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Potenzial radiologischer und nuklearmedizinischer Funktionsdiagnostik

Gezielte Anwendung im onkologischen Therapiemonitoring

Potential of radiological and functional imaging modalities in oncological therapy monitoring

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Morphologiebasierte Methoden zum Therapiemonitoring (RECIST-Kriterien) haben insbesondere mit der zunehmenden Anwendung neuer molekularer Krebstherapien eine begrenzte Aussagekraft.

Ziel

Ziel ist die Evaluation des Potenzials von modernen funktionellen radiologischen und nuklearmedizinischen Bildgebungsmodalitäten wie Perfusions- und Dual-Energy-CT, dynamische Perfusions- und Diffusions-MRT sowie Hybridbildgebung (PET-CT, PET-MRT) für die Beurteilung des Therapieansprechens onkologischer Erkrankungen.

Material und Methoden

Es erfolgte eine selektive Literaturrecherche in der Datenbank PubMed und eine Auswertung eigener Patienten zum Einsatz funktioneller Bildgebung im onkologischen Therapiemonitoring.

Ergebnisse

Die Volumen-Perfusions-CT und die dynamische MRT erfassen die Tumormikrozirkulation, welche sich bereits frühzeitig unter antiangiogenetischer Therapie verändert. Unterschiedliche Gewebezusammensetzungen und die Jodaufnahme in Tumoren können mit der Dual-Energy-CT dargestellt werden, Veränderungen der Tumorzelldichte unter Therapie mit der diffusionsgewichteten MRT. Die PET-CT ist im Therapiemonitoring vieler Tumoren bereits etabliert und ermöglicht die kombinierte Darstellung von Morphologie und Metabolismus der Tumoren.

Schlussfolgerungen

Moderne funktionelle Bildgebungsmethoden besitzen ein großes Potenzial zur verbesserten Tumorcharakterisierung und genaueren und früheren Therapieevaluation über morphologische Veränderungen hinaus. Für ihren routinemäßigen Einsatz ist allerdings häufig noch eine Validierung in größeren Patientenkollektiven und eine Standardisierung bezüglich der Untersuchungsabläufe und Bewertungskriterien sowie z. T. der Auswertemethoden erforderlich.

Abstract

Background

Morphology-based methods for therapy monitoring, such as the response evaluation criteria in solid tumors (RECIST), have shortcomings in oncological therapy evaluation especially of new molecular therapies.

Objectives

Evaluation of the potential of modern functional imaging modalities, including volume perfusion computed tomography (CT), dual energy CT, dynamic contrast-enhanced magnetic resonance imaging (MRI), diffusion-weighted imaging and hybrid imaging, such as positron emission tomography (PET) CT and PET-MRI for therapy monitoring of oncological diseases.

Material and methods

The results of a selective Pubmed search and an evaluation of own analyses regarding the use of functional imaging in therapy evaluation of oncological diseases are presented.

Results

Early changes of tumor perfusion under antiangiogenetic therapy can be measured by volume perfusion CT and dynamic contrast-enhanced MRI. Different chemical tissue compositions and the maximum iodine uptake can be assessed by dual energy-CT. On the other hand, PET-CT is an established hybrid modality for therapy evaluation and provides information about morphology and tumor metabolism. Diffusion-weighted MRI enables the measurement of the higher cellularity in tumor lesions and the changes under therapy.

Conclusion

The new functional imaging modalities have a great potential to improve characterization of tumors and enable an earlier and more precise therapy evaluation of oncological diseases beyond morphological changes; however, validation in larger patient cohorts and standardization concerning examination techniques and interpretation criteria as well as postprocessing are still needed.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Pfannenberg, C. Brendle, W. Thaiss, M. Bongers, M. Notohamiprodjo, C. la Fougere und K. Nikolaou geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Abteilung für Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland

    C. Brendle, W. Thaiss, M. Bongers, M. Notohamiprodjo, K. Nikolaou &  C. Pfannenberg

  2. Abteilung für Nuklearmedizin, Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland

    C. la Fougere

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  1. C. Brendle
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  2. W. Thaiss
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  4. M. Notohamiprodjo
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  5. C. la Fougere
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  6. K. Nikolaou
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Correspondence to C. Pfannenberg.

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Brendle, C., Thaiss, W., Bongers, M. et al. Potenzial radiologischer und nuklearmedizinischer Funktionsdiagnostik. Onkologe 21, 402–413 (2015). https://doi.org/10.1007/s00761-014-2816-x

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