Nuklearmedizinische Verfahren zum Nachweis hypoxischer Gewebe

Zusammenfassung

Hypoxie spielt in der Pathogenese zahlreicher Erkrankungen eine bedeutende Rolle. Während in vielen Fällen die Hypoxie klinisch bzw. durch indirekte Zeichen (z. B. Minderperfusion) diagnostiziert werden kann, ist dies bei malignen Tumoren nicht möglich. Neben der invasiven pO₂-Histografie sind nuklearmedizinische Verfahren unter Verwendung radioaktiv markierter Hypoxiemarker der bislang einzige praktikable Ansatz. Bewährt haben sich vor allem ¹⁸F markierte Derivate des Nitroimidazols, die nach i. v. Injektion in die Zelle diffundieren und dort reduziert werden. Die entstehenden Intermediate binden unter hypoxischen Bedingungen an Makromoleküle in der Zelle und werden auf diese Weise retendiert, während bei Normoxie eine rasche Rückdiffusion erfolgt. In ersten klinischen Anwendungen konnte gezeigt werden, dass die lokale Anreicherung der Hypoxiemarker im Tumor mit einem schlechten Therapieansprechen verknüpft ist und somit konkrete Relevanz für die Therapieplanung bekommen könnte. Vor Aufnahme der Hypoxiebildgebung in die Planungsprotokolle der Radiotherapie sind jedoch größere prospektive Studien zur Überprüfung dieser ersten Ergebnisse erforderlich.

Abstract

Hypoxia plays an important role in the pathogenesis of many diseases. While it can be diagnosed clinically or assumed by indirect signs (reduced perfusion) in many instances, this cannot be achieved in malignant tumors. Besides invasive pO₂-polarography nuclear medicine procedures are the only practical approach to detect tumor hypoxia so far. ¹⁸F labelled derivatives of nitroimidazole were shown to be suitable in both experimental and clinical studies. After iv injection they enter the cells via diffusion, are reduced, and finally bind to intracellular macromolecules, if hypoxia is present. In case of normoxia they rapidly leave the cells by rediffusion. First clinical studies demonstrated that local retention of hypoxia markers in malignant tumors was indicative for poor therapeutic outcome and may therefore gain relevance for treatment planning in the future. Prior to this, however, large prospective trials are needed to substantiate the first clinical results.

Schlüsselwörter

Hypoxie - Nitroimidazol - PET - Tumor - Radiotherapie

Key words

hypoxia - nitroimidazole - PET - tumor - radiotherapy

Literatur

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