Die Positronenemissionstomographie des Skelettsystems mit<sup>18</sup>FNa: Häufigkeit, Befundmuster und Verteilung benigner Veränderungen

Schirrmeister, Holger; Kotzerke, J.; Rentschler, M.; Träger, Harald; Fenchel, Sabine; Nüssle, K; Diederichs, C. G.; Reske, S. N.

doi:10.1055/s-2007-1015095

Cited by 9 publications

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“…Osteoblastische Metastasen werden vor allem bei Patienten mit Prostatakarzinom beobachtet. Die Wirbelsäule ist die am häufigsten betroffene Skelettregion [12]. Meist liegen multiple Metastasen vor.…”

Section: Sekundäre Knochentumorenunclassified

Die Positronenemissionstomographie in der Diagnostik von Erkrankungen des Skelettsystems

Schirrmeister¹

2002

Der Nuklearmediziner

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Primäre maligne Knochentumoren sind mit einer Inzidenz von 1 : 100 000 Einwohnern seltene Malignome, die vor allem bei jüngeren Patienten auftreten [1]. Der Altersgipfel liegt bei Osteosarkomen und Ewing-Sarkomen im ersten und zweiten Lebensjahrzehnt, Chondrosarkome sind dagegen häufiger im dritten Lebensjahrzehnt zu beobachten [1]. Maligne Knochentumoren metastasieren meist hämatogen, insbesondere in die Lunge oder in das Skelettsystem. Die intraossäre Metastasierung von Osteosarkomen (¹skip-lesionsª) stellt eine typische, aber eher seltene Metastasierungsform dar. Bei High-Grade-Sarkomen kommen über-wiegend multimodale Therapiekonzepte zum Einsatz, während bei niedrig malignen Tumoren die alleinige operative Entfernung des Tumors im Vordergrund steht. Die prätherapeutisch durchgeführte Diagnostik dient der exakten Beschreibung der lokalen und systemischen Ausdehnung des Tumors und der Beurteilung des Malignitätsgrades. Hierfür ist die Durchführung einer Sonographie, konventionelle Röntgenaufnahmen, MRT, CT-Thorax und Ganzkörperskelettszintigramme obligat. ZusammenfassungNach Vorstellung des ersten industriereifen Positronenemissionstomographen im Jahre 1975 stand zunächst die Untersuchung des Hirnstoffwechsels im Vordergrund der klinischen Forschung. Seit Ende der Achtzigerjahre kommt die PET auch zunehmend in der Kardiologie und Onkologie zur Anwendung. Seit der Mitte der Neunzigerjahre wird die PET auch zur Klärung orthopädischer Fragestellungen, beispielsweise bei der Diagnostik einer Osteomyelitis oder in der Vitalitätsdiagnostik von Knochentransplantaten eingesetzt. Die onkologische Skelettdiagnostik beinhaltet die Suche nach Skelettmetastasen und die Untersuchung der Aggressivität, dem Staging und der Therapiekontrolle primärer Knochentumoren. Im Folgenden werden die aus der Literatur bekannten Ergebnisse der Skelettdiagnostik mit PET vorgestellt und diskutiert. Schlüsselwörter PET´Skelett´Fluordesoxyglukose´Natriumfluorid AbstractThe first PET camera was introduced into clinical practice in 1975. Initially, PET was considered an excellent research modality for assessment of brain metabolism. Since the early 1980s numerous studies demonstrated its ability to answer questions in cardiology and oncology like detecting hibernating myocardium and differential diagnosis, staging and therapy control of several malignant tumors. Since the mid-1990s PET has also been used for orthopaedic indications such as assessment of osteomyelitis and viability control of bone crafts. Further applications in assessment of bone disorders are screening for bone metastases and staging and therapy control of primary bone tumors.

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Section: Sekundäre Knochentumorenunclassified

Die Positronenemissionstomographie in der Diagnostik von Erkrankungen des Skelettsystems

Schirrmeister¹

2002

Der Nuklearmediziner

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“…Furthermore, the specificity may be increased due to improved visualization of anatomical bone structures. This may facilitate the differentiation of metastases from degene- rative changes [129]. However, increased fluoride uptake in bone remains an unspecific sign of increased osteoblastic activity.…”

