Diagnostik von Knochenmetastasen heute und morgen

Zusammenfassung

Knochenmetastasen sind häufig mit Schmerzen und Bewegungseinschränkungen verbunden. Pathologische Frakturen stellen ein zusätzliches Risiko dar. Moderne interdisziplinäre Therapien bieten heute die Möglichkeit, Symptome zu lindern und ein Fortschreiten der Erkrankung zu verzögern. Die Radiologie und die Nuklearmedizin spielen im Management von Knochenmetastasen eine herausragende Rolle sowohl bei der Detektion als auch bei der Therapieevaluation. Technische Neuerungen ermöglichen heute ein einzeitiges vollständiges Ganzkörperstaging mittels Ganzkörper-MRT und PET-CT. Sogenannte Theranostika erlauben darüber hinaus die Kombination von Diagnostik und Therapie. Insgesamt ist das Management von Knochenmetastasen von der Diagnostik über die Therapie bis hin zur Therapieevaluation eine interdisziplinäre Aufgabe, um eine möglichst individuelle, auf die spezifischen Bedürfnisse des einzelnen Patienten zugeschnittene, therapeutische Strategie zu entwickeln.

Summary

Bone metastases are often associated with pain and movement restrictions. Pathological fractures represent an additional risk. Modern interdisciplinary therapies now offer the ability to relieve symptoms and to delay disease progression. Radiology and nuclearmedicine play an outstanding role in the management of bone metastases both in detection and in treatment evaluation. Technical innovations now enable a single-stage complete whole-body staging by means of whole-body MRI and PET-CT. So-called theranostics also allow the combination of diagnosis and therapy. Overall, the management of bone metastases from diagnosis to treatment to therapy evaluation is an interdisciplinary task to develop more individual, tailored to the specific needs of the individual patient, therapeutic strategies.

