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Hämatoonkologische Bildgebung

Stellenwert der Hybridverfahren

Hemato-oncological imaging

Importance of hybrid procedures

  • Leitthema
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Zusammenfassung

Klinisches/methodisches Problem

Bildgebende Verfahren spielen bei hämatoonkologischen Erkrankungen eine wesentliche Rolle für das Staging vor der Therapie und die Beurteilung des Therapieansprechens.

Radiologische Standardverfahren

Ursprünglich waren es v. a. die CT und die Ganzkörper-MRT, welche die für das therapeutische Management relevanten Informationen lieferten.

Methodische Innovationen

Im letzten Jahrzehnt erfolgte bei dieser Gruppe von Tumorerkrankungen jedoch eine Abkehr von den rein morphologischen Verfahren hin zu den Hybridverfahren Positronenemissionstomographie(PET)-CT und PET-MRT, welche auch metabolische und funktionelle Informationen liefern.

Leistungsfähigkeit

Bei Lymphomen steht der PET-Tracer 18F-Fluordesoxyglukose (18F-FDG) mittlerweile im Zentrum der Diagnostik und ist auch fest in der aktuellen Lugano-Klassifikation verankert. Bei multiplen Myelomen ist die Suche nach dem optimalen Tracer, welcher auch Frühformen der Erkrankung erfassen kann, hingegen noch im Gange. Funktionelle MR-Techniken wie die diffusionsgewichtete Bildgebung (DWI), perfusionsgewichtete Sequenzen sowie dynamische kontrastmittelgestützte Sequenzen konnten sowohl bei Lymphomen als auch bei multiplen Myelomen ebenfalls interessante Ergebnisse erzielen.

PET-Bewertung

Eine PET-MR kann diese unterschiedlichen Informationen aufgrund ihres multiparametrischen Ansatzes sinnvoll kombinieren.

Empfehlung für die Praxis

Die PET-MR könnte sich bei hämatoonkologischen Erkrankungen möglicherweise zukünftig als bevorzugtes Hybridverfahren durchsetzen.

Abstract

Clinical/methodical issue

Biomedical imaging procedures play a major role in hemato-oncological diseases with respect to pre-therapeutic staging and assessment of treatment response.

Standard radiological methods

Originally, the therapeutic management was the domain of computed tomography (CT) and whole-body magnetic resonance imaging (MRI).

Methodical innovations

Over the last decade these purely morphological techniques have gradually been replaced by hybrid imaging techniques, such as positron emission tomography-CT (PET/CT) and PET/MRI, which also provide metabolic and functional information.

Performance

For lymphomas, the PET tracer 18F-fluorodeoxyglucose (18 F-FDG) is meanwhile so well-established that its use is a cornerstone of the Lugano classification; however, for multiple myeloma the search for an optimal PET tracer that can also detect early disease stages is still ongoing. Functional MRI techniques, such as diffusion-weighted imaging (DWI), perfusion-weighted imaging and dynamic contrast-enhanced imaging have shown promising results for both lymphomas and multiple myelomas.

Achievements

The PET/MRI technique can combine the different types of information due to its truly multiparametric approach.

Practical recommendations

In the future PET/MRI could possibly become the hybrid imaging technique of choice for hemato-oncological diseases.

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Authors and Affiliations

  1. Abteilung für Allgemeine und Kinderradiologie, Medizinische Universität Wien, Univ.-Klinik für Radiologie und Nuklearmedizin, Waehringer Guertel 18–20, 1090, Wien, Österreich

    M. E. Mayerhoefer

  2. Abteilung für Nuklearmedizin, Medizinische Universität Wien, Univ.-Klinik für Radiologie und Nuklearmedizin, Wien, Österreich

    A. Haug

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Correspondence to M. E. Mayerhoefer.

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Interessenkonflikt

M.E. Mayerhoefer und A. Haug geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Mayerhoefer, M., Haug, A. Hämatoonkologische Bildgebung. Radiologe 56, 597–604 (2016). https://doi.org/10.1007/s00117-016-0126-6

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