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Z Gastroenterol 2008; 46(4): 367-375
DOI: 10.1055/s-2007-963637
Übersicht

© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

[18F]-FDG-PET in der Diagnostik gastrointestinaler Tumoren

[18F]-FDG-PET in the Diagnostics of Gastrointestinal TumorsI. Buchmann1 , T. M. Ganten2 , U. Haberkorn1
  • 1Abteilung für Nuklearmedizin, Universitätskliniken Heidelberg
  • 2Innere Medizin IV, Gastroenterologie, Universitätsklinik Heidelberg
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Publication History

Manuskript eingetroffen: 4.9.2007

Manuskript akzeptiert: 4.10.2007

Publication Date:
07 April 2008 (online)

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Zusammenfassung

Die Positronenemissionstomografie (PET) mit dem Tracer 2-[18F]-Fluoro-2-desoxy-d-Glukose (FDG) ist ein Verfahren der funktionellen Bildgebung. In der Diagnostik gastrointestinaler Tumoren wird sie bei speziellen Fragestellungen zunehmend eingesetzt. Eine der wichtigsten Domänen der FDG-PET ist hierbei, dass sie beim Ösophagus- und Magenkarzinom frühzeitig den Erfolg einer neoadjuvanten Therapie beurteilen kann: Sie weist sowohl das Therapienansprechen als auch das -versagen frühzeitig nach und ermöglicht, Patientengruppen zu definieren, die von einem Therapiewechsel profitieren. In der Primärdiagnostik des Ösophagus- und Magenkarzinoms ist die FDG-PET bei fortgeschrittenen, lokal jedoch noch resezierbaren Tumoren hilfreich. In kleinen Studien selektierte sie jene Patienten, die einem Stadium IV angehörten und von einer primären Operation wahrscheinlich nicht profitieren. Beim kolorektalen Karzinom ist eine der Hauptindikationen der FDG-PET ebenfalls die Beurteilung des Therapieansprechens. Darüber hinaus ist die FDG-PET insbesondere in der Rezidivdiagnostik hilfreich, um einerseits zwischen Narbe und Tumorrezidiv, insbesondere beim Rektumkarzinom, zu differenzieren und andererseits bei ansteigendem Tumormarker das Rezidiv zu lokalisieren. In der Primärdiagnostik des Kolonkarzinoms werden hepatische und pulmonale Metastasen mit der FDG-PET nachgewiesen. Lymphknotenfiliae hingegen werden zwar mit hoher Spezifität, jedoch nur geringer Sensitivität erkannt. Beim Pankreaskarzinom kann die FDG-PET zur Dignitätsbeurteilung unklarer Raumforderungen des Pankreas und in der Rezidivdiagnostik eingesetzt werden. Bei gastrointestinalen Stromatumoren gewinnt die FDG-PET in der Beurteilung des Therapienansprechens und im initialen Staging neben der CT an Bedeutung. Primäre Leber- und Gallenblasenkarzinome werden mit der FDG-PET nur unzureichend abgebildet.

Abstract

Positron emission Tomography (PET) with 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) is a functional imaging technique with increasing value in special diagnostic fields of gastrointestinal tumours. In the initial staging of esophageal and gastric cancer, FDG-PET is useful in the staging of patients with advanced but local resectable disease. The detection of distant metastases results in an up-staging, and these patients should not be treated by surgery. Furthermore, FDG-PET is sufficient for monitoring early therapy responses after neoadjuvant treatment and enables one to select non-responders who may benefit from therapy alterations. Major indications for FDG-PET in patients with rectal carcinoma are therapy monitoring and diagnosis of relapses, especially the differentiation between tumour and scar and also the localisation of tumour manifestations in cases with increasing tumour markers. FDG-PET is very efficient in the imaging of pulmonal and hepatic metastases of colorectal cancer but not in lymph node staging. In diagnostic procedures for pancreatic carcinoma, FDG-PET can be recommended to explore the dignity of pancreatic lesions and in the imaging of tumour relapses. For gastrointestinal stroma tumours, FDG-PET is useful for the monitoring of therapy and the initial staging. For imaging of hepatocellular carcinoma and carcinoma of the gall bladder, FDG-PET is not sufficient.

Schlüsselwörter

FDG-Positronen-Emissionstomografie - gastrointestinaler Tumor - funktionelle Bildgebung - kolorektales Karzinom - Pankreaskarzinom - Ösophaguskarzinom

Key words

FDG positron emission tomography - gastrointestinal cancer - functional imaging - colon carcinoma - pancreatic carcinoma - esophageal carcinoma

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Dr. Inga Buchmann

Abteilung für Nuklearmedizin, Universitätskliniken Heidelberg

Im Neuenheimer Feld 400

69120 Heidelberg

Phone: ++ 49/62 21/5 63 94 61

Email: inga.buchmann@med.uni-heidelberg.de