Rolle der PET/CT beim multiplen Myelom und anderen Plasmazellerkrankungen

Zusammenfassung

Die ¹⁸F-Fluordesoxyglukose (FDG) Positronen-Emissions-Tomografie/Computertomografie (PET/CT) als Verfahren der molekularen Bildgebung erlaubt die simultane Beurteilung morphologischer Charakteristika des mineralisierten Knochens (z. B. Osteolysen) sowie molekularer Parameter (z. B. Stoffwechselaktivität) und bietet damit umfassende (patho)biologische Informationen. Sie hat in den letzten Jahren einen zunehmend wichtigen Stellenwert in der Bildgebung der Plasmazellerkrankungen gefunden, ist zentrales Instrument sowohl in der Differenzialdiagnostik als auch in der Ausbreitungsdiagnostik der einzelnen Entitäten und erlaubt ein Therapiemonitoring im Verlauf. In der Initialdiagnostik leistet die FDG PET/CT einen wertvollen Beitrag in der Differenzialdiagnostik der Plasmazellerkrankungen, insbesondere beim solitären Plasmozytom. Zudem ermöglicht sie eine sensitive Ausbreitungsdiagnostik beim multiplen Myelom durch die Erfassung eines fokalen und diffusen Knochenmarkbefalls sowie para- und extramedullärer Myelommanifestationen. Die FDG PET/CT ist dabei dem konventionellen Röntgenstatus und der low-dose Computertomografie (LDCT) überlegen und der Ganzkörper-Magnetresonanztomografie (GK-MRT) weitestgehend gleichwertig. Sie liefert zudem prognostische Informationen, insbesondere vor Stammzelltransplantation, und ist aufgrund ihres hohen positiv prädiktiven Wertes bildgebender Referenzstandard zur Beurteilung des Therapieansprechens. Zudem kann sie zusammen mit anderen Methoden eingesetzt werden, um eine minimale Resterkrankung (MRD)-Negativität zu definieren. Neue Radiopharmaka und theranostische Ansätze erweitern das Einsatzfeld für die PET bei Plasmazellerkrankungen.

Abstract

Molecular imaging by ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) allows for simultaneous assessment of morphologic characteristics of mineralized bone (e. g., osteolysis) as well as molecular parameters (e. g., glucose metabolism), thereby providing comprehensive (patho)biological information. In recent years, FDG PET/CT has found its well-defined role in imaging plasma cell disorders and has become an indispensable instrument for differential diagnosis and staging of the respective entities. It also allows for therapy monitoring in the course of the disease. In initial diagnosis, FDG PET/CT decisively contributes to establishing the differential diagnosis of plasma cell disorders, particularly in solitary plasmacytoma. In addition, it provides a sensitive staging method detecting both focal and diffuse bone marrow involvement as well as paramedullary and extramedullary myeloma lesions. FDG PET/CT is superior to both conventional whole-body x-ray (WBXR) and low-dose computed tomography (LDCT), and equals the performance of whole-body magnetic resonance imaging (WB-MRI). FDG PET also provides prognostic information, in particular before hematopoietic stem cell transplantation. PET has become the preferred imaging method for therapy response assessment due to its high positive predictive value. Moreover, PET may be applied in conjunction with other methods to define minimal residual disease (MRD)-negativity. Novel radiopharmaceuticals and theranostic approaches broaden the role for PET in plasma cell disorders.

Schlüsselwörter

Myelom - Plasmozytom - Monoklonale Gammopathie unklarer Signifikanz - Bildgebung - PET - PET/CT

Keywords

Myeloma - Plasmocytoma - Monoclonal Gammopathy of Undetermined Significance - Imaging - PET - PET/CT

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