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RSNA Edition Customer Magazine
Medical Solutions Magazine
Medical Solutions shows how our trend-setting innovations and solutions, as well as our unique approach to improve workflow and processes, lead to more efficiency in healthcare institutions all around the world.
Molecular Imaging
MI being a highly innovate field in the area of diagnostic and therapeutic technology, in this special edition we present ongoing developments in all modalities across the molecular imaging field
Molecular Imaging: A Triad of Technologies
Completing a three-city interview tour
with three prominent molecular specialists
in Boston, Los Angeles, and Knoxville on
exciting new developments in molecular
imaging, reminded Siemens journalist Tim
Friend of the challenges of a triathlon. And
indeed, his explorations proved that successful
players in the field must excel in three
important areas of expertise in molecular
medicine – in vitro diagnostics, imaging, and
information technology. Just as a triathlete
must perform equally well in swimming,
biking, and running, the combination of the
three is what makes a good athlete.
By Tim Friend
A Vision for Nuclear Imaging in Breast Cancer Care
Breast cancer is the most common malignancy
among women in the United States and
second only to lung cancer as a cause of
cancer-related death. In 2005, an estimated
211,240 new cases of breast cancer are
expected to occur in the U.S. and 40,410
women are expected to die of this disease [1]. The risk for developing breast cancer
increases with age, beginning in the fourth
decade of life. Besides age, other risk factors
for developing breast cancer include a family
or personal history of breast cancer, biopsy confirmed
atypical hyperplasia, and having a
first child after age 30 [2].
Multiple well-designed trials have concluded
mortality reduction attributable to screening
mammography ranging from no significant
effect to a 32 percent reduction in breast
cancer mortality [3–5]. The meta-analysis
performed for the most current published
data found that the pooled effect size of
the combined trials was sizable and statistically
significant.
Richard C. Cho, M.D.
Iraj Khalkhali, M.D., FACR
Gregory M. Eckel, M.D.
Department of Radiology,
LA BioMed Research Institute at Harbor-UCLA Medical Center
Hernan I. Vargas, M.D., FACS
Douglas J. Wagenaar, Ph.D.
Department of Surgery,
LA BioMed Research Institute at Harbor-UCLA Medical Center,
and Siemens Medical Solutions Molecular Imaging
Small Animal PET Imaging for the Study of Diseases and Drug Development
Positron Emission Tomography (PET) has
been used clinically for a few years already
for staging and evaluation of malignancy
of numerous forms of cancer. Its strength
resides in the ability to accurately measure
the amount of tracer accumulation in organs.
The recent progress of scanner development
has made possible the construction of
imaging devices with less than 2 mm spatial
resolution, sufficient for the imaging of
radiotracers in small laboratory animals,
such as mice or rats. This capability is very
attractive as it permits the possibility to study
diseases in vivo, to monitor the response to
novel therapy, and to evaluate the action of
newly developed drugs. The wide availability
of animal models, often from transgenic
animals, allows for faster and lower cost
development of more efficacious treatment
strategies, the most successful of which will
eventually be used in humans.
Richard Laforest, Ph.D.
Mallinckrodt Institute of Radiology,
Washington University, St. Louis, MO, U.S.A.
MR-PET: Combining Function, Anatomy, and More
It is widely accepted that coregistration of
anatomical information improves the diagnostic
value of functional imaging. At the
moment, this is reflected in the success of
hybrid scanners using PET and CT imaging.
But the combination of PET and MR imaging
may also offer advantages, such as higher
soft tissue contrast in the MR anatomical
images, real simultaneous acquisition, and
minimum radiation exposure to the patient.
Correlative imaging will open exciting new
applications in oncology, neurology, and
cardiology. For now, the compatibility of
PET detectors with magnetic fields still
poses a technical challenge and space
limitations inside the magnet must be
resolved. There is no fully developed and
mature clinical MR-PET system on the market
yet, but the approach of using scintillation
crystals inside the magnet combined with
external photo sensors has been successfully
implemented for small animal imaging. Semiconductor
readout of scintillation crystals is
in development and may offer the opportunity
to develop a clinical MR-PET system.
