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Bedeutung der FDG-PET/CT für die Chirurgie des Rektumkarzinoms

Importance of FDG-PET/CT for surgery of rectal cancer

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Zusammenfassung

Hintergrund

Die kombinierte Bildgebung mit [18F]Fluordesoxyglukose-Positronenemissionstomographie (FDG-PET) und Computertomographie (CT) erlangt für die Diagnostik und das Therapiemanagement von Patienten mit malignen Erkrankungen eine zunehmende Bedeutung.

Fragestellung

Welche Bedeutung hat die FDG-PET/CT für die Diagnostik und Therapie des Rektumkarzinoms?

Ergebnisse

Die FDG-PET/CT hat vor allem in der Nachsorge beim Verdacht auf Vorliegen eines Rezidivs einen festen Stellenwert. Dies ist insbesondere bei einem Anstieg von Tumormarkern während der Nachsorge ohne sonst fassbares Korrelat zur Beurteilung suspekter Leberraumforderungen und zur Differenzierung einer unklaren Gewebsvermehrung im ehemaligen Operationsgebiet der Fall. Hier kann mittels FDG-PET/CT zwischen Narbe und Rezidivtumor unterschieden werden. Aktuell gibt es eine zunehmende Evidenz dafür, dass auch eine Beurteilung des Überlebens bei Primärdiagnose anhand der Speicherintensität in der FDG-PET möglich ist. Interessanterweise besteht die Möglichkeit, durch eine Evaluation mittels FDG-PET eine frühzeitige Aussage über das Ansprechen auf eine neoadjuvante Therapie zu erreichen.

Diskussion

Trotz einiger Einschränkungen hat die FDG-PET/CT mittlerweile einen festen Stellenwert in der Diagnose und Behandlung von Patienten mit Rektumkarzinom.

Abstract

Background

Examinations using 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT) are becoming increasingly more important in clinical practice for the diagnosis and therapy of cancer patients.

Question

What role does FDG-PET/CT examination play in the diagnosis and therapy of rectal cancer?

Results

The FDG-PET/CT method is especially valuable during postoperative care when a recurrence is suspected. Especially when tumor marker levels rise with no other symptoms, FDG-PET/CT can be used to evaluate unclear lesions in the liver and unclear tissue formations at the surgery site and distinguish between scar tissue and recurring tumors. Currently, there is increasing evidence that a survival prognosis may be possible based on the tracer uptake of FDG-PET/CT. There is also a great interest in the possibility of evaluating the success of neoadjuvant therapy with FDG-PET/CT.

Discussion

Despite some limitations FDG-PET/CT plays a significant role in the diagnosis and treatment of patients with rectal cancer.

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Danksagung

Die Autoren danken Dr. V. Wiegering und PD Dr. N. Schlegel für die kritische Durchsicht des Manuskriptes.

Einhaltung ethischer Richtlinien

Interessenskonflikt: A. Wiegering; K. Herrmann; C. Bluemel; A.K. Buck und C.-T. Germer geben an, dass kein Interessenskonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Tieren oder Menschen.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinik Würzburg, Oberdürrbacherstr. 2, 97080, Würzburg, Deutschland

    A. Wiegering & C.-T. Germer

  2. Institut für Biochemie und Molekularbiologie, Universität Würzburg, Würzburg, Deutschland

    A. Wiegering

  3. Klinik und Poliklinik für Nuklearmedizin, Universitätsklinik Würzburg, Würzburg, Deutschland

    K. Herrmann, C. Bluemel & A.K. Buck

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  1. A. Wiegering
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  2. K. Herrmann
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  3. C. Bluemel
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  5. C.-T. Germer
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Correspondence to A. Wiegering.

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Wiegering, A., Herrmann, K., Bluemel, C. et al. Bedeutung der FDG-PET/CT für die Chirurgie des Rektumkarzinoms. Chirurg 85, 487–492 (2014). https://doi.org/10.1007/s00104-013-2669-7

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