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Postoperative und posttherapeutische Veränderungen nach primären Knochentumoren

Was ist wichtig für den Radiologen?

Postoperative and posttherapeutic changes after primary bone tumors

What’s important for radiologists?

  • Leitthema
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Zusammenfassung

Die posttherapeutische Bildgebung primärer Knochentumoren stellt eine diagnostische Herausforderung für jeden Radiologen dar. In Abhängigkeit vom primären Knochentumor werden zur Nachsorge die gängigen radiologischen Standardverfahren eingesetzt (Projektionsradiographie, Computertomographie [CT] und Magnetresonanztomographie [MRT]). Die Projektionsradiographie und CT haben einen besonderen Stellenwert v. a. bei benignen Knochentumoren sowie bei primär matrixbildenden Knochentumoren. Die MRT kommt vorzugsweise zur Rezidivdiagnostik bei malignen Knochentumoren und weichteilig rezidivierender Tumoren zum Einsatz. Knochenszintigraphische Verfahren sind vorteilhaft, wenn eine primär multifokale Manifestation der Knochentumorkrankheit vorliegt bzw. eine Metastasierung vermutet wird. Die molekulare Bildgebung (Fluordesoxyglucose-Positronenemissionstomographie [FDG-PET] bzw. ihre Hybridbildgebung in Kombination mit der CT) spielt eine zunehmende Bedeutung hinsichtlich des neoadjuvanten Therapiemonitorings und der Rezidivfrüherkennung. Die aktuelle Literatur führt für die molekularen Bildgebungstechniken (PET, PET-CT) Sensitivitäten und Spezifitäten bzgl. der Rezidiverkennung von bis zu 92 % bzw. 93 % an. Die diagnostische Genauigkeit wird mit bis zu 95 % angegeben, was sowohl diejenige des CT mit 67 % und jene der MRT mit 86 % deutlich übertrifft. In ähnlicher Weise trifft dies auch für die Beurteilung der neoadjuvanten Therapie zu, wobei hier die PET-basierten Verfahren mit Hilfe prätherapeutischer SUV-Werte („standard uptake value“) prognostisch verwertbare Aussagen machen können (v. a. für Ewing-Sarkome). Die modernen Bildgebungsverfahren haben ihren Fortschritt hinsichtlich Rezidivdiagnostik und der Einschätzung des Therapieansprechens valide und reproduzierbar unter Beweis gestellt.

Abstract

Posttreatment imaging of primary bone tumours represents a diagnostic challenge for radiologists. Depending on the primary bone tumour common radiological procedures, such as radiography, computed tomography (CT), and magnetic resonance imaging (MRI), are employed. Radiography and CT are particularly useful in benign bone tumours and in matrix-forming bone tumours. MRI comes into consideration with malignant tumour recurrence and tumoral soft tissue infiltration. Bone scintigraphy is of superior importance if a primarily multifocal manifestation of bone tumour or metastasizing tumour disease is suspected. Molecular imaging (FDG-PET and hybrid imaging, using CT) are gaining increasing importance in light of monitoring neoadjuvant chemotherapy and detecting recurrent tumour appearance. The current literature shows sensitivity and specificity values for recurrent detection of up to 92% and 93%. Diagnostic accuracy is as high as 95%, thus, exceeding accuracy values for CT (67%) and MRI (86%) by far. Likewise, this is also applicable for the assessment of the neoadjuvant chemotherapy. Moreover, PET-based modalities are able to establish prognostic statements using SUV-threshold values at baseline (especially for Ewing sarcomas). Advanced imaging techniques have made a great diagnostic step forward and have proven to be relevant and reproducible with respect to both relapse detection and treatment assessment. Furthermore, it is not clear whether a higher detection rate of early tumour recurrence will inevitably lead to better outcome and survival.

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Danksagung

Die Autoren danken Frau Professor Dr. A. Baur-Melnyk, LMU München, für ihre kritische Durchsicht des Manuskriptes. Ebenso danken die Autoren den Anregungen zum Beitrag durch Herrn Dr. B. Jobke, San Francisco. Abb. 4, 5, 7, 8, 9 und 16: Danksagung an Frau PD Dr. Nöbauer-Huhmann, Wien; Abb. 6: Danksagung an Radiol. Univ.-Klinik, LMU, München; Abb. 13a–f: Danksagung an Prof. Dr. G. Schulte-Altedorneburg, München-Harlaching; Abb. 15: Danksagung an Hessing-Klinik Augsburg.

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  1. Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland

    T. Grieser

  2. Univ.-Klinik für Radiologie und Nuklearmedizin, Med. Universität Wien, Währinger Gürtel 18–20, 1090, Wien, Österreich

    I.-M. Nöbauer-Huhmann

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Grieser, T., Nöbauer-Huhmann, IM. Postoperative und posttherapeutische Veränderungen nach primären Knochentumoren. Radiologe 57, 938–957 (2017). https://doi.org/10.1007/s00117-017-0304-1

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