Schlüsselwörter

Knochenmetastasen - PET-CT - Ganzkörper-MRT

Keywords

Bone metastases - PET-CT - whole-body MRI

• Literatur

• 1 Padhani AR, Makris A, Gall P. et al. Therapy monitoring of skeletal metastases with whole-body diffusion MRI. JMRI 2014; 39 (05) 1049-1078.
• 2 Hausmann D, Jochum S, Utikal J. et al. Comparison of the diagnostic accuracy of whole-body MRI and whole-body CT in stage III/IV malignant melanoma. JDDG 2011; 09 (03) 212-222.
• 3 Hausmann D, Kern C, Schroder MT. et al. [Wholebody MRI in preoperative diagnostics of breast cancer - a comparison with [corrected] staging methods according to the S 3 guidelines]. RöFo: Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin 2011; 183 (12) 1130-1137.
• 4 Weckbach S, Michaely HJ, Stemmer A. et al. Comparison of a new whole-body continuous-tablemovement protocol versus a standard whole-body MR protocol for the assessment of multiple myeloma. European radiology 2010; 20 (12) 2907-2916.
• 5 Liu T, Cheng T, Xu W. et al. A meta-analysis of 18FDG-PET, MRI and bone scintigraphy for diagnosis of bone metastases in patients with breast cancer. Skeletal radiology 2011; 40 (05) 523-531.
• 6 Yang HL, Liu T, Wang XM. et al. Diagnosis of bone metastases: a meta-analysis comparing 18FDG PET, CT, MRI and bone scintigraphy. European radiology 2011; 21 (12) 2604-2617.
• 7 Taylor JS, Tofts PS, Port R. et al. MR imaging of tumor microcirculation: promise for the new millennium. Journal of magnetic resonance imaging: JMRI 1999; 10 (06) 903-907.
• 8 Tofts PS, Brix G, Buckley DL. et al. Estimating kinetic parameters from dynamic contrast-enhanced T(1)-weighted MRI of a diffusable tracer: standardized quantities and symbols. JMRI 1999; 10 (03) 223-232.
• 9 Therasse P, Arbuck SG, Eisenhauer EA. et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. Journal of the National Cancer Institute 2000; 92 (03) 205-216.
• 10 Koh TS, Bisdas S, Koh DM, Thng CH. Fundamentals of tracer kinetics for dynamic contrast-enhanced MRI. JMRI 2011; 34 (06) 1262-1276.
• 11 Geith T, Biffar A, Schmidt G. et al. Quantitative analysis of acute benign and malignant vertebral body fractures using dynamic contrast-enhanced MRI. AJR 2013; 200 (06) W635-W643.
• 12 Biffar A, Baur-Melnyk A, Schmidt GP. et al. Quantitative analysis of the diffusion-weighted steady-state free precession signal in vertebral bone marrow lesions. Investigative radiology 2011; 46 (10) 601-609.
• 13 Wu LM, Gu HY, Zheng J. et al. Diagnostic value of whole-body magnetic resonance imaging for bone metastases: a systematic review and meta-analysis. JMRI 2011; 34 (01) 128-135.
• 14 Padhani AR, Koh DM, Collins DJ. Whole-body diffusion-weighted MR imaging in cancer: current status and research directions. Radiology 2011; 261 (03) 700-718.
• 15 Blackledge MD, Collins DJ, Tunariu N. et al. Assessment of treatment response by total tumor volume and global apparent diffusion coefficient using diffusion-weighted MRI in patients with metastatic bone disease: a feasibility study. PloS one 2014; 09 (04) e91779.
• 16 Duo J, Han X, Zhang L. et al. Comparison of FDG PET/CT and gadolinium-enhanced MRI for the detection of bone metastases in patients with cancer: a meta-analysis. Clin Nucl Med 2013; 38 (05) 343-348.
• 17 Yang HL, Liu T, Wang XM. et al. Diagnosis of bone metastases: a meta-analysis comparing 18FDG PET, CT, MRI and bone scintigraphy. Eur Radiol 2011; 21 (12) 2604-2617.
• 18 Liu T, Xu JY, Xu W. et al. Fluorine-18 deoxyglucose positron emission tomography, magnetic resonance imaging and bone scintigraphy for the diagnosis of bone metastases in patients with lung cancer: which one is the best? - a meta-analysis. Clin Oncol (R Coll Radiol) 2011; 23 (05) 350-358.
• 19 Qu X, Huang X, Yan W. et al. A meta-analysis of 18FDG-PET-CT, 18FDG-PET, MRI and bone scintigraphy for diagnosis of bone metastases in patients with lung cancer. Eur J Radiol 2012; 81 (05) 1007-1015.
• 20 Ota N, Kato K, Iwano S. et al. Comparison of 18F-fluoride PET/CT, 18F-FDG PET/CT and bone scintigraphy (planar and SPECT) in detection of bone metastases of differentiated thyroid cancer: a pilot study. Br J Radiol 2014; 87 (1034): 20130444.
• 21 Wondergem M, van der Zant FM, van der Ploeg T, Knol RJ. A literature review of 18F-fluoride PET/ CT and 18F-choline or 11C-choline PET/CT for detection of bone metastases in patients with prostate cancer. Nucl Med Commun 2013; 34 (10) 935-945.
• 22 Shen CT, Qiu ZL, Han TT, Luo QY. Performance of 18F-Fluoride PET or PET/CT for the Detection of Bone Metastases: A Meta-analysis. Clin Nucl Med. 2014 Oct 6. [Epub ahead of print].
• 23 Poulsen MH, Petersen H, Hoilund-Carlsen PF. et al. Spine metastases in prostate cancer: comparison of technetium-99m-MDP whole-body bone scintigraphy, [18F]choline positron emission tomography(PET)/computed tomography (CT) and [18F]NaF PET/CT. BJU Int. 2013 Dec 9. doi: 10.1111/bju.12599. [Epub ahead of print].
• 24 Shen G, Deng H, Hu S, Jia Z. Comparison of choline-PET/CT, MRI, SPECT, and bone scintigraphy in the diagnosis of bone metastases in patients with prostate cancer: a meta-analysis. Skeletal Radiol 2014; 43 (11) 1503-1513.
• 25 Afshar-Oromieh A, Zechmann CM, Malcher A. et al. Comparison of PET imaging with a (68)Ga-labelled PSMA ligand and (18)F-choline-based PET/ CT for the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2014; 41 (01) 11-20.
• 26 Lindstrom LS, Karlsson E, Wilking UM. et al. Clinically used breast cancer markers such as estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 are unstable throughout tumor progression. J Clin Oncol 2012; 30 (21) 2601-2608.
• 27 Foukakis T, Astrom G, Lindstrom L. et al. When to order a biopsy to characterise a metastatic relapse in breast cancer. Ann Oncol 2012; 23 (10) x349-x353.
• 28 van Kruchten M, de Vries EG, Brown M. et al. PET imaging of oestrogen receptors in patients with breast cancer. Lancet Oncol 2013; 14 (11) e465-e475.
• 29 Linden HM, Stekhova SA, Link JM. et al. Quantitative fluoroestradiol positron emission tomography imaging predicts response to endocrine treatment in breast cancer. J Clin Oncol 2006; 24 (18) 2793-2799.
• 30 Dehdashti F, Mortimer JE, Trinkaus K. et al. PETbased estradiol challenge as a predictive biomarker of response to endocrine therapy in women with estrogen-receptor-positive breast cancer. Breast Cancer Res Treat 2009; 113 (03) 509-517.