Zusammenfassung
Die Anwendung von Schnittbildverfahren bei laborchemisch nachgewiesen Gastrinom hat drei Aufgaben:
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Tumorlokalisation, vor Erst- und Rezidiveingriff (sporadisches Gastrinom MEN 1)
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Staging bei metastasiertem Tumor zum Nachweis von Lymphknoten- und Fernmetastasen, wünschenswert auch Angaben zu einer möglichen Leberresektion
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Postoperatives Monitoring einer Bio- oder Chemotherapie im Rahmen von Nachuntersuchungen
Die Lokalisation des Primärtumors korreliert eng mit seiner Größe. Der Erfolg der operativen Lokalisation durch erfahrene Chirurgen bei kleinen Tumoren ist höher als mit herkömmlicher präoperativer Bildgebung. Zur Lokalisation des Pankreastumors bei asymptomatischen Patienten im Rahmen des MEN 1 Syndroms kommt die Endosonographie (EUS) gefolgt von der Somatostatin-Rezeptor-Szintigraphie (SRS) zum Einsatz. Die Szintigraphie zeigt die höchste Sensivität bei symptomatischen Patienten und beim Nachweis von Metastasen. CT und MRI sind lokalisationsdiagnostische Möglichkeiten der zweiten Wahl. Ihre Sensitivität hängt von der Patientenselektion ab. Vor Leberresektionen sind die sich laufend weiterentwickelnden 3D-CT-Rekonstruktion hilfreich. Wegen fehlender Strahlenexposition kommt die MRI zum Monitoring einer systemischen Therapie im Rahmen klinischer Studien zur Anwendung.
Summary
Cross sectional imaging in the assessment of gastrinomas has three major applications:
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Tumor localization (sporadic gastrinoma, MEN I) in patients undergoing primary or secondary surgery
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Staging of metastasized tumors, especially assessment of lymph nodes and liver metastases, possibly including a risk analysis prior to liver resection
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Post-surgery follow-up and monitoring of bio- or chemotherapy.
Detection of primary tumors is strongly correlated with their size. However, the sensitivity of surgical assessment of the mostly small tumors by experienced surgeons is much higher than that of any imaging modality. Of all imaging modalities, endoultrasonography (EUS) followed by Somatostatin receptor scintigraphy (SRS) is the most sensitive modality for the assessment of pancreatic tumors in asymptomatic patients suffering from a MEN-I syndrome. Scintigraphy has the highest sensitivity in tumors of symptomatic patients and in the assessment of metastases. CT and MRI are only second line diagnostic modalities. Their sensitivity is largely dependent on the selection of patients. As a potential application, 3D reconstruction of nearly isotropic CT data sets for the risk assessment prior to liver resection is currently developing. Due to the absent radiation exposure, MRI is increasingly utilized to monitor the response of metastases under systemic therapy, e.g. in clinical trials.
References
Sugg SL, Norton JA, Fraker DL, et al (1993) A prospective study of introperative methods to find and resect duodenal gastrinomas. Ann Surg 218: 138
Snow ND, Liddle RA (1995) Neuroendocrine tumours. In: Rustigi AK (ed) Gastrointestinal cancers: biology, diagnosis and therapy. Lippincott-Raven, Philadelphia, p 585
Stabile BE, Morrow DJ, Passaro E (1987) The gastrinoma triangle: Operative implications. Am J Surg 209: 550
Van Hoe L, Gryspeerdt S, Marchal G, et al (1995) Helical CT for the preoperative localization of islet cell tumors of the pancreas: value of arterial and parenchymal phase images. AJR 165: 1437
Thoeni RF, Müller-Lisse UG, Chan R, et al (2000) Detection of small, functional islet cell tumors in the pancreas: Selection of MR imaging sequences for optimal sensitivity. Radiology 214: 483
Pamuklar E, Semelka RC (2005) MR imaging of the pancreas. Magn Reson Imaging Clin N Amer 13: 313
Klose KJ (2006) (FaPaCa-Studie, unveröff Daten)
Legmann P, Vignaux O, Dousset B, et al (1998) Pancreatic tumors: comparison of dual-phase helical CT and endoscopic sonography. AJR 170: 1315
Pisegna JR, Doppman JL, Norton JA, et al (1993) Prospective comparative study of the ability of MR imaging and other imaging modalities to localize tumors in patients with Zollinger-Ellison syndrom. Dig Dis Sci 38: 1318
Gibril F, Reynolds JC, Doppman JL, et al (1996) Somatostatin receptor scintigraphy: its sensitivity compared with other imaging methods in detecting primary and metastatic gastrinomas. A prospective study. Ann Intern Med 125: 26
Kisker O, Bastian D, Bartsch DK, et al (1998) Localization, malignant potential and surgical management of gastrinomas. World J Surg 22: 651
Langer P, Kann PH, Fendrich V, et al (2004) Prospective evaluation of imaging procedures for the detection of pancreatico-duodenal endocrine tumors in patients with multiple endocrine neoplasia Type 1. World J Surg 28: 1317
Fendrich V, Bartsch DK, Langer P, et al (2005) Zollinger-Ellison Syndrom. Das gewandelte Verständnis der Chirurgie. Chirurg 76: 217
Dromain C, de Baere T, Lumbroso J, et al (2005) Detection of liver metastases from endocrine tumors: a prospective comparison of somatostatin receptor scintigraphy, computed tomography and magnetic resonance imaging. J Clin Oncol 23: 70
Ricke J, Klose KJ (2000) Imaging procedures in neuroendocrine tumours. Digestion 62 [Suppl 1]: 39
Ramage JK, Davies AH, Ardill J, et al (2005) Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut 54 [Suppl 4]: 1
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Klose, K., Heverhagen, J. Localisation and staging of gastrin producing tumours using cross-sectional imaging modalities. Wien Klin Wochenschr 119, 588–592 (2007). https://doi.org/10.1007/s00508-007-0886-0
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DOI: https://doi.org/10.1007/s00508-007-0886-0