disease
Other conditions that may be related to organic brain syndrome
include: depression, neuroses, and psychoses of various types, which
may occur simultaneously with the OBS.
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Proces starenja
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
PET – smanjenje u nakupljanju neurotransmitera
tijekom procesa starenja
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
PET, 18F-FDG
Tipičan prikaz
Alheimerove bolesti –
parijetotemporalni
hipometabolizam
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
PET – Progresija Alheimerove demencije
Uredan
Rani stadij
Kasni stadij
Dijete
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Alzheimerova demencija – umjerena i teška forma
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Pickova demencija
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Rani stadij frontotemporalne demencije
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Frontotemporalna
demencija
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Vaskularna demencija
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Lewy body demencija
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Huntingtonova demencija
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb
Novi radiofarmaci
Uredan
PET - FDG
PET - PIB
AD
PET Pittsburgh
Compound-B
(PIB),
omogućava
kvanitativnu
procjenu
depozita
amiloida
Nordberg
Lancet Neurology
2004
Clinical Department of Nuclear Medicine
and Radiation Protection, KBC Zagreb