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Einsatz der PET/CT zur Diagnostik und Therapiestratifizierung des Bronchialkarzinoms

PET/CT for diagnostics and therapy stratification of lung cancer

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Zusammenfassung

Die Einführung der Positronenemissionstomographie (PET) in die klinische Onkologie und die kürzlich eingeführten Hybridsysteme mit der CT haben die Betreuung von Tumorpatienten essenziell verändert. Die Kombination von PET-Scanner und Multidetektor-CT ermöglichte eine Integration von metabolischer Funktion und hochauflösender morphologischer Bildgebung. Die PET/CT ist ein etabliertes Verfahren zur Beurteilung unklarer Tumorläsionen, zum initialen Tumorstaging, zur Tumorregression und Beurteilung des Therapieansprechens. Das wachsende Interesse an der PET/CT zeigt sich in einer zunehmenden Anzahl von Geräteinstallationen sowie wissenschaftlichen Publikationen. Der Trend geht in Richtung einer kombinierten Untersuchungstechnik, bei der die PET/CT-Untersuchung durch eine intravenöse kontrastmittelverstärkte diagnostische CT ergänzt wird.

Die PET/CT hat sich insbesondere bei der Stadieneinteilung von Lungentumorerkrankungen als Referenzmethode etabliert, da sie bei dieser Tumorentität einen diagnostischen Zugewinn für das T-, N- und M-Staging darstellt. Eine zuverlässige, nichtinvasive Stadienklassifizierung erhöht die Rate erfolgreich operierter Patienten und ermöglicht den Verzicht auf eine invasive Zusatzdiagnostik. Die PET/CT erlaubt gleichzeitig eine individuellere Therapiestratifizierung bei inoperablen Lungentumoren, was wiederum eine hohe Kosteneffizienz für das Gesundheitssystem bedeutet.

In diesem Übersichtsartikel soll der Stellenwert der PET/CT beim Bronchialkarzinom zur Diagnostik und Therapieplanung bzw. Verlaufsbeobachtung aufgezeigt werden. Dabei wird hier auf die wesentlichen Elemente der PET/CT eingegangen: Dignitätsbeurteilung von Rundherden, Stadieneinteilung, Rezidivdiagnostik, Bestrahlungsplanung und Therapieverlaufsbeobachtung.

Abstract

With the introduction of positron emission tomography (PET) and more recently the hybrid systems PET/CT, the management of cancer patients in the treatment strategy has changed tremendously. The combination of PET with multidetector CT scanning enables the integration of metabolic and high resolution morphological image information. PET/CT is nowadays an established modality for tumor detection, characterization, staging and response monitoring. The increased installation of PET/CT systems worldwide and also the increased scientific publications underline the importance of this imaging modality. PET/CT is particular the imaging modality of choice in lung cancer staging and re-staging (T, N and M staging). The possible increased success of surgery in lung cancer patients and also the expected reduction in additional invasive diagnostics lead to benefits for both the individual patient and the healthcare system.

In this review article PET and PET/CT is presented for diagnostic and therapeutic stratification in lung cancer. The fundamentals of glucose metabolism, staging, tumor recurrence and therapeutic monitoring are presented.

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Danksagung

Für die Bildunterstützung bezüglich FMISO möchten wir unseren besonderen Dank Herrn Prof. Andrew Scott (Australien) aussprechen. Ebenfalls danken wir Herrn PD Dr. Münter (Strahlentherapie, Universitätsklinikum Heidelberg) für die hilfreichen Anmerkungen und Bildunterlagen bezüglich der Strahlentherapie.

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Kratochwil, C., Haberkorn, U. & Giesel, F. Einsatz der PET/CT zur Diagnostik und Therapiestratifizierung des Bronchialkarzinoms. Radiologe 50, 684–691 (2010). https://doi.org/10.1007/s00117-009-1960-6

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