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PET-CT in der nuklearmedizinischen Diagnostik des multiplen Myeloms

PET-CT for nuclear medicine diagnostics of multiple myeloma

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Zusammenfassung

Hintergrund

Funktionelle oder morphologisch-funktionelle bildgebende Verfahren werden in der Diagnostik und im Therapiemanagement des multiplen Myeloms (MM) primär für wissenschaftliche Zwecke eingesetzt. Ein routinemäßiger klinischer Einsatz ist trotz neuer Stadieneinteilung nicht erfolgt.

Fragestellung

Die Wertigkeit der Positronenemissionstomographie (PET) ist noch offen. Die Rolle von PET und PET-CT für die Diagnostik und das Therapiemanagement wird diskutiert.

Ergebnisse

Die PET mit Fluordesoxyglukose (FDG) erlaubt die Erfassung vitaler Myleomläsionen und korreliert zum Stadium der Erkrankung. Eine negative FDG-Untersuchung korreliert mit einer besseren Prognose. Die Anzahl der fokalen Läsionen sowie das gesamte funktionelle Volumen gemessen mit FDG haben eine prognostische Bedeutung. Mehrere Studien belegen die Wertigkeit der FDG für die Beurteilung des Therapieeffekts und zeigen, dass FDG im Vergleich zur MRT ein früherer Indikator für das Ansprechen ist. Die CT-Komponente der neuen Hybridsysteme ermöglicht die Erfassung osteolytischer Läsionen im CT und deren Vitalität in der FDG. Die Kombination eines PET-Scanners mit einem MRT erlaubt die simultane Erfassung des Knochenmarkbefalls und der Vitalität.

Schlussfolgerung

Der Einsatz moderner Hybridscanner wie PET-CT und PET-MRT ermöglicht die simultane Erfassung vitaler Myelomläsionen, osteolytischer Läsionen und des Knochenmarkbefalls im gesamten Körper und wird zunehmend eine größere Rolle sowohl für die Diagnostik als auch für das Therapiemonitoring spielen.

Abstract

Background

Functional or morphofunctional imaging modalities are used in myeloma patients for the diagnosis and therapy management within research protocols. Despite new staging criteria, which take into account the viability of a myeloma lesion, positron emission tomography (PET) is not used routinely.

Objectives

The impact of PET is therefore open. The role of PET and PET computed tomography (PET-CT) for the diagnosis and therapy management is discussed.

Results

The use of PET with 18F-fluorodeoxyglucose (FDG) allows the measurement of viable myeloma lesions and correlates with the stage of disease. A negative FDG examination correlates with a better prognosis. Furthermore, the number of focal lesions as well as the whole functional volume of myeloma lesions in FDG have a prognostic impact. Several studies have demonstrated the impact of FDG for the assessment of therapy monitoring and show that FDG is an earlier indicator for therapy response as compared to magnetic resonance imaging (MRI). The CT component of the new hybrid systems allows the assessment of osteolytic lesions in CT and their viability in FDG. The combination of PET with an MRT scanner allows the simultaneous measurement of bone marrow infiltration, focal lesions and their viability.

Conclusion

The use of modern hybrid scanners, such as PET-CT and PET-MRT facilitates the simultaneous measurement of viable myeloma lesions, osteolytic lesions and bone marrow infiltration in the whole body; therefore, it is expected that these imaging modalities will play a greater role both in diagnosis and therapy management.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Dimitrakopoulou-Strauss gibt an, dass kein Interessenkonflikt besteht. Alle angewandten Verfahren stehen im Einklang mit den ethischen Normen der verantwortlichen Kommission für Forschung am Menschen (institutionell und national) und mit der Deklaration von Helsinki von 1975 in der revidierten Fassung von 2008. Alle Patienten wurden erst nach erfolgter Aufklärung und Einwilligung in die Studie eingeschlossen.

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  1. Klinische Kooperationseinheit Nuklearmedizin, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland

    A. Dimitrakopoulou-Strauss

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Correspondence to A. Dimitrakopoulou-Strauss.

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Dimitrakopoulou-Strauss, A. PET-CT in der nuklearmedizinischen Diagnostik des multiplen Myeloms. Radiologe 54, 564–571 (2014). https://doi.org/10.1007/s00117-013-2629-8

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  • DOI: https://doi.org/10.1007/s00117-013-2629-8

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