Zusammenfassung
Das Bronchialkarzinom ist der häufigste maligne Tumor in den Industrieländern. Die
adäquate Behandlung und damit die Prognose der Erkrankung sind massgeblich von einer
akkuraten initialen Diagnostik abhängig. Die Positronen-Emissions-Tomographie (PET)
mit [18F]-2-Fluor-2-deoxy-D-glukose (FDG) weist in diesem Kontext insbesondere bei der Beurteilung
mediastinaler Lymphknotenmetastasen und beim Nachweis von Fernmetastasen sehr zuverlässige
Ergebnisse auf und hat gegenüber der Computertomographie (CT) eine signifikant erhöhte
Sensitivität und Spezifität. Eine Limitation kann aber in der exakten anatomischen
Zuordnung von Befunden beispielsweise mediastinal liegen. Durch die intrinsische Kombination
funktioneller und anatomischer Bildgebung am kombinierten PET/CT besteht seit dem
Jahr 2000 die Möglichkeit einer quasi-simultanen Bildaquisition und dementsprechend
einer akkuraten Korrelation der einzelnen Untersuchungsmodalitäten. Erste Untersuchungen
mit FDG-PET/CT bei nicht-kleinzelligen Bronchialkarzinomen zeigen, dass sich die Anzahl
der Patienten mit korrektem Staging signifikant erhöht und die Bildfusion so signifikante
Vorteile gegenüber der Auswertung der einzelnen Modalitäten insbesondere im Hinblick
auf eine Therapieplanung hat. Eine abschließende Beurteilung der klinischen und prognostischen
Relevanz einer kombinierten Bildgebung bedarf jedoch weiterer prospektiver randomisierter
Studien.
Abstract
Lung cancer has been the leading cause of tumor-related deaths in men and women over
the past years. Accurate determination of the tumor size, potential infiltration of
adjacent structures, mediastinal lymph node involvement, as well as detection of distant
metastases are crucial in diagnostic work-up as they provide the basis for therapy
decision and patient prognosis. FDG-PET has been proven to be substantially more sensitive
and specific for determination of mediastinal lymph node and distant metastases than
CT. However, due to only poor spatial resolution of PET images accurate localization
of focally increased tracer uptake sometimes is compromised. To overcome this limitation
recently available dual-modality PET/CT imaging systems which provide accurately fused
functional and morphologic data sets, are promising. First clinical studies showed
that dual-modality FDG-PET/CT imaging significantly increases the number of correctly
staged patients in non-small-cell lung carcinoma with an impact on patient management.
However, the studies did not address the issue of patients survival and further studies
are required to investigate this issue.
Schlüsselwörter
Bronchialkarzinom - Staging - PET - PET/CT - FDG - Bildfusion
Key words
Lung cancer - staging - PET - PET/CT - FDG - dual modality - image fusion
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Dr. med. L. S. Freudenberg M. A.
Dipl. Gesundheitsökonom (BI)
Klinik für Nuklearmedizin
Universitätsklinikum Essen
Hufelandstraße 55
45122 Essen
Phone: +49-2 01-7 23-20 32
Fax: +49-2 01-7 23-59 64
Email: l.f@t-online.de