quantification temp/tdm - sfmn saint... · 2017-09-12 · suv avg 6.2 . quantification temp/tdm...
TRANSCRIPT
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Quantification TEMP/TDM
Torsten Kuwert
Clinique de Médecine Nucléaire
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Quantification TEMP/TDM
Introduction
Quantification
Correction des artefacts
Calibration
Validation
Potentiel clinique
Résumé
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La lutte des technologies
TEMP TEP
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TEMP a des difficultés à mesurer
la concentration de la
radioactivité in vivo en unités
absolues, par exemple en kBq/ml
Progrès technologiques en TEMP?
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La chaîne de la formation des images TEMP
Ritt P et al. Eur J Nucl Med Mol Imag 2011
Les facteurs
perturbant
la mesure de la
C*
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Quantification TEMP/TDM
Introduction
Quantification
Correction des artefacts
Calibration
Validation
Potentiel clinique
Résumé
![Page 7: Quantification TEMP/TDM - SFMN SAINT... · 2017-09-12 · SUV avg 6.2 . Quantification TEMP/TDM Introduction Quantification Correction des artefacts Calibration Validation Potentiel](https://reader034.vdocuments.us/reader034/viewer/2022042301/5ecca9a6a0af283cb576d4d3/html5/thumbnails/7.jpg)
Roadmap to Absolute Quantification with
SPECT/CT
True Activity
Distribution
Measured Activity
Distribution
SPECT Measured Count
Distribution
Calibration
Motion
correction
Attenuation
correction
Scatter
correction
Resolution
recovery
Reconstruction
Finite Resolution
Scatter
Attenuation
Dead Time
Motion
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Le RC dépend du rapport entre le volume de la
structure d´intérêt et la résolution spatiale
2
Zeintl et al. JNM 2010
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La correction pour les artéfacts a été facilitée par
le développement de la reconstruction itérative
Corrections
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L´erreur de la quantification dépend du nombre
des itérations
Zeintl et al. JNM 2010
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Recovery in Phantom
50%
55%
60%
65%
70%
75%
80%
85%
90%
0 32 64 96 128 160 192 224 256
# of Updates
Recocery
[%
]
Lu-177 113 keV 16ml
Lu-177 208 keV 16ml
Tc-99m 16ml
Lu-177 113 keV 8ml
Lu-177 208 keV 8ml
Tc-99m 8ml
Need to iterate more due to the lower
spatial resolution, compared to Tc-99m.
Le nombre nécessaire d´itérations dépend aussi
de l´isotope choisi
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Roadmap to Absolute Quantification with
SPECT/CT
True Activity
Distribution
Measured Activity
Distribution
SPECT Measured Count
Distribution
Calibration
Motion
correction
Attenuation
correction
Scatter
correction
Resolution
recovery
Reconstruction
Finite Resolution
Scatter
Attenuation
Dead Time
Motion
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30 % de diffusé dans 140 keV± 5%
du spectre du Tc-99m
Correction de diffusé (soustraction)
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Spectre en énergie du Lu-177
Lu-177 Spectra
1,E-05
1,E-04
1,E-03
1,E-02
1,E-01
1,E+00
0 50 100 150 200 250 300
Energy [keV]
Counts
(N
orm
alized)
HPGe
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Lu-177 Spectra
1,E-05
1,E-04
1,E-03
1,E-02
1,E-01
1,E+00
0 50 100 150 200 250 300
Energy [keV]
Counts
(N
orm
alized)
HPGe NaI (T2 PointSource) NaI T2 (CylinderSource)
Spectre en énergie du Lu-177
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Fenêtres en énergie
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Roadmap to Absolute Quantification with
SPECT/CT
True Activity
Distribution
Measured Activity
Distribution
SPECT Measured Count
Distribution
Calibration
Motion
correction
Attenuation
correction
Scatter
correction
Resolution
recovery
Reconstruction
Finite Resolution
Scatter
Attenuation
Dead Time
Motion
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Atténuation photonique
Fantôme cylindrique (In-111)
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Coefficients d´atténuation linéaires vs.
