Skip to main content
SpringerLink
Log in

Bild gebende Diagnostik von Metastasen in Hirn, Knochen, Leber und Lunge

Imaging diagnosis of metastases in the brain, bones, liver, and lung

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Bei der Diagnostik von Metastasen maligner Tumoren spielen Bild gebende Verfahren eine zentrale Rolle. Die zahlreichen zur Verfügung stehenden Modalitäten sind vielfältig, unterliegen einer ständigen technischen Weiterentwicklung und umfassen sowohl morphologische als auch funktionelle Techniken. Für einen effizienten und kostengünstigen Einsatz der Modalitäten sind eingehende Kenntnisse der Leistungsfähigkeit und Grenzen der einzelnen Verfahren erforderlich. Im Folgenden werden die wichtigsten Untersuchungsverfahren wie konventionelle Röntgendiagnostik, Ultraschall, Computertomographie, Magnetresonanztomographie und Positronenemissionstomographie vorgestellt, ihre Einsatzgebiete bei der Diagnostik von typischen Metastasenlokalisationen diskutiert und Empfehlungen für die tägliche onkologische Praxis gegeben.

Abstract

Imaging procedures play a central role in diagnosis of metastases from malignant tumors. The numerous modalities available are multifaceted, subject to continuous technical enhancements, and include both morphological and functional techniques. In-depth knowledge of the capabilities and limitations of the individual methods is necessary for effective and cost-efficient use of these modalities. The following article presents the most important examination procedures such as X-ray diagnosis, ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography, discusses their areas of application for diagnosis of typical sites of metastases, and offers recommendations for everyday practice in oncology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1a-d
Abb. 2
Abb. 3a–e
Abb. 4a–d
Abb. 5

Literatur

  1. Antoch G, Vogt FM, Freudenberg LS, Nazaradeh F, Goehde SC, Barkhausen J, Dahmen G, Bockisch A, Debatin JF, Ruehm SG (2003) Whole-body dual-modality PET/CT and whole-body MRI for tumor staging in oncology. JAMA 290:3199–3206

    Article  CAS  PubMed  Google Scholar 

  2. Adams S, Baum R, Rink T, Schumm-Drager PM, Usadel KH, Hor G (1998) Limited value of fluorine-18 fluorodeoxyglucose positron emission tomography for the imaging of neuroendocrine tumours. Eur J Nucl Med 25:79–83

    Article  PubMed  Google Scholar 

  3. Alexander HR, Allegra CJ, Lawrence TS (2001) Metastatic cancer to the liver. In: DeVita VT, Jr., Hellman S, Rosenberg SA (eds) Cancer: Principles and practice of oncology. Lippincott Williams & Wilkens, Baltimore, pp 2690–2713

  4. Arulampalam T, Costa D, Visvikis D, Boulos P, Taylor I, Ell P (2001) The impact of FDG-PET on the management algorithm for recurrent colorectal cancer. Eur J Nucl Med 28:1758–1765

    CAS  PubMed  Google Scholar 

  5. Bathmann J, Moser E (1995) Vergleich von Skelettszintigraphie und Knochenmarkszintigraphie beim Nachweis ossärer Metastasen. Radiologe 35:8-14

    CAS  PubMed  Google Scholar 

  6. Benjamin MS, Drucker EA, McLoud TC, Shepard JAO (2003) Small pulmonary nodules: Detection at chest CT and outcome. Radiology 226:489–493

    PubMed  Google Scholar 

  7. Beissert M, Jenett M, Kessler C (2001) Diagnostik von Leberraumforderungen. Was leisten die bildgebende Verfahren? MMW Fortschr Med 143:375–379

    Google Scholar 

  8. Bernatik T, Becker D, Neureiter D, Hänsler J, Frieser M, Schaber S, Hahn EG, Strobel D (2003) Lebermetastasendetektion. Vergleich Kontrastmittel-Ultraschall mit Echosignalverstärkern der ersten versus zweiten Generation. Ultraschall Med 24:175–179

