PET und PET/CT in der Diagnostik des Prostatakarzinoms

Zusammenfassung

Dieser Übersichtsartikel befasst sich mit dem Nutzen der PET und PET/CT in der Diagnostik des Prostatakarzinoms. Die bisher am häufigsten verwendeten PET-Tracer zur Detektion von Prostatakarzinomen sind ¹¹C-Acetat sowie ¹¹C- oder ¹⁸F-markiertes Cholin. Die derzeit verfügbare Fachliteratur, die sich mit der Leistungsfähigkeit der PET und PET/CT in der Primärtumor- und Metastasendiagnostik des Prostatakarzinoms befasst, wird diskutiert. Darüber hinaus werden eigene vorläufige Studienergebnisse im Hinblick auf die Leistungsfähigkeit von ¹¹C-Cholin-PET und -PET/CT in der Diagnostik von Patienten mit Verdacht auf ein Prostatakarzinom präsentiert. Die Prävalenz des Prostatakarzinoms lag bei den 43 in die Studie eingeschlossenen Patienten bei 55,8 %. PET und PET/CT zeigten hierbei in der Detektion des Primärkarzinoms eine Sensitivität von 88 % bei einer Spezifität von 63 %. Die Sensitivität in der Metastasendetektion lag in einer patientenbasierten Auswertung bei 77 %. Hierbei zeigten sich keine falsch-positiven Resultate. Die möglichen Vorteile und Limitationen kombinierter PET/CT-Geräte im Vergleich zu PET-Einzelgeräten werden ebenfalls erörtert. PET und PET/CT sind die derzeit einzigen bildgebenden Verfahren, die sowohl funktionelle Informationen über den Primärtumor als auch dessen Metastasen bereitstellen. Dies unterscheidet die PET von der MRT in Kombination mit der Magnetresonanzspektroskopie, einem konkurrierenden Verfahren. Unsere eigenen vorläufigen Daten, sowie die nach wie vor limitierte verfügbare wissenschaftliche Literatur legen nahe, dass PET und PET/CT sich in der Diagnostik des Prostatakarzinoms als nützlich erweisen könnten.

Abstract

This review article provides an overview of the current literature data regarding the value of PET and PET/CT for imaging of prostate cancer. Most widely used PET tracers for prostate cancer imaging are ¹¹C-acetate and ¹¹C- or ¹⁸F-labeled choline. Available literature data on the performance of PET and PET/CT in the detection of the primary malignancy as well as local or distant metastases are presented and discussed. In addition, our own preliminary results regarding the diagnostic efficacy of ¹¹C-choline PET and PET/CT in 43 patients with suspected prostate cancer are provided. The prevalence of prostate cancer in this patient sample was 55.8 %. PET and PET/CT showed a sensitivity of 88 % with a specificity of 63 % in the detection of the primary prostate cancer. The sensitivity in the detection of metastatic spread was 77 % and no false-positives were found. The possible value and limitations of combined PET/CT systems when compared to stand alone PET scanners are discussed. PET and PET/CT is at present the single imaging modality providing functional information not only regarding the primary malignancy but also its metastases. This unique feature distinguishes PET from MRI complemented with magnetic resonance spectroscopy - a competing procedure. Our own results as well as the still limited literature data suggest, that PET and PET/CT may prove to be useful methods for imaging of prostate cancer.

PET - ¹¹C-Cholin - Prostatakarzinom

PET - ¹¹C-choline - prostate cancer

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