Badania obrazowe z uzyciem radioznacznikow ?

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Badania obrazowe z uzyciem radioznacznikow ?

Nieprzeczytany postautor: wlobo135 » 07 mar 2013, 13:02

Motto: Zanim potępisz staraj się zrozumieć.
Ur. 1941 VI/09 PSA5,3 X/09 PSA9,7 Biopsja Gl 9(5+4) Scany: wszystko czyste 30/XI/09 prostatektomia radykalna z usunieciem wiązki nerwowo-naczyniowej. Gleason 10 pT3aN0M0 21/I/10 PSA 0,7 4/III/10 PSA 0,77. 26/III/10 PSA 1.0 Doubling time 4,5 mca. V/10 hormony (Zoladex) i radioterapia 66Gy. VIII/10 PSA 0,04 X/10 PSA 0.03 XII/10 PSA 0,03 testosteron 23ng/dL(0,8nml/L) II/11 PSA<0,05/<0,03 IV/11 PSA<0,05 testosteron<0,5nmol/L(<14ng/dL) Przerwa w hormonoterapii :) VII/11 PSA 0,001 Testosteron 1,03/30 IX/11 PSA<0.05, Testosteron3.8/112, 11/2011 PSA 0,04 testosteron 7,1/208 1/2012 PSA 0,1 2/2012 PSA 0,18Obrazekpowrót do HT 4/2012 PSA 0,03. 5/2012 PSA<0.03 7/2012 PSA 0,03 9/2012PSA 0,01 11/2012 PSA <0,03 1/2013 PSA <0,03 3/2013PSA <0,03 testosteron <23/0,8 Ponowne przerwanie HT 6/2013 PSA <0,003 testosteron<2,6 ng/dl 10/2013 PSA <0,03 testosteron 17,6 ng/dl. 2/2014 PSA<0.03 testosteron 138 7/2014 PSA-0,62, 8/2014 PSA-1,85 10/2014 PSA-7,9 11/2014 PSA-7,57PET/CT zajęte cztery węzły chłonne w miednicy, skierowanie na RT (SBRT) powrót do HT(3 miesiące) 2/2015 PSA-3,43 4/2015 PSA-0,72 7/2015 PSA-0,72 testosteron 40/1,3 10/2015 PSA-1,2 testosteron 168/5,8 12/2015 PSA-0,78 3/2016 PSA-0,71 6/2016 PSA-0,34 9/2016 PSA-0,16 12/2016 PSA-0,22 3/2017 PSA-0,54 7/2017 PSA-1,7 11/2017 PSA-0,3 2/2018 PSA-0,11 5/2018 PSA-0,09 7/2018 PSA-0,169 testosteron 37/1,34

Wykres obrazujący przebieg leczenia. http://www.fotosik.pl/zdjecie/4c0bd44ca8968802
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wlobo135
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Nieprzeczytany postautor: wlobo135 » 17 gru 2014, 13:05

Nowe radioznaczniki w badaniach obrazowych.
(Skopiowane z australijskiego forum)

A positron emission tomography (PET) scan is an imaging test that uses a radioactive substance called a radiotracer to look for disease in the body.
Before carrying out a PET scan, a radioactive medicine is produced in a cyclotron (a type of machine).
The radioactive medicine is then tagged to a natural chemical.
This natural chemical could be glucose, water, or ammonia.
The tagged natural chemical is known as a radiotracer.
The radiotracer is then inserted into the patient’s body, normally through a canula which has been inserted into the patient’s arm.


When it is inside, the radiotracer will go to areas inside the body that use the natural chemical.

For example, the 18F-FDG (fluorodeoxyglucose) is a radiotracer that is tagged to glucose.
The glucose goes into those parts of the body that use glucose for energy.
Cancers, for example, use glucose differently from normal tissue - so, an FDG PET Scan can show up cancers.


The 18F-FDG PET Scan is probably the commonly used PET Scan in hospitals.
Because prostate cancer is slow-growing, it does not take up glucose as much as other cancers.
For this reason researchers have been looking to develop radiotracers that were more suitable to use for imaging prostate cancer
.




For several years the 11C-Choline PET scan introduced at the Mayo Clinic has been regarded as leading the way in the imaging of prostate cancer.
The major limitation of 11C-Choline is that it has a 20-minute half-life
(The half life is the time required for one half of the atoms of a given amount of a radioactive substance to disintegrate).
This means that 11C-Choline must be used very quickly after it is produced.
For this reason, it must be produced on site very close to where it is administered.

Normally radiotracers are produced off site for safety reasons.

11C-Choline has shown limited sensitivity in men with very low PSAs.
One study showed a 5% detection rate where PSA levels were less than 1 ng/ml.


18F-Fluorocholine is another radiotracer that has been trialled in Europe and Australia with good results.
However, it is less sensitive than 11C-Choline and requires a higher PSA level in order to get an effective image.



A PSMA PET scan is one that uses a radiotracer which is targeted to a protein (Prostate-Specific Membrane Antigen) that is found in prostate cancer.

There are different types of radiotracers are being developed for PSMA PET Scans.
For example, in the United States Johns Hopkins University has developed a 18F-DCFBC radiotracer and Memorial Sloan Kettering Cancer Centre has developed a Zr89-J591 radiotracer.
In Australia we are now using a Gallium(Ga68) radiotracer which was developed in Germany.


The Gallium PSMA PET Scan produces a sharply defined image at very low PSA levels.
Because the Gallium PSMA PET Scan targets the Prostate-Specific Membrane Antigen protruding from the outer membrane of the cancer cells, the radiotracer “lights up” on the PET images showing clearly metastases to lymph nodes as well as to bone.


