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
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Korrespondenzadresse
Prof. Dr. R. Bares
Abteilung Nuklearmedizin
Radiologische Klinik
Universitätsklinikum Tübingen
Otfried-Müller-Str. 14
72076 Tübingen
Phone: +49/7071/29 82179
Fax: +49/7071/29 4601
Email: roland.bares@med.uni-tuebingen.de
