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New Technologies for Human Cancer Imaging

John V. Frangioni

From the Division of Hematology/Oncology, Department of Medicine, and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA

Corresponding author: John V. Frangioni, MD, PhD, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Rm SL-B05, Boston, MA 02215; e-mail: jfrangio{at}bidmc.harvard.edu

Despite technical advances in many areas of diagnostic radiology, the detection and imaging of human cancer remains poor. A meaningful impact on cancer screening, staging, and treatment is unlikely to occur until the tumor-to-background ratio improves by three to four orders of magnitude (ie, 10³- to 10⁴-fold), which in turn will require proportional improvements in sensitivity and contrast agent targeting. This review analyzes the physics and chemistry of cancer imaging and highlights the fundamental principles underlying the detection of malignant cells within a background of normal cells. The use of various contrast agents and radiotracers for cancer imaging is reviewed, as are the current limitations of ultrasound, x-ray imaging, magnetic resonance imaging (MRI), single-photon emission computed tomography, positron emission tomography (PET), and optical imaging. Innovative technologies are emerging that hold great promise for patients, such as positron emission mammography of the breast and spectroscopy-enhanced colonoscopy for cancer screening, hyperpolarization MRI and time-of-flight PET for staging, and ion beam-induced PET scanning and near-infrared fluorescence-guided surgery for cancer treatment. This review explores these emerging technologies and considers their potential impact on clinical care. Finally, those cancers that are currently difficult to image and quantify, such as ovarian cancer and acute leukemia, are discussed.

Supported by Grants No. R01-CA-115296, R01-EB-005805, R21/R33-EB-000673, and R21-CA-129758 from the National Institutes of Health, the Lewis Family Fund, and the Ellison Foundation.

Disclaimers: J.V.F. is named on patents licensed to GE and VisEn Medical. GE and Siemens are subcontractors of the principal investigator on National Institutes of Health grants aimed at optimizing intraoperative near-infrared fluorescence imaging system technology.

Author's disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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