PET bei Gliomen

Zusammenfassung

Gliome, die 30% der intrakraniellen Tumoren darstellen, sind morphologische Veränderungen, sodass an erster Stelle der Diagnostik CT und MRT stehen, wobei MRT aufgrund der besseren Weichteilauflösung und zusätzlicher funktioneller Modalitäten (PWI, DWI, MRS) der Vorzug gegeben werden sollte. Mit diesen vor allem die Morphologie darstellenden bildgebenden Verfahren sind aber Aussagen über Malignitätsgrad, Infiltration und Effekte auf umgebendes Gewebe, Differenzierung zwischen Rezidiv und Nekrose, Prognose und Therapieeffekte nur eingeschränkt möglich.

Solche Aussagen können aus PET-Untersu- chungen des Glukosestoffwechsels mit FDG, der Aminosäurenaufnahme und der Proteinsynthese mit ¹¹C-Methionin, ¹⁸F-Fluorethylty- rosin und ¹⁸F-Fluordeoxyphenylalanin und der Proliferationsrate mit ¹⁸F-Deoxythymidin getroffen werden. Durch die zunehmende Verfügbarkeit von ¹⁸Fluor-Tracern gewinnt der Einsatz der PET bei Gliomen an klinischer Bedeutung. In allen Anwendungen sollte eine Koregistrierung zu Ergebnissen aus morphologischen bildgebenden Verfahren erfolgen, wofür nun auch schon Hybridgeräte (PET- MR) zum Einsatz kommen.

Summary

Gliomas which represent 30% of intracranial tumours are morphologic lesions and therefore CT and MRI are the first line diagnostic procedures with MRI giving better soft tissue resolution and permitting additional functional information. These mainly morphologic imaging modalities yield only restricted information on grade of malignancy, on infiltration into and effects on surrounding brain tissue, on differentiation between necrotic and recurrent tumour, on prognosis and on efficacy of treatment.

Information on these important issues for patient management can be obtained by PET- studies of glucose metabolism with FDG, of aminoacid-uptake and protein synthesis with ¹¹C-methionin, ¹⁸F-fluorethyltyrosin and ¹⁸F-fluor-deoxyphenylalanin and of proliferation by ¹⁸F-deoxythymidin. With the increasing availability of ¹⁸F-tracers PET has obtained wider spread clinical application. In all these applications a coregistration with morphologic imaging should be obtained, and for that purpose hybrid installations (PET- MR) are already being used.

Schlüsselwörter

Gliome - PET - Glukosestoffwechsel - Aminosäureaufnahme - Proliferation - Graduierung - Prognose - Rezidivtumor - Therapiekontrolle

Keywords

Glioma - PET - glucose metabolism - aminoacid uptake - proliferation - grade of malignancy - prognosis - recurrent tumour - efficacy of treatment

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