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„Chemical exchange saturation transfer“ (CEST)

Magnetresonanztomographie in der onkologischen Diagnostik

Chemical exchange saturation transfer (CEST)

Magnetic resonance imaging in diagnostic oncology

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Zusammenfassung

Hintergrund

Die Kontrasterzeugung mittels „chemical exchange saturation transfer“ (CEST) ist ein zuletzt rasant an Bedeutung gewinnendes Forschungsfeld in der Magnetresonanztomographie (MRT), das großes Potenzial für die klinische Anwendung besitzt.

Methode

Dieses Review behandelt die methodischen Grundlagen und fasst die klinischen Erfahrungswerte der bis dato durchgeführten onkologischen CEST-Bildgebungsstudien zusammen.

Ergebnisse und Schlussfolgerung

Durch die selektive Anregung von Metabolit-gebundenen Protonen und den nachfolgenden Magnetisierungstransfer auf freies Wasser können mittels CEST-MRT niedrig konzentrierte Metaboliten wie Peptide oder Glukose detektiert werden. Durch diese Technik können zusätzliche Informationen über den Metabolismus und das Mikromilieu von Geweben, ohne den Bedarf an konventionellen Kontrastmitteln oder radioaktiven Tracern, gewonnen werden. Insbesondere im neuroonkologischen Kontext konnte gezeigt werden, dass mittels CEST-MRT eine verbesserte Einschätzung der Malignität von Tumoren möglich ist und dass die Proteinkontraste Hinweise auf das frühe Ansprechen von Tumoren vor und in der ersten Verlaufskontrolle nach Therapie liefern könnten.

Kernaussagen

Die CEST-MRT ermöglicht die indirekte Detektion von Metaboliten ohne radioaktive Tracer oder Kontrastmittel. Klinische Erfahrungswerte liegen insbesondere in der neuroonkologischen Bildgebung vor. Hier könnte die CEST-MRT eine verbesserte Einschätzung der Prognose und des Therapieansprechens ermöglichen.

Abstract

Background

Contrast generation by chemical exchange saturation transfer (CEST) is a recently emerging magnetic resonance imaging (MRI) research field with high clinical potential.

Methods

This review covers the methodological principles and summarizes the clinical experience of CEST imaging studies in diagnostic oncology performed to date.

Results and conclusion

CEST enables the detection of lowly concentrated metabolites, such as peptides and glucose, through selective saturation of metabolite-bound protons and subsequent magnetization transfer to free water. This technology yields additional information about metabolic activity and the tissue microenvironment without the need for conventional contrast agents or radioactive tracers. Various studies, mainly conducted in patients with neuro-oncolgic diseases, suggest that this technology may aid to assess tumor malignancy as well as therapeutic response prior to and in the first follow-up after intervention.

Key points

CEST-MRI enables the indirect detection of metabolites without radioactive tracers or contrast agents. Clinical experience exists especially in the setting of neuro-oncologic imaging. In oncologic imaging, CEST-MRI may improve assessment of prognosis and therapy response.

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Danksagung

Die Autoren möchten sich herzlich bei den Abteilungen von Herrn Professor Heinz-Peter Schlemmer, Herrn Professor Mark Ladd und Herrn Professor Peter Bachert für die sehr erfolgreiche, kontinuierliche und vertrauensvolle Zusammenarbeit bedanken. Die Forschungsstrukturen am DKFZ und Uniklinikum Heidelberg, mit der exzellenten methodischen Entwicklung und unmittelbaren Translation in die Praxis, schaffen ideale Bedingungen für die Erforschung und Translation neuer Bildgebungstechniken. Unser besonderer Dank gilt hierbei auch dem gesamten MTA-, IT-, Studien-, und Administrationsteam im FSE für die herausragende Unterstützung bei unseren Studien.

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  1. Abteilung Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland

    N. von Knebel Doeberitz, S. Maksimovic, L. Loi &  D. Paech

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  1. N. von Knebel Doeberitz
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  2. S. Maksimovic
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  3. L. Loi
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  4. D. Paech
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Correspondence to D. Paech.

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Interessenkonflikt

D. Paech gibt an, dass wissenschaftliche Studien zur CEST-MRT unter seiner Leitung am Deutschen Krebsforschungszentrum durchgeführt werden, die durch die Deutsche Forschungsgemeinschaft (DFG) gefördert werden. N. von Knebel Doeberitz, S. Maksimovic, L. Loi und D. Paech geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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von Knebel Doeberitz, N., Maksimovic, S., Loi, L. et al. „Chemical exchange saturation transfer“ (CEST). Radiologe 61, 43–51 (2021). https://doi.org/10.1007/s00117-020-00786-z

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