Molecular Imaging in Oncology: PET, MRI, and MRS PDF
Preview Molecular Imaging in Oncology: PET, MRI, and MRS
Molecular Imaging in Oncology Springer Berlin Heidelberg New York Barcelona Hong Kong London Milan Paris Singapore Tokyo E. E. Kim · E. F. Jackson Molecular Imaging in Oncology PET, MRI, and MRS With Contributions by J. Aoki . H. Baghaei . S. Ilgan . T. Inoue· H. Li . J. Uribe EC.L. Wong· W.-H. Wong· D.J. Yang With 219 Figures in 387 Separate Parts 5 in Full Color Springer E. Edmund Kim, M.D., M.S. Edward F. Jackson, Ph.D. Division of Diagnostic Imaging The University of Texas M.D. Anderson Cancer Center 1515 Holcombe Blvd. Houston, TX 77030 USA ISBN-13: 978-3-642-64163-3 e-ISBN-13: 978-3-642-59879-1 DOl: lO.lO07/ 978-3-642-59879-1 Library of Congress Cataloging-in-Publication Data Kim, E. Edmund. Molecular imaging in oncology: PET, MRI, and MRS/E. E. Kim and E. E Jackson. p. cm. Includes bibliographical references and index. ISBN 3-540-64101-7 (alk. paper). I. Cancer - Imaging. 2. Cancer - Tomography. 3. Cancer - Magnetic resonance imaging. 4. Nuclear magnetic resonance spectro scopy - Diagnostic use. 5. Tomography, Emission. l. Jackson, E.E, (Edward E), 1961- . II. Title. [DNLM: I. Neoplasms - diagnosis. 2. Magnetic Resonance Imaging. 3. Nuclear Magnetic Resonance. 4. Tomography, Emission-Computed. QZ 241K49b 1999] RC270.3.D53K54 1999 616.99'40754-dc21 DNLMIDLC for Library of Congress 98-33852 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Viola tions are liable for prosecution under the German Copyright Law. © Springer-Verlag Berlin· Heidelberg 1999 Softcover reprint of the hardcover 1st edition 1999 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and appli cation contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: Anna Deus, Heidelberg Typesetting: K + V Fotosatz GmbH, Beerfelden SPIN 10628559 21/3135-5 4 3 2 1 0 - Printed on acid-free paper This book is dedicated to our wives Bo and Sondra and children Patrick, Sharon, Matthew Michelle and Jonathan Foreword Medical imaging in oncology mostly has emphasized the relationship of struc tural changes in the body, as exemplified by detection of "masses". However, recent advances in genetics and molecular biology have led to an interest in mutational changes in cancer that result in alterations in cellular behavior that emphasize "functional" changes on images. This has led to a merging of phys ics and chemistry that calls for new ways of viewing oncologic diseases. The editors of this book on Molecular Imaging in Oncology, a clinician and a physi cist, and their colleagues, have taken the challenge of preparing an introduc tory text to this rapidly growing field. The emphasis on magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS) and positron emission tomography (PET) is appropriate as these are the prototypical technologies used to explore the inner world of the cell by external imaging. Advances in the past decade in instrumentation have been paralleled by radiotracers and contrast materials and are being applied in research directed toward the improvement of diagnosis, treatment selection and disease monitoring. This text will prepare the oncologist, radiologist and nuclear physician to understand current advantages and limitations of these modalities. The book is divided into two parts. The first part on "basic principles and techniques" is devoted to biologic, chemical and physical subjects along with explanation of techniques. The second part presents current clinical applica tions in various specific cancers, based both on the experience at the M. D. An derson Cancer Center and on the literature. As with any medical technology it is important to understand the weaknesses and the strengths of the approach. As this is a rapidly evolving field, the authors have tried to prepare the read er for what might lie ahead, as well as enlighten the path that has been fol lowed. An honest appraisal would conclude that we have only scratched the surface of this subject. Much exciting territory is yet unexplored. It is to be hoped that readers will be inspired by the progress that has been made to date and will be stimulated to contribute to the field's expansion in the future. Thomas P. Haynie, Professor Emeritus of Nuclear Medicine, UT M.D. Anderson Cancer Center, Houston, Texas Preface The development of molecular biology and genetics over the past two decades has provided medical science with an unprecedented chance to understand the molecular basis of disease. While disease is usually defined as gross structural or histopathological abnormality, it can now be defined on the basis of abnor mal deviation from normal regional biochemistry. Cancer is viewed as a failure of multiple chemical processes or genetic disease. Molecular derangements oc cur at the very beginning of disease processes, and anatomically detectable ab normalities occur much later. MRI and PET are biochemical or molecular imaging techniques which can be used as probes of molecular and genetic phenomena. MR spectroscopy or spectroscopic imaging can characterize tissues by its metabolic