[In my case with a very low PSA of 0.58, the Gallium PSMA PET Scan detected 4 metastases that were not visible on other scans.]
Seeing is believing.
Memorial Sloan Kettering Cancer Centre has produced an excellent video showing the difference that a PSMA PET Scan makes:


http://www.mskcc.org/videos/prostate-specific-pet-scans


Whilst radiology oncologists are predicting that the PSMA PET Scan will revolutionise the treatment of prostate cancer, that revolution is some time away.
At the moment the technology is still being trialled in Australia.
There is limited availability of these scans: only a few hospitals in Australia are offering them.
The scans are expensive and are not covered by Medicare.




Na ten sam temat, skopiowane z postu Zosi:

Dla nieznajacych angielskiego:
Wstepne proby uzycia PET z wykorzystaniem nowego znacznika 68Ga-PSMA majace na celu wykrycie wznowy oraz przerzutow w raku prostaty okazaly sie nader obiecujace. Dzieki uzyskanemu grantowi w wys. 50 tys. dolarow, kilka osrodkow australijskich prowadzi obecnie proby kliniczne, ktorych celem jest porownanie efektywnosci oceny zmian rakowych w zlokalizowanym CaP przy uzyciu 68Ga-PSMA PET oraz MP MRI. Wszystkie badania obrazowe zostana skonfrontowane z histopatologia usunietego gruczolu.


Evaluation of Prostate-specific Membrane Antigen Based PET and MRI for the Detection of MultipleCancer Foci in Localised Prostate Cancer Patients

Prostate cancer is difficult to detect on most imaging methods such as X-rays, Computed Tomography scans, conventional Magnetic Resonance Imaging (MRI) scans and conventional Positron Emission Tomography (PET) scans.
Therefore, reliable and advanced imaging tests are needed to locate prostate cancer accurately and to reflect the pathological features of the prostate.

Multiparametric (MP) MRI has become popular, complementing T2W images with diffusion-weighted imaging, dynamic contrast-enhanced (DCE) imaging, and MR spectroscopy imaging (MRSI) to improve diagnostic accuracy.
MP MRI remains imperfect because its sensitivities and specificities depend on technical factors and the composition of the study population.
Therefore, there is still a need to identify prostate cancer accurately.

Recently, a preliminary study has demonstrated promising PET results with a novel PET radiotracer, [68Ga] Gallium labelled prostate-specific membrane antigen ligand (68Ga-PSMA), for the detection of prostate cancer relapses and metastases.
Moreover, a study has shown that PET imaging with 68Ga-PSMA ligand can present lesions suspicious for prostatecancer with excellent contrast and a high detection rate even when the level of prostatespecific antigen is low.
However, the role of PET imaging with 68Ga-PSMA ligand in cancerfoci detection in localised prostate cancer has not been well established.

In this study, 68Ga-PSMA PET and MP MRI will be compared with whole-mount pathology to evaluate the applicability of 68Ga-PSMA PET and MP MRI for detecting and locating tumour foci as well as to characterise 68Ga-PSMA uptake in patients with localised prostate cancer.
All the imaging results will be compared with whole-mount prostate gland histology.
Motto: Zanim potępisz staraj się zrozumieć.
Ur. 1941 VI/09 PSA5,3 X/09 PSA9,7 Biopsja Gl 9(5+4) Scany: wszystko czyste 30/XI/09 prostatektomia radykalna z usunieciem wiązki nerwowo-naczyniowej. Gleason 10 pT3aN0M0 21/I/10 PSA 0,7 4/III/10 PSA 0,77. 26/III/10 PSA 1.0 Doubling time 4,5 mca. V/10 hormony (Zoladex) i radioterapia 66Gy. VIII/10 PSA 0,04 X/10 PSA 0.03 XII/10 PSA 0,03 testosteron 23ng/dL(0,8nml/L) II/11 PSA<0,05/<0,03 IV/11 PSA<0,05 testosteron<0,5nmol/L(<14ng/dL) Przerwa w hormonoterapii :) VII/11 PSA 0,001 Testosteron 1,03/30 IX/11 PSA<0.05, Testosteron3.8/112, 11/2011 PSA 0,04 testosteron 7,1/208 1/2012 PSA 0,1 2/2012 PSA 0,18Obrazekpowrót do HT 4/2012 PSA 0,03. 5/2012 PSA<0.03 7/2012 PSA 0,03 9/2012PSA 0,01 11/2012 PSA <0,03 1/2013 PSA <0,03 3/2013PSA <0,03 testosteron <23/0,8 Ponowne przerwanie HT 6/2013 PSA <0,003 testosteron<2,6 ng/dl 10/2013 PSA <0,03 testosteron 17,6 ng/dl. 2/2014 PSA<0.03 testosteron 138 7/2014 PSA-0,62, 8/2014 PSA-1,85 10/2014 PSA-7,9 11/2014 PSA-7,57PET/CT zajęte cztery węzły chłonne w miednicy, skierowanie na RT (SBRT) powrót do HT(3 miesiące) 2/2015 PSA-3,43 4/2015 PSA-0,72 7/2015 PSA-0,72 testosteron 40/1,3 10/2015 PSA-1,2 testosteron 168/5,8 12/2015 PSA-0,78 3/2016 PSA-0,71 6/2016 PSA-0,34 9/2016 PSA-0,16 12/2016 PSA-0,22 3/2017 PSA-0,54 7/2017 PSA-1,7 11/2017 PSA-0,3 2/2018 PSA-0,11 5/2018 PSA-0,09 7/2018 PSA-0,169 testosteron 37/1,34

Wykres obrazujący przebieg leczenia. http://www.fotosik.pl/zdjecie/4c0bd44ca8968802
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