PET/CT - Stellenwert beim Schilddrüsenkarzinom

Zusammenfassung

Für die drei histologischen Hauptentitäten des Schilddrüsenkarzinoms: anaplastisches, medulläres (MTC) und von den Follikelzellen (FTC) ausgehendes Karzinom, hat sich die FDG-PET einen festen Platz in der Diagnostik erworben. Bei jeder dieser Tumorarten bietet sie eine hohe Treffsicherheit, die durch die Kombination mit der CT-Untersuchung noch gesteigert wird. Darüber hinaus ermöglicht die intrinsisch hochwertige Koregistrierung von PET und CT beim PET/CT die zuverlässige Zuordnung eines PET-Befundes zur Morphologie im - oft unauffälligen - CT-Bild. Neben der FDG-PET haben sich in der Diagnostik des Schilddrüsenkarzinom hochspezifische Tracer (¹³¹I, ¹²³I, ¹¹¹In-Pentetreotid) etabliert, die - allerdings nicht routinemäßig - auch als Positronenemitter verfügbar sind: ¹²⁴I für das FTC und ⁶⁸Ga-DOTATOC mit der Hauptanwendung beim MTC und dem onkozytären Schilddrüsenkarzinom. Für derartige hochspezifische Tracer ist die Koregistrierung mit dem CT von besonderer Wichtigkeit, da die PET-Bilder erheblich weniger anatomische Orientierungspunkte bieten als das FDG-Bild. Darüber hinaus ist die präzise Koregistrierung auch für die Volumetrie der Läsionen, die für die Dosimetrie vor Radioiod- oder Somatotstatin-vermittelter Radionuklid-Therapie essenziell ist, wertvoll.

Abstract

FDG-PET is well established in the diagnostics of the three histologic main groups of thyroid cancer: anaplastic, medullary (MTC) and follicular cell derived (FTC) cancer. For each of the histologic groups a high accuracy is established for FDG-PET which can be increased by combining with a CT investigation. Moreover the intrinsically precise coregistration of PET and CT when using PET/CT enables the reliable coregistration of PET findings to morphology in the - often normal - CT image. Besides FDG-PET highly specific tracers (¹³¹I, ¹²³I, ¹¹¹In-Pentetreotide) are established in the diagnostics of thyroid cancer. Such tracers are also available with positron emitters, however not yet on a routine basis: ¹²⁴I for FTC and ⁶⁸Ga-DOTATOC mainly for MTC and oncocytic thyroid cancer. For such highly specific tracers coregistration and especially the hardware based coregistration is of special importance, as the images display considerably less anatomic information compared to e. g. the FDG image. Moreover, the precise coregistration is valuable when performing volumetry of lesions, what is essential for dosimetry of radioiodine or somatostatin-related radionuclide therapy.

