PET und PET/CT mit ¹⁸F-Fluorid in der Diagnostik von Knochenmetastasen

Zusammenfassung

Die Bestimmung des exakten Tumorstadiums im Rahmen der TNM-Klassifikation ist wichtig, um das optimale therapeutische Vorgehen für den Patienten festlegen zu können. Beim M-Staging ist es unabdingbar Knochenmetastasen nachzuweisen bzw. auszuschließen. Bei Tumoren wie dem Bronchialkarzinom, dem Prostata- und Mammakarzinom, bei denen häufig ossäre Metastasen zu beobachten sind, kommt der Knochenszintigrafie zum Metastasen-Screening eine entscheidende Rolle zu. Von dem Ergebnis der Knochenszintigrafie hängt z. B. ab, ob eine kurative Therapie möglich ist, ob eine operative oder chemotherapeutische Behandlung erfolgen muss. Die PET und PET/CT mit ¹⁸F-Natrium-Fluorid sind neue Untersuchungsmethoden zum Nachweis bzw. Ausschluss von ossären Metastasen. Die ¹⁸F-Fluorid-PET ermöglicht Schnittbilder mit hoher räumlicher Auflösung, die mit der Knochenszintigrafie nicht erreichbar ist. Die pharmakokinetischen Eigenschaften von ¹⁸F-Natrium-Fluorid sind günstig und führen zu einem hohen Tracer-Uptake im Knochen und einer schnellen Ausscheidung, was Aufnahmen hoher Qualität bereits eine Stunde p. i. ermöglicht. Im Vergleich zur planaren Ganzkörperszintigrafie kann die ¹⁸F-Fluorid-PET deutlich mehr Knochenmetastasen (vor allem in der Wirbelsäule) nachweisen. Im Vergleich zum Knochen-SPECT lassen sich deutlich weniger zusätzliche Metastasen nachweisen. Dies konnte insbesondere für das Bronchial- und Prostatakarzinom gezeigt werden. Bei einem kleinen Anteil der Patienten wird die ¹⁸F-Fluorid-PET trotz negativer Knochenszintigrafie einschl. SPECT Knochenmetastasen nachweisen können. Hingegen, lässt sich die Spezifität der SPECT durch die ¹⁸F-Fluorid-PET nicht merklich verbessern. Hier zeigt sich, dass neue Kamera-Systeme wie PET/CT und SPECT/CT aufgrund der CT-Komponente und der exakten anatomischen Lokalisierung der Mehranreicherung die Spezifität deutlich verbessern.

Abstract

The exact tumor stage needs to be determined with the help of the TNM classification before the optimal therapeutic procedure for the patient is proposed. If M-staging is under question bone metastases must be excluded or be proven. Bone scintigraphy plays a major role for bone metastases screening of patients with lung cancer, prostate and breast cancer in whom osseous disease is often present. The result of bone scintigraphy has a significant impact on further therapy e. g. whether curative treatment is possible, whether operative resection or chemotherapy must be performed. PET and PET/CT with ¹⁸F sodium fluoride are new imaging modalities for the detection of bone metastases. PET with ¹⁸F fluoride allows for cross sectional imaging with high resolution in a way that is not achievable by conventional bone scintigraphy. Pharmacokinetic properties of ¹⁸F fluoride are advantageous and lead to high tracer uptake and quick renal clearance. This allows the acquisition of high quality images as early as one hour after the injection. Compared with planar whole body scintigraphy, ¹⁸F fluoride is able to detect significantly more bone metastases (especially in the vertebral column). In comparison to bone SPECT, less additional metastatic lesions are detected by bone PET. This could be demonstrated in detail for lung and prostate cancers. In a small group of patients, ¹⁸F fluoride will diagnose osseous metastatic disease in spite of a negative planar whole body scintigraphy and a negative bone SPECT. However, specificity of bone SPECT is not markedly improved by ¹⁸F fluoride PET. It seems that new camera systems like PET/CT and SPECT/CT can enhance specificity impressively by adding the CT component to exactly localize a tracer accumulation.

Schlüsselwörter

PET - PET/CT - ¹⁸F Fluorid - Knochenmetastasen - Knochenszintigrafie

Key words

PET - PET/CT - ¹⁸F fluoride - bone metastases - bone scan - bone scintigraphy

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