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FDG-PET/CT-Diagnostik in der Gastroenterologie

Typische Anwendungen bei kolorektalen Karzinomen und bei CUP-Syndromen

FDG-PET/CT diagnostics in gastroenterology

Typical applications in colorectal cancer and CUP syndrome

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Der Gastroenterologe Aims and scope

Zusammenfassung

Die Diagnostik mittels PET/CT ist ein etabliertes Verfahren in der Onkologie im Rahmen des Stagings, der Detektion von Lokalrezidiven und metachronen Metastasen sowie der Beurteilung des funktionellen Therapieansprechens. Da sie als Hybridverfahren in der Lage ist, die morphologische Bildgebung mit präzisen funktionellen Informationen zu ergänzen, gewinnt die FDG-PET/CT zunehmend an Bedeutung.

Obwohl sich die Mortalität durch Darmkrebs in den vergangenen Jahren regredient erweist und kolorektale Karzinome häufiger in früheren Stadien detektiert werden – maßgeblich infolge des Koloskopiescreenigs –, ist das Gesamtüberleben häufig durch Metastasen und Rezidive limitiert. Die FDG-PET/CT hat sich mit ihrer hohen Treffsicherheit beim Nachweis von Rezidiven und deren Lokalisation als hilfreich erwiesen. In einer randomisierten Studie zum Einsatz der FDG-PET/CT im Rahmen der Nachsorge konnten signifikant häufiger Rezidive gefunden werden als bei der herkömmlichen Diagnostik. Dann konnte zumeist eine R0-Resektion durchgeführt werden. Die R0-Resektion von Rezidiven und Metastasen beeinflusst das Langzeitüberleben günstig. Es gibt also starke Hinweise auf einen relevanten Nutzen des Einsatzes der FDG-PET/CT bei kolorektalen Karzinomen.

Im Kontext der Rezidivdiagnostik empfehlen aktuelle Leitlinien den Einsatz der FDG-PET/CT bei ansteigendem Serumspiegel des karzinoembryonalen Antigens (CEA) sowie bei fraglichem Befund in der morphologischen Bildgebung.

Abstract

Diagnostics using PET/CT is an established procedure in oncology for staging, detection of local recurrences and metachronous metastases as well as assessment of the functional response to therapy. Because this hybrid procedure is capable of supplementing morphological imaging with precise functional information, F18-fluorodeoxyglucose (FDG) PET/CT is becoming increasingly more important.

In recent years a significant decrease in mortality related to colorectal cancer has been observed which might be a consequence of the introduction of screening by colonoscopy and the detection of colorectal cancer in earlier stages. However, overall survival is often limited by metastases and tumor relapse. In a randomized follow-up trial FDG-PET/CT has proven its superior performance in the detection and localization of tumor relapse and metastases. The complete resection (R0) of recurrent tumors and metastases is associated with a better long-term survival. Thus, there is strong evidence of a relevant benefit of using FDG-PET/CT in the follow-up of colorectal cancer.

Current guidelines recommend the use of FDG-PET/CT to localize the site of recurrence in the case of increasing serum levels of carcinoembryonic antigen (CEA) if detection of the site of recurrence by anatomical imaging is not conclusive.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. J. Grosse und D. Hellwig geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Abteilung für Nuklearmedizin, Universitätsklinikum Regensburg, 93053, Regensburg, Deutschland

    J. Grosse & D. Hellwig

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Grosse, J., Hellwig, D. FDG-PET/CT-Diagnostik in der Gastroenterologie. Gastroenterologe 9, 448–457 (2014). https://doi.org/10.1007/s11377-014-0909-0

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