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Ganzkörper-MRT und FDG-PET/CT in der bildgebenden onkologischen Diagnostik

Whole-body MRI and FDG-PET/CT imaging diagnostics in oncology

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Zusammenfassung

Die Ganzkörper-MRT (GK-MRT) ermöglicht im Gegensatz zu den etablierten sequenziellen, multimodalen diagnostischen Algorithmen eine onkologische Bildgebung mit einem systemischen Ansatz. Durch Innovationen auf dem Gebiet der Hardware, wie der Einführung von Ganzkörperscannern bei 1,5 und auch 3 Tesla in Kombination mit schnelleren Bildakquisitionstechniken ist die GK-MRT nun klinisch umsetzbar. Damit ist eine dedizierte Beurteilbarkeit individueller Organe mit unterschiedlichen Kontrasten, hoher räumlicher Auflösung und Kontrastmitteldynamik in Kombination mit der GK-Bildgebung möglich.

Mit der PET/CT können neben der morphologischen Bildgebung auch wichtige metabolische Informationen gewonnen werden, sodass dieses Verfahren beim initialen Staging verschiedener Tumoren sich etabliert hat, speziell zur Beurteilung von Lymphknotenmetastasen und Abschätzung der Tumorvitalität. Neue methodische Entwicklungen, wie die GK-MRT-Diffusionsbildgebung, haben das Potenzial, die diagnostische Genauigkeit der GK-MRT weiter zu verbessern. Die GK-MRT hat Vorteile bei der Detektion von Fernmetastasen, speziell bei Tumoren, die häufig in die Leber, Knochen oder das ZNS metastasieren, und stellt eine sinnvolle strahlenfreie Alternative zur Bildgebung pädiatrischer Tumorpatienten dar, bei denen häufig wiederholte Untersuchungen erforderlich sind.

Die GK-MRT eignet sich auch dazu, das gesamte Knochenmark in einem Untersuchungsgang darzustellen und liefert sehr genaue Informationen beim Staging maligner hämatologischer Erkrankungen, wie z. B. dem multiplen Myelom. In diesem Beitrag sollen aktuelle Entwicklungen und klinische Anwendungen der GK-MRT im Vergleich mit der PET/CT bei der onkologischen Bildgebung dargestellt werden.

Abstract

The advent of whole-body MRI (WB-MRI) has introduced a systemic approach to oncologic imaging compared to established sequential, multi-modal diagnostic algorithms. Hardware innovations, such as whole-body scanners at 1.5 Tesla and also recently 3 Tesla, combined with acquisition acceleration techniques, have made WB-MRI clinically feasible. With this method dedicated assessment of individual organs with various soft tissue contrast, high spatial resolution and contrast media dynamics can be combined with whole-body anatomic coverage.

PET/CT has established itself as a powerful modality in the staging of patients suffering from malignant tumors. In addition to the morphologic information provided by the CT component of this hybrid modality, the PET component contributes invaluable metabolic information, which greatly enhances accuracy in the assessment of lymphatic spread and viability of tumor tissue. Whole-body MR diffusion imaging is a novel and promising technique which may contribute to superior sensitivity in the detection of tumor manifestations. In the assessment of distant metastatic spread WB-MRI is highly sensitive and has advantages over PET/CT, especially in those tumors frequently spreading to the liver, bone or brain. WB-MRI is also very attractive as a radiation-free alternative for imaging of pediatric tumor patients in whom multiple follow-up examinations may be required.

WB-MRI allows for precise assessment of the bone marrow and has been proven to be highly accurate for the staging of hematologic diseases, such as multiple myeloma. In this article recent developments and applications of WB-MRI in oncologic imaging are addressed and compared to the results of PET/CT.

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  1. Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    G.P. Schmidt, A. Haug, M.F. Reiser & C. Rist

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  1. G.P. Schmidt
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  2. A. Haug
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  3. M.F. Reiser
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  4. C. Rist
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Correspondence to G.P. Schmidt.

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Schmidt, G., Haug, A., Reiser, M. et al. Ganzkörper-MRT und FDG-PET/CT in der bildgebenden onkologischen Diagnostik. Radiologe 50, 329–338 (2010). https://doi.org/10.1007/s00117-009-1971-3

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