Health Imaging & IT - June 2008 - (Page 20)

special secTiOn MOlecular iMaging SPECT/CT Proving its Potential A study conducted at MUSC and Walter Reed Army Medical Center in Washington, D.C., published in Reviews in Urology (August 2006, supplement), stated that the co-registration of fused CT and SPECT in ProstaScint imaging was of great benefit. “The much clearer fused scans have been correlated with stepsectioned evaluation of prostate specimens to demonstrate an 80 percent overall accuracy, with sensitivity of 79 percent, specificity of 80 percent, positive predictive value of 68 percent, and negative predictive value of 88 percent for detection of cancer within the prostate gland,” the authors report. The preliminary study was used to guide focal brachytherapy for intermediate- to high-risk prostate cancer patients, for whom the treatment field was altered on the basis of increased signal in areas of the prostate on the image. “The 7-year follow-up data for 239 patients demonstrated superior results across all risk categories compared with the 5year meta-analysis of brachytherapy patients (96 percent vs. 87 percent for low risk, 87 percent vs. 74 percent for intermediate risk, and 73 percent vs. 50 percent for high risk),” the authors wrote. “Furthermore, patients with positive scan results outside the pelvis showed a 9-fold increase in biochemical disease recurrence, regardless of risk category.” The MUSC work demonstrated the utility of fused SPECT/CT images in managing prostate cancer patients, according to the researchers. “These data suggest that the scan results can be used both to predict better outcomes on the basis of the absence of distant signal intensity and to direct increased dosimetry to focal areas of increased uptake within the prostate gland,” they wrote. “These results have stimulated the use of focal image guidance to deliver intensity-modulated external beam radiotherapy (EBRT), with encouraging results. On the basis of these findings, focal image-guided cryotherapy for localized prostate cancer is now underway at several sites.” Obesity impacts cardiac, inflammation utilization Diabetes afflicts approximately 21 million people, or 7 percent of the population in the United States, according to the Centers for Disease Control (CDC). According to Linda S. Geiss, the chief of the CDC’s diabetes surveillance, diabetes (concurrently with obesity) has grown in the U.S. for the past 15 years and shows no sign of slowing down; the CDC estimates that the diabetes epidemic is growing by 5 percent annually. Rao has seen first hand the impact of the obesity and diabetes epidemic at Coney Island Hospital. The majority of the work performed on SPECT/CT by her department is conducted on 20 Health Imaging & IT | June 2008 cardiac patients as well as infection/inflammation imaging for diabetes patients. “A significant number of heavy patients present for cardiac disease SPECT/CT exams,” she says. “With our cardiac exams we are able to avoid a lot of unnecessary cardiac catheterization procedures on these patients.” In addition, the facility is seeing an increase in the number of bone scans it is conducting with the technology. “With the bone scans it is very crucial to use SPECT/CT,” she notes. “It used to be that people with diabetic feet would have a gallium scan and it would light up everywhere. We couldn’t rule out osteomyelitis, so they would have to have an MRI and CT. They would go through a very difficult diagnostic route, and in many cases, there still would not be a definitive answer. With SPECT/CT, we’re able to provide a very specific diagnostic answer to our referring clinicians.” Davidson’s institution in South Carolina has also experienced a significant increase in cardiac presentations for molecular imaging. So much so that MUSC has dedicated its recently acquired Symbia TruePoint SPECT/CT systems (one T2 and two T6 models) for deployment at a newly constructed cardiology and digestive diseases hospital. “We’re performing a lot of myocardial perfusion imaging using Cardiolite [Lantheus Medical Imaging] technetium Tc99m sestamibi,” he said. “Now that we’ve opened up our new facility, we’re really concentrating on our SPECT/CT cardiac imaging.” He reports that clinicians at the facility have found tremendous benefit to the attenuation correction available with the CT portion of the hybrid technology. “There’s different ways of performing attenuation correction for cardiac studies,” he says. “One is with a sealed source, which is not quite as good as doing it with a CT. The CT portion of the SPEC/CT has better imaging characteristics and is not as limiting as the sealedsource method. In addition, sealed sources have to be replaced every 12 to 18 months due to their half-life, which poses an additional problem. It also just doesn’t have the strength of the CT for the morbidly obese patient. We feel that the CT method for attenuation correction is far superior to what we’ve used in the past.” As word about the capabilities of SPECT/CT has spread among the clinical specialties representing the continuum of care— oncologists, cardiologists, orthopedics, and surgeons—served by Coney Island Hospital and MUSC, both Rao and Davidson noted that their referring physician base has specified SPECT/ CT exams with greater frequency. “Once they saw the reports and images, they’re all demanding that we perform SPECT/CT studies for them now,” Rao says. HealthImaging.com http://HealthImaging.com

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Health Imaging & IT - June 2008 Contents On The Web The Enterprise News Update Cover Story: Pushing Productivity: How Imaging is Building Efficiency and Cutting Costs Technology Outlook: Imaging Procedures Poised for Growth Great Expectations: PET/CT Delivers SPECT/CT Proving it's Potential MR/PET Holds Promise Good Image Management: Infiltrating Molecular Imaging SNM Preview Modality Review: Mammography’s Next Step: The Dawning of Breast Tomosynthesis Managing Technology: Radiation Oncology: Opening the Doors to IT Reader's Resource Stat Sheet

Health Imaging & IT - June 2008

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