Schilddrüsenkarzinom - PET - PET/CT - FDG - ¹²⁴I - ⁶⁸Ga-DOTATOC

Thyroid cancer - PET - PET/CT - FDG - ¹²⁴I - ⁶⁸Ga-DOTATOC

Literatur

• 1 Amodeo C, Caglia P, Gandolfo L, Veroux M, Donati M, Imme A. Undifferentiated carcinoma of the thyroid.  Tumori. 2003;  89 (Suppl) 205-206
• 2 Antoch G, Vogt F M, Bockisch A, Ruehm S G. Whole-body tumor staging: MRI or FDG-PET/CT?.  Radiologe. 2004;  44 882-888
• 3 Beyer T, Townsend D W, Brun T. et al . A combined PET/CT scanner for clinical oncology.  J Nucl Med. 2000;  41 1369-1379
• 4 Bockisch A, Brandt-Mainz K, Gorges R, Muller S, Stattaus J, Antoch G. Diagnosis in medullary thyroid cancer with [18F]FDG-PET and improvement using a combined PET/CT scanner.  Acta Med Austriaca. 2003;  30 22-25
• 5 Bockisch A, Beyer T, Antoch G, Freudenberg L S, Kuehl H, Debatin J F, Müller S P. PET/CT-imaging protocols, artifacts, and pitfalls.  Mol Imaging Biol. 2004;  [in press]
• 6 Bodei L, Handkiewicz-Junak D, Grana C, Mazzetta C, Rocca P, Bartolomei M, Lopera Sierra M, Cremonesi M, Chinol M, Macke H R, Paganelli G. Receptor radionuclide therapy with 90Y-DOTATOC in patients with medullary thyroid carcinomas.  Cancer Biother Radiopharm. 2004;  19 65-71
• 7 Brandt-Mainz K, Müller S P, Görges R, Saller B, Bockisch A. The value of fluorine-18 fluorodeoxyglucose PET in patients with medullary thyroid cancer.  Eur J Nucl Med. 2000;  27 490-496
• 8 Chin B B, Patel P. et al . Recombinant Human Thyrotropin Stimulation of Fluoro-D-Glucose Positron Emission Tomography Uptake in Well-Differentiated Thyroid Carcinoma.  J Clin Endocrinol Metab. 2004;  89 91-95
• 9 Clarke J C. PET/CT “Cometh the hour, cometh the machine?”.  Clin Radiol. 2004;  59 775-776
• 10 Crippa F, Alessi A. et al . FDG-PET in thyroid cancer.  Tumori. 2003;  89 540-543
• 11 Diehl M, Risse J H. et al . Fluorine-18 fluorodeoxyglucose positron emission tomography in medullary thyroid cancer: results of a multicentre study.  Eur J Nucl Med. 2001;  28 1671-1676
• 12 Dietlein M, Dressler J. et al . Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 2).  Nuklearmedizin. 2004;  43 115-120
• 13 Dietlein M, Scheidhauer K. et al . Flourine-18 flouro deoxyglukose positron tomography and iodine-131 whole- body scintigraphy in the follow-up of differentiated thyroid cancer.  Eur J Nucl Med. 1997;  24 1342
• 14 Engelbach M, Görges R, Forst T, Pfützner A, Dawood R, Heerdt S, Kunt T, Bockisch A, Beyer J. Improved diagnostic methods in the follow-up of medularry thyroid carcinoma by highly specific calcitonin measurements.  J Clin Endocrinol Metab. 2000;  85 1890-1894
• 15 Erdi Y E, Macapinlac H, Larson S M, Erdi A K, Yeung H, Furhang E E, Humm J L. Radiation Dose Assessment for I-131 Therapy of Thyroid Cancer Using I-124 PET Imaging.  Clin Positron Imaging. 1999;  2 41-46
• 16 Eschmann S M, Reischl G. et al . Evaluation of dosimetry of radioiodine therapy in benign and malignant thyroid disorders by means of iodine-124 and PET.  Eur J Nucl Med Mol Imaging. 2002;  29 760-767
• 17 Feine U, Lietzenmayer R, Hanke J P, Wohrle H, Muller-Schauenburg W. 18FDG whole-body PET in differentiated thyroid carcinoma. Flipflop in uptake patterns of 18FDG and 131I.  Nuklearmedizin. 1995;  34 127-134
• 18 Frasoldati A, Pesenti M, Gallo M, Caroggio A, Salvo D, Valcavi R. Diagnosis of neck recurrences in patients with differentiated thyroid carcinoma.  Cancer. 2003;  97 90-96
• 19 Freudenberg L S, Antoch G, Jentzen W, Pink R, Knust J, Gorges R, Muller S P, Bockisch A, Debatin J F, Brandau W. Value of (124)I-PET/CT in staging of patients with differentiated thyroid cancer.  Eur Radiol. 2004;  30 2092-2098
• 20 Freudenberg L S, Antoch G. et al . Combined PET/CT with iodine-124 in diagnosis of spread metastatic thyroid carcinoma: a case report.  Eur Radiol. 2003;  13 (Suppl 4) 19-23
• 21 Freudenberg L S, Antoch G. et al . 124I-PET/CT in metastatic follicular thyroid carcinoma.  Eur J Nucl Med. 2002;  29 1106
• 22 Freudenberg L S, Antoch G. et al . Combined PET/CT with Iodine-124 in diagnosis of mediastinal micrometastases in thyroid carcinoma.  Internet J Radiol. 2002;  2 2
• 23 Frilling A, Tecklenborg K, Görges R, Weber F, Clausen M, Broelsch E C. Preoperative diagnostic value of [18F]Fluorodeoxyglucose Positron Emission Tomography in patients with radiodine-negative recurrent well-differentiated thyroid carcinoma.  Ann Surg. 2001;  234 804-811
