Anwendung der Aminosäure-PET in der Diagnostik und Therapie von zerebralen Gliomen

 

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Zusammenfassung

Die Anwendung von radioaktiv markierten Aminosäuren als Tracer für die Positronen-Emissions-Tomografie (PET) liefert wichtige Informationen über die biologische Aktivität von zerebralen Gliomen. Durch Kombination dieser funktionellen bildgebenden Methode mit der Magnetresonanztomografie (MRT) ist es möglich, die Versorgung von Patienten mit Hirntumoren entscheidend zu verbessern. Dies beruht im Wesentlichen auf einer spezifischeren Darstellung der Ausdehnung des soliden Gliomgewebes, welche bei der Planung einer Biopsie, eines neurochirurgischen Eingriffs und einer Strahlentherapie signifikante Zusatzinformationen bieten kann. Des Weiteren können Tumorrezidive von posttherapeutischen Veränderungen besser differenziert, prognostische Informationen bei niedrig- und hochgradigen Gliomen gewonnen und Therapieeffekte frühzeitig beurteilt werden. Zunehmend werden auch funktionelle Verfahren der MRT wie zum Beispiel die perfusions- und die diffusionsgewichtete MR-Bildgebung und die MR-Protonenspektroskopie eingesetzt, um Informationen über Metabolismus, Perfusion, Vaskularisation von Hirntumoren zu gewinnen. Vergleichende Studien der Aminosäure-PET mit modernen funktionellen MR-Verfahren sind daher sehr wichtig, um die unterschiedliche Leistungsfähigkeit und die synergistischen Effekte dieser diagnostischen Verfahren bei verschiedenen neuroonkologischen Fragestellungen zu untersuchen.

Abstract

Structural as well as functional imaging methods are of special importance in neurooncology. Improvements of radionuclide and magnetic resonance-based imaging modalities over the past decade have enabled clinicians to non-invasively assess the dynamics of disease-specific processes at the molecular level in patients with malignant gliomas. To date, a range of complementary imaging parameters have been established in the diagnostic work-up of patients with brain tumours. Magnetic resonance imaging (MRI) provides morphological information as well as functional information such as vascular permeability, cell density, tumour perfusion, and metabolic information by using magnetic resonance spectroscopy. The use of radiolabelled amino acids for positron emission tomography (PET) allows a better delineation of tumour margins and improves targeting of biopsy and radiotherapy, and planning surgery. In addition, amino acid imaging appears useful in distinguishing tumour recurrence from non-specific post-therapeutic scar tissue, in predicting prognosis in low-grade gliomas, and in monitoring metabolic response during treatment. Taken together, MRI and PET provide complementary information about tumour biology and activity, thereby resulting in an improved understanding of the kinetics of tumour growth and therefore allow new insights into the pathophysiology of malignant brain tumours. However, multimodal imaging studies comparing the value of amino acid PET and functional methods of MRI (e. g., perfusion and diffusion weighted imaging) are needed. From these studies, surrogate MRI and PET imaging techniques need to be derived to gain complementary structural and functional information of brain tumours that can be placed into common clinical practice which will optimise the clinical management of patients with malignant gliomas.

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