Clinical Department of Nuclear Medicine

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Nuklearnomedicinsko oslikavanje demencija
SPECT
Doktorski studij "BIOMEDICINA I
ZDRAVSTVO Granski predmet Neurobiologija
starenja Voditelj Prof. dr. sc. Goran Šimic
Ratimir Petrovic
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PET je najskuplja i najkompleksnija metoda
nuklearnomedicinskog oslikavanja
Produkcija radionuklida u ciklotronu
Transport u vrucu stanicu

• Sinteza radiofarmaka
• Sterilizacija

Isporuka doze
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• SPECT
• Single Photon Emission Computerised Tomography
• prikaz regionalnog cerebralnog protoka
• 99-mTc-HMPAO - radiofarmak prvog prolaza
• korelira s regionalnom neuronalnom aktivnošcu
• relativno jeftin i dobavljiv
• ALI
• nije moguca kvantitativna analiza

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PET vs. SPECT

• Slabija rezolucija
• Kompleksne i velike molekule
• Manje kvantitativan
• Duže poluvrijeme raspada
• Lako dobavljiv
• Ne tako skup
• Nepotrebna posebna oprema za produkciju izotopa

• Bolja rezolucija
• Biološki korisni izotopi
• 11C, 13N, 15O, 18F
• Kvantitativan (b)
• Kratko poluvrijeme raspada T1/2
• Vrlo skup
• Ciklotron

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Konvencionalni PET radionuklidi
15O
13N
11?
18F
2,04 min
9,96 min
20,4 min
109,8 min
Jedino 18F-radiofarmaci mogu biti transportirani
na vece udaljenosti od proizvodnog pogona
(ciklotrona)

• 96.9 ?
• Emax 0.635 MeV

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• Trenutacno 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 clanaka)

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18Fluoro-2-deoksi-D-glukoza
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Poredba PET-a i SPECT-a
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1 Tehnicka ispravnost i položaj 2 Opci
pregled velikih struktura 3 Globalni nivo
metabolizma 4 Fokalna kortikalna metabolicka
patologija (hiper ili hipo) ... i poredba s
ocekivanom distribucijom radiofarmaka 5. Pojava
tipicnih metabolickih obrazaca !
Koregistracija slike
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Progresivni PET Obrasci
Obrazac
Parijetalni/Temporalni Frontalni
hipoometabolizam
Predominantno frontalni hipometabolizam
Ametabolizam Bazalnih Ganglija (Huntingtonova
bolest)
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Stacionarni PET Obrasci
Normalni Metabolizam
Globalni Hipometabolizam
Fokalni Hipometabolizam
Obrazac
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Uredan PET mozga 18F-FDG
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Different causes of Dementia
Organic Brain Syndrome Degenerative
disorders Alzheimers dementia,
Creutzfeldt-Jakob disease, Huntington disease,
Multiple Sclerosis (MS), Normal pressure
hydrocephalus, Picks 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) Parkinsons 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 Addisons
disease, Cushings 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
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Proces starenja
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PET smanjenje u nakupljanju neurotransmitera
tijekom procesa starenja
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PET, 18F-FDG
Tipican prikaz Alheimerove bolesti
parijetotemporalni hipometabolizam
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PET Progresija Alheimerove demencije
Uredan Rani stadij Kasni stadij Dijete
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Alzheimerova demencija umjerena i teška forma
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Pickova demencija
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Rani stadij frontotemporalne demencije
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Frontotemporalna demencija
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Vaskularna demencija
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Lewy body demencija
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Huntingtonova demencija
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Novi radiofarmaci
Uredan AD
PET - Pittsburgh Compound-B (PIB), omogucava
kvanitativnu procjenu depozita amiloida
PET - FDG
PET - PIB
Nordberg Lancet Neurology 2004