• 24 Furhang E E, Larson S M. et al . Thyroid Cancer Dosimetry Using Clearance Fitting.  J Nucl Med. 1999;  40 131-136
• 25 Görges R, Antoch G. et al . Combination PET/CT with 124I positron rays in metastatic follicular thyroid carcinoma.  Nuklearmedizin. 2002;  41 N 68-N 71
• 26 Görges R, Brandt-Mainz K, Freudenberg L, Frilling A, Grimm W, Bockisch A. Kontinuierliche Sensitivitatssteigerung in der Schilddrüsenkarzinom-Nachsorge im Verlauf dreier Thyreoglobulin-IMA-Generationen.  Nuklearmedizin. 2003;  42 157-166
• 27 Görges R, Liedke M O, Worm K, Frilling A, Bockisch A, Schmid K W. Rapid diagnosis of recurrence of a tall cell variant of papillary thyroid cancer by endogenous TSH stimulation.  Nuklearmedizin. 2003;  42 N15-N18
• 28 Görges R, Eising E G, Fotescu D, Renzing-Kohler K, Frilling A, Schmid K W, Bockisch A, Dirsch O. Diagnostic value of high-resolution B-mode and power-mode sonography in the follow-up of thyroid cancer.  Eur J Ultrasound. 2003;  16 191-206
• 29 Görges R, Kahaly G, Muller-Brand J, Macke H, Roser H W, Bockisch A. Radionuclide-labeled somatostatin analogues for diagnostic and therapeutic purposes in nonmedullary thyroid cancer.  Thyroid. 2001;  11 647-659
• 30 Görges R. The changing epidemiology of thyroid cancer. In: Biersack HJ, Grünwald F (eds). Thyroid Cancer. Springer Verlag, Berlin, New York, Heidelberg 2001; 3-25
• 31 Grauer A, Raue F, Ziegler R. Clinical usefulness of a new chemiluminescent two-site immunoassay for human calcitonin.  Exp Clin Endocrinol Diabetes. 1998;  106 353-359
• 32 Grünwald F, Kälicke T. et al . Fluorine-18 fluorodeoxyglucose positron emission tomography in thyroid cancer: results of a multicentre study.  Eur J Nucl Med. 1999;  26 1547-1552
• 33 Hofmann M, Maecke H. et al . Biokinetics and imaging with the somatostatin receptor PET radioligand 68Ga-DOTATOC: preliminary data.  Eur J Nucl Med. 2001;  28 1751-1757
• 34 Jadvar H, Fischman A J. Evaluation of Rare Tumors with [F-18]Fluorodeoxy glucose Positron Emission Tomography.  Clin Positron Imaging. 1999;  2 153-158
• 35 Kostakoglu L, Hardoff R. et al . PET-CT Fusion Imaging in Differentiating Physiologic from Pathologic FDG Uptake.  Radiographics. 2004;  24 1411-1431
• 36 Loffler M, Weckesser M. et al . Iodine excretion during stimulation with rh-TSH in differentiated thyroid carcinoma.  Nuklearmedizin. 2003;  42 240-243
• 37 Mazzaferi E L. Radioiodine and other treatments and outcomes. In: Braverman LE, Utiger RD (eds). Werner and Ingbar's The thyroid: a fundamental and clinical text. 7th ed. J. B. Lippincott-Raven, Philadelphia 1996; 922-943
• 38 Moog F, Linke R. et al . Influence of thyroid-stimulating hormone levels on uptake of FDG in recurrent and metastatic differentiated thyroid carcinoma.  J Nucl Med. 2000;  41 1989-1995
• 39 Petrich T, Borner A R, Otto D, Hofmann M, Knapp W H. Influence of rhTSH on [(18)F]fluorodeoxyglucose uptake by differentiated thyroid carcinoma.  Eur J Nucl Med Mol Imaging.. 2002;  29 641-647
• 40 Reske S N, Kotzerke J. FDG-PET for clinical use. Results of the 3rd German Interdisciplinary Consensus Conference, “Onko-PET III”, 21 July and 19 September 2000.  Eur J Nucl Med. 2001;  28 1707-1723
• 41 Townsend D W, Cherry S R. Combined anatomy and function: the path of true image fusion.  Eur Radiol. 2001;  11 1968-1974
• 42 Truong M T, Erasmus J J, Munden R F, Marom E M, Sabloff B S, Gladish G W, Podoloff D A, Macapinlac H A. Focal FDG Uptake in Mediastinal Brown Fat Mimicking Malignancy: A Potential Pitfall Resolved on PET/CT.  AJR Am J Roentgenol. 2004;  183 1127-1132
• 43 Valentin J. Radiation dose to patients from radiopharmaceuticals (Addendum 2 t oICRP Publication 53).  Ann ICRP. 1998;  28 3
• 44 Wieler H, Bartenstein P. et al . Guideline for therapy of malignant thyroid tumours: pleading for an actualization.  Nuklearmedizin. 2004;  43 121-123
• 45 Wiseman S M, Loree T R, Rigual N R, Hicks W L, Douglas W G, Anderson G R, Stoler D L. Anaplastic transformation of thyroid cancer: review of clinical, pathologic, and molecular evidence provides new insights into disease biology and future therapy.  Head Neck. 2003;  25 662-670