Advancing Nuclear Medicine Through Innovation (2007) / Chapter Skim
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3 Nuclear Medicine Imaging in Diagnosis and Treatment
3 Nuclear Medicine Imaging in Diagnosis and Treatment
Pages 43-58
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From page 43... ...
These functional processes include tissue blood flow and metabolism, protein -- protein interactions, expression of cell receptors in normal and abnormal cells, cell -- cell interactions, neurotransmitter activity, cell trafficking and homing, tissue invasion, and programmed cell death. By providing information on these processes, nuclear medicine imaging offers a broad array of tools for probing normal and disease-related states of tissue function and response to treatment.
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From page 44... ...
3.2 CURRENT STATE OF NUCLEAR MEDICINE IMAGING AND EMERGING PRIORITIES This section describes the use of nuclear medicine imaging for three types of diseases to illustrate its impact on patient diagnosis and management and to identify emerging priorities. The three types of disease are cancer (Section 3.2.1)
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From page 45... ...
The accumulation of FDG in cancer cells represents an in vivo correlate of the abnormal mitochondrial function found in many types of cancer cells. Differences in rate of glucose utilization distinguish malignant from benign tumors and identify the presence and spread of tumor metastases as measures of disease severity.
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From page 46... ...
However, depending on the radiotracer used, PET provides diagnostic information based on other types of metabolic activity, such as amino acid1 metabolism, cell proliferation, and tissue hypoxia.2 For example, amino acids and amino acid analogs3 have been labeled with fluorine-18 or carbon-11 and have been reported to be superior to FDG for imaging of brain tumors (Pirotte et al. 2004, Nariai et al.
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From page 47... ...
3.2.2 Cardiovascular Disease In cardiology, nuclear medicine imaging has assumed an important role in the diagnosis as well as the management of patients with coronary artery disease.4 Myocardial perfusion imaging (Sidebar 3.2) is the most widely used approach in patients with suspected cardiac disease.
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From page 48... ...
This allows physicians to provide better care to patients with advanced and disabling cardiac disease by guiding therapeutic decisions; the therapies can range from conservative, drug-based management of disease to more aggressive forms of intervention, such as surgery to restore blood flow. Because of the high prevalence of coronary artery disease, myocardial perfusion imaging studies have become the most widely used nuclear medicine imaging test.
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Light pink indicates normal and dark blue diminished blood flow. Note the area of reduced blood flow on the stress images (ar rows)
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Existing imaging techniques also offer a means for assessing the effectiveness of gene- and cell-based approaches for repairing the injured heart muscle tissue or for improving cardiac function. Changes in blood flow in response to angiogenic gene therapy with vascular endothelial growth factor, for example, can be monitored non-invasively (Udelson and Spiegler 2001)
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. 3.2.3 Neurological Disorders A third clinical specialty where nuclear medicine imaging has played an important role in patient care is neurology.
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is associated with diminished FDG uptake and thus reduced glucose utilization (center) but demonstrates intense amino acid uptake as seen on the FDOPA PET image (right panel)
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This change causes degeneration of brain cells that result in uncontrolled move ment, loss of intellectual faculties, and emotional disturbances, such as mood swings and depression (NINDS 2006a)
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The PET PIB images are compared to anatomic maps of the brain generated with MRI which do not indicate any abnormalities. Note the intense radiotracer uptake in the AD patient (yellow and red colors)
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From page 55... ...
As described in Chapter 2, use of nuclear medicine imaging during the drug development process could identify which drugs should advance from animal to human studies, validate the mechanism of drug localization, evaluate drug distribution to target tissue, establish the drug occupancy of receptor sites, assess the actions of new agents on specific molecular targets or pathways, and determine appropriate dose range and regimen (Eckelman 2003)
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. 3.3 IMPEDIMENTS TO PROGRESS AND CURRENT AND FUTURE NEEDS As described above, nuclear medicine imaging has the potential to further improve patient care in a variety of ways.
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From page 57... ...
Radiotracers for nuclear medicine imaging are supplied on a dose basis through networks of radiopharmacies and radiopharmaceutical distribution centers. Most radiopharmaceutical distribution centers in the United States are located within a less than 100-mile radius of nuclear medicine imaging facilities.
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From page 58... ...
Accordingly, there is a need for greater uniformity of nuclear medicine imaging, including universally accepted image-derived measures of regional tissue function. Standardization of imaging study protocols, of image formatting, data handling, and data storage, as well as of image-derived parameters, will be especially critical for design and performance of multi-center clinical trials for drug evaluation and determination of efficacy of newly developed imaging approaches.
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