Der Beitrag der ¹⁸FDG-PET in der Entzündungsdiagnostik

Zusammenfassung

Die ¹⁸FDG-PET/CT kann bei der Diagnostik entzündlicher Erkrankungen eine entscheidende Rolle spielen. Die PET/CT kombiniert die Möglichkeit der Ganzkörperaufnahme mit einer guten anatomischen Zuordnung von Befunden durch die simultan durchgeführte low dose CT. Sie ist daher eine exzellente Technik nicht nur für die Suche nach Entzündungsherden, sondern auch für die differenzialdiagnostische Unterscheidung von entzündlichen /Autoimmun-Erkrankungen und Tumorerkrankungen. Die hohe Sensitivität geht jedoch mit einer eher geringen Spezifität der FDG-Aufnahme einher. Daher ist die Erkennung bestimmter Muster und die korrekte Interpretation der Verteilung von Läsionen zusammen mit dem klinischen Kontext entscheidend für den Beitrag der FDG-PET/CT im Hinblick auf das klinische Management von Patienten. In dieser Arbeit wird eine Übersicht über die möglichen Ursachen und pathophysiologischen Mechanismen entzündlicher Erkrankungen (wie z. B. Sarkoidose, entzündliche Lungenerkrankungen, Osteomyelitis, Fieber unklarer Genese, Infektionen von Gefäßprothesen, Streuherde bei Infektionserkrankungen, etc.), sowie die damit verbundenen typischen Muster der FDG-Anreicherung gegeben. Weiterhin werden Differenzialdiagnosen diskutiert und Hinweise zur optimalen Bildinterpretation gegeben.

Abstract

¹⁸FDG-PET/CT can play an important role in diagnosis and guiding treatment of inflammatory diseases. PET/CT combines sensitive whole body imaging with anatomical information obtained by simultaneous low dose CT imaging. Like this, PET represents an excellent imaging technology not only for the assessment of disseminated infection foci, but also for differentiation between inflammatory/autoimmune disease and tumors. However, the high sensitivity comes with the disadvantage of a low specificity of FDG uptake in tissues. Therefore, recognition of uptake patterns that are associated with specific inflammatory diseases is of crucial importance for correct interpretation of PET images aiming at improving patient management. We aim to give an overview of the potential causes and pathophysiological mechanisms of infectious diseases (such as sarcoidosis, inflammatory lung disease, osteomyelitis, fever of unknown origin, vascular graft infection, metastatic infectious foci etc.). In addition, we discuss different typical patterns of FDG uptake, including differential diagnosis and optimized image interpretation.

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