PET und PET/CT - Stellenwert bei Kopf-Hals-Tumoren

Zusammenfassung

Die molekulare Bildgebung durch PET basiert auf dem Einsatz spezifischer radiomarkierter Moleküle als Quelle des Bildkontrastes. In der HNO wurden am häufigsten der Glukose- und vereinzelt auch der Aminosäure- und Proteinstoffwechsel zur Tumordiagnostik mit PET verwendet. Substrate des Thymidin salvage pathway und die Proliferations- sowie Gewebshypoxiemarker haben ein hohes Potenzial zur Modulation des Strahlenfeldes bzw. zur Effizienzkontrolle zytoreduktiver Therapieschemata und werden derzeit klinisch geprüft. In dieser Kurzübersicht werden aktuelle klinische Anwendungen und Perspektiven der PET bei Kopf-Hals-Tumoren im klinischen Kontext kurz dargestellt. FDG-PET wurde zum Primärtumornachweis, zur Primärtumorsuche bei CUP-Syndrom, zum N- und M-Staging, zur Therapiekontrolle nach zytoreduktiver Therapie und zur Rezidivdiagnostik eingesetzt. Im Lymphknotenstaging und in der Rezidivdiagnostik lagen die Sensitivität und Spezifität der FDG-PET bei ca. 80-100 %. FDG-PET war in den meisten Studien der konventionellen bildgebenden Diagnostik überlegen. Beim CUP-Syndrom ließ sich ein Primärtumor bei Œ bis œ der Patienten lokalisieren. Die Fusionsbildgebung der PET und der CT in einem Kombinationsgerät hat wegen ihrer vielseitigen PET-basierten Detektionsprinzipien mit anatomisch hochauflösender und präziser CT-basierter morphologischer Bildgebung ein hohes klinisches und wissenschaftliches Potenzial.

Abstract

Molecular imaging with PET is based on the use of specific radioactive molecules as source of image contrast. In ENT-tumors mostly glucose and occasionally amino acid/protein metabolism were assessed with PET for tumor diagnosis. Thymidine salvage pathway and proliferation as well as tissue hypoxia are tested already in clinical studies and bear considerable potential for modulation of radiation ports and therapeutic response of cytoreductive regimens. This short review summarises actual clinical indications and potential of PET in ENT-tumors. For both nodal staging as well as detection of recurrent disease, sensitivity and specifity of FDG-PET were 80-100 %. FDG-PET proved to be superior to conventional imaging in most published studies. In CUP-syndrome the primary could be detected in 25-50 % of patients. Acquisition of PET and CT images in a combined scanner allow versatile PET based metabolic imaging in combination with high resolution and anatomical precise CT-based morphological imaging and thus combines advantages of both imaging modalities. Clinical as well as scientific potential of this functional metabolic and high resolution morphological imaging approach is high.

Schlüsselwörter

PET - PET/CT - Onkologie - HNO-Tumoren

Key words

PET - PET/CT - oncology - ENT-malignomas

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