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Stellenwert der FDG-PET/Computertomographie beim kolorektalen Karzinom

Importance of FDG-PET/computed tomography in colorectal cancer

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Zusammenfassung

Hintergrund

Die Hybridbildgebung FDG-PET/CT (18F‑Fluordesoxyglukose-Positronen-Emissions-Tomographie/Computertomographie) hat in den letzten Jahren einen zunehmenden Stellenwert in der Onkologie erlangt und wird auch beim kolorektalen Karzinom eingesetzt.

Diagnosestellung

Einer fokal erhöhten FDG-Aufnahme im Gastrointestinaltrakt kann ein kolorektales Karzinom zugrunde liegen. Ein solcher Befund bedarf daher einer weiterführenden Abklärung.

Primäres Staging

Das Staging des Primärtumors und der lokregionären Lymphknoten ist weiterhin Domäne der etablierten Bildgebungsmethoden, da die FDG-PET/CT hierbei keinen eindeutigen zusätzlichen Nutzen erbringt. Lebermetastasen können mittels FDG-PET/CT mit hoher Sensitivität detektiert werden, allerdings ist die MRT bei kleinen Läsionen überlegen.

Bestrahlungsplanung

Die FDG-PET/CT spielt für die Bestrahlungsplanung beim Rektumkarzinom bisher eine untergeordnete Rolle. Zur Optimierung des Bestrahlungsfelds kann sie jedoch potenziell beitragen.

Therapiekontrolle

Die FDG-PET/CT eignet sich zum Therapiemonitoring, da neben den rein morphologischen zusätzlich auch metabolische Veränderungen des Tumors frühzeitig erfasst werden können. Dies ermöglicht beispielsweise, nach Beginn einer neoadjuvanten Radiochemotherapie eines Rektumkarzinoms Nonresponder frühzeitig zu erkennen. Die FDG-PET/CT kann auch zur Therapiekontrolle von Lebermetastasen, insbesondere nach lokaltherapeutischen Verfahren, sinnvoll eingesetzt werden.

Rezidivdiagnostik

Bei klinischem Verdacht auf ein Lokalrezidiv und erhöhten Tumormarkern besitzt die FDG-PET/CT einen hohen Stellenwert, da Tumorrezidive mit hoher Sensitivität und Spezifität erkannt werden können.

Abstract

Background

Hybrid imaging FDG PET/CT (18F‑fluordeoxyglucose positron emission tomography/computed tomography) has gained increasing importance in oncology in recent years.

Diagnosis

A focal increase in FDG uptake in the gastrointestinal tract may be due to colorectal carcinoma. Such a finding requires further clarification.

Primary staging

Staging of the primary and locoregional lymph nodes remains a domain of established imaging modalities as FDG PET/CT does not provide a clear additional benefit. Liver metastases can be detected with high sensitivity by FDG PET/CT, but MRI is superior in small lesions.

Radiation therapy planning

So far FDG PET/CT plays a subordinate role in the radiation therapy planning of rectal cancer. However, it can potentially contribute to the optimization of planning target volumes.

Therapy monitoring

FDG PET/CT is suitable for monitoring therapy because morphological and metabolic changes of the tumor can be detected in early stages. This enables early detection of nonresponders after beginning neoadjuvant chemoradiation therapy of rectal cancer. FDG PET/CT can also be used for therapy control of liver metastases, especially after local therapeutic procedures.

Detection of recurrence

With clinical suspicion of local recurrence and increased tumor markers, FDG PET/CT is a valuable tool as tumor recurrence can be detected with high sensitivity and specificity.

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  1. Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    S. Kleiner MHBA &  W. Weber

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S. Kleiner und W. Weber geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Kleiner, S., Weber, W. Stellenwert der FDG-PET/Computertomographie beim kolorektalen Karzinom. Radiologe 59, 812–819 (2019). https://doi.org/10.1007/s00117-019-00584-2

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