Principi PET-CT preiskave. Marko Grmek
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1 Principi PET-CT preiskave Marko Grmek
2 PET-CT PET pozitronska emisijska tomografija CT računalniška tomografija Fuzijska slika
3 Detektor sevanja - PET skener - CT naprava PET-CT preiskava Radiofarmak - 18 F-FDG - drugi farmaki označeni z 18 F (holin, timidin) - drugi pozitronski sevalci 11 C, 13 N, 15 O, 68 Ga
4 PET-CT preiskava z 18 F-FDG 18 F-FDG (2-deoksi-2-[ 18 F]fluoro-D-glucose) se obnaša v telesu enako kot glukoza 18 F-FDG-6-fosfat (FDG-6-P), metabolit 18 F- FDG, se kopiči v celicah in prikaže porabo glukoze v organih in tkivih telesa 18 F-FDG - pozitronski sevalec - t 1/2 110 min - aktivnost MBq
5 PET-CT - načini izvedbe preiskave Lokalizacijski CT + PET (najpogosteje) Diagnostični CT + PET Samo PET Samo CT (CTA) Lokalizacijski CT + PET + diagnostični CT Lokalizacijski CT - low dose CT, uporabljamo tudi za korekcijo atenuacije
6 PET-CT preiskava z 18 F-FDG Doza sevanja: PET 3-7 msv CT (lokalizacijski) 2-3 msv Skupno 5-10 msv Povprečna letna doza iz naravnega ozadja = 2,4 msv
7 PET-CT preiskava z 18 F-FDG Priprava bolnika Tešč (brez hrane, sladkih pijač ) 6 ur Popiti 1-2 litra vode Bolniki s sladkorno boleznijo, ki ne morejo biti tešči: - Preiskavo bomo naredili pozno dopoldne - okrog 12 ure - Ohranijo naj običajen režim hranjenja in jemanja zdravil (Prosim označite na napotnici oz. nam sporočite)
8 PET-CT preiskava z 18 F-FDG Izvedba preiskave Vstavitev iv. kanala Aplikacija radiofarmaka ( 18 F-FDG) Čakanje - počitek (1 uro) Slikanje na PET-CT (15 45 min) Evalvacija rezultatov (izvid)
9 Evalvacija rezultatov PET-CT preiskave z 18 F-FDG Vizualna ocena PET scintigramov in tomogramov lokalizacijskega CT fuzijske slike
10 Evalvacija rezultatov PET-CT preiskave z 18 F-FDG Semikvantitativna ocena - SUV (standardized uptake value)
11 Evalvacija rezultatov PET-CT preiskave z 18 F-FDG Normalno kopičenje Patološko kopičenje - velikost lezije (vsaj nekaj mm) Lokalizacija Aktivnost lezije
12 PET-CT preiskava z 18 F-FDG - indikacije Maligne bolezni maligne celice imajo over-expression glukoznega prenašalca GLUT-1 in povečano aktivnost heksokinaze Diagnostika (redko) Razširjenost staging Učinkovitost zdravljenja Povrnitev bolezni
13 PET-CT preiskava z 18 F-FDG - indikacije Vnetje Prikaz vnetja (ob endoprotezi, spondilodiscitisa) Vročina neznanega izvora KVČB (aktivnost, razširjenost) Možgani Opredeljevanje demenc Določitev mesta epileptogenega žarišča Drugo Kardiologija Viabilnost miokarda
14 Dg: Spondilodiscitis PET-CT preiskava z 18 F-FDG
15 PET-CT preiskava z 18 F-FDG v hematologiji Limfom - Diagnosis No - Staging - Recurrence - general staging Suggested - bone marrow staging Yes - for HD and NHL after completion of initial treatment - for general follow-up of asymptomatic HD or NHL Yes No Fletcher JW, Djulbegovic B, Soares HP, Siegel BA, Lowe VJ, Lyman GH, et al. Recommendations on the use of F-18-FDG PET in oncology. J Nucl Med. 2008;49:
16 PET-CT preiskava z 18F-FDG v hematologiji Dg: Limfom
17 PET-CT preiskava z 18 F-FDG v hematologiji Dg: Limfom
18 PET-CT preiskava z 18 F-FDG v hematologiji Restaging Kdaj: Najmanj 3 tedne (najbolje 6 8 tednov) po končani kemoterapiji 8-12 tednov po radioterapiji ali kemoradioterapiji
19 PET-CT preiskava z 18 F-FDG v hematologiji Limfom Moulin-Romsee G, Spaepen K, Stroobants S, Mortelmans L. Non-Hodgkin lymphoma: retrospective study on the cost-effectiveness of early treatment response assessment by FDG-PET. Eur J Nucl Med Mol Imaging. 2008;35:
20 PET-CT preiskava z 18 F-FDG v hematologiji Dg: Limfom pred in po 2 ciklusih KT
21 PET-CT preiskava z 18 F-FDG v hematologiji Plazmocitom Staging in restaging - diseminirani - solitarni - ekstramedularni Aktivnost bolezni
22 PET-CT preiskava z 18 F-FDG v hematologiji Dg: Plazmocitom
23 PET-CT preiskava z 18 F-FDG v hematologiji Leukemija of limited use ekstramedularne manifestacije (granulocitni sarkom)? proliferacijski marker 18 F-FLT ( 18 F-fluorotimidin) Histiocitoza Prikaže razširjenost in aktivnost bolezni (boljša kot scintigrafija skeleta)
24 PET-CT preiskava z 18 F-FDG v hematologiji Dg: ALL, Okužba?
25 PET/CT preiskava z 18 F-FDG Literatura Fletcher JW, Djulbegovic B, Soares HP, Siegel BA, Lowe VJ, Lyman GH, et al. Recommendations on the use of F-18-FDG PET in oncology. J Nucl Med. 2008;49: FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging. _onco_fdgpet.pdf
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