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 | 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

Therapixel Wins the Digital Mammography Challenge
News | Mammography | June 23, 2017
June 23, 2017 — French radiology technology company Therapixel was recently named the winner of the Digital Mammograp
ClearRead CT Nearing 50 Installations Milestone
News | Computed Tomography (CT) | June 22, 2017
June 22, 2017 — Riverain Technologies announced that it is now processing data from nearly 50...
MRI Plus Mammography Improves Detection of New Breast Cancer After Surgery
News | Breast Imaging | June 22, 2017
A new article published by JAMA Oncology compares outcomes for combined mammography and magnetic resonance imaging (MRI...
RadNet Inc. Acquires Equity Stake in Medic Vision
News | Radiation Dose Management | June 21, 2017
June 21, 2017 — RadNet Inc. and Medic Vision Imaging Solutions Ltd.
RSNA Research and Education Foundation Awarding $4 Million in Grants in 2017
News | Business | June 21, 2017
The Radiological Society of North America (RSNA) Research and Education (R&E) Foundation will fund $4 million in...
Dual-Agent PET/MR With Time of Flight Detects More Cancer

Tc-99m MDP bone scan (left) is negative for osseous lesions. NaF/FDG PET/MRI (right and second slide) confirms absence of bone metastases, but shows liver metastases. Image courtesy of Stanford University.

News | PET-MRI | June 20, 2017
Simultaneous injections of the radiopharmaceuticals fluorine-18 fluorodeoxyglucose (18F-FDG) and 18F-sodium fluoride (...
Combined Optical and Molecular Imaging Could Guide Breast-Conserving Surgery

WLE specimen from a patient with a grade 3, ER-/HER2-, no special type (NST) carcinoma. (A) Cerenkov image; (B) Grey-scale photographic image overlaid with Cerenkov signal. An increased signal from the tumor is visible (white arrows); mean radiance is 871 ± 131 photons/s/cm2/sr, mean TBR is 3.22. Both surgeons measured the posterior margin (outlined in blue) as 2 mm (small arrow); a cavity shaving would have been performed if the image had been available intraoperatively. The medial margin (outlined in green) measured >5 mm by both surgeons. Pathology ink prevented assessing the lateral margin; a phosphorescent signal is visible (open arrows). (C) Specimen radiography image. The absence of one surgical clip to mark the anterior margin, and the odd position of the superior margin clip (white arrow) prevented reliable margin assessment. (D) Combined histopathology image from two adjacent pathology slides on which the posterior margin (bottom of image) and part of the primary tumor are visible (open arrows). The distance from the posterior margin measured 3 mm microscopically (double arrow). The medial margin is > 5 mm (not present in image). Credit: A. D. Purushotham, M.D., King’s College London, UK

News | Nuclear Imaging | June 20, 2017
June 20, 2017 — Breast-conserving surgery (BCS) is the primary treatment for early-stage...
Henry Ford Cancer Institute First in World to Install Viewray MRIdian Linac
News | Image Guided Radiation Therapy (IGRT) | June 19, 2017
The Henry Ford Cancer Institute is the first in Michigan – and first in the world – to offer patients advanced...
New Image Wisely Radiation Safety Case Discusses Child-Sizing CT Dose
News | Radiation Dose Management | June 19, 2017
The tenth special edition Image Wisely Radiation Safety Case is now available to help radiologists, imaging...
Overlay Init