Markus Schwaiger, M.D.
Sibylle Ilse Ziegler, Ph.D.
Stephan Gerhardt Nekolla, Ph.D.
Clinic and Polyclinic of Nuclear Medicine, Klinikum Rechts der Isar of the Technical University Munich,
Munich, Germany
Molecular Magnetic Resonance Imaging
Molecular MRI (mMRI) is a special implementation
of molecular imaging for the noninvasive
visualization of biological processes
at the cellular and molecular level. More
specifically, mMRI comprises the contrast
agent-mediated alteration of tissue relaxation
times for the detection and localization
of molecular disease markers (such as cell
surface receptors, enzymes, or signaling
molecules), cells (e. g., lymphocytes, stem
cells) or therapeutic drugs (e. g., liposomes,
viral particles). MRI yields topographical,
anatomical maps, functional MRI (fMRI)
provides rendering of physiologic functions,
and magnetic resonance spectroscopy (MRS)
reveals the distribution patterns of some
specific metabolites. mMRI provides an additional
level of information at the molecular
or cellular level, thus extending MRI further
beyond the anatomical and physiological
level. These advances brought by mMRI are
mandatory for MRI to be competitive in the
age of molecular medicine. mMRI is already
today increasingly used for research purposes;
e. g., to facilitate the examination
of cell migration, angiogenesis, apoptosis,
or gene expression in living organisms. In
medical diagnostics, mMRI will pave the
way toward a significant improvement in
early detection of disease, therapy planning,
or monitoring of outcome and will therefore
bring significant changes in the medical
treatment of patients.
Arne Hengerer, Ph.D.
Siemens AG, Medical Solutions,
Erlangen, Germany
Jan Grimm, M.D., Ph.D.
Center for Molecular Imaging Research,
MGH, Boston, Massachusetts, U.S.A.
Molecular Imaging of Vulnerable Atherosclerotic Plaques
Molecular imaging draws on expertise from
many fields, ranging from basic physics or
chemistry to clinical practice. The National
Institutes of Health included molecular
imaging as a part of the NIH Roadmap
to Biomedical Research. There has been
increased funding for molecular imaging
research, resulting in exciting new developments
representing greater things to come.
In terms of atherosclerosis, a major goal
of molecular imaging is to target specific
plaque-associated molecules with agents
that provide sensitive and specific imaging
contrast [1]. This will greatly improve
detection and characterization of atherosclerotic
and atherothrombotic lesions [1].
Particular plaque components such as a
lipid-rich core, thin fibrous cap, and macrophage
infiltration are highly associated with
plaque rupture and vulnerability to rupture
as well as consequences thereof [2–3].
Thus, knowledge about plaque composition may
have tremendous clinical utility in terms of
managing patients with coronary artery
disease (CAD).
Vardan Amirbekian, B. S.
Imaging Science Laboratories, Mount Sinai School of Medicine, New York, NY,
Johns Hopkins University School of Medicine, Baltimore, MD,
The Sarnoff Endowment for Cardiovascular Science, Great Falls, VA, U.S.A.
Smbat Amirbekian
Imaging Science Laboratories, Mount Sinai School of Medicine, New York, NY,
Emory University School of Medicine, Atlanta, GA, U.S.A.
Zahi A. Fayad, Ph.D.
Department of Radiology and Cardiology,
Imaging Science Laboratories, Mount Sinai School of Medicine, New York, NY, U.S.A.
Intravenous Cellular MR Contrast Agent with an Enormous Clinical Potential
Pelvic lymph node metastases have a significant
impact on the prognosis of patients
with malignancies. In prostate cancer, for
example, even micrometastases in a single
node rule out surgical cure by the available
treatment protocols. For bladder cancer,
lymph node metastases are also significant.
More than five lymph node metastases
or extracapsular growth preclude curative
surgical treatment. Thus, the status of the
lymph nodes largely dictates the management
of the primary tumor.
Jelle Barentsz, M.D., Ph.D.
