Clinical Department of Nuclear Medicine

and Radiation Protection, KBC Zagreb

Nuklearnomedicinsko oslikavanje demencija

Ratimir Petrović

SPECT

Doktorski studij "BIOMEDICINA I ZDRAVSTVO“Granski predmet:Neurobiologija starenjaVoditelj:Prof. dr. sc. Goran Šimić

Clinical Department of Nuclear Medicine

and Radiation Protection, KBC Zagreb

Produkcija radionuklida u ciklotronu

Isporuka doze

PET je najskuplja i najkompleksnija metoda nuklearnomedicinskog

oslikavanja

• Sinteza radiofarmaka• Sterilizacija

Transport u “vruću stanicu”

Clinical Department of Nuclear Medicine

and Radiation Protection, KBC Zagreb

18F +

-

p

511 keV

511 keV

e+

e-

18F ->

18O + 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 dobavljivALI

– 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 18F18F

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

1818Fluoro-2-deoFluoro-2-deoksiksi-D-glukoza-D-glukoza

HO

O

OH

OH

18F

OH

PLAZMA TKIVO

FDG FDG FDG–6–P

glukoza glukoza glukoza–6–P

CO2 + H2O[18F]–FDG

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

Koregistracija slike

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 !

Clinical Department of Nuclear Medicine

and Radiation Protection, KBC Zagreb

ProgresivProgresivnini PET PET ObrasciObrasci

PariParijjetaletalnini/Temporal/Temporalnini± Frontal± Frontalnini

hipohipoometaboliometabolizamzam

PredominantPredominantno frontalnino frontalnihipohipometabolimetabolizazamm

AmetaboliAmetabolizazam Bam Bazzalalnihnih GangliGanglijja a

(Huntington(Huntingtonovaova bolestbolest))

ObrazacObrazac::

Clinical Department of Nuclear Medicine

and Radiation Protection, KBC Zagreb

StacionarniStacionarni PET PET ObrasciObrasci

NormalNormalniniMetaboliMetabolizazamm

GlobalGlobalniniHHiipometabolipometabolizazamm

FoFokkalalniniHHiipometabolipometabolizazam m

ObrazacObrazac::

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

Organic Brain Syndrome

Degenerative disorders:

Alzheimer’s dementia, Creutzfeldt-Jakob disease, Huntington disease, Multiple Sclerosis (MS), Normal pressure hydrocephalus, Pick’s disease

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)

Infections:

Any acute or chronic infection, Septicaemia (presence in the bloodstream of toxic by-products caused by infection), Meningitis, Encephalitis

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.

Metabolic Causes

Endocrine disorders

Addison’s disease, Cushing’s disease, Diabetic nephropathy, Diabetic ketoacidosis, Insulinoma or hypoglycemia, Hypoparathyroidism, Hyperparathyroidism, Hypothyroidism, Thyrotoxicosis, Pheochromocytoma

Metabolic disorders

Acid/base disorders of any type, Fluid electrolyte disorders of any type, Hyponatremia, Hypercalcemia, Kidney failure with uremia, Liver disease, Porphyria

Nutritional disorders

Vitamin B-1 deficiency, Vitamin B-12 deficiency, Pellagra, Protein-calorie malnutrition

Different causes of Dementia

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 demencijePET – Progresija Alheimerove demencije

UredanUredan Rani stadijRani stadij Kasni stadijKasni stadij Dijete 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

PET - FDG

PET - PIB

NordbergLancet Neurology2004

PET - Pittsburgh Compound-B (PIB), omogućava kvanitativnu procjenu depozita amiloida

Uredan AD