Section: Other Radiopharmaceuticals Used For Oncological Pet Studiesmentioning

confidence: 99%

Relevance of Positron Emission Tomography (PET) in Oncology

Weber

Avril²,

Schwaiger

1999

Strahlentherapie und Onkologie

133

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Numerous studies have documented the high diagnostic accuracy of PET studies using the glucose analogue F-18-fluordeoxyglucose (FDG-PET) for detection and staging of malignant tumors. In this field, FDG-PET has been particularly successful in lung cancer, colorectal cancer, malignant lymphoma and melanoma. Furthermore, FDG-PET has often proven to be superior to morphological imaging techniques for differentiation of tumor recurrence from scar tissue. Due to the high glucose utilization of normal gray matter radiolabeled amino-acids like C-11-methionine are superior to FDG for detection and delineation of brain tumors by PET. In the future, more specific markers of tumor cell proliferation and gene expression may allow the application of PET not only for diagnostic imaging also but for non-invasive biological characterization of malignant tumors and early monitoring of therapeutic interventions.

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“…In the last decade Positron Emission Tomography (PET) with markedly improved temporal and spatial resolution opened new possibilities for F-18 studies. The sensitivity in detection of small bone lesions and the accuracy in anatomical localization has been significantly increased (20,30,35). In conjunction with kinetic modeling absolute quantification has become possible for particular bone regions.…”

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Assessment of the incorporation of revascularized fibula grafts used for mandibular reconstruction with F-18-PET

Berding¹,

Schliephake²,

Hoff³

et al. 2001

Nuklearmedizin

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Summary Aim: Determination of the range of regional blood flow and fluoride influx during normal incorporation of revascularized fibula grafts used for mandibular reconstruction. Evaluation, if healing complications are preceded by typical deviations of these parameters from the normal range. Assessment of the potential influence of using “scaled population-derived” instead of “individually measured” input functions in quantitative analysis. Methods: Dynamic F-l 8-PET images and arterialized venous blood samples were obtained in 11 patients early and late after surgery. Based on kinetic modeling regional blood flow (K1) and fluoride influx (Kmlf) were determined. Results: In uncomplicated cases, early postoperative graft K1 - but not Kmlf -exceeded that of vertebrae as reference region. Kmn values obtained in graft necrosis (n = 2) were below the ranges of values observed in uncomplicated healing (0.01 13-0.0745 ml/min/ml) as well as that of the reference region (0.0154-0.0748). Knf values in mobile non-union were in the lower range - and those in rigid non-union in the upper range of values obtained in stable union (0.021 1-0.0694). If scaled population-derived instead of measured input functions were used for quantification, mean deviations of 23 ± 17% in K1 and 12 ± 16% in Kmlf were observed. Conclusions: Normal healing of predominantly cortical bone transplants is characterized by relatively low osteoblastic activity together with increased perfusion. It may be anticipated that transplant necrosis can be identified by showing markedly reduced F− influx. In case that measured input functions are not available, quantification with scaled population-derived input functions is appropriate if expected differences in quantitative parameters exceed 70%.

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Die Positronenemissionstomographie des Skelettsystems mit¹⁸FNa: Häufigkeit, Befundmuster und Verteilung benigner Veränderungen

Abstract: Most of the degenerative lesions (84%) detected with 18F-PET had a very typical appearance and could be detected with the improved spatial resolution and advantages of a tomographic technique. 18F-PET had an increased accuracy in detecting degenerative bone lesions.

Cited by 9 publications

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Die Positronenemissionstomographie in der Diagnostik von Erkrankungen des Skelettsystems

Die Positronenemissionstomographie in der Diagnostik von Erkrankungen des Skelettsystems

Relevance of Positron Emission Tomography (PET) in Oncology

Assessment of the incorporation of revascularized fibula grafts used for mandibular reconstruction with F-18-PET

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Die Positronenemissionstomographie des Skelettsystems mit18FNa: Häufigkeit, Befundmuster und Verteilung benigner Veränderungen

Abstract: Most of the degenerative lesions (84%) detected with 18F-PET had a very typical appearance and could be detected with the improved spatial resolution and advantages of a tomographic technique. 18F-PET had an increased accuracy in detecting degenerative bone lesions.

Cited by 9 publications

References 0 publications

Die Positronenemissionstomographie in der Diagnostik von Erkrankungen des Skelettsystems

Die Positronenemissionstomographie in der Diagnostik von Erkrankungen des Skelettsystems

Relevance of Positron Emission Tomography (PET) in Oncology

Assessment of the incorporation of revascularized fibula grafts used for mandibular reconstruction with F-18-PET

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Die Positronenemissionstomographie des Skelettsystems mit¹⁸FNa: Häufigkeit, Befundmuster und Verteilung benigner Veränderungen