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Images from inside the body: hope for image-based diagnostics
In Munich, Siemens presented a new type of full-body scanner that combines the measuring principles of magnetic resonance imaging (MRI) and post-electron emission tomography (PET) in one device.
When the new diagnostic device was put into operation in the “Klinikum rechts der Isar” at the Technical University of Munich on Saturday, the developers explained that for the first time it had been possible to combine two techniques that were previously technically mutually exclusive. With the financial support of the German Research Foundation (DFG), Siemens Healthcare has developed a combination device that is the first system in the world to combine magnetic resonance imaging (MRI) and post-electron emission tomography (PET). In this way, pictures can be taken of the inside of the body, which open up completely new perspectives for image-based diagnostics. The PET examination shows how strong the metabolism in the tissue is and shows how active and aggressive possible tumors are. For this purpose, the corresponding images of the inside of the body are delivered three-dimensionally and with millimeter precision, the developers explained.
From the large-scale clinical device called “Biograph mMR”, the doctors hope to significantly improve the diagnosis of numerous diseases, especially cancer and dementia. Professor Markus Schwaiger, Director of the Clinic for Nuclear Medicine at the "Klinikum rechts der Isar" emphasized: "We are entering a new dimension of image-based diagnostics", thereby underlining the importance of innovation for medicine.
With the "Biograph mMR" full-body scanner, doctors will be able to use a full-body image to identify, for example, where there are any cancer tumors in the body and how active they are. From now on, tumors and metastases can be diagnosed much earlier with the help of image-based diagnostics. However, the new combination device also offers new options for aftercare in cancer medicine. Because in the future, the treating physicians can use the whole body image to better assess whether chemotherapy was successful or not. A single examination can determine whether the tumor has shrunk and how its metabolic activity behaves. This provides better clues in tumor diagnostics than before to assess the success of the respective treatment approach in cancer patients.
Neurodegenerative diseases can also be better detected with the "Biograph mMR", so the doctors hope at the "Klinikum rechts der Isar". Because with neurological diseases such as dementia, the metabolic activity in certain areas of the brain decreases, which can be clearly determined with the new combination device. The doctors hope to be able to diagnose dementia before the appearance of clear symptoms. Early diagnosis is particularly important in the case of such diseases, because treatment that is initiated early can often be used to gain a few more years in which the patient remains suitable for everyday use. With the development of ever better medication, the progression of the disease may even be stopped or at least significantly slowed down in the future, the experts hope. This would make early diagnosis all the more important, because after the outbreak of neurodegenerative diseases, patients have little chance of improvement.
Both MRI and PET have been used as examination methods for years and the combination of diagnostic methods was also possible through successive examinations even before the "Biograph mMR" was developed. However, two examination appointments and a considerable additional medical effort were necessary for this. In addition, they gave far less precise results because the diagnostic images from inside the body had to be overlaid subsequently. However, since the patients in the various examinations, in spite of all the efforts of the specialist staff for accuracy, usually do not take the exact same position in the whole-body scanner twice, the precision of the images was previously limited accordingly. With the new "Biograph mMR", these precision problems are eliminated and the examination will in future only require a measurement time of 30 minutes.
So far, it has not been possible to combine the various examination methods in one device because the strong magnetic fields required for the MRI scan have disturbed the sensitive sensors of the PET devices. The developers at Siemens Healthcare, on the one hand, have now used novel gamma radiation detectors that work even in strong magnetic fields and, on the other hand, have cleverly miniaturized all the necessary components of the two diagnostic devices in a single combination device, which is barely larger than one of the original devices.
The detectors of a PET device must be able to detect the gamma radiation caused by the so-called tracer. Tracers are injected into the patient's bloodstream prior to the examination, using mostly glucose labeled with radioactive fluorine. The preparation, known as fluorine-18-deoxyglucose, travels in the body and is absorbed by all cells that use sugar as an energy source. Cells with an increased energy turnover, such as tumor cells, absorb more of the radioactive labeled glucose used as a tracer and the gamma radiation generated during radioactive decay can be detected by the detectors of the PET devices. While scintillation detectors were used in conventional devices that do not work in strong magnetic fields, the Siemens developers at the "Biograph mMR" replaced these sensors with so-called avalanche photodiodes. The developers explained that the new diodes are so small that the currents flowing in them cannot be influenced by the magnetic fields of the MRI system.
The new combination device, which was put into operation for the first time at the nuclear medicine clinic on November 19 in the presence of the Bavarian Prime Minister Horst Seehofer, has so far been a prototype. Before the commercial launch, the “Biograph mMR” will have to demonstrate its performance in a clinical application test carried out by the two university hospitals in Munich in the coming years. When and for what price the device would be available to buy, Siemens developers could not say when it was first put into operation. (fp)
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