unités d´Hounsfield
Conversion of HU to Linear Attenuation Coefficients
0,000
0,050
0,100
0,150
0,200
0,250
0,300
0,350
-100
0-9
00-8
00-7
00-6
00-5
00-4
00-3
00-2
00-1
00 010
020
030
040
050
060
070
080
090
0
1000
1100
1200
1300
1400
1500
Hounsfield Units
µ [
1/c
m]
µ(140 keV)
µ(364 keV)
µ(511 keV)
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Image d´émission TDM „µ-map“
Correction de l´atténuation photonique par l´utilisation de la TDM
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Homogénéisation de la distribution du traceur par la correction d´atténuation
Correction de l´atténuation photonique par l´utilisation de la TDM
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Quantification TEMP/TDM
Introduction
Quantification
Correction des artefacts
Calibration
Validation
Potentiel clinique
Résumé
![Page 23: Quantification TEMP/TDM - SFMN SAINT... · 2017-09-12 · SUV avg 6.2 . Quantification TEMP/TDM Introduction Quantification Correction des artefacts Calibration Validation Potentiel](https://reader034.vdocuments.us/reader034/viewer/2022042301/5ecca9a6a0af283cb576d4d3/html5/thumbnails/23.jpg)
Roadmap to Absolute Quantification with
SPECT/CT
True Activity
Distribution
Measured Activity
Distribution
SPECT Measured Count
Distribution
Calibration
Motion
correction
Attenuation
correction
Scatter
correction
Resolution
recovery
Reconstruction
Finite Resolution
Scatter
Attenuation
Dead Time
Motion
![Page 24: Quantification TEMP/TDM - SFMN SAINT... · 2017-09-12 · SUV avg 6.2 . Quantification TEMP/TDM Introduction Quantification Correction des artefacts Calibration Validation Potentiel](https://reader034.vdocuments.us/reader034/viewer/2022042301/5ecca9a6a0af283cb576d4d3/html5/thumbnails/24.jpg)
Calibration de la caméra TEMP/TDM par rapport à un activimètre
Fantôme cylindrique contenant 200-300
MBq Tc-99m
Image courtesy of Zeintl J. 12,531 (cpm/ml)/(kBq/ml) on Symbia® T6
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Tc-99m LEHR, Symbia T2: 5.62 cpm/kBq Lu-177 MELP, Symbia T2: 0.61, 0.65 cpm/kBq (f(keV))
Facteurs de calibration
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Quantification TEMP/TDM
Introduction
Quantification
Correction des artefacts
Calibration
Validation
Potentiel clinique
Résumé
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Quantitative Capabilities of four State-of-the Art SPECT-CT Cameras (3 Calibrations, 3 Phantoms, 5 ROIs)
20 %
- 25 %
Seret A et al. EJNMMI Res 2012
Error < 10% in large volumes
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Le “gold standard”: La concentration de radioactivité dans la vessie et dans l´urine
16 patients
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Zeintl et al. J Nucl Med 2010
Erreur moyenne: 6,8 %
(SE 8.0%; 95% CI: -14.6 – 16.6)
Quantification de C* à l´aide de la TEMP in vivo (Tc-99m)
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Quantitative Lu-177-SPECT/CT
Validation in 8 Patients
0,00%
20,00%
40,00%
60,00%
80,00%
100,00%
120,00%
140,00%
1 2 3 4 5 6 7 8
Quantitative Accuracy in Bladder
Hand Segmentation Ellipsoid
In elliptical VOIs, mean error 8.03 %
Sanders J et al. (in prep.)
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Premier outil pour la quantification TEMP
disponible commercialement
Carte de kBq/ml ou SUV
pixel par pixel
résultant directement
de la reconstruction
(9/2013,
XSPECT quant, Siemens)
SUV avg 6.2
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Quantification TEMP/TDM
Introduction
Quantification
Correction des artefacts
Calibration
Validation
Potentiel clinique
Résumé
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Quelle est la C* dans les corps vertèbraux
de patients soumis à la scintigraphie osseuse?
50 patients féminins
TEMP 4 ± 0,5 h après 8,26 ± 1,41 MBq DPD/ kg i.v.
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48,15 ± 13,66 kBq/ml
(95% CI 45.81 – 50.50; n = 50) (Cachovan et al. EJNMMI Res 2013)
C* dans les corps vertèbraux
de patients soumis à la scintigraphie osseuse
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5,91 ± 1,54 SUV
(95% CI 5,71 – 6,24) (Cachovan et al. EJNMMI Res 2013)
SUV dans les corps vertèbraux
de patients soumis à la scintigraphie osseuse
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Potentiel clinique de la TEMP quantitative
Perturbations diffuses
de l´accumulation
d´un radiotraceur
Evaluation de la réponse
des tumeurs à la
thérapie
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SUV vs. Hounsfield Units dans un groupe de
50 femmes soumises à la DPD-TEMP/TDM
r = 0,678, p < 0,0001 (95% CI 0,575 – 0,761) Cachovan et al.