    Article  CAS  PubMed  Google Scholar 

  9. Bluemke DA, Paulson EK, Choti MA, DeSena S, Clavien PA (2000) Detection of hepatic lesions in candidates for surgery:comparison of ferumoxide-enhanced MR-imaging and dual-phase helical CT. Am J Roentgenol 175:1653–1658

    CAS  Google Scholar 

  10. Braga HJ, Choti MA, Lee VS, Paulson EK, Siegelman ES, Bluemke DA (2002) Liver lesions:manganese-enhanced MR and dual-phase helical CT for preoperative detection and characterization comparison with receiver operating characteristic analysis. Radiology 223:525–531

    PubMed  Google Scholar 

  11. Brown HK, Healey JH (2001) Metastatic cancer to the bone. In: DeVita VT, Jr, Hellman S, Rosenberg SA (eds) Cancer: Principles and practice of oncology. Lippincott Williams & Wilkens, Baltimore, pp 2713–2729

  12. Chung JK, Kim YK, Kim SK, Lee YJ, Paek S, Yeo JS, Jeong JM, Lee DS, Jung HW, Lee MC (❚) Usefulness of 11C-methionine PET in the evaluation of brain lesions that are hypo- or isometabolic on 18F-FDG PET. Eur J Nucl Med Mol Imaging 29:176–182

  13. Cook GJR, Fogelman I (2002) The role of positron emission tomography in the management of bone metastases. Cancer (Suppl) 88:2927–2933

    Google Scholar 

  14. Cosgrove D (2000) Ultrasound in liver malignancy. Cancer Imaging 1:80–81

    Google Scholar 

  15. Dewan NA, Shehan CJ, Reeb SD, Gobar LS, Scott WJ, Ryschon K (1997) Likelihood of malignancy in a solitary pulmonary nodule: comparison of Bayesian analysis and results of FDG-PET scan. Chest 112:416–422

    CAS  PubMed  Google Scholar 

  16. Diederich S (2003) The pulmonary nodule: change of paradigm. Cancer Imaging 3:117–118

    Google Scholar 

  17. Eustace S, Tello R, DeCarvalho V, Carey J, Wroblicka JT, Melhem ER, Yucel EK (1997) A comparison of whole-body turboSTIR MR imaging and planar 99mTc-methylene diphosphonate scintigraphy in the examination of patients with suspected skeletal metastases. AJR 169:1655–1661

    CAS  Google Scholar 

  18. Forster GJ, Engelbach MJ, Brockmann JJ, Reber HJ, Buchholz HG, Macke HR, Rosch FR, Herzog HR, Bartenstein PR (2001) Preliminary data on biodistribution and dosimetry for therapy planning of somatostatin receptor positive tumours: comparison of (86)Y-DOTATOC and (111)In-DTPA-octreotide. Eur J Nucl Med 28:1743–1750

    CAS  PubMed  Google Scholar 

  19. Fröhlich A, Diederichs CG, Staib L, Vogel J, Beger HG, Reske SN (1999) Detection of liver metastases from pancreatic cancer using FDG PET. J Nucl Med 40:250–255

    Google Scholar 

  20. Gallowitsch HJ, Kresnik E, Gasser J, Kumnig G, Igerc I, Mikosch P, Lind P (2003) F-18 fluorodeoxyglucose positron-emission tomography in the diagnosis of tumor recurrence and metastases in the follow-up of patients with breast carcinoma: a comparison to conventional imaging. Invest Radiol 38:250–256

    Article  PubMed  Google Scholar 

  21. Gupta NC, Maloof J, Gunel E (1996) Probability of malignancy in solitary pulmonary nodules using fluorine-18-FDG and PET. J Nucl Med 37:943–948

    CAS  PubMed  Google Scholar 

  22. Hagspiel KD, Neidl KFW, Eichenberger AC, Weder W, Marincek B (1995) Detection of liver metastases: comparison of superparamagnetic iron oxide-enhanced and unenhanced MR imaging at 1.5T with dynamic CT, intraoperative US, and percutaneous US. Radiology 196:471–478

    CAS  PubMed  Google Scholar 

  23. Hain SF, Curran KM, Beggs AD, Fogelman I, O’Doherty MJ, Maisey MN (2001) FDG-PET as a „metabolic biopsy“ tool in thoracic lesions with indeterminate biopsy. Eur J Nucl Med 28:1336–1340

