Year in Images 2014

This year, Molecular Imaging Insight is not only providing some of the most stunning images from our pages, but also a few research exclusives and offerings from a handful of scientific meetings from around the world, including the Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the World Molecular Imaging Congress (WMIC) and the European Congress of Radiology (ECR). These exemplary images cover the full spectrum of molecular imaging from brain SPECT to oncologic PET and hyperpolarized MRI.

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Source: GE Healthcare

Amyloid PET Imaging Via Vizamyl

F-18 flutemetamol, also known as Vizamyl, is one of three FDA-approved amyloid PET agents to help rule out Alzheimer’s disease in the absence of amyloid binding in the brain. In the presence of amyloid burden, a positive F-18 flutemetamol scan can trigger further clinical evaluation toward a definitive Alzheimer’s diagnosis.

This year was a benchmark for F-18 Flutemetamol because news of approval by the European Commission was announced in September. This image shows low amyloid binding, or a negative scan, on the left and a positive scan for amyloid burden on the right.

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Source: Laura S. Sasportas, Stanford University

CTC Radioluminescence

This glowing display of high-resolution radioluminescence microscopy and single-cell autoradiography was a scientific highlight at this year’s Society of Nuclear Medicine and Molecular Imaging (SNMMI) Annual Meeting press conference in St. Louis. It was also part of a visual presentation in the running for SNMMI Image of the Year.

The image represents a breakthrough in molecular imaging by pinpointing just a few malignant cancer cells out of billions in a blood sample. Laura S. Sasportas, a PhD candidate from Stanford, presented the corresponding study of circulating tumor cell (CTC) imaging as a means of liquid biopsy. With this technology, researchers can tag specific proteins or receptor over-expression in an effort to capture aggressive and metastatic disease.

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Source: Olivier Gevaert, PhD, Stanford Center for Biomedical Informatics Research, Stanford University

Radiogenomics Defined

The integration of quantitative analysis from advanced medical imaging, molecular subtyping and genomic data is the new wave in oncologic imaging. Coined radiogenomics, this area of research goes beyond conventional cancer imaging to find complex patterns of heterogeneity and molecular subtyping.

Left: Visualization of a glioblastoma lesion on T1-weighted post contrast MR image where the enhancement and necrotic region were outlined by a neuroradiologist.

Right: Heatmap of matched gene expression data. Red signifies high gene expression and green indicates low gene expression.

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Source: Society of Nuclear Medicine and Molecular Imaging

Tau Imaging

This vibrant brain PET image of neurofibrillary tangles in Alzheimer’s disease using F-18 THK5117 and C-11 Pittsburgh compound B (PIB) stole SNMMI’s 2014 Image of the Year award.

A team of researchers including Nobuyuki Okamura, MD, PhD, from the department of Tohoku University School of Medicine in Sendai, Japan, evaluated F-18 THK5117 as an in-vivo biomarker of hallmark tau pathology—and, more specifically, hyperphosphorylated tau deposits in the brain.

This is an important neuroimaging technique because preliminary research suggests that it may better exemplify progression of neurodegeneration and progression of Alzheimer’s disease, unlike amyloid pathology, which may level off even as symptoms worsen over time.

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Source: Journal of Nuclear Medicine

PET/MR DOTATOC Picks Up On NETs

Example of Ga-68 DOTATOC PET/MR for advanced neuroendocrine cancer. (A) Fused coronal T2-weighted short-τ inversion recovery and PET. (B and C) PET and fused images of liver metastases with high somatostatin receptor expression. (D) DTI with multiple lesions. (E) Fused axial T2-weighted fat-saturated HASTE. (F and G) Fused axial T2-weighted fluid-attenuated inversion recovery image and axial T1-weighted gadolinium-enhanced image showing uptake of hypophysis and no brain metastases.  

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Source: Journal of Nuclear Medicine

Amino-acid Planar Imaging of PRRT

PET and SPECT are well represented, but here planar imaging provides a clear view of Lu-177 DOTA-JR11 and Lu-177 DOTATATE peptide receptor radionuclide therapy. (A) Shows Lu-177 DOTA-JR11 planar scans, (B) isodose curves, (C) a side-by-side comparison of DOTA-JR11 and DOTATATE and (D) isodose curves.

