Greg Freiherr, Industry Consultant
Greg Freiherr, Industry Consultant

Greg Freiherr has reported on developments in radiology since 1983. He runs the consulting service, The Freiherr Group.

Blog | Greg Freiherr, Industry Consultant | Radiology Imaging | June 01, 2016

Screening: How New Looks at Old Modalities Might Turn Imaging Upside Down

screening, imaging

Graphic courtesy Pixabay

Cancer screening is the only circumstance in which apparently healthy people subject themselves purposely to an agent known to cause cancer. It is the paradox of mammography, a screening tool that has substantially reduced breast cancer morbidity, whose success has only added to its paradoxical nature.

While mammography may be the most recognizable type of screening, it is not the only one. Ultrasound is widely used to screen for cardiovascular disease, for example. But, unlike mammography, it does not rely on ionizing radiation. Nor does magnetic resonance imaging (MRI), an imaging tool deemed too expensive — and limited in scope — for use in screening. But that could change.

Consider GLINT (glucoCEST Imaging of Neoplastic Tumors) — an MR-based technique being developed to visualize the body’s use of glucose. GLINT imaging is based on the use by tumors of massive amounts of glucose. This concept underlies the ability of positron emission tomography (PET) to spot the presence and recurrence of tumors. But, whereas PET exposes patients to ionizing radiation through the use of glucose molecules tagged with positron-emitting fluorine (as well as the computed tomography (CT) with which it is commonly paired), GLINT records hot spots coming from the use of non-labeled glucose.

 

Too Early To Tell

In a May 24 press release announcing the GLINT program, Vienna-based European Institute for Biomedical Imaging Research (EIBIR) framed the technique as a “game changer for cancer screening.”

This possibility is as exciting, as it is speculative.

GLINT is only a few months old, its development having been formally launched in January this year. Its four-year development program, guided by EIBIR, involves major universities, research institutes and corporations in seven countries – one in Israel, the others in Europe.

GLINT is being groomed as an MR technique for finding disease. It may be especially useful against cancer. But also might be used for other diseases. It may be very inexpensive. (The GLINT project group claims that this technique might be six to ten times less expensive than current MR techniques.) But a need for glucose analogues could negate those savings.

Clearly, much about GLINT is up in the air. One thing is for sure, however. GLINT is not going to replace mammography any time soon. It may never do so, unless the technique can be developed for use on dedicated, low-cost screening devices. The capital investment underlying MRI is substantial, far more so than mammography or ultrasound.

Intriguing, however, is the metabolic basis of this technique, which promises to transform MRI from an anatomical modality into molecular imaging. The practical implications are huge. According to the project team, the development and commercialization of glucoCEST MRI will “benefit the global cancer population by improving the diagnostic accuracy of MRI and providing early readouts of treatment efficacy, leading to improved clinical decisions and outcomes.”

While economic considerations might blunt GLINT’s role in screening, they might work in its favor as a means to monitor patients for cancer recurrence following therapy. This would be especially so for pediatric patients who may be monitored using PET/CT and, consequently, exposed to ionizing radiation periodically during their formative years and long after. Notably, the research team is looking specifically at pediatric lymphomas, as well as squamous cell carcinoma and primary gliomas.

 

Much Potential, Little Proven

GLINT might be used on these and other cancers. Adding to its appeal is the possibility that GLINT might even be used to find diseases other than cancer, thanks to its ability to image proteins, according to Prof. Klaus Scheffler, Ph.D., of the Max Planck institute for Biological Cybernetics in Tübingen.

In the near term, multi-site research teams are concentrating on cancer and the detection of native glucose (D-glucose) uptake in tumors. They are also reportedly looking into glucose analogues, such as 3-oxy-methyl-D-glucose. Because methylated analogues of sugar cannot be metabolized, they might serve as tracers.

While such studies keep GLINT in the cancer wheelhouse, they raise questions about a basic premise underlying the development of this technique — its potential for low-cost exams. The use of such tracers would undoubtedly add to the expense.

Pushing such considerations aside is the exciting nature of GLINT — what its development signifies for the medical imaging community — that free thinkers are looking at an established modality not for what it is but for what it might be.

GLINT is the result of thinking outside the box, of asking “why not?” This begs the question: What other wonders of medical imaging might be similarly unlocked if the status quo is challenged?