signatures for the tissue diagnosis and evaluation of therapeutic response. PET is the unique method to study both the pharmacokinetics and the pharmacodynamics of new cancer drugs. Tumor or tissue-specific contrast agents for MRI or radio pharmaceuticals will provide a better understanding of tumor receptor systems and metabolic pathways. The care of cancer patients has become a cooperative multidisciplinary en deavor. If the medical disciplines involved in cancer treatment work well to gether, they are able to communicate with precision. A multidisciplinary approach in the diagnosis, staging, treatment, and follow-up of cancers takes a great deal of effort, but the rewards to the patient and oncologists are tremen dous. It is critical for imaging specialists to embrace and participate in a multi disciplinary environment so that they are considered valued and equal partners. Multidisciplinary participation for the imaging specialist entails routine daily imaging interpretation, multidisciplinary conference, tumor board meeting, and being available for consultation to help oncologists use the most appropri ate imaging. Review of outside imaging studies allows oncologists to have all the information necessary to make a therapeutic decision, as well as to fully discuss the treatment plan with the patients. The major goal of imaging is to answer specific clinical questions. This goal is much easier to accomplish if the questions are known before, rather than after, the examination is performed. Imaging specialists must understand not only the imaging modalities available, but also the clinical problems they present. Familiarity with the natural history and treatment paradigms of cancer and the staging systems is a necessity for successful cancer manage ment. This book is organized into two parts consisting of eight basic science and nine clinical chapters. Basic science chapters discuss the basic principles of cancer molecular biology, biochemistry, immunology and pathology; imaging strategies and perspectives for cancer diagnosis and monitoring; physical prin ciples of MRI, MRS and PET; radiopharmaceuticals for tumor imaging and MRI contrast agents; MRI receptor imaging and PET technique and artifacts. Clinical chapters deal with basic considerations emphasizing molecular biolog ic information; pathology, diagnosis, staging; MRI and MRS; and PET of lung, X Preface breast, gastrointestinal, gynecologic, urologic, head and neck cancers, musculo skeletal, sarcomas and miscellaneous tumors. It is our goal and hope that this text will provide the information relevant to molecular or biochemical imaging that is needed by radiologists, nuclear phy sicians and oncologists dealing with malignant disease. Acknowledgements We are very appreciative and indebted to Judy Bunch for her tremendous ef forts to make this book the best of its kind by typing and editing materials. We also are deeply grateful to all colleagues whom we often harassed for their timely contributions. We wish to thank Drs. Donald Podoloff and William Mur phy for their support of our work. Finally, we wish to thank Dr. Ute Heilmann and her assistants at Springer-Verlag who supported in the creation and edit ing of this book. E.E. Kim E. F. Jackson Contents Principles and Technology 1 Principles of Cancer Biology, Biochemistry, Immunology and Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 E. E. Kim 2 Imaging Strategies and Perspectives in Oncology 13 E. E. Kim 3 Magnetic Resonance Imaging: Physical Principles to Advanced Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 E. F. Jackson 4 Magnetic Resonance Spectroscopy: Physical Principles and Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 E. F. Jackson 5 Principles and Instrumentation of Position Emission Tomography 71 W.-H. Wong, J. Uribe, H. Li and H. Baghaei 6 Radiopharmaceuticals for Tumor Imaging and Magnetic Resonance Imaging Contrast Agents ................................. 81 D. J. Yang, S. Ilgan and E. E. Kim 7 Receptor Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 10 1 F. C. L. Wong and E. E. Kim 8 Practical Magnetic Resonance Imaging and Positron Emission Tomography Techniques and Their Artifacts. . . . . . . . . . . . . . . . . .. 107 E. E. Kim Clinical Applications of MRI, MRS and PET 9 Lung Cancers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 123 T. Inoue, J. Aoki and E. E. Kim 10 Breast Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 145 E. E. Kim 11 Gastrointestinal Carcinomas 159 E. E. Kim 12 Urologic Cancers 181 E. E. Kim XII Contents 13 Gynecologic Cancers 199 E. E. Kim 14 Brain Tumors ......................................... 211 F. C. L. Wong and E. E. Kim 15 Head and Neck Tumors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 231 F. C. L. Wong and E. E. Kim 16 Musculoskeletal Tumors ................................. 243 T. Inoue, J. Aoki and E. E. Kim 17 Melanoma, Lymphoma and Myeloma. . . . . . . . . . . . . . . . . . . . . . .. 271 E. E. Kim Subject Index ............................................. 287
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