Rektumkarzinom – Lokales Staging und Bildgebung unter neoadjuvanter Therapie

Der Radiologe - Tập 52 - Trang 519-528 - 2012
M. Karpitschka1
1Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, München, Deutschland

Tóm tắt

Beim Rektumkarzinom ist das Restaging nach neoadjuvanter Therapie von zentraler Bedeutung. Einerseits kann anhand der aktuellen Tumorausdehnung das weitere chirurgische Vorgehen geplant, andererseits durch die radiologische Evaluation des Therapieansprechens eine prognostische Einschätzung getroffen werden. Als bildgebende Modalitäten stehen die Endosonographie, die CT bzw. PET/CT und die MRT zur Verfügung. Die Perfusions-CT könnte in Zukunft wertvolle Informationen bzgl. des Therapieansprechens liefern, da hierdurch die Tumorvaskularität und ihre Veränderungen unter Therapie dargestellt werden können. Die Evaluation des Therapieansprechens, insbesondere die Beurteilung des zirkumferenziellen Resektionsrandes (CRM) ist zur operativen Planung erforderlich. Die Bildgebung nach neoadjuvanter Therapie ist präoperativer Standard in der Rektumchirurgie. Für die Beurteilung des lokalen Therapieansprechens (T-Status) hat sich die hochauflösende Dünnschicht-MRT bewährt, wohingegen der M-Status am besten in Anlehnung an die RECIST-Kriterien in der Multidetektor(MD)-CT beurteilt werden kann. Hinsichtlich des Lymphknotenstatus (N-Status) empfehlen sich ebenfalls die MRT und die PET/CT, gefolgt von der CT.

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