¹¹C-Methionin-PET in der Neuroonkologie

Zusammenfassung

Die ¹¹C-Methionin-PET kann in der Hirntumordiagnostik einzigartige Informationen liefern. Sie bietet im Vergleich zur ¹⁸F-FDG-PET aufgrund der niedrigen Aminosäureaufnahme im normalen Hirngewebe und in Entzündungszellen einen guten Kontrast für die Diagnostik niedriggradig maligner Tumoren und die Differenzierung gegenüber entzündlichen Veränderungen. Verglichen mit der MRT zeichnet sich die PET mit radioaktiv markierten Aminsäuren durch eine realistische Widerspiegelung des biologisch aktiven Tumoranteils aus. Dieser ist oftmals größer als die durch die Kontrastmittelanreicherung in der MRT gekennzeichnete Region der Blut-Hirn-Schranken-Störung, aber kleiner als das im T2-gewichteten Bild erkennbare Tumorödem. Damit kann die ¹¹C-Methionin-PET einen wesentlichen Beitrag leisten bei der Planung chirurgischer oder strahlentherapeutischer Behandlungen. Bei der Verlaufskontrolle therapeutischer Ergebnisse ist insbesondere auch die quantitative Information hinsichtlich der regionalen Ausdehnung und Intensität der Steigerung der Aminosäureaufnahme hilfreich, um ggf. die Notwendigkeit und das Ausmaß einer Re-Intervention festzulegen. Für die klinische Forschung stellen Untersuchungen mit radioaktiv markierten Aminosäuren aufgrund ihres prognostischen Potenzials ein Tool zur Auswahl biologisch vergleichbarer Tumoren im Rahmen von prospektiven Studien dar. Aus Sicht des Patienten ist insbesondere die ¹¹C-Methionin-PET ein einfaches, nicht-invasives Verfahren, welches zudem auch mit einer vergleichsweise geringen Strahlenexposition einhergeht.

Abstract

¹¹C-Methionine PET provides unique information in the diagnosis of brain tumours. In comparison to ¹⁸F-FDG PET, due to low uptake in normal brain tissue and inflammatory cells, high contrast is obtained for the diagnosis of low-grade tumours and differentiation against inflammatory changes. When compared to MRT, one major advantage of PET with radioactive labelled amino acids is the realistic reflection of the biologically active part of the tumour. This part is often larger than the area of blood brain barrier disturbance as outlined by the enhancement of contrast media in MRT – and smaller than the tumour oedema as shown in the T2 weighted images. Hence, ¹¹C-Methionine PET is able to contribute substantially in planning of surgical or radiation therapy. In the evaluation of treatment results, especially the quantitative information with regard to regional extension and intensity of elevated amino acid uptake can be crucial to establish the necessity and size for re-intervention as the case may be. For clinical research, radio-labelled amino acids can be used – due to their prognostic potential – as a tool to select biologically comparable tumours for a prospective study. From the patients perspective, ¹¹C-Methionine PET is a simple, non-invasive procedure, with a relatively low radiation exposure.

Schlüsselwörter

¹¹C-Methionin - Aminosäuren - PET - Hirntumoren - Strahlennekrose

Key words

¹¹C-Methionine - amino acids - PET - brain tumours - radiation necrosis

Literatur

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