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Potenziale der PET/MRT in der Diagnostik des Prostatakarzinoms

Potential of PET/MRI for diagnosis of prostate cancer

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Zusammenfassung

Klinisches/methodisches Problem

Das Ziel besteht in der Verbesserung der Detektion und Staging des Prostatakarzinoms mittels innovativer Bildgebungstechnik wie PET/MRT.

Radiologische Standardverfahren

Die Modalität der Wahl zur Detektion des Prostatakarzinoms ist die multiparametrische MRT. Des Weiteren wird die PET/CT insbesondere zum Staging und zur Detektion von Fernmetastasten/Rezidivdiagnostik eingesetzt. Zur Darstellung von Knochenmetastasen ist das am häufigsten eingesetzte Verfahren die Szintigraphie.

Methodische Innovationen

Die Entwicklung einer simultanen, hybriden PET/MRT stellt die letzte große „Vereinigung“ der bekannten Schnittbildmodalitäten dar. Zusätzlich ermöglicht die Synthese von neuen innovativen Tracern wie 18F-FACBC und 68Ga-PSMA (PSMA prostataspezifisches Membranantigen) spezifischere Detektion des Prostatakarzinoms.

Leistungsfähigkeit

Die hybride PET/MRT-Bildgebung hat das Potenzial, in der Zukunft konventionelle Techniken abzulösen.

Bewertung

Das Verfahren steht erst am Anfang der breiten Anwendung. Die Studienlage muss ausgebaut werden, um den zusätzlichen Nutzen zu belegen.

Empfehlung für die Praxis

Aktuell besteht noch eine geringe Verbreitungslage, da es sich um ein neues und kostenintensives Verfahren handelt. Zugleich existiert noch keine einheitliche Lösung des Kostenersatzes durch die Kassen. Die Bedeutung für die Praxis steigt erst mit Klärung der Vergütungssituation und Beleg des Nutzens durch größere Studien.

Abstract

Clinical/methodical issue

A present goal is to improve detection and staging of prostate cancer using innovative imaging technology such as PET/MRI.

Standard radiological methods

The modality of choice for detection of prostate cancer is multiparametric MRI. Furthermore, PET/CT is used, in particular, for the detection and staging of distant metastases and recurrent disease. For assessment of bone metastases, the method most commonly used is bone scintigraphy.

Methodical innovations

The development of a simultaneous hybrid PET/MRI system is the last great “fusion” of the known cross-sectional image modalities. In addition, synthesis of new, innovative tracers such as 18F-FACBC or 68Ga-PSMA allows more specific detection of prostate cancer.

Performance

Hybrid PET/MRI imaging has the potential to replace conventional imaging techniques in the future.

Achievements

The method is just starting the broad application. Clinical studies must be expanded in order to substantiate the additional value of the method.

Practical recommendations

Currently, there is still a low distribution situation, since it is a new and cost-intensive method. At the same time, there is still no consistent solution for reimbursement. The importance in practice first rises by clarifying the payment situation and further demonstration of the method’s benefit by larger studies.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. Der korrespondierende Autor weist auf folgende Beziehungen hin: M.C. Röthke hat Referenten- oder Beraterhonorare von folgenden Firmen erhalten: Siemens Healthcare, Curagita, Covidien; A. Ashfar-Oromieh erklärt keinen Interessenkonflikt. H.-P. Schlemmer hat Referenten- oder Beraterhonorare von folgenden Firmen erhalten: Siemens Healthcare, Curagita, Covidien, Bayer Healthcare. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Abteilung für onkologische Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland

    M.C. Röthke & H.-P. Schlemmer

  2. Klinik für Nuklearmedizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    A. Afshar-Oromieh

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  1. M.C. Röthke
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  2. A. Afshar-Oromieh
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  3. H.-P. Schlemmer
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Correspondence to M.C. Röthke.

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Röthke, M., Afshar-Oromieh, A. & Schlemmer, HP. Potenziale der PET/MRT in der Diagnostik des Prostatakarzinoms. Radiologe 53, 676–681 (2013). https://doi.org/10.1007/s00117-013-2499-0

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  • DOI: https://doi.org/10.1007/s00117-013-2499-0

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