Kernspintomographie zum Metastasen-Screening? Ein prospektiver Vergleich mit der Skelettszintigraphie^[*]

Zusammenfassung

Bei 102 Patienten mit Tumoren mit häufiger Skelettmetastasierung, wurde im Vergleich zur Skelettszintigraphie (SkSz) der Stellenwert der Kernspintomographie (KST) von Wirbelsäule, Becken, Femora und proximalen Tibiae zum Metastasen-Screening geprüft. Alle Patienten hatten in der SkSz keinen Metastasen-Hinweis, 96 (94%) auch bei der KST. Nur bei 6% der Patienten fanden sich mit KST im Knochenmark Herdbefunde. Dies bedeutet, daß eine 94%ige Wahrscheinlichkeit auf Metastasenfreiheit gegeben ist, wenn die SkSz normal ausfällt, weshalb sie nach wie vor die Methode der Wahl zum Screening nach ossären Metastasen ist. Trotz hoher Sensitivität und Spezifität kann die KST mit der momentanen Routinetechnik die SkSz derzeit wegen längerer Untersuchungszeiten, höherer Kosten und fehlender Ganzkörperaufnahme noch nicht ersetzen, erscheint aber bei radiologisch negativen fraglichen Befunden der SkSz indiziert.

Summary

To define the value of magnetic resonance imaging (MRI) in screening for bone metastases (BM) compared to bone scintigraphy (BSc) 102 patients with tumours with frequent BM were examined also by MRI of spine, plevis, femora, and proximal tibiae. All patients had normal BSc and 96 (94%) normal MRI. Only 6% of the patients had focal abnormalities within the bone marrow. This indicates that there is a 94% probability of absence of BM if BSc is normal. Therefore, BSc should currently remain the method of choice for screening for BM. Despite MRI is sensitive and specific, with the common technique up to now it should not be used instead of BSc in screening because of costs, duration, and lack of whole body examination. MRI is a valuable adjunct in equivocal findings in BSc with negative results on radiographs.

Schlüsselwörter

Skelettmetastasen - Kernspintomographie - Magnetresonanztomographie - Skelettszintigraphie - Knochenmark - Screening

Key words

Bone metastases - magnetic resonance imaging - bone scintigraphy - bone marrow - screening

^* Herrn Prof. Dr. med. D. Emrich zum 65. Geburtstag

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