    PubMed  Google Scholar 

  24. Hansmann HJ, Wunsch C, Schneider B, Brado M, Flesch M, Richter GM, Kauffmann GW (1998) Radiologische Diagnostik von Knochenmetastasen. Orthopäde 27:224–230

    Google Scholar 

  25. Hartmann M, Sartor K (2000) Neuroradiologische Diagnostik bei Hirnmetastasen. Onkologe 6:930–938

    Article  Google Scholar 

  26. Helmberger T, Gregor M, Holzknecht N, Gauger J, Rau H, Reiser MF (1999) detektion und Charakterisierung fokaler Leberläsionen: Vergleich von biphasischer, kontrastverstärkter Spiral-CT, nativer und SPIO-verstärkter MRT. Radiologe 39:678–684

    Article  CAS  PubMed  Google Scholar 

  27. Hoegerle S, Schneider B, Kraft A, Moser E, Nitzsche EU (1999) Imaging of a metastatic gastrointestinal carcinoid by F-18-DOPA positron emission tomography. Nuklearmedizin 38:127–130

    CAS  PubMed  Google Scholar 

  28. Hofmann M, Maecke H, Borner R, Weckesser E, Schoffski P, Oei L, Schumacher J, Henze M, Heppeler A, Meyer J, Knapp H (2001) Biokinetics and imaging with the somatostatin receptor PET radioligand (68)Ga-DOTATOC: preliminary data. Eur J Nucl Med 28:1751–1757

    CAS  PubMed  Google Scholar 

  29. Hsia TC, Shen YY, Yen RF, Kao CH, Changlai SP (2002) Comparing whole body 18F-2-deoxyglucose positron emission tomography and technetium-99m methylene diophosphate bone scan to detect bone metastases in patients with non-small cell lung cancer. Neoplasma 49:267–271

    CAS  PubMed  Google Scholar 

  30. Jeong HJ, Chung JK, Kim YK, Kim CY, Kim DG, Jeong JM, Lee DS, Jung HW, Lee MC (2002) Usefulness of whole-body (18)F-FDG PET in patients with suspected metastatic brain tumors. J Nucl Med 43:1432–1437

    PubMed  Google Scholar 

  31. Johnson K, Bakhsh A,Young D, Martin TE Jr, Arnold M (2001) Correlating computed tomography and positron emission tomography scan with operative findings in metastatic colorectal cancer. Dis Colon Rectum 44:354–357

    CAS  PubMed  Google Scholar 

  32. Jung G, Cohnen M, Poll LW, Koch JA, Mödder U (2003) Wertigkeit der CT und MRT in der Diagnostik von Lebermalignomen. Onkologe 9:263–271

    Article  Google Scholar 

  33. Kinkel K, Lu Y, Both M, Warren RS, Thoeni RF (2002) Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis. Radiology 224:748–756

    PubMed  Google Scholar 

  34. Krenning EP, Kwekkeboom DJ, Bakker WH, Breeman WA, Kooij PP, Oei HY, van-Hagen M, Postema PT, de Jong M, Reubi JC (1993) Somatostatin receptor scintigraphy with [111In-DTPA-D-Phe1]- and [123I-Tyr3]-octreotide: the Rotterdam experience with more than 1000 patients. Eur J Nucl Med 20:716–731

    CAS  PubMed  Google Scholar 

  35. Krug B, Dietlein M, Groth W, Stutzer H, PsarasT, Gossmann A, Scheidhauer K, Schicha H, Lackner K (2000) Fluor-18-fluorodeoxyglucose positron emission tomography (FDG-PET) in malignant melanoma. Diagnostic comparison with conventional imaging methods. Acta Radiol 41:446–452

    Article  CAS  PubMed  Google Scholar 

  36. Langenhoff BS, Oyen WJ, Jager GJ, Strijk SP, Wobbes T, Corstens FH, Ruers TJ (2002) Efficacy of fluorine-18-deoxyglucose positron emission tomography in detecting tumor recurrence after local ablative therapy for liver metastases: a prospective study. J Clin Oncol 20:4453–4458