Department of Radiology,University Medical Center,
Nijmegen, The Netherlands
Cellular and Molecular Imaging of Disease with Targeted Contrast Ultrasound Imaging
In the next decade, molecular imaging will
begin to transition from investigational to
clinical application. Contrast ultrasound will
likely play a key role in these applications,
since it provides high-resolution imaging,
low cost, and ease of availability compared to
CT, MRI, PET, SPECT, and optical imaging.
Siemens ultrasound is committed to the continuous
development of high-resolution and
high-sensitivity technology requisite for the
continued growth of this exciting new field.
Jonathan R. Lindner, M.D.
Cardiovascular Imaging Center,
Cardiovascular Division,
University of Virginia School of Medicine,
Charlottesville, Virginia, U.S.A.
James E. Chomas, Ph.D.
Patrick J. Phillips, Ph.D.
Siemens Medical Solutions,
Ultrasound Division, Mountain View,
California, U.S.A.
In Vivo Detection of β-Amyloid Deposits by Near-Infrared Imaging
As Alzheimer’s disease pathogenesis is
associated with the formation of insoluble
aggregates of amyloid-β peptide, approaches
allowing the direct, noninvasive visualization
of plaque growth in vivo would be beneficial
for biomedical research. This is a description
of the in vivo imaging application of the
in-house synthesized first plaque-specific
near-infrared fluorescence dye (AOI987),
which readily penetrates the intact bloodbrain
barrier and binds to β-amyloid plaques.
Using near-infrared fluorescence imaging,
specific interaction of the oxazine dye
AOI987 with amyloid plaques in APP23
transgenic mice has been demonstrated
in vivo as confirmed by postmortem analysis
of brain slices. Quantitative analysis revealed
increasing fluorescence signal intensity
with increasing plaque load of the animals
and significant binding of AOI987 was
observed for APP23 transgenic mice of
age 9 months and older. Thus, the plaquespecific
dye AOI987 is an attractive probe to
noninvasively monitor disease progression in
animals of Alzheimer’s disease and to
evaluate effects of potential Alzheimer’s
disease drugs on the plaque load.
H.-U. Gremlich, Ph.D., M. Hintersteiner, Ph.D.,
R. Kneuer, Ph.D., M. Stoeckli, Ph.D., A. Suter
Discovery Technologies
Novartis Institutes for Biomedical Research Basel, Switzerland
Molecular Imaging Portal:New Development IT Platform for Imaging, Nonimaging and Genomics
Modern imaging systems such as CT, SPECT,
PET, MRI, ultrasound, and others generate a
continuously growing amount of clinical and
preclinical data every day – easily reaching
terabytes in short time periods. In addition,
the multiinstitutional and multidisciplinary
nature of today’s clinical research projects
requires the creation of collaborative data
repositories with secure, controlled access.
Furthermore, data acquired from multimodality
imaging platforms should ideally
be associated with laboratory and molecular
(genomic/proteomic) datasets. In view of
the shortcomings of existing commercial
systems, the Center for Molecular Imaging
Research (CMIR) at Massachusetts General
Hospital (MGH) and Siemens have created
a new prototype information platform –
the Molecular Imaging Portal (MIPortal).
It extends the common PACS functionality
beyond radiological imaging and allows
storage and query of any type of imaging
and data file.
C. P. Schultz, Ph.D.
Siemens Medical Solutions, Business Development, Charlestown, MA, U.S.A.
R. Weissleder, M.D., Ph.D., M. Pivovarov, M.S., U. Mahmood, M.D., Ph.D.
Center for Molecular Imaging Research, Massachusetts General Hospital, Charlestown, MA, U.S.A.
G. Bhandary, Ph.D., D. Datta, Ph.D., S. Owens
Siemens Medical Solutions, SW-West, Princeton, NJ, U.S.A.
A. Hengerer, Ph.D.
Siemens Medical Solutions, Magnetic Resonance Division, Erlangen, Germany
G. Zahlmann, Ph.D. , D. Brett, Ph.D., R. Rechid, M. Naraghi, M.D., Ph.D.
Siemens Medical Solutions, Business Development, Erlangen, Germany
Competence in Molecular Imaging
Presenting the Siemens Medical Solutions Molecular Imaging Portfolio – in collaboration with industrial and clinical research partners.
