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Onkologie up2date 2022; 04(01): 93-106
DOI: 10.1055/a-1712-0674
Tumoren der endokrinen Organe

Neuroendokrine Tumoren – von der morphologischen zur funktionellen Bildgebung

Harun Ilhan
,
Moritz Schnitzer
,
Johannes Rübenthaler
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Im Rahmen der Primärabklärung von neuroendokrinen Tumoren (NET) kommen neben der Ultraschalldiagnostik die Computertomografie und die Magnetresonanztomografie zum Einsatz. Je nach Verfügbarkeit stellt darüber hinaus die funktionelle Bildgebung mittels Szintigrafie bzw. Single-Photon-Emissionscomputertomografie (SPECT) und Positronenemissionstomografie (PET) eine obligate Untersuchungsmethode für die Abklärung von NET dar.
Kernaussagen

  • Neuroendokrine Tumoren sind eine relativ seltene Tumorentität, die jedoch eine stetig steigende Inzidenz aufweisen. Dieser Anstieg ist überwiegend auf die moderne Bildgebung zurückzuführen, die eine Diagnostik neuroendokriner Tumoren auch in früheren Stadien ermöglich.

  • Die Ultraschalldiagnostik stellt bei neuroendokrinen Tumoren eher eine Untersuchungsmodalität zur gezielten Diagnostik bestimmter Regionen dar (z. B. Endosonografie, Lebersonografie).

  • Die CT- und MRT-Bildgebung zeigen eine ähnliche Sensitivität und Spezifität im Rahmen der Primärdiagnostik und sollten nach Möglichkeit immer unter Verwendung von Kontrastmittel durchgeführt werden. Die MRT-Bildgebung eignet sich insbesondere zur Abklärung hepatischer Metastasen, bei der zusätzlich zur Kontrastmittelgabe die Beurteilung diffusionsgewichteter Sequenzen von großer Bedeutung ist.

  • Ein besonderes Merkmal neuroendokriner Tumoren ist die (Über-)Expression von Somatostatin-Rezeptoren auf der Zelloberfläche, welche die Grundlage für die nuklearmedizinische Bildgebung und Therapie darstellt. Die Rezeptoren dienen mittels diagnostischen und therapeutischen Radionukliden markierten Somatostatin-Analoga als Zielstruktur.

  • Den Referenzstandard für die funktionelle Bildgebung gastroenteropankreatischer neuroendokriner Tumoren stellt die PET-Bildgebung mit überwiegend 68Ga-markierten Somatostatin-Analoga dar. Neuere Entwicklungen beinhalten dabei auch mittels 64Cu oder 18F markierte Somatostatin-Analoga, die im Vergleich zum Generatorprodukt 68Ga pharmakokinetische Vorteile aufweisen.

  • Darüber hinaus können auch andere Radiopharmaka wie beispielsweise 18F-FDG, 18F-DOPA oder 123I/131I-MIBG für die Bildgebung und das Therapiemanagement neuroendokriner Tumoren von großer Bedeutung sein. Diese werden in diesem Beitrag jedoch nicht im Detail beleuchtet.

Schlüsselwörter

NET - Bildgebung - CT - MRT - PET/CT - Somatostatin-Analoga


Publication History

Article published online:
11 March 2022

© 2022. Thieme. All rights reserved.

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