    Article  CAS  PubMed  Google Scholar 

  37. Lodge JPA (2000) Modern surgery for liver metastases. Cancer Imaging 1:77–79

    Google Scholar 

  38. Lütolf M (2001) Moderne Bildgebung zur Detektion und Lokalisation von Fernmetastasen. Therapeutische Umschau 58:701–708

    PubMed  Google Scholar 

  39. MacVicar DM (1998) Metastatic effects on the nervous system. In: Husband JES, Reznek RH (eds) Imaging in oncology. Part V: Metastases. Isis Medical Media, Oxford, pp 811–830

    Google Scholar 

  40. Marcou Y, Lindquist C, Adams C, Retsas S, Plowman PN (2001) What is the optimal therapy of brain metastases? Clin Oncol 13:105–111

    CAS  Google Scholar 

  41. Nakamoto Y, Osman M, Wahl RL (2003) Prevalence and patterns of bone metastases detected with positron emission tomography using F-18 FDG. Clin Nucl Med 28:302–307

    Article  PubMed  Google Scholar 

  42. Nakamoto Y, Higashi T, Sakahara H, Tamaki N, Kogire M, Imamura M, Konishi J (1999) Contribution of PET in the detection of liver metastases from pancreatic tumours. Clin Radiol 54:248–252

    CAS  PubMed  Google Scholar 

  43. Padhani A, Husband J (1998) Bone. In: Husband JES, Reznek RH (eds) Imaging in oncology. Part V: Metastases. Isis Medical Media, Oxford, pp 765–786

    Google Scholar 

  44. Padhani A (1998) Lung and pleura. In: Husband JES, Reznek RH (eds) Imaging in oncology. Part V: Metastases. Isis Medical Media, Oxford, pp 749–764

    Google Scholar 

  45. Paulson EK (2001) Evaluation of the liver for metastatic disease. Semin Liver Dis 21:225–236

    Article  CAS  PubMed  Google Scholar 

  46. Pfannenberg AC, Horger M, Heuschmid M, Trabold T, Wierecky J, Claussen CD (2003) Ganzkörper-Mehrschicht-CT in Niedrigdosis-Technik beim Staging und Therapie-Monitoring von Patienten mit Plasmozytom: Erste Ergebnisse. Fortschr Röntgenstr 2003; 175 (Suppl): S211

  47. Pieterman RM, Que TH, Elsinga PH, PruimJ, van-Putten JW, Willemsen AT, Vaalburg W, Groen HJ (2002) Comparison of (11)C-choline and (18)F-FDG PET in primary diagnosis and staging of patients with thoracic cancer. J Nucl Med 43:167–172

    PubMed  Google Scholar 

  48. Putnam JB, Jr (2001) Metastatic cancer to the lung. In: DeVita VT, Jr, Hellman S, Rosenberg SA (eds) Cancer: Principles and practice of oncology. Lippincott Williams & Wilkens, Baltimore, pp 2670–2689

  49. Reimer P, Jahnke N, Fiebich M, Schima W, Deckers F, Marx C, Holzknecht N, Saini S (2000) Hepatic lesion detection and characterization: value of nonenhanced MR imaging, superparamagnetic iron oxide-enhanced MR imaging, and spiral CT-ROC analysis. Radiology 217:152–158

    CAS  PubMed  Google Scholar 

  50. Rieden K (1995) Konventionelle Bildgebung und Computertomographie in der Diagnostik von Skelettmetastasen. Radiologe 35:15–20

    CAS  PubMed  Google Scholar 

  51. Robinson PJ (2002) The early detection of liver metastases. Cancer Imaging 2:1–3

    CAS  Google Scholar 

  52. Robinson P (2000) Imaging liver metastases: current limitations and future prospects for CT and MRI. Cancer Imaging 1:81–85

    Google Scholar 

  53. Robinson P (1998) Liver. In: Husband JES, Reznek RH (eds) Imaging in oncology. Part V: Metastases. Isis Medical Media, Oxford, pp 787–809