 

Editor's note: This is the first blog in a four-part series on screening

Related Content

negative RT-PCR results and chest CT findings compatible with 2019-nCoV pneumonia

Figure 1: Patient flowchart. Of 167 patients screened, 5 (3%) had negative RT-PCR results and chest CT findings compatible with 2019-nCoV pneumonia. Chart courtesy of Radiology

Feature | Computed Tomography (CT) | February 14, 2020
As the 2019-nCoV Pneumonia is taking the world by storm, researchers have found a possible way to predict this virus
SIR-Spheres Y-90 resin

SIR-Spheres Y-90 resin microspheres are released into the hepatic artery.

News | Nuclear Imaging | February 14, 2020
February 14, 2020 —  ...
MolecuLight’s i:X procedure in wound care
News | Radiology Imaging | February 13, 2020
February 13, 2020 — MolecuLight Inc., a leader in handheld fluorescence imaging for real-time detection of bacteria i
The Caption Guidance software uses artificial intelligence to guide users to get optimal cardiac ultrasound images in a point of care ultrasound (POCUS) setting.

The Caption Guidance software uses artificial intelligence to guide users to get optimal cardiac ultrasound images in a point of care ultrasound (POCUS) setting.

News | Artificial Intelligence | February 13, 2020
February 13, 2020 — The U.S.
Hyperfine Research, Inc. announced that it has received U.S. Food and Drug Administration (FDA) 510(k) clearance for the world’s first bedside Magnetic Resonance Imaging (MRI) system

Hyperfine's point-of-care MRI wheels directly to the patient’s bedside, plugs into a standard electrical wall outlet, and is controlled via a wireless tablet. Photo courtesy of Business Wire

News | Magnetic Resonance Imaging (MRI) | February 12, 2020
February 12, 2020 — Hyperfine Research, Inc. announced that i
Mobile devices proved both reliable and accurate for the clinical decision to administer IV thrombolysis in patients with acute stroke

Appearance of same unenhanced CT scan on three reading systems: E-2620 monitor (Barco) (A), Galaxy S8 Plus (Samsung) smartphone (B) and ThinkPad T460s laptop computer (Lenovo) (C).

News | Computed Tomography (CT) | February 12, 2020
February 12, 2020 — Mobile devices proved both reliable and accurate for the clinical decision to administer IV throm
The magnetic resonance imaging (MRI) contrast agents market is expected to grow rapidly

Image courtesy of GE Healthcare

News | Magnetic Resonance Imaging (MRI) | February 11, 2020
February 11, 2020 — The magnetic resonance imaging (MRI) contrast agents market is expected to grow rapidly in the fo
CT image of Novel Coronavirus 2019-nCoV from the Radiology article showing a baseline CT image of a 75 year old male with multiple patchy areas of pure ground glass opacity (GGO) and GGO with reticular and/or interlobular septal thickening. Follow-up CT images on day 3 after admission show an overlap of organizing pneumonia with diffuse alveolar damage in that it is more diffuse and associated with underlying reticulation. Read more and see 15 more images from novel coronavirus patients in the article.

An image from the Radiology article showing a baseline CT image of a 75 year old male with multiple patchy areas of pure ground glass opacity (GGO) and GGO with reticular and/or interlobular septal thickening. Follow-up CT images on day 3 after admission show an overlap of organizing pneumonia with diffuse alveolar damage in that it is more diffuse and associated with underlying reticulation. Read more and see 15 more images from novel coronavirus patients in the article.

Feature | Computed Tomography (CT) | February 11, 2020
February 11, 2020 — The Radiological Society of North America (RSNA) jo
Mammograms of a 49-year-old woman with invasive lobular carcinoma on the right-side breast

Mammograms of a 49-year-old woman with invasive lobular carcinoma on the right-side breast. A small mass with micro-calcifications on the right-side breast was detected correctly by AI with an abnormality score of 96%. This case was recalled by 7 out of 14 radiologists (4 breast radiologists and 3 general radiologists) initially (without AI) and all 14 radiologists recalled this case correctly with the assistance of AI.

News | Artificial Intelligence | February 11, 2020
February 11, 2020 — A new study, published in...
A patient-specific airway stents developed by Cleveland Clinic physician Tom Gildea, M.D. 

A patient-specific airway stents developed by Cleveland Clinic physician Tom Gildea, M.D. 

News | Computed Tomography (CT) | February 10, 2020
February 10, 2020 — The U.S.