One of the seminal events of the annual SNM conference is the selection of the “Image of the Year” from the thousands of scientific presentations delivered over the course of the annual meeting. This year, two images were jointly selected as the 2008 SNM Image of the Year. One image reveals a relapse of neuroendocrine cancer—a malignancy of the interface between the hormonal and nervous systems—including a nodal involvement. The second image illustrates the exact extent and location of an infection in the foot.
“Molecular imaging is making major scientific contributions by improving healthcare through prevention, diagnosis, treatment planning, treatment monitoring and disease recurrence assessment,” said Henry Wagner Jr., MD, SNM past president and professor at Johns Hopkins University Bloomberg School of Public Health in Baltimore, who annually selects the SNM image of the year. “These are the ‘big five’ functions of molecular imaging,” he added.
The two images selected by Wagner not only demonstrate the breadth and depth of molecular imaging but also show that imaging techniques are increasingly being used in combination to provide precise snapshots of both the molecular function and the anatomy of disease in various parts of the human body.
“Using PET/CT, one group of physicians was able to see that a suspicious lesion in the left ear was not confined just to that area, but also involved a lymph node. This helped them plan the subsequent treatment,” said Wagner.
The image comes from a case of a neuroendocrine tumor located in the left middle ear that was referred for restaging. “The patient was a young male treated by surgery a few months before,” said Stefano Fanti, MD, professor of nuclear medicine at the Policlinico S. Orsola–Università di Bologna in Italy. “Conventional imaging, including CT and MR, showed a suspect local relapse. PET/CT confirmed the local relapse, but also demonstrated a nodal involvement, leading to an alteration of his treatment. The finding was subsequently confirmed by CT, and the patient was scheduled for systemic treatment.”
Wagner’s second selection is a fused image, demonstrating the combined capabilities of SPECT and MRI.
“The image of the foot shows that SPECT with MRI is being used just as successfully as PET/CT,” Wagner said. “The fused image shows clearly that the patient has not only a soft tissue infection but also osteomyelitis—or infection of bone or bone marrow.”
The image reveals an abnormal cellular process in the infected foot of a diabetic patient. “MRI provides almost perfect images of anatomy and bony structure changes, but it may exaggerate the extent of infection,” said Karin Knesaurek, MD, associate professor in the department of radiology and nuclear medicine at Mount Sinai Medical School. “SPECT imaging is more accurate for infection localization but lacks anatomical reference. By combining these, we were able to determine the exact extent and location of the disease, and the patient underwent selective excision of the second metatarsal head only, preserving the rest of her foot.”