    Google Scholar 

  54. Rohren EM, Provenzale JM, Barboriak DP, Coleman RE (2003) Screening for cerebral metastases with FDG PET in patients undergoing whole-body staging of non-central nervous system malignancy. Radiology 226:181–187

    PubMed  Google Scholar 

  55. Rohren EM, Paulson EK, Hagge R, WongTZ, Killius J, Clavien PA, Nelson RC (2002) The role of F-18 FDG positron emission tomography in preoperative assessment of the liver in patients being considered for curative resection of hepatic metastases from colorectal cancer. Clin Nucl Med 27:550–555

    Article  PubMed  Google Scholar 

  56. Rybak.LD, Rosenthal DI (2001) Radiological imaging for the diagnosis of bone metastases. Q J Nucl Med 45:53–64

    PubMed  Google Scholar 

  57. Savelli G, Maffioli L, Maccauro M, De Deckere E, Bombardieri E (2001) Bone scintigraphy and the added value of SPECT (single photon emission tomography) in detecting skeletal lesions. Q J Nucl Med 45:27–37

    CAS  PubMed  Google Scholar 

  58. Schirrmeister H, Glatting G, Hetztel J et al. (2001) Prospective Evaluation of the clinical value of planar bone scans, SPECT, and18F-labeled NaF PET in newly diagnosed lung cancer. J Nucl Med 42:1800–1804

    CAS  PubMed  Google Scholar 

  59. Semelka RC, Martin DR, Balci C, Lance T (2001) Focal liver lesions: comparison of dual-phase CT and multisequence multiplanar MR imaging including dynamic gadolinium enhancement. J Magn Reson Imaging 13:397–401

    Article  CAS  PubMed  Google Scholar 

  60. Schueller G, Herold CJ (2003) Lung metastases. Cancer Imaging 3:126–128

    Google Scholar 

  61. Shreve PD, Grossman HB, Gross MD, Wahl RL (1996) Metastatic prostate cancer: initial findings of PET with 2-deoxy-2-[F18]fluoro-D-glucose. Radiology 199:751–756

    CAS  PubMed  Google Scholar 

  62. Steinborn MM, Heuck AF, Tiling R, Bruegel M, Gauger L, Reiser MF (1999) Whole-body bone marrow MRI in patients with metastatic disease to the skeletal system. J Comput Assist Tomogr 23:123–129

    CAS  PubMed  Google Scholar 

  63. Ward J, Naik KS, Guthrie JA, Wilson D, Robinson PJ (1999) Hepatic lesion detection: comparison of MR imaging after the administration of superparamagnetic iron oxide with dual-phase CT by using alternative-free response receiver operating characteristic analysis. Radiology 210:459–466

    CAS  PubMed  Google Scholar 

  64. Wen PY, Mclaren Black P, Loeffler JS. (2001) Metastatic Brain Cancer. In: DeVita VT, Jr, Hellman S, Rosenberg SA (eds) Cancer: Principles and practice of oncology. Lippincott Williams & Wilkens, Baltimore, pp 2655–2670

  65. Woodard PK, Dehdashti F, Putman CE (1998) Radiologic diagnosis of extrathoracic metastases to the lung. Oncology (Huntingt) 12:431–438

  66. Wormanns D, Roos N, Heindel W (2003) Wertigkeit bildgebender Verfahren bei malignen pulmonalen Erkrankungen. Onkologe 9:232–246

    Article  Google Scholar 

  67. Wu HC, Yen RF, Shen YY, Kao CH, Lin CC, Lee CC (2002) Comparing whole body 18F-2-deoxyglucose positron emission tomography and technetium-99m methylene diphosphate bone scan to detect bone metastases in patients with renal cell carcinomas—a preliminary report. J Cancer Res Clin Oncol 128:503–506

    Google Scholar 

  68. Yang SN, Liang JA, Lin FJ, Kao CH, Lin CC, Lee CC (2002) Comparing whole body (18)F-2-deoxyglucose positron emission tomography and technetium-99m methylene diphosphonate bone scan to detect bone metastases in patients with breast cancer. J Cancer Res Clin Oncol 128:325–328

    Article  CAS  PubMed  Google Scholar 

  69. Yankelevitz D, Reeves A, Kostis WJ, Zhao B