Digitale SPECT und PET: Klinische Konsequenzen

Bei der Betrachtung physikalischer Vorteile von neuartigen Technologien für Gammakameras und PET-Scanner sollte stets auch der konkrete Mehrwert für die Patientinnen und Patienten beachtet und überprüft werden. Dieser CME-Artikel bietet einen Überblick über mögliche klinische Konsequenzen und Vorteile dieser Technologien und insbesondere die bisherige klinische Evidenz.

Abstract

In the thorough examination of physical advantages of new technologies for gamma cameras and PET scanners, the concrete benefit for patients should be taken into account and validated. This CME article provides an overview of potential clinical consequences and advantages of these technologies with special emphasis on the current clinical evidence.

Kernaussagen

• CZT-basierte Gammakameras eignen sich aufgrund der überlegenen Energieauflösung verglichen mit NaI-Kameras bevorzugt für simultane duale Isotopenuntersuchungen.

• Sowohl die CZT-Detektoren für Gammakameras als auch die SiPM-Technologie für die PET-Bildgebung und neuartige BPL-Rekonstruktionsalgorithmen bieten das Potenzial einer reduzierten Aktivität oder Akquisitionszeit aufgrund einer verbesserten Sensitivität. Im Allgemeinen fehlen bislang jedoch etablierte Protokolle, um daraus konkreten klinischen Mehrwert zu gewinnen.

• Das klinische Potenzial der CZT-Technologie kann in spezialisierten Kameradesigns wie den dedizierten Herzkameras und ringförmig konfigurierten SPECT-Kameras besonders ausgeschöpft werden. CZT-Herzkameras erreichen eine mindestens ebenso hohe diagnostische Genauigkeit wie NaI-Doppelkopfkameras für eine koronare Herzerkrankung bei erheblich kürzerer Akquisitionszeit. Ringförmige Kamerasysteme können trotz kürzerer Akquisitionszeit ebenfalls eine bessere Bildqualität und Bildschärfe erreichen.

• Die nachweislich verbesserte Läsionsdetektion in der PET durch die SiPM-Technologie und BPL-Rekonstruktion kann Anpassungen in diagnostischen Schwellwerten erfordern, um vermehrte falsch-positive Befunde zu vermeiden. Studien, die eine diagnostische Überlegenheit gegenüber herkömmlichen Technologien anhand eines diagnostischen Goldstandards belegen, sind bislang rar.

• Die erhebliche Steigerung der Sensitivität durch den Einsatz von Ganzkörper-PET-Scannern könnte grundlegende Fortschritte in der klinischen Anwendung der PET-Diagnostik implizieren, beispielsweise für pädiatrische Patientinnen und Patienten oder dynamische Ganzkörperuntersuchungen.

Schlüsselwörter

CZT - digitale PET - Silizium-Photomultiplier - SiPM - Bildrekonstruktion - Ganzkörper-PET-Scanner

Keywords

CZT - digital PET - silicon photomultipliers - SiPM - image reconstruction - long axial field-of-view PET scanner

Publication History

Article published online:
16 August 2022

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