0:01

This is the final section in our scans protocols.

0:03

And we're gonna talk about dynamic versus static imaging.

0:06

And so this is something that we do in my practice

0:09

and it really is looking for post prostatectomy recurrence.

0:13

So we tend to only do dynamic imaging in patients

0:15

who have had a prostatectomy, which is why we try

0:17

to gauge this knowledge before they even arrive.

0:20

So the thing is with post ectomy recurrence,

0:22

if the prostate is not there, the prostate descends

0:25

and the proximity of that bladder, which is filled with

0:27

that really radioactive radio urine to the prostate bed

0:30

that we are examining, you know, is quite close.

0:32

So you can potentially obscure small regions

0:35

of recurrent disease.

0:36

And then it also helps us to troubleshoot, you know,

0:39

if I see some uptake, is it real?

0:40

Is it urine? And really helping me

0:42

to answer the question whether or not this is disease

0:44

or just physiological activity.

0:47

So for these dynamic protocols,

0:49

we do injection on the pet CT scanning bed

0:52

and then do continuous imaging for 10 minutes,

0:54

which is then reprocessed into a little video clip.

0:57

And I'll show you a couple in the upcoming slides.

0:59

And what we're trying to do is distinguish radio urine from

1:02

physiological uptake, um, in those sites of disease

1:04

as we saw in the prior slide.

1:06

And we are leveraging the fact that it does take time

1:08

for the kidneys to filter out the radiopharmaceutical

1:11

and we will see that there is uptake, um,

1:13

in many cases insights of disease

1:15

before the radio urine hits the bladder.

1:18

So we're looking for what time it emerges.

1:22

And here is a normal study

1:24

and I'll just play the little video clip here.

1:26

Um, so if you can see, this is

1:27

what it looks like when we compress that 10 minutes

1:30

of imaging into a video clip.

1:31

We can see that there's areas of uptake in the kidney.

1:34

We are seeing the radio urine,

1:35

which if we just concentrate on this kidney, it's starting

1:38

to move into the collecting system there.

1:40

And this was a normal study.

1:42

And here is this from another view and this is our full mip.

1:45

You can see it almost flushing out going

1:47

through the arterial and venous system.

1:49

Um, and then kind of moving into the tissues over

1:53

that examination period.

1:55

And so I'll watch this like a video, I'll step through it,

1:57

I'll go through different levels

1:59

and different slices on the low dose CT

2:00

and the functional data to troubleshoot it.

2:02

And I'll turn this MIP around to really get a sense

2:05

of whether or not there's something going on

2:07

in the prostate bed.

2:08

And here's one, sorry, this one's a little bit shaky

2:11

but we'll still play it anyway.

2:12

So this just gives an idea about how sites

2:14

of disease will start to emerge at early times.

2:17

So we're still in the blood vessels,

2:18

but you can already see sites

2:19

of multiple metastases all through the spine.

2:21

And this is very early.

2:22

So within 10 minutes we're starting to see those sites

2:24

of disease pop up

2:25

and including this area of recurrence down

2:27

here in the pelvis us.

2:30

So here is another one.

2:32

Um, so we are looking here at this patient,

2:35

so in the bloodstream

2:37

and it's filtering through, we're seeing our animation come

2:40

through and what we, I want you to kind

2:43

of have a look down is just here, just here.

2:46

So coming down when the bloodstream

2:48

and then something is starting

2:49

to pop up just here, just underneath it.

2:52

If we go back and play it one more time, you'll see

2:54

that there's this area down here on the rotating mi

2:56

where the cursor is that kind of flushes

2:59

Darker the tracer

3:00

and that's going to be physiological, um, blood flow,

3:04

but there's a spot that is persisting.

3:06

And then if we move onto the next image

3:09

and we'll play it through here.

3:11

And so we're seeing it's in the

3:13

blood, it's going to come through.

3:16

So what I'm gonna do is I'm gonna scroll through this one.

3:18

So here we go here. This is exactly the same patient we're

3:21

seeing on the dynamic that there is this spot

3:23

of uptake here in the prostate bed.

3:25

Um, and then coming through, we're just gonna step

3:28

through it a little bit and we're gonna go

3:29

to the midline sagittal.

3:30

So you can see that there is that spot of uptake coming down

3:34

and this is actually the bladder.

3:35

And interestingly what you can see in the bladder is

3:37

there's actually nothing in there.

3:39

So it's photonic, the urine hasn't got there.

3:42

So this area of accumulation is certainly abnormal.

3:46

And here we go. One more time.

3:48

This is the static imaging

3:49

for this patient showing the rotating mip

3:51

that on the delayed here just to the left of the midline is

3:55

that focus of uptake.

3:56

And because I saw it appear on the dynamic imaging

3:59

before urine even hit that bladder

4:01

and accumulate as such, I can be confident

4:04

that this spot here is real.

4:06

It is disease, it is not radio urine,

4:08

it is not physiological activity.

4:10

And I can make that diagnosis with certainty.

4:14

The other thing I've got with this patient as well,

4:16

and I'm just going to pause it

4:17

and come back here just one moment, is you can see

4:20

that the patient has also got iodine contrast in on board.

4:23

So another check I'll do when I'm going through is to ensure

4:26

that there's no bright radio contrast in there, um,

4:28

to tell me that it's urine as a checkpoint.

4:31

And on this case, there wasn't.

4:33

And this was a confirmed site of local recurrence.