2013
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TEMP dynamique?
TEMP quantitative pourrait faciliter
l´analyse compartimentale
Blake GM et al. SNM 2001
ECF Plasma Bone
mineral
Krenal
K1
KBone K2
K4
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Patient âgé de 75 ans atteint d´un cancer
de la glande prostatique (T2cpN0; Gleason 4 + 3 = 7)
PSA 01/13:
100 ng/ml
PSA 10/13:
395,6 ng/ml
Métastases
actives?
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SUV: 9 SUV: 9.5
Patient âgé de 75 ans atteint d´un cancer
de la glande prostatique (T2cpN0; Gleason 4 + 3 = 7)
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Limites préliminaires de normalité
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
16.00
18.00
20.00
BG1
(L1)
BG2
(L2)
BG3
(L5)
BG4
(Pelvis)
BG5
(Pelvis)
BG6
(Pelvis)
T1 (L
3)
T2 (L
4)
T3 (P
elvis M
et.)
T4 (P
elvis M
et.)
SU
V
SUV Mean
SUV max
Lower 95% Conf.Int.
(Approx.)
Upper 95% Conf.Int.
(Approx.)
Patient âgé de 75 ans atteint d´un cancer
de la glande prostatique (T2cpN0; Gleason 4 + 3 = 7)
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Tc-99m-HMPAO-SPECT du rCBF
En moyenne, % dose injectée de
2.18 ± 0.45 dans le cerveau entier (n = 32) (Welz et al. En préparation)
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Global HMPAO Uptake corrèle avec la
performance cognitive
Cerebral %ID vs. MMSE: r = -0.34, p < 0.012
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Potentiel clinique de la TEMP quantitative
Perturbations diffuses
de l´accumulation
d´un radiotraceur
Evaluation de la réponse
des tumeurs à la
thérapie
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Female patient with abnormal uptake in skull
Patiente âgée de 58 ans atteinte
d´un cancer du sein (pT1c pN3a cM0; OP 03/2010)
Scintigraphie osseuse 03/2012
Foyer d´hyperfixation dans la calotte (SUV 4,8),
TDM normale
Recommendation d´un examen de suivi
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Female patient with abnormal uptake in skull
Scintigraphie osseuse 6 mois plus tard
Augmentation du SUV de 4.8 à 6
Thérapie avec les bisphosphonates
Patiente âgée de 58 ans atteinte
d´un cancer du sein (pT1c pN3a cM0; OP 03/2010)
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Female patient with abnormal uptake in skull
Scintigraphie osseuse encore 5 mois plus tard
Réduction du SUV de 6 à 5,1
Patiente âgée de 58 ans atteinte
d´un cancer du sein (pT1c pN3a cM0; OP 03/2010)
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0
1
2
3
4
5
6
7
Focal Area Background
SU
V M
ax 06.03.12
04.09.12
18.02.13
Suivi longitudinal
Bisphosphonates
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Patient âgé de 52 ans atteint d´une néoplasie
neuroendocrine du pancréas (G2 cM1 cN1)
Scintigraphie à la Tc-99m-octéotide 03/2012
Plusieurs foyers hépatiques, douleurs abdominales
Traitement avec 5.1 GBq Y-90-DOTATATE 09/2012
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Examen de suivi 4 mois plus tard
Patient âgé de 52 ans atteint d´une néoplasie
neuroendocrine du pancréas (G2 cM1 cN1)
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Régression: Continuation de la radiothérapie vectorisée
0
2
4
6
8
10
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14
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18
20
Focal Area Background
SU
V M
ax
06.03.2012
21.01.2013
Patient âgé de 52 ans atteint d´une néoplasie
neuroendocrine du pancréas (G2 cM1 cN1)
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Quantification TEMP/TDM
Introduction
Quantification
Correction des artefacts
Calibration
Validation
Potentiel clinique
Résumé
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Résumé I
La TEMP/TDM quantitative est devenue
accessible au clinicien.
Les erreurs de la mesure de la C* sont < 10 %
dans des volumes > 2 x FWHM.
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Le diagnostic des maladies
affectant l´accumulation des
radiotraceurs d´une manière
plutôt diffuse:
Ostéoporose, neurodégenération,
maladie coronaire, métastases
disséminées
SUV avg 6.2
Résumé II: Potentiel clinique
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L´évaluation de la réponse des
tumeurs à la thérapie
Dosimétrie de la radiothérapie
moléculaire
(Lu-177, I-123?, I-131?)
SUV avg 6.2
Résumé III: Potentiel clinique