Molekulare Bildgebung in der Onkologie

Zusammenfassung

„Molekulare Bildgebung” wird im Allgemeinen definiert als nicht-invasive Darstellung von Makromolekülen oder biologischen Prozessen in lebenden Organismen. Ein wesentliches Kennzeichen der Molekularen Bildgebung ist ihr nicht-invasiver Charakter, wodurch wiederholte Untersuchungen an einem Patienten möglich sind, sodass biologische Prozesse im zeitlichen Verlauf darstellbar werden. Im Bereich der Onkologie ist die molekulare Bildgebung deshalb insbesondere für die Erfolgskontrolle bei der Behandlung maligner Tumoren geeignet. In experimentellen Studien können verschiedene Techniken für die molekulare Bildgebung eingesetzt werden. Dazu gehören optische Verfahren wie die Fluoreszenz- und Biolumineszenz-Bildgebung, die Magnetresonanztomografie (MRT) sowie nuklearmedizinische Untersuchungen. Klinisch stehen nuklearmedizinische Verfahren jedoch ganz im Vordergrund, da bislang nur mit radioaktiv markierten Tracern eine ausreichende Sensitivität erzielt werden kann, um die Expression und Funktion von biologisch relevanten Makromolekülen nicht-invasiv darzustellen. Mit Hilfe nuklearmedizinischer Verfahren läst sich am Patienten die Expression verschiedener Rezeptoren (Östrogen-, Androgen-, Somatostatinrezeptoren sowie Integrine) nachweisen. Außerdem stehen Tracer zur Untersuchung der Tumorhypoxie und Proliferation zur Verfügung. Der Schwerpunkt der molekularen Bildgebung in der Onkologie liegt jedoch im Bereich des Tumorstoffwechsels. Der gesteigerte Glukosestoffwechsel maligner Tumoren kann mit Hilfe der Positronen-Emissions-Tomografie mit dem Glukoseanalogon [¹⁸F]Fluordeoxyglukose (FDG-PET) dargestellt und quantitativ erfasst werden. Zahlreiche Studien haben dabei gezeigt, dass die Abnahme des Tumorglukosestoffwechsels unter Therapie eine frühe Vorhersage des Tumoransprechen und des Patientenüberlebens ermöglicht. In klinischen Studien wird derzeit überprüft, ob so mit Hilfe der FDG-PET die Therapie von malignen Tumoren individualisiert werden kann.

Abstract

Molecular imaging is generally defined as noninvasive and quantitative imaging of targeted macromolecules and biological processes in living organisms. A characteristic of molecular imaging is the ability to perform repeated studies and assess changes in biological processes over time. Thus molecular imaging lends itself well for monitoring the effectiveness of tumor therapy. In animal models a variety of techniques can be used for molecular imaging. These include optical imaging (bioluminescence and fluorescence imaging), magnetic resonance imaging (MRI) and nuclear medicine techniques. In the clinical setting, however, nuclear medicine techniques predominate, because so far only radioactive tracers provide the necessary sensitivity to study expression and function of macromolecules non-invasively in patients. Nuclear medicine techniques allows to study a variety of biological processes in patients. These include the expression of various receptors (estrogen, androgen, somatostatin receptors and integrins). In addition, tracers are available to study tumor cell proliferation and hypoxia. The by far most commonly used molecular imaging technique in oncology is, however, positron emission tomography (PET) with the glucose analog [¹⁸F]fluorodeoxyglucose (FDG-PET). FDG-PET permits non-invasive quantitative assessment of the accelerated exogenous glucose use of malignant tumors. Numerous studies have now shown that reduction of tumor FDG-uptake during therapy allows early prediction of tumor response and patient survival. Clinical studies are currently underway to determine whether FDG-PET can be used to individualize tumor therapy by signaling early in the course of therapy the need for therapeutic adjustments in patients with likely non-responding tumors.

molekulare Bildgebung - Therapiekontrolle - Positronen-Emissions-Tomografie

Molecular imaging - treatment monitoring - positron emission tomography

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