FDOPA-PET als Paradigma molekularer Bildgebung in der Onkologie

Zusammenfassung

In der Diagnostik der Parkinsonerkrankungen hat der PET-Tracer 6-[18F]fluoro-L-3,4-dihydroxyphenylalanin (FDOPA) weite Verbreitung gefunden. Die Aminosäure ist als wichtiger Baustein im Proteinstoffwechsel und als Vorstufe in der Katecholaminsynthese auch zur Untersuchung einer Vielzahl, vor allem neuroendokriner, Tumore geeignet. Die spezifischen Anreicherungsmechanismen des FDOPA lassen diesen Radiotracer als ein Musterbeispiel der „Molekularen Bildgebung” erscheinen. Die vorliegende Arbeit fasst eigene Erfahrungen und die publizierten Ergebnisse onkologischer PET-Untersuchungen mit FDOPA zusammen und bewertet den Stellenwert der Methode bei klinischen Fragestellungen. Hervorragende Ergebnisse werden vor allem im Staging von Phäochromozytomen und Paragangliomen sowie Serotonin-positiven neuroendokrinen Tumoren des gastroenteropankreatischen Systems (NET-GEP) erreicht. In der schwierigen Rezidivdiagnostik medullärer Schilddrüsenkarzinome erweitert FDOPA die Palette der Untersuchungsmöglichkeiten. Auch in der Diagnostik von Hirntumoren bietet sich FDOPA als Alternative zu ¹¹C-markierten Aminosäuren an. Erste Arbeiten zeigten eine hohe Genauigkeit in der Unterscheidung zwischen Tumorrezidiv und Strahlennekrose sowohl bei hoch- als auch bei niedrig-differenzierten Tumoren. Des Weiteren korreliert die FDOPA-Speicherung mit der Expression von Proliferationsmarkern. Therapierelevant ist heute die nichtinvasive Differenzierung einer fokalen von der diffusen Form des kongenitalen Hyperinsulinismus, der kleinere operative Eingriffe erlaubt und vielen betroffenen Kindern eine Prognose ohne Diabetes mellitus ermöglicht.

Abstract

In recent years, positron emission tomography with 6-[18F]fluoro-L-3,4-dihydroxyphenylalanine (FDOPA) has become a wide-spread method in the diagnostics of Parkinson's disease. The amino acid is an important component in protein metabolism. As a precursor in the synthesis of catecholamines it is also of use in metabolic imaging of a variety, mostly neuroendocrine, tumors. The specific uptake mechanisms make FDOPA a paradigm of metabolic imaging. The current review assesses the value of the tracer in the diagnostics of different oncological diseases. It summarizes own experiences and the published results of oncological FDOPA PET-studies. Above all, there is a very high impact of FDOPA in the staging of pheochromocytomas and paragangliomas as well as serotonin-positive neuroendocrine tumors of the gastroentero-pancreatic system (NET-GEPs). Additionally, FDOPA extends the diagnostic possibilities in recurrent medullary thyroid cancer. In the imaging of tumors of the central nervous system, FDOPA represents an alternative to ¹¹C-labelled PET-tracers. First reports show a high accuracy in the differentiation of radiation induced necrosis and recurrent disease in both high and low grade brain tumors. Furthermore, there is a correlation between the uptake of FDOPA and the expression of proliferation markers. Today, the noninvasive differentiation of focal and diffuse congenital hyperinsulinism has therapeutic consequences. In cases of focal disease, the extent of pancreas resection can be limited resulting in better prognosis without diabetes mellitus.

FDOPA - PET - Paragangliome - neuroendokrine Tumore - medulläres Schilddrüsenkarzinom

FDOPA - PET - paraganglioma - neuroendocrine tumors - medullary thyroid cancer

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