Radiologisch-nuklearmedizinische Bildgebung des Prostatakarzinoms

Zusammenfassung

Die radiologische und nuklearmedizinische Bildgebung in der Diagnostik des Prostatakarzinoms sowie von lokoregionären Rezidiven und even­tuell befallener Lymphknoten hat in den letzten Jahren wesentliche Fortschritte erzielt. Mit der technischen Weiterentwicklung im Bereich der Magnetresonanztomografie (MRT) und der nuklearmedizinischen Tracer konnte eine Erhöhung der Sensitivität auf 85–90 % und der Spezifität auf 75–90 % erreicht werden. Insbesondere die MRT hat mit der Einführung der Spektroskopie und diffusionsgewichteter Sequenzen, aber auch mit dem zunehmenden klinischen Einsatz von ­Sequenzen zur Auswertung der Perfusion wesentliche Beiträge in der multiparametrischen Diagnostik geliefert. Mithilfe von speziellen lymphknotenspezifischen Kontrastmitteln, sogenannten „ultrasmall paramagnetic iron particles“ ­(USPIO) konnten in Studien bis zu 100 % aller patholo­gisch befallenen Lymphknoten detektiert werden. Auch in der nuklearmedizinischen Diagnostik konnten wesentliche Fortschritte durch die Entwicklung von an ¹⁸Fluor koppelbare Tracer ­erreicht werden, die sich durch eine längere Halbwertszeit auszeichnen und daher auch an Insti­tuten ohne eigenes Zyklotron verwendet wer­den können. Die ­so erreichten Sensitivitäten und Spezifitäten für die Detektion des Primär­tumors und loko­re­gio­närer Rezidive liegen damit zwischen 85 und 95 %.

Abstract

The diagnostic methods in radiology and nuclear medicine for the imaging of prostate cancer as well as for the detection of locoregional recurrent disease and positive lymph nodes have pro­gressed dramatically over the past years. Regard­ing technical advances in magnetic resonance imaging (MRI) and the new tracers used in nu­clear medicine, an increase in sensitivity up to 85–90 % and in specificity up to 75–90 % has been achieved. Especially in MRI, efforts had been made to implement multiparametric imaging using the diagnostic methods of spectroscopy and diffusion-weighted sequences and by includ­ing dynamic contrast enhancement studies. In ­addition, by the use of dedicated, lymph-node specific contrast media, “ultrasmall paramagnetic iron particles” (USPIO), up to 100 % of all patho­log­ical lymph nodes were detected in the pub­lished studies. Also in the field of nuclear medicine there have been relevant advances such as the development of specific tracer substances, which can be coupled to ¹⁸fluorine, a nuclide that is characterised by a longer half-life time than ¹¹C and is therefore usable even in sites without an in-house cyclotron. Using this nuclide, the sensi­tivity and specificity rates in the detection of ­primary prostate cancer as well as in locoregional ­recurrences have been increased to values be­tween 85 and 95 %.

Schlüsselwörter

Prostatakarzinom - bildgebende Diagnostik - multiparametrische Bildgebung - PET / CT

Key words

prostate cancer - image-guided diagnosis - multiparametric imaging - PET / CT

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