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A new role for PET in interventional procedures

By Farhad Daghighian
From the June 2018 issue of DOTmed HealthCare Business News magazine

It’s well known that positron emission tomography (PET) imaging provides physiologic, molecular and functional information on tumors and various organs.

One way to improve biopsy results is to leverage the physiologic (metabolic or immunologic) information provided by PET imaging to effectively target and sample tissues, especially when X-ray CT or ultrasound does not identify the abnormality.
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Cost and logistic issues hinder the wide use of PET in interventional settings. In order to make interventional PET economically viable, it should be portable between the radiology and interventional rooms. While in a radiology department it will be placed parallel to a CT scanner for routine PET/CT scanning. When needed, it will be moved to surgery rooms, ER, ICU, and radiotherapy suites.

Prescient Imaging LLC has developed a low-cost, portable PET scanner (P-Arm) that can make PET imaging accessible for interventional procedures. P-Arm has wheels and is a portable PET scanner, similar to that of X-ray C-arm. One set of its detectors moves under the patient, while another set is placed above the patient for complete 360 degree views while the patient is within the scanner.

18F-FDG PET can identify the most metabolically active portion of a tumor or abnormality, and distinguish between biologically aggressive and non-aggressive regions of malignant masses, thus providing a greater chance to effectively sample suspicious tissues and obtain a higher quality biopsy sample (higher tumor content) suitable for molecular diagnosis. Other radiotracers, with different biological properties (such as monoclonal antibodies), have shown promise for advancing precision medicine by detecting occult lesions and enabling their targeting with biopsy.

Physicians at Rambam Health Center in Israel retrospectively assessed data from 311 consecutive patients with lung nodules who underwent 18F-FDG PET/CT and CT-guided FNA within an interval of less than 30 days. They concluded that anatomy- and metabolism-based fine-needle-aspiration guidance using information provided by both 18F-FDG PET and CT may improve the accuracy of histologic examinations, decrease the rate of false negative results, and thus increase the probability of achieving a definitive diagnosis.

PET is being increasingly used to aid interventional procedures at major academic centers. For example, Dr. Stephen B. Solomon used a PET/CT scanner that was installed in the Center for Image-Guided Intervention at Memorial Sloan Kettering Cancer Center to image liver tumors in more than 300 patients, before and after radioablation, in order to detect any untreated region of the tumor and complete the therapy. Also, in a recent pilot study they have demonstrated the feasibility of performing delayed PET image-guided biopsy using 89Zr anti-PSMA or trastuzumab radiotracers without tracer reinjection. This is an efficient method to optimize workflow, since 89Zr half-life is 79 hours.
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