SPECT/CT bei neuroendokrinen Tumoren

Zusammenfassung

Die Koregistrierung anatomischer Informationen führt insbesondere bei der funktionellen Bildgebung mit hochspezifischen Radiopharmaka, die bei neuroendokrinen Tumoren zum Einsatz kommen, zu einer deutlichen Verbesserung der diagnostischen Genauigkeit. Nebenschilddrüsenadenome können mit ^99mTc-MIBI nicht nur sensitiv nachgewiesen werden, sondern auch anatomisch exakt lokalisiert werden. Dies wird für minimal-invasive chirurgische Techniken eine zunehmende Rolle spielen. Mit SPECT/CT lassen sich insbesondere extra-adrenale Manifestationen von Phäochromozytomen und Tumoren der Nebennierenrinde mit hoher Sensitivität und Spezifität nachweisen. Durch die Verfügbarkeit des PET-Radiopharmakons ⁶⁸Ga-DOTATOC hat die ¹¹¹In-Octreotidszintigrafie zum Nachweis von Manifestationen neuroendokriner Tumoren zuletzt an Bedeutung verloren. Aufgrund der besseren Verfügbarkeit repräsentieren SPECT und SPECT/CT jedoch weiterhin Standardverfahren in der Diagnostik neuroendokriner Tumoren. Für Verlaufsbeobachtungen und das Monitoring radiopeptidbasierter Therapien, die bei neuroendokrinen Tumoren zunehmend eingesetzt werden, stellt SPECT/CT eine überlegene Diagnostik dar.

Abstract

The accuracy of functional SPECT imaging has been significantly improved by addition of CT. This is especially relevant for functional imaging of neuroendocrine tumors using highly specific radiopharmaceuticals. Parathyroid adenomas can be detected by ^99mTc-MIBI SPECT/CT with very high sensitivity and specificity, playing an important role especially when minimally invasive techniques are used for surgical resection. With SPECT/CT, extra-adrenal manifestations of pheochromocytomas and tumors of the adrenal cortex can be detected with high accuracy. Because of the availability of PET radiopharmaceuticals such as ⁶⁸Ga-DOTATOC, the clinical relevance of ¹¹¹In-Octreotide SPECT for detection of neuroendocrine cancers has been recently reduced. Because of the better availability, SPECT and SPECT/CT still represent standard tools for imaging neuroendocrine cancers. SPECT/CT represents the superior imaging modality for monitoring radiopeptide based therapies, which are now increasingly used for treatment of neuroendocrine cancers.

SPECT/CT - Hybridbildgebung - SPECT-Tracer - neuroendokrine Tumoren

SPECT/CT - hybrid imaging - SPECT tracer - neuroendocrine tumors

Literatur

• 1 Apostolova I, Riethdorf S, Buchert R. et al . SPECT/CT stabilizes the interpretation of somatostatin receptor scintigraphy findings: a retrospective analysis of inter-rater agreement.  Ann Nucl Med. 2010;  24 477-483
• 2 Buchmann I, Henze M, Engelbrecht S. et al . Comparison of 68Ga-DOTATOC PET and 111In-DTPAOC (Octreoscan) SPECT in patients with neuroendocrine tumours.  Eur J Nucl Med Mol Imaging. 2007;  34 1617-1626
• 3 Buck AK, Nekolla S, Ziegler S. et al . Spect/Ct.  J Nucl Med. 2008;  49 1305-1319
• 4 Even-Sapir E, Keidar Z, Sachs J. et al . The new technology of combined transmission and emission tomography in evaluation of endocrine neoplasms.  J Nucl Med. 2001;  42 998-1004
• 5 Fottner C, Helisch A, Anlauf M. et al . 6-18F-fluoro-L-dihydroxyphenylalanine positron emission tomography is superior to 123I-metaiodobenzyl-guanidine scintigraphy in the detection of extraadrenal and hereditary pheochromocytomas and paragangliomas: correlation with vesicular monoamine transporter expression.  J Clin Endocrinol Metab. 2010;  95 2800-2810
• 6 Gabriel M, Hausler F, Bale R. et al . Image fusion analysis of (99m)Tc-HYNIC-Tyr(3)-octreotide SPECT and diagnostic CT using an immobilisation device with external markers in patients with endocrine tumours.  Eur J Nucl Med Mol Imaging. 2005;  32 1440-1451
• 7 Hillel PG, van Beek EJ, Taylor C. et al . The clinical impact of a combined gamma camera/CT imaging system on somatostatin receptor imaging of neuroendocrine tumours.  Clin Radiol. 2006;  61 579-587
• 8 Krausz Y, Bettman L, Guralnik L. et al . Technetium-99m-MIBI SPECT/CT in primary hyperparathyroidism.  World J Surg. 2006;  30 76-83
• 9 Krausz Y, Keidar Z, Kogan I. et al . SPECT/CT hybrid imaging with 111In-pentetreotide in assessment of neuroendocrine tumours.  Clin Endocrinol (Oxf). 2003;  59 565-573
• 10 Lavely WC, Goetze S, Friedman KP. et al . Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy.  J Nucl Med. 2007;  48 1084-1089
• 11 Meyer-Rochow GY, Schembri GP, Benn DE. et al . The utility of metaiodobenzylguanidine single photon emission computed tomography/computed tomography (MIBG SPECT/CT) for the diagnosis of pheochromocytoma.  Ann Surg Oncol. 2010;  17 392-400
• 12 Pool SE, Krenning EP, Koning GA. et al . Preclinical and clinical studies of peptide receptor radionuclide therapy.  Semin Nucl Med. 2010;  40 209-218
• 13 Sandstrom M, Garske U, Granberg D. et al . Individualized dosimetry in patients undergoing therapy with (177)Lu-DOTA-D-Phe (1)-Tyr (3)-octreotate.  Eur J Nucl Med Mol Imaging. 2010;  37 212-225
• 14 Steffen IG, Mehl S, Heuck F. et al . Attenuation correction of somatostatin receptor SPECT by integrated low-dose CT: is there an impact on sensitivity?.  Clin Nucl Med. 2009;  34 869-873
• 15 Wiseman GA, Pacak K, O’Dorisio MS. et al . Usefulness of 123I-MIBG scintigraphy in the evaluation of patients with known or suspected primary or metastatic pheochromocytoma or paraganglioma: results from a prospective multicenter trial.  J Nucl Med. 2009;  50 1448-1454
• 16 Yen RF, Wu VC, Liu KL. et al . 131I-6beta-iodomethyl-19-norcholesterol SPECT/CT for primary aldosteronism patients with inconclusive adrenal venous sampling and CT results.  J Nucl Med. 2009;  50 1631-1637

Korrespondenzadresse