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Source: European Society of Radiology

Theranostics for Neuroendocrine Cancer: Imaging with DOTATATE

All of the images on this page are prime examples of a burgeoning area of molecular imaging called theranostics, wherein researchers can actively treat and track the progress of therapy using powerful molecular agents.

These two PET/CT images show disease staging and subsequent therapy of liver metastases resulting from neuroendocrine cancer. Wolfgang A. Weber, MD, Memorial Sloan Kettering Cancer Center in New York City presented his research during a scientific session on theranostics at the most recent European Congress of Radiology in Vienna.

Left: Prior to therapy there were multiple liver metastases with high expression of somatostatic receptors with Ga-68 DOTATATE.

Right: Following two cycles of therapy with Lu-177 DOTATATE there was a marked reduction in the number of metastases.

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Source: Irina Velikyan, PhD, Associate Professor, The PET-Centre at the Centre for Medical Imaging, Uppsala University Hospital, Uppsala, Sweden

More DOTATATE for NETs

Another stunning image of amino acid imaging with the theranostic Ga-68 DOTATATE, which can be used to scout out the path of peptide receptor radionuclide therapies such as Lu-177 DOTATATE. Here DOTATATE has captured thoracic neuroendocrine tumors.

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Source: Jens Sorensen, MD, PhD, Professor of Clinical PET, The PET Centre, Uppsala University Hospital, Sweden, The Nuclear Medicine and PET Clinical Institute, Aarhus University, Denmark

First-In-Human Trial for HER2 Tracer

Molecular imaging of human epidermal growth receptor 2 (HER2) expression with the investigational In-111 ABY-025 affibody molecule could help clinicians select patients for HER2-targeted therapy by providing a map of the distribution and affinity of HER2 tracer uptake. High HER2 tracer uptake has been shown to be a strong predictor of therapy response.

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Athinoula A. Martinos Center;  Associate Director, The PET Core, Massachusetts General Hospital, Boston

PET/MR for Psychiatric Disorders

This simultaneous PET/MRI image of the human brain is color-coded to reveal the brain receptor distribution via PET imaging and the structure of the brain and surrounding skull with MR imaging. The color scale represents the intensity of receptor distribution, with red and white indicating very strong uptake of the molecular imaging agent and blue indicating areas of low binding affinity.

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Source: Howard Schneider, MD, Sheppard Associates, Ontario, Canada

3D Brain SPECT

These 3D SPECT scans show the bilateral perfusion defects in the prefrontal cortex and in the anteromedial aspects of the temporal lobes, which may be associated with psychiatric disease.

In a recent study in the Winter 2014 issue of the Journal of Neuropsychiatry and Clinical Neurosciences, researchers demonstrate how brain SPECT, when used to guide treatment of psychiatric disorders, led to improved health outcomes and cognitive performance in psychiatric patients.

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Source: Grace Kong, MBBS, nuclear medicine physician, The Peter MacCallum Cancer Centre in East Melbourne, Australia.

Peptide Receptor Radionuclide Therapy for NETs

This comparison following peptide receptor radionuclide therapy (PRRT) with Lu-177 DOTA-octreotate (LuTate) knocks out neuroendocrine tumors (NETs) over the course of treatment. Kong’s team is also studying a new therapy that combines PRRT with an infusion of 5FU chemotherapy. This combined treatment is being called peptide receptor chemoradionuclide therapy (PRCRT). So far, the combined treatment has been shown to be very successful for advanced NETs with high somatostatin receptor expression.

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Source: Journal of Nuclear Medicine

Fluorescence imaging finds hypoxia

Dual fluorescence images (A) are overlaid to show distribution of hypoxia relative to vasculature. Hypoxic tissue is indicated by EF5 staining in orange. Vasculature is indicated by the perfusion marker in blue. (B) A whole tumor section staining image was generated by stitching together images from microscope stage scans.