Michel Herranz Molecular Imaging in the Cancer Field. Past Present and Future
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Transcript of Michel Herranz Molecular Imaging in the Cancer Field. Past Present and Future
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MOLECULAR IMAGINGIN THE CANCER FIELD .
PAST, PRESENT AND FUTURE
Dr. Michel HerranzInstituto De Biología Molecular
Y Celular Del Cáncer
IBMCC-CSIC-USAL.
Par a ver est a p elícu la, d eb ed isp on er d e Qu ickTim e™ y d eu n d escom p r esor Gr áfi cos.
Universidad de Salamanca
Consejo Superior deInvestigaciones Científicas
Instituto de Biolog ía Moleculary Celular del Cáncer.
Junta de Castilla y Le ón
Unión Europea
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The presence of an untreatable problem generates a research need
A safe, effective drug,device or treatment isthen used for treatment of the problem.
Information obtained from basic research generates ideas for drugs, devices or techniques to treat the problem
Drugs, devices and treatments are tested for safety and efficacy, first in laboratory assays, then in animals, finally in human volunteers
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MOLECULARIMAGING
MOLECULARIMAGING
MOLECULARIMAGING
MOLECULARIMAGING
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ESCENARIO
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Cáncer
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CANCER
“Ruptura del comportamiento social de las células debido a mutacionesque dan al traste en cuestión de días o meses con centenares de miles de años de
evolución”
Joan Massagué. EL PAIS. 22 de Octubre 2004
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+
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TECNOLOGIA DE IMAGEN
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=
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TRANSLATION
-Detección-Pronóstico
-Terapia
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IMAGEN MÉDICA
TRANSLATION
-Detección TEMPRANA-Pronóstico ACERTADO
-Terapia ADECUADA Fármaco
DosisPauta de administraciónEfectos secundarios
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Detección Temprana
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Early Disease Detection
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EARLY DIAGNOSIS BRING DOWN DEATHS
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MEDICAL IMAGING. OUT OF SIGHT BUT NOT OUT OF MIND.
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?
One picture as worth ten thousand words
Frederic Barnhard (1927)
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One picture as worth ten thousand words
Frederic Barnhard (1927)
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EVOLUCIÓN
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PAST: Cut, then see.
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PRESENT: See, then cut.
Preoperative Imaging
Intraoperative Execution
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FUTURE: Combine, see and minimally cut.
Image guidance Augmented reality
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MEDICAL TECHNOLOGY TRANSFORMS HEALTHCARE
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Role of Diagnostic Imaging in Healthcare
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Technical evolution
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• Goals: – Create images of the interior of the living human body from the outside for
diagnostic purposes.
• Biomedical Imaging is a multi-disciplinary field involving– Physics (matter, energy, radiation, etc.)– Math (linear algebra, calculus, statistics)– Biology/Physiology– Engineering (implementation)– Computer science (image reconstruction, signal processing)
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Imaging Modalities– Anatomical modalities
• Depicting primarily morphology• X-ray, CT, MRI, US, • MRA, DSA, CTA and Doppler
– Functional Modalities• Depicting primarily information on the metabolism of the
underlying anatomy• SPECT, PET, fMRI, EGG and MEG• pMRI, fCT, EIT and MRE
MR-FDG PETMR-FDG PET MR-Dopamine PETMR-Dopamine PET CT-MRCT-MR CT-CTACT-CTA
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1) X-Rays
2) CT scan: 3-dimensional cross-sectional views of tissues to determine tumor density, size, and location
3) MRI: Detailed sectional images using magnetic fields to differentiate diseased tissue from healthy tissue and to study blood flow. It visualizes tumors hidden by bone or other structures
4) PET: Computed cross-sectional images of increased concentrations of radioisotopes in malignant cells, providing information about the biologic activity of the cells. Differentiates benign & malignant processes and responses to treatment.
5) Ultrasound: Used to detect abnormalities of a body organ or structure. Sound wave reflections are projected on a screen and may be recorded.
6) Optical Imaging: Needs an external ligth source (Fluorescence) or chemical sustrate (Luminiscence). It visualizes processes in tags cells or transgenic animals.
RADIOLOGIC AND IMAGING TEST FOR CARDIOVASCULAR PHENOTYPING
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MULTIMODALITY APPROACH
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WHERE IS THE STORM?
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OCTOBER 2Oth 2006.8.36a.m GMTEU Meteo-Satellite IKF-2343
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MULTIMODALITY APPROACH
Clinical Study - Lung Tumour
CT PET
Fused
Clinical Study - Lung Tumour
CT PET
Fused
PHYSIOLOGY
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MULTIMODALITY APPROACH
Clinical Study - Lung Tumour
CT PET
Fused
Clinical Study - Lung Tumour
CT PET
Fused
ANATOMY
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MULTIMODALITY APPROACH
Clinical Study - Lung Tumour
CT PET
Fused
Clinical Study - Lung Tumour
CT PET
Fused
DIAGNOSIS
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MULTIMODALITY APPROACH
Clinical Study - Lung Tumour
CT PET
Fused
Clinical Study - Lung Tumour
CT PET
Fused
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TÉCNICAS DE IMAGEN
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IMAGING TESTS
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Rayos-X
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BMI methods: X-Ray imaging
• Year discovered: 1895 (Röntgen, NP 1905)
• Form of radiation: X-rays = electromagnetic radiation (photons)
• Energy / wavelength of radiation: 0.1 – 100 keV / 10 – 0.01 nm(ionizing)
• Imaging principle: X-rays penetrate tissue and create
"shadowgram" of differences in density.
