Der Radiologe

, Volume 52, Issue 6, pp 529–536 | Cite as

Stellenwert der PET/CT zur Bildgebung des kolorektalen Karzinoms

  • F.G. Meinel
  • N. Schramm
  • A.R. Haug
  • A. Graser
  • M.F. Reiser
  • C. Rist
Leitthema

Zusammenfassung

Klinisches/methodisches Problem

Die Fluordesoxyglukose-Positronenemissionstomographie/Computertomographie (FDG-PET/CT) hat in den letzten Jahren zunehmende Bedeutung zur Bildgebung des kolorektalen Karzinoms erlangt. In diesem Beitrag stellen wir den Stand der Literatur zur Rolle der PET/CT bei Screening, Staging, Bestrahlungsplanung, Beurteilung eines Therapieansprechens und Nachsorge des kolorektalen Karzinoms dar. Zudem wird auf gesundheitsökonomische Aspekte und zukünftige Entwicklungen eingegangen.

Radiologische Standardverfahren

CT, MRT, FDG-PET, beim Rektumkarzinom zusätzlich endorektaler Ultraschall.

Methodische Innovationen

Kombinierte FDG-PET/CT.

Leistungsfähigkeit

Während andere Bildgebungsverfahren eine genauere Visualisierung der lokalen Tumorausdehnung und Infiltrationstiefe ermöglichen, ist die PET/CT die sensitivste Methode zum Nachweis kolorektaler Fernmetastasen.

Bewertung

Wir empfehlen, die PET/CT beim kolorektalen Karzinom gezielt bei unklarem M-Staging, vor Metastasenchirurgie sowie bei begründetem Verdacht auf ein Tumorrezidiv oder -residuum einzusetzen. Die Rolle der PET/CT bei der Bestrahlungsplanung und Beurteilung des Therapieansprechens kann noch nicht sicher beurteilt werden. Ein routinemäßiger Einsatz der PET/CT zum kolorektalen Screening, zum Staging und zur Nachsorge erscheint nach gegenwärtigem Stand nicht sinnvoll.

Empfehlung für die Praxis

Um die Synergie morphologischer und funktioneller Informationen optimal auszunützen, sollte eine FDG-PET beim kolorektalen Karzinom grundsätzlich als integrierte FDG/PET-CT mit kontrastverstärkter CT-Komponente durchgeführt werden.

Schlüsselwörter

Kolorektales Karzinom Rektumkarzinom Positronenemissionstomographie/Computertomographie (PET/CT) Staging Nachsorge 

Importance of PET/CT for imaging of colorectal cancer

Abstract

Clinical/methodical issue

Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) has emerged as a very useful imaging modality in the management of colorectal carcinoma. Data from the literature regarding the role of PET/CT in the initial diagnosis, staging, radiotherapy planning, response monitoring and surveillance of colorectal carcinoma is presented. Future directions and economic aspects are discussed.

Standard radiological methods

Computed tomography (CT), magnetic resonance imaging (MRI) and FDG-PET for colorectal cancer and endorectal ultrasound for rectal cancer.

Methodical innovations

Combined FDG-PET/CT.

Performance

While other imaging modalities allow superior visualization of the extent and invasion depth of the primary tumor, PET/CT is most sensitive for the detection of distant metastases of colorectal cancer.

Achievements

We recommend a targeted use of PET/CT in cases of unclear M staging, prior to metastasectomy and in suspected cases of residual or recurrent colorectal carcinoma with equivocal conventional imaging. The role of PET/CT in radiotherapy planning and response monitoring needs to be determined. Currently there is no evidence to support the routine use of PET/CT for colorectal screening, staging or surveillance.

Practical recommendations

To optimally exploit the synergy between morphologic and functional information, FDG-PET should generally be performed as an integrated FDG-PET/CT with a contrast-enhanced CT component in colorectal carcinoma.

Keywords

Colorectal cancer Rectal cancer Positron emission tomography/computed tomography Staging Surveillance 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • F.G. Meinel
    • 1
  • N. Schramm
    • 1
  • A.R. Haug
    • 2
  • A. Graser
    • 1
  • M.F. Reiser
    • 1
  • C. Rist
    • 1
  1. 1.Institut für Klinische RadiologieKlinikum der Ludwig-Maximilians-Universität München, Campus GroßhadernMünchenDeutschland
  2. 2.Klinik und Poliklinik für NuklearmedizinKlinikum der Ludwig-Maximilians-Universität München, Campus GroßhadernMünchenDeutschland

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