Langen K-J, Bartenstein P, Boecker H, Brust P, Coenen H H, Drzezga A, Grünwald F, Krause B J, Kuwert T, Sabri O, Tatsch K, Weber W A, Schreckenberger M
Institut für Neurowissenschaften und Medizin, Forschungszentrum Jülich, 52425 Jülich.
Nuklearmedizin. 2011;50(4):167-73. doi: 10.3413/nuk-2011041. Epub 2011 Jul 14.
For the primary diagnosis of brain tumours, morphological imaging by means of magnetic resonance imaging (MRI) is the current method of choice. The complementary use of functional imaging by positron emitting tomography (PET) and single photon emitting computerized tomography (SPECT) with labelled amino acids can provide significant information on some clinically relevant questions, which are beyond the capacity of MRI. These diagnostic issues affect in particular the improvement of biopsy targeting and tumour delineation for surgery and radiotherapy planning. In addition, amino acid labelled PET and SPECT tracers are helpful for the differentiation between tumour recurrence and non-specific post-therapeutic tissue changes, in predicting prognosis of low grade gliomas, and for metabolic monitoring of treatment response. The application of dynamic PET examination protocols for the assessment of amino acid kinetics has been shown to enable an improved non-invasive tumour grading. The purpose of this guideline is to provide practical assistance for indication, examination procedure and image analysis of brain PET/SPECT with labelled amino acids in order to allow for a high quality standard of the method. After a short introduction on pathobiochemistry and radiopharmacy of amino acid labelled tracers, concrete and detailed information is given on the several indications, patient preparation and examination protocols as well as on data reconstruction, visual and quantitative image analysis and interpretation. In addition, possible pitfalls are described, and the relevant original publications are listed for further information.
对于脑肿瘤的初步诊断，通过磁共振成像（MRI）进行形态学成像是目前的首选方法。正电子发射断层扫描（PET）和单光子发射计算机断层扫描（SPECT）与标记氨基酸的功能成像的互补使用，可以为一些MRI无法解决的临床相关问题提供重要信息。这些诊断问题尤其影响活检靶向性的改善以及手术和放疗计划中肿瘤轮廓的描绘。此外，氨基酸标记的PET和SPECT示踪剂有助于区分肿瘤复发和非特异性治疗后组织变化，预测低级别胶质瘤的预后，并用于治疗反应的代谢监测。已证明应用动态PET检查方案评估氨基酸动力学能够改善无创肿瘤分级。本指南的目的是为使用标记氨基酸的脑PET/SPECT的适应症、检查程序和图像分析提供实际帮助，以确保该方法具有高质量标准。在对氨基酸标记示踪剂的病理生物化学和放射性药物学进行简短介绍后，给出了关于几种适应症、患者准备和检查方案以及数据重建、视觉和定量图像分析与解读的具体详细信息。此外，还描述了可能存在的陷阱，并列出了相关原始出版物以供进一步参考。