• Imaging volume: Whole body
• Resolution: Very high (sub-mm)
• Applications: Mammography, lung diseases,orthopedics, dentistry,
cardiovascular, GI
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Computed Tomography
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BMI methods: X-Ray computed tomography
• Year discovered: 1972 (Hounsfield, NP 1979)
• Form of radiation: X-rays
• Energy / wavelength of radiation: 10 – 100 keV / 0.1 – 0.01 nm (ionizing)
• Imaging principle: X-ray images are taken under many angles from which
tomographic ("sliced") views are computed
• Imaging volume: Whole body
• Resolution: High (mm)
• Applications: Soft tissue imaging (brain, cardiovascular, GI)
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Computed tomography (CT), sometimes called CAT scan, uses special x-ray equipment to obtain many images from different angles, and then join them together to show a cross-section of body tissues and organs
Computed Tomography (CT)
• A standard tube produces X-rays with an energy of approximately 150 keV.
• The X-ray focal spot scans across and around the patient.
• The technique measures the X-ray attenuation coefficient of the different tissues in the body.
Bone shows up brightBone shows up brightDifferent densities of tissue give inter-mediate results
Different densities of tissue give inter-mediate results
Air is darkAir is dark
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Tortuous middle cerebral artery. 14 year old boy who presented with chronic headaches. A cranial-caudad image including clip planes demonstrates tortuosity of the middle cerebral artery (arrow). An MRA was initially performed on this patient, which demonstrated a possible ACA aneurysm and stenosis of the MCA.
Supraorbital AVM. 12 year old male who presented with mass involving the left side of the face above the eye. A left anterior oblique VRT image demonstrates the arteriovenous malformation and its draining vessels (arrow).
Computed Tomography (CT) in arteriovenous malformations
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Positron Emission Tomography (PET)
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BMI methods: Nuclear imaging (PET/SPECT)
• Year discovered: 1953 (PET), 1963 (SPECT)
• Form of radiation: Gamma rays
• Energy / wavelength of radiation: > 100 keV / < 0.01 nm (ionizing)
• Imaging principle: Accumulation or "washout" of radioactive isotopes in
the body are imaged with x-ray cameras.
• Imaging volume: Whole body
• Resolution: Medium – Low (mm - cm)
• Applications: Functional imaging (cancer detection,
metabolic processes, myocardial infarction)
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• Noninvasive, diagnostic imaging technique for measuring metabolic activity in the human body
• Unlike traditional diagnostic tools like x-rays, CT scans or MRI, PET produces images of the body’s biochemistry
• PET has a significant advantage being able to capture early changes of biochemical processes within a cell due to a disease
Positron Emission Tomography (PET)
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Physics of PET• When a positron is emitted, it “finds” a nearby electron and annihilates with it.
• The annihilation creates two x-ray photons that fly off the point of annihilation (at the speed of light) in (nearly) opposite directions.
• The photons, in turn, are captured by a pair of crystals within a ring of these detectors.
• The counts of these coincident events constitute the intensity of the attenuated projections.
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Labeling and Tracers
• PET involves the use of radioactive atoms (isotopes) that is attached or “tagged” to a compound we’d like to follow through the body. This process is called labeling.
• One of the big advantages of PET is that the atoms that can be labeled are the same atoms that naturally comprise the organic molecules in the body. Like oxygen, carbon, nitrogen, etc.
• Second important attribute of PET is that the labeled compounds can be introduced into a body in trace quantities (without affecting the normal process of the body). They are called tracers
Commonly Used PET Radioisotopes
109.8 minutesUsually attached to a glucose molecule to produce FDG for observation of brain’s sugar metabolism
Fluorine-18
2.03 minutesAttached to oxygen gas for the study of oxygen metabolism, carbon monoxide for the study of blood volume, or water for the study of blood flow in the brain
Oxygen-15
20.3 minutesStudy of kidney and renal diseaseCarbon-11
Half-lifeUsed forLabeling agent
109.8 minutesUsually attached to a glucose molecule to produce FDG for observation of brain’s sugar metabolism
Fluorine-18
2.03 minutesAttached to oxygen gas for the study of oxygen metabolism, carbon monoxide for the study of blood volume, or water for the study of blood flow in the brain
Oxygen-15
20.3 minutesStudy of kidney and renal diseaseCarbon-11
Half-lifeUsed forLabeling agent
FDG=2FDG=2--fluorofluoro--22--deoxydeoxy--DD--glucoseglucose
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Steps in the PET Process
• Production of positron emitting isotope in a cyclotron.
