Update: PET/CT und PET/MRT bei Tumoren des Kopf-Hals-Bereiches

Jirka Grosse; Dirk Hellwig

doi:10.1055/a-0621-3150

Der Nuklearmediziner, Table of Contents

Der Nuklearmediziner 2018; 41(03): 222-231
DOI: 10.1055/a-0621-3150

PET Update 2018

Update: PET/CT und PET/MRT bei Tumoren des Kopf-Hals-Bereiches

Update: PET/CT and PET/MRI in Head and Neck Cancer

Jirka Grosse

Abteilung für Nuklearmedizin, Universitätsklinikum Regensburg, Regensburg

,

Dirk Hellwig

Abteilung für Nuklearmedizin, Universitätsklinikum Regensburg, Regensburg

› Author Affiliations

Abstract

Zusammenfassung

Die Positronen-Emissions-Tomografie (PET) mit ¹⁸F-Fluorodesoxyglukose (FDG) in Verbindung mit einer Computertomografie (CT) wird bei speziellen Indikationen in der Diagnostik bei Patienten mit Kopf-Hals-Tumoren eingesetzt. Die Einsatzmöglichkeiten umfassen die Suche nach einem okkulten Primärtumor bei zervikaler Lymphknotenmetastasierung mit zuvor inkonklusiver Diagnostik, das lokale Staging, die Beurteilung des Therapieansprechens nach Radio(chemo)therapie sowie Nachsorgeuntersuchungen, wenn zwischen therapieinduzierten Gewebealterationen und einem Tumorrezidiv differenziert werden muss. Der Erfolg einer Bestrahlung in Hochpräzisionslagerungstechnik (Stereotaxie) bzw. einer intensitätsmodulierten Strahlentherapie scheint durch die Bestimmung des Tumorvolumens unter Einbeziehung der PET/CT verbessert zu werden. Die kombinierte PET/Magnetresonanztomografie (MRT) bietet in diesem Indikationsfeld durch höhere anatomische Detailgenauigkeit Vorteile beim Staging hinsichtlich der Beurteilung des lokalen und lokoregionären Befundes, ist der PET/CT bei der Detektion pulmonaler Metastasen/Zweittumore jedoch deutlich unterlegen.

Auf dem höchstmöglichen Evidenzniveau einer randomisierten Studie wurde gezeigt, dass man bei Patienten mit lokal fortgeschrittenem Kopf-Hals-Tumor bei unauffälliger FDG-PET/CT nach Radiochemotherapie operative Eingriffe ohne Überlebensnachteil vermeiden kann. Die FDG-PET/CT bei Kopf-Hals-Tumoren konnte dadurch vom Gemeinsamen Bundesausschuss (G-BA) als notwendige Leistung für die Versorgung gesetzlich Versicherter anerkannt werden.

Abstract

Positron emission tomography (PET) with ¹⁸F-fluordeoxyglucose (FDG) in combination with computed tomography (CT) is well established for the diagnostic work-up of patients with head and neck cancer. Possible applications include the detection of an occult primary tumor metastatic to cervical nodes, locoregional staging, assessment of treatment response to external beam irradiation (also in combination with chemotherapy), and surveillance for recurrence. The success of high-precision irradiation techniques such as intensity-modulated radiation therapy (IMRT) appears to be improved by delineating the tumor volume using PET/CT. Combined PET/Magnetic Resonance Imaging (MRI) offers advantages in staging with regard to increased anatomical details and radiation dose reduction but is inferior to PET/CT in the detection of pulmonary metastases and secondary tumors. As shown by a randomized trial in patients with advanced head and neck cancer, neck dissection can be omitted if FDG PET/CT is negative after radiochemotherapy and survival is not compromised. With this high level of evidence PET/CT in head and neck cancer currently found its way into the catalog of diagnostic procedures for patients in the statutory health insurances.

Schlüsselwörter

PET/CT - PET/MRT - FDG - Malignom des Kopf-Hals-Bereiches

Key words

PET/CT - PET/MRI - FDG - head neck and neck malignancy

Full Text

References

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