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Kombinierte funktionelle und morphologische Bildgebung bei Sarkomen

Stellenwert für Diagnostik und Therapiemonitoring

Combined functional and morphological imaging of sarcomas

Significance for diagnostics and therapy monitoring

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Zusammenfassung

Die 18F-Fluordeoxyglukose-Positronenemissionstomographie (FDG-PET) und insbesondere die Hybridbildgebung als FDG-PET/CT gewinnen beim klinischen Management erwachsener und pädiatrischer Sarkompatienten zunehmend an Bedeutung. Durch die CT-Komponente werden v. a. die Spezifität, aber auch die Sensitivität des Verfahrens weiter gesteigert. Ein Staging von Sarkompatienten einschließlich der Erfassung von Lungenmetastasen ist damit in einem Untersuchungsgang möglich. Die PET/CT wird bei Patienten mit primär ossären und Weichteilsarkomen zur Diagnosestellung, zum Staging und Restaging, zum „metabolischen Tumorgrading“, zur Biopsieplanung, zum Rezidivnachweis sowie zum Therapiemonitoring eingesetzt. Es konnte gezeigt werden, dass der FDG-Uptake des Tumors vor Therapie sowie die Änderungen im FDG-Uptake nach Therapie signifikant mit der histopathologischen Response und dem Überleben der Patienten korrelieren. Damit ermöglichen PET und PET/CT auch prognostische Aussagen. Neue Perspektiven der Hybridbildgebung mit der PET/CT ergeben sich durch die Etablierung neuer Radiotracer sowie durch die kombinierte Untersuchung von Tumormetabolismus und -perfusion. Die hochauflösende MRT bleibt für die lokale Primärdiagnostik sowie zur präoperativen Planung mit Klärung der exakten anatomischen Situation und möglicher Infiltration vaskulärer oder nervaler Strukturen weiter unverzichtbar. Die kontrastverstärkte MRT ist ein wichtiges und gut verfügbares Alternativverfahren zur Rezidivdiagnostik, ganz besonders für nichthypermetabole Tumoren. Dynamische, kontrastverstärkte MRT-Sequenzen gewinnen für das Therapiemonitoring zunehmend an Bedeutung und sollten in prospektiven Studien mit der FDG-PET/CT korreliert werden.

Abstract

18F-fluorodeoxyglucose positron-emission tomography (FDG-PET) and especially hybrid FDG-PET/CT is becoming more and more accepted for the clinical management of adult and pediatric patients with sarcomas. By integrating the CT component the specificity in particular but also the sensitivity of the modality are improved further. With PET/CT a complete staging including the detection of lung metastases is feasible in a single examination. For patients with primary bone and soft tissue sarcomas FDG-PET/CT is utilized for diagnosis, staging and restaging, metabolic tumor grading, guidance of biopsies, detection of tumor recurrence and therapy monitoring. Furthermore, it has been demonstrated that FDG uptake of the tumor prior to treatment and changes of FDG uptake after therapy significantly correlate with histopathologic response and survival of patients. Therefore, PET and PET/CT have a prognostic value. In the future new perspectives of hybrid PET/CT imaging will arise by introducing novel radiotracers and combined functional imaging of tumor metabolism and perfusion. High resolution MRI is essential for local evaluation of the primary tumor and preoperative planning with assessment of possible infiltration of vascular or neural structures. Contrast-enhanced MRI remains a key tool in the diagnosis of recurrent disease, especially in tumors which are not hypermetabolic. Dynamic contrast-enhanced MR sequences can significantly contribute to therapy monitoring. More research is necessary to prospectively compare dynamic contrast-enhanced MRI and FDG-PET/CT for evaluation of local and recurrent diseases.

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  1. Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    N. Schramm, C. Rist, M.F. Reiser &  F. Berger

  2. Medizinische Klinik und Poliklinik III, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, München, Deutschland

    M. Schlemmer & R. Issels

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  1. N. Schramm
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Schramm, N., Schlemmer, M., Rist, C. et al. Kombinierte funktionelle und morphologische Bildgebung bei Sarkomen. Radiologe 50, 339–348 (2010). https://doi.org/10.1007/s00117-009-1973-1

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