• Labeling a compound with positron emitter and preparing it in a form suitable for administration in humans.
• Administration (injection) of tracer compound and data acquisition with PET camera.
• Image reconstruction algorithms. Fourier slice theorem gives a recipe showing the 1-D Fourier transform of a single set of parallel lines of the sinogram gives the 2-D Fourier transform of the image density along a unique line in Fourier space.
dxdytyxyxfftm )sincos(),(}{),(
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Procedimiento
+ -180o
511 kev 511 kev
18FDG
radiofármaco
+ -180o
511 kev 511 kev
18FDG
radiofármaco tomógrafotomógrafotomógrafo
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Typical PET Studies
FDG Study of Patient with Stroke
“Dead” areas of brainNo glucose metabolism
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NUCLEAR MAGNETIC RESONANCE
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BMI methods: Magnetic resonance imaging
• Year discovered: 1945 ([NMR] Bloch, NP 1952)1973 (Lauterbur, NP 2003)1977 (Mansfield, NP 2003)
1971 (Damadian, SUNY DMS)
• Form of radiation: Radio frequency (RF) (non-ionizing)
• Energy / wavelength of radiation: 10 – 100 MHz / 30 – 3 m (~10-7 eV)
• Imaging principle: Proton spin flips are induced, and the RF emitted by their response (echo) is detected.
• Imaging volume: Whole body
• Resolution: High (mm)
• Applications: Soft tissue, functional imaging
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• Certain atomic nuclei including 1H exhibit nuclear magnetic resonance.
• Nuclear “spins” are like magnetic dipoles.1H1H
No Applied Field Applied Field
B0
No Applied Field Applied Field
B0
Polarization
• Spins are normally oriented randomly.• In an applied magnetic field, the spins align with the
applied field in their equilibrium state.
• Excess along B0 results in net magnetization.
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Relaxation
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Relaxation
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T2 Contrast
CSF
White/Gray Matter
Sig
nal
Time
Long Echo-TimeShort Echo-Time
T1 Contrast
Sig
nal
Time
Sig
nal
Time
Short Repetition Long Repetition
CSF
White/Gray Matter
Decay: T2
Recovery: T1
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Cardiovascular MRIAngiography
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MR Imaging
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Ultrasound Imaging
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BMI methods: Ultrasound imaging
• Year discovered: 1952 (clinical: 1962)
• Form of radiation: Sound waves (non-ionizing)
NOT EM radiation!
• Frequency / wavelength of radiation: 1 – 10 MHz / 1 – 0.1 mm
• Imaging principle: Echoes from discontinuities in tissue density/speed of
sound are registered.
• Imaging volume: < 20 cm
• Resolution: High (mm)
• Applications: Soft tissue, blood flow (Doppler)
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Use of Ultrasound in Obstetrics
18 Weeks 19 Weeks18 Weeks 19 Weeks
Bi-parietal diameter Length of femur
Measurements of foetus in utero
Bi-parietal diameter Length of femur
Measurements of foetus in utero
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Use of Ultrasound in Obstetrics
Duplex Duplex of flow in umbilical chord
Measurements of blood flow on the foetus in utero
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Duplex Doppler Flow Data
“Signed” velocity “Doppler Power”
Flow pattern at the bifurcation of the carotid artery
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Use of Ultrasound in Cardiology modeling
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COMPARATIVE
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Cardiac modeling evolution
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NON-INVASIVE TECHNOLOGY
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NON-INVASIVE TECHNOLOGY
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Isidro Sánchez-García
Mª Jesús Pérez-Caro
Michel Herranz
Manuel A. Sánchez
Carolina Vicente-Dueñas
Camino Bermejo
Katja Gutsche
Inés González Herrero
Teresa Malvar
Olga Soto
Mohamed Arji
Iris López Hernández
Teresa Flores Corral
Mº Angeles Nava Rodríguez
Isabel Lara Alvarez
Esther Alonso Escudero
David Pentón
Lab
ora
tori
o 1
3.
IBM
CC
-CS
IC.U
SA
L
Collaborators
Acknowledgeme
ntsPilar PallaresIrene Cuevas LópezAlejandra López García
Santiago LamasCarlos ZaragozaConcepción García-RamaTania R. Lizarbe
Juan Carlos Murciano
Manuel DescoJuan J. VaqueroMarisa Soto
Delfina SanguinoMiguel Angel Piris
Sebastián Cerdán
Marina Benito
Pilar López
Patricia Sánchez
Jesús Ruiz CabelloAntonio HerreraMarien Fernández-VallePalmira Villa ValverdeDavid Castejón
Para ver est a p elícu la, d eb ed isp on er d e Qu ickTime™ y d eu n d escomp resor Gráfi cos.
Universidad de Salamanca
Consejo Superior deInvestigaciones Científicas
Instituto de Biolog ía Moleculary Celular del Cáncer.
Junta de Castilla y Le ón
Unión Europea
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Antares Heart. Denice lewis. 1992