Gebt mir einen festen Punkt im All, und ich hebe die Welt aus den Angeln

Real-time ultrasound and freehand-SPECT. Experiences with sentinel lymph node mapping

Aim of this work is to report first experiences of the feasibility and applicability of a hybrid freehandSPECT/ultrasound (fh-SPECT/US) imaging concept, with regard to SLN imaging, in patients with breast cancer and malignant melanoma.

PATIENTS, METHODS

18 patients with breast cancer or malignant melanoma received standard SLN scintigraphy. Following this, fh-SPECT using declipse®SPECT (SurgicEye, Munich, Germany) was performed, a handheld-gamma camera-based method to visualize activity distribution within a region of interest as a cross-sectional data set. These data were transferred to an ultrasound device and sensor-navigated ultrasound was performed combining fh-SPECT data with ultrasound images, displaying superimposed images. Quality of fh-SPECT and co-registration accuracy was assigned to one of four categories and occurrence of artefacts was assessed.

RESULTS

In 4/18 examinations, there was a no deviation regarding co-registration of both data sets. For 9/18 patients, there was a deviation of <1 cm (mean 0.7±0.3 cm, range 0.3-1.0 cm). For 3/18 patients, a deviation >1 cm was present (mean 1.7±0.3 cm, range 1.5-2.0 cm). In 2/18 examinations no lymph node was found in the region of highest activity. Fh-SPECT reconstruction artifacts occurred in 6/18 examinations.

CONCLUSION

The fusion imaging concept combining SLN information with ultrasound images presented here proves to be feasible and technically successful. However, significant technical limitations were shown in fh-SPECT quality and fusion precision. Subject to technical optimisation of SPECT quality and co-registration, a meaningful contribution to the preoperative planning of lymph node therapy is imaginable. Thus, fundamentally a preoperative histological examination by fh-SPECT/US-guided biopsy is possible.

[Molecular imaging in oncological surgery: technical principles and importance]

BACKGROUND

Diagnostic imaging with positron emission tomography (PET) is becoming increasingly more involved in oncological therapy management.

OBJECTIVES

How can PET be helpful in oncological surgery?

METHODS

After a short introduction into the basic principles of PET the current state of imaging as well as indications and limitations of the method are described.

RESULTS

The PET is a functional and quantitative imaging technique, enabling detection and characterization of tumors. It is applied in pretherapeutic staging as well as in follow-up and therapy assessment. The use of PET changes the therapy management in about one third of all oncology patients. New radiopharmaceuticals and novel technologies expand the diagnostic potential.

DISCUSSION

Hybrid imaging with PET computed tomography (CT) and PET magnetic resonance imaging (MRI) further improves diagnostic imaging and increases the acceptance of PET further.