New Techniques in Oncologic Imaging

426 Pages·2005·11.66 MB·English

by  Anwar R. Padhani

New
Techniques
in Oncologic
Imaging
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New
Techniques
in Oncologic
Imaging
edited by
Anwar R. Padhani, F.R.C.P., F.R.C.R.
Mount Vernon Cancer Centre
London, U.K.
Peter L. Choyke, M.D.
Molecular Imaging Program
National Cancer Institute
Bethesda, Maryland, U.S.A.
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DK3536_Discl.fm Page 1 Monday, September 19, 2005 3:25 PM
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To
Our mentors—Janet Husband and Andrew Dwyer
Our wives—Femeeda and Lynda
Our children—Shahid, Sabiha, Aliya and Adam, Sarah
For their patience and continued support

Foreword
As the wealth of laboratory and clinical research in cancer takes us beyond today’s
practiceintothenewparadigmfor21stcenturymedicineinwhichmalignantdisease
willbedetectedmuchearlier,wheretumorswillbegenotypicallyprofiledandfactors
influential in phenotype will become known, and where treatments will be targeted
according to abnormalities in specific molecular pathways and directed to eradica-
tion of small volume disease using highly sophisticated surgical and radiotherapy
techniques, so medical imaging will take center stage. Thus we are at the dawn of
a new era in medicine and the vision of imaging in this new era has been captured
by Drs. Padhani and Choyke in their book New Techniques in Oncologic Imaging.
The goal of cancer imaging is to provide a detailed portrait of a tumor by
combining exquisite morphological information with pathophysiological and meta-
bolic measurements. The elegant anatomical detail provided by three-dimensional,
multi-slicecomputedtomography(CT)islikelytocontinueasthemainstayforpro-
viding morphological information on the presence and extent of tumor, tumor
volume, and anatomic relationships. Morphological information provided by mag-
netic resonance imaging (MRI) surpasses CT in well-defined anatomical sites and
in the evaluation of specific tumors, so the role of MRI in this context continues
to evolve. However, the fundamental requirement remains—the need to provide
detailed morphological information about relevant biological processes including
angiogenesis, hypoxia, apoptosis, cellular membrane integrity, necrosis, and other
malignancy specific processes. Based on these parameters, clinicians will be able to
make more precise management decisions noninvasively, thereby fine-tuning cancer
therapy whether it be with targeted drugs, surgery, or radiotherapy. Such develop-
ments in imaging will also allow new therapies to be developed such as robotic
surgical procedures and focused physical therapies.
Thistextisaimedatthosewhoareorwishtobeengagedinadvancedimaging
including scientists, physicists, chemists, biologists; radiologists, and clinicians—all
of whom have an increasing need for the latest information on advances in cancer
imaging techniques that will underpin much of the future developments in clinical
practice.
Drs. Padhani and Choyke have recognized and responded to this exciting
challenge in New Techniques in Oncologic Imaging. A major advantage of this text
isthattheeditorshavebroughttogetherstate-of-the-artevidence inallthedifferent
imagingmodalitiesbeingappliedtocancerresearchand,insodoing,haveprovided
acomprehensivereviewofthewholefieldofmorphologicalandfunctionalmeasure-
mentoftumors.Thistextwillnotonlyallowthosefocusedononeaspectofresearch
v
vi Foreword
to acquaint themselves with progress in other modalities, but will set the scene for
functional imaging to be viewed as a whole rather than as a topic of measurement
confined to one modality. At this time of staggering advances in imaging, this
approachprovidesanoutstandingcontributiontomedicalliterature.Surelythiswill
guideandinformfutureclinicalpractice,whichwillbebasedonintegratedmorpho-
logy, pathophysiological, and metabolic information rather than being confined to
measurementprovidedbyasingletechnique.
Drs. Padhani and Choyke are both outstanding experts in cancer imaging
who have contributed individually to the growing body of literature in the field of
functional imaging. They have brought their expertise and experience together in
New Techniques in Oncologic Imaging, and have recruited a superb team of experts
from many different fields of cancer imaging from the United States and Europe.
Thetextcoversultrasound,CT,magneticresonance,nuclearmedicine,andpositron
emission tomography, and looks to the future with reviews on electron spin reso-
nance, optical imaging, and bioluminescence.
The important issue of image processing, central to the development and
effective use of modern imaging, is also appropriately considered. The editors are
tobecongratulatedfortheirvisionandcommitmentinbringingthisexcitingproject
to fruition.
Janet E. Husband, OBE. FMedSci, FRCP, FRCR
Professor of Diagnostic Radiology
Royal Marsden NHS Foundation Trust
President, Royal College of Radiologists
London, U.K.
Foreword
The nexus between oncology and imaging grows continually stronger. Today,
imagingisakeyenablingbiomarker formodern oncologic practice. The traditional
requirement of oncologists was to stage disease; i.e., to define the extent of involve-
ment by cancer. With structurally oriented imaging, it is now possible to obtain
imagesfromheadtotoewithinminutesbycomputedtomography(CT)andmagnetic
resonance imaging (MRI). We today have imaging technologies that enable assess-
ment at multiple levels of resolution from the whole body to a targeted molecular
pathway.Moreover,thesepowerfulimagingmethodscannowbeharnessedtoguide
the delivery of therapeutic interventions such as minimal invasive surgery, high
precision radiotherapy, or percutaneous ablations. Modern multi-slice spiral CT
and fast gradient MRI are now routinely available in most cancer centers and both
physiciansandpatientshavehighexpectationsthatthesemethodologieswillcontinue
torapidly improve and todeliver tangible clinical benefits.
Despite their continued and rapid improvement in resolution, structural ima-
ging modalities like X-ray, CT, and static MRI rely on morphology that is funda-
mentally non-specific. The past decade has now seen the addition of functional or
physiologic information on top of excellent anatomic depiction. The best example
of this is fluorodeoxyglucose (FDG) imaging, which has revolutionized the practice
ofoncology.Whileitsclinicaldevelopmentandacceptancehastakenmorethanten
years, it is now possible and accepted to classify lesions according to their level of
glucose metabolism. In some cases, this directly relates to treatment response and
prognosis. Additionally, dynamic contrast enhanced MRI (DCE-MRI) and MR
spectroscopy (MRS) have provided novel insights into the behavior of disease at
diagnosisandduringtreatment.Functionalimagingrepresentsamajorstepforward
in the evolution of oncologic imaging and it will rapidly continue to evolve with
targeted molecular and nano-compound enabled imaging.
Novel imaging methodologies, currently being developed seek to identify
neoplasms at the limits of their detectability. Methods such as optical imaging and
radionuclide and PET imaging are capable of detecting biochemical compounds at
the nano to pico-molar concentration level. This sensitivity is matched only by the
specificity with which such targeted imaging probes are able to seek out and label
cancers.Thepromiseofthenon-invasive‘‘virtualbiopsy,’’inwhichallofthemeta-
bolic, proteomic, and genomic information needed to make management decisions
can be derived from imaging, is not as far fetched today as it was ten years ago.
Indeed, reporter gene strategies have proved the principle that highly specific
imaging probes can selectively enhance targeted tissue.
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