Quantifizierung von Glukosemetabolismus und Hypoxie mittels PET bei Kopf-Hals-Tumoren

Zusammenfassung

Der vorliegende Artikel beschäftigt sich mit der Bedeutung der FDG- und der Hypoxie-PET bei Kopf-Hals-Tumoren. Dabei liegt der Fokus auf den verschiedenen Quantifizierungsmöglichkeiten und deren Wertigkeit für die klinische Routine und Forschung. Die FDG-PET erfordert in der klinischen Routine nicht zwingend eine quantitative Analyse. Demgegenüber ist die ausschließlich qualitative Auswertung der Hypoxie-PET durch den im Vergleich zum FDG deutlich niedrigeren Kontrast, den alle Hypoxietracer gemein haben, erschwert.

Dem Nachteil des niedrigeren Kontrastes steht hier die strikt eindimensionale Aufnahme bzw. das Verweilen des Hypoxie-Tracers im hypoxischen Gewebe gegenüber, ein eindeutiger Vorteil im Vergleich zum Hochkontrast-Tracer FDG, dessen Aufnahme in Tumorzellen multifaktoriell ist.

Es gibt eine Vielzahl quantitativer Parameter, die weit über den scheinbar omnipräsenten, aber keinesfalls unumstrittenen maximalen Standardized uptake value (SUV_max) hinausgehen. Deren Erfordernis und ihr Einfluss auf die klinische Routinediagnostik werden dargestellt und kritisch abgewogen.

Abstract

The present article deals with the role of FDG- and hypoxia-PET in head and neck cancer. The focus lays on the multitudinously different methods of quantification and their valence in clinical routine and research. FDG PET does not necessarily require a quantitative analysis. However, hypoxia PET imaging typically suffers from a low contrast compared to FDG which hampers pure qualitative analysis.

Hypoxia tracers advantageously show a strict one-dimensional uptake / retention, while the accumulation in tumor cells of the high-contrast tracer FDG is driven by several factors.

There is a variety of further quantitative parameters beside the apparently omnipresent but debatable maximum standardized uptake value (SUV_max). Their influence on clinical routine diagnostics will be presented and critically considered.

Schlüsselwörter

PET - Quantifizierung - Kopf-Hals-Tumore - FDG - F-MISO - Hypoxie

Keywords

PET - quantification - HNSCC - FDG - F-MISO - hypoxia

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