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.

Schlüsselwörter

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

Key words

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

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