Η Πυρηνική Καρδιολογία Το 2017 ΟΜΑΔΑ ΕΡΓΑΣΙΑΣ ΑΠΕΙΚΟΝΙΣΤΙΚΩΝ ΤΕΧΝΙΚΩΝ

Η Πυρηνική Καρδιολογία Το 2017 ΟΜΑΔΑ ΕΡΓΑΣΙΑΣ ΑΠΕΙΚΟΝΙΣΤΙΚΩΝ ΤΕΧΝΙΚΩΝ

huma human n Setting diagnosis of the early stages of chronic diseases (i.e cancer, neuropsychiatric, cardiovascular disorders), in whom the prompt therapeutic intervention will improve the outcomes.

Atherosclerosis Imaging Early identification of patients at higher risk

Why Molecular Plaque Imaging? Plaque Rupture Myocardial infarction Stroke Peripheral vascular occlusion Detect disease earlier Stratify disease subsets Monitor therapies Determine prognosis

Atherosclerotic Plaque Imaging Questions to be answered Introduction Plaque angiogenesis Plaque Inflammation

WHAT IS A HIGH RISK PLAQUE?

Atherosclerotic Plaque Imaging Questions to be answered Introduction Plaque angiogenesis Plaque Inflammation

Role of hypoxia in tumor angiogenesis IHF-1a:hypoxia induced transcription factor Pre-angiogenetic phenotype Carmeliet, Nature 2000

Atherosclerotic Plaque Imaging Questions to be answered Introduction Plaque angiogenesis Plaque Inflammation

Non-invasive techniques Magnetic resonance Imaging (MRI) Computed tomography (CT) Nuclear Cardiology Imaging (SPECT-PET) Ultrasound Imaging

Characteristics of imaging modalities

Targets for Molecular Plaque Imaging Concept : Translate specific Signal into high Resolution, non-invasive imaging

Choosing Nuclear molecular imaging for atherosclerosis

Why Nuclear Imaging Approaches To Imaging Vulnerable Plaques? Nuclear molecular imaging,, such as single photon emission computed tomography (SPECT) and positron emission tomography (PET) alone or in combination with anatomical imaging approaches, are capable of detecting sufficiently small quantities of tracer uptake to be able to quantify pathophysiologically important molecular and cellular features after the injection of small (and physiologically inert) quantities of radiolabeled tracer

What Is A High Risk Plaque? MMPS

Molecular Imaging of Matrix Metalloproteinase in Atherosclerotic Lesions Resolution With Dietary Modification and Statin,

PET CT imaging with the Vascular Cell Adhesion Mollecule VCAM-1 targeted tracer 18F-4V

Imaging of Metabolically Active Macrophages With F-18 PET

Why might FDG PET be suited to imaging arterial inflammation?

Hydroxyapatite is the central structural component of vascular calcification and is laid down during the earliest and most active stages of mineralisation and it propagate, and mineralise the extracellular matrix. Fluoride ions are incorporated into the Hydrap

NaF APPEARS TO IDENTIFY CULPRIT PLAQUE

ICA or any approach that solely evaluates the arterial lumen will be inadequate for identifying the biological and clinical relevance of the disease in the arterial wall. It is likely that PET and SPECT will play key roles in the development of molecular imaging in subjects screened while the atherosclerotic disease is still at a preclinical stage, having the ability to image plaque activity in the absence of flow-limiting stenosis that is essential in our attempts to prevent sudden ischemic cardiac death and unheralded myocardial infarction. One of the main challenges is the poor anatomic resolution of radionuclide approaches, which argues for a combined approach by use of CT, MRI, or ultrasound to identify informative anatomic features, with nuclear imaging providing complementary functional data. (Multidiscipline Approach)

Conclusions Within the not too distant future, noninvasive radionuclide studies will be able to identify atherosclerotic plaques at risk of rupture One of the main challenges is the poor anatomic resolution of radionuclide approaches, which argues for a combined approach by use of CT, MRI, or ultrasound to identify informative anatomic features, with nuclear imaging providing complementary functional data. Although imaging of coronary atheroma presents unique problems associated with size and movement, atheroma imaging in other arteries, particularly the carotids, is clearly feasible. Imaging of the vulnerable plaque will identify the vulnerable asymptomatic patient its pre-clinical course of atherosclerotic heart disease

Characteristics of imaging modalities Matter et al. EHJ 2009

Plaque Rupture

NUCLEAR IMAGING APPROACHES TO IMAGING VULNERABLE PLAQUES Nuclear imaging has several advantages over most of the other modalities including its noninvasive nature and its potential to image different vascular beds within one scanning session The main challenge for nuclear imaging of atherosclerotic plaques is the small size of most lesions and their proximity to the blood pool Molecular imaging, complements traditional anatomical imaging approaches that identify plaque structure and composition Techniques, such as single photon emission computed tomography (SPECT) and positron emission tomography (PET) are capable of detecting sufficiently small quantities of tracer uptake to be able to quantify pathophysiologically important molecular and cellular features after the injection of small (and physiologically inert) quantities of radiolabeled tracer