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Bildgebende Verfahren bei gastrointestinalen Stromatumoren

Imaging procedures for gastrointestinal stromal tumors

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Zusammenfassung

Morphologische und funktionelle bildgebende Verfahren werden für das Staging gastrointestinaler Stromatumoren (GIST) sowie die Verlaufskontrolle von GIST unter Therapie eingesetzt. Die Computertomographie (CT) wird am häufigsten in der klinischen Routine verwendet und wird von internationalen Richtlinien als Standardverfahren empfohlen. Die Positronenemissionstomographie mit [18F]-2‚-Fluoro-2‚-desoxy-D-Glukose (FDG-PET) kann insbesondere bei der Beurteilung des Ansprechens eines GIST auf die Therapie den rein morphologischen bildgebenden Verfahren überlegen sein. Während die Größe eines Tumorherdes unter Therapie nur sehr langsam abnimmt, kann die FDG-PET ein Ansprechen des Tumors bereits 24 h nach der Therapieeinleitung nachweisen. Aber auch mit der CT ermöglichen neue, dichtebasierte Kriterien deutlich früher den Nachweis eines Therapieansprechens im Vergleich zu einer rein größenbasierten Auswertung. Diese Übersichtsarbeit behandelt die Indikationen bildgebender Verfahren bei GIST und gibt einen Überblick charakteristischer bildgebender Befunde beim Staging und der Therapiekontrolle.

Abstract

Morphological and functional imaging methods are used for staging of gastrointestinal stromal tumors (GIST) and to follow-up GIST patients undergoing therapy. Computed tomography is the most frequently used morphological imaging procedure and has been recommended as the imaging method of choice according to current GIST guidelines. However, positron emission tomography using [18F]-2-fluoro-2-deoxy-D-glucose (FDG-PET) as the radiotracer has shown to be advantageous over morphological imaging procedures when assessing therapy response at an early time point. While tumor size reduction in morphological imaging typically requires time to develop, a decrease in FDG uptake can be detected as early as 24 h following therapy initiation. To overcome the limitations of size-based therapy response assessment on morphological imaging procedures, new density-based therapy response criteria have been developed and implemented for GIST. This review addresses both indications and accuracy of morphological and functional imaging modalities for GIST.

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Interessenkonflikt

Prof. Dr. G. Antoch ist als Referent für die Fa. Novartis Oncology tätig und erhält Studienunterstützung durch Novartis Oncology.

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Authors and Affiliations

  1. Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45127, Essen, Deutschland

    G. Antoch & T.A. Heusner

  2. Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland

    K. Herrmann & A.K. Buck

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  1. G. Antoch
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  2. K. Herrmann
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  3. T.A. Heusner
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  4. A.K. Buck
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Correspondence to G. Antoch.

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Antoch, G., Herrmann, K., Heusner, T. et al. Bildgebende Verfahren bei gastrointestinalen Stromatumoren. Radiologe 49, 1109–1116 (2009). https://doi.org/10.1007/s00117-009-1852-9

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  • DOI: https://doi.org/10.1007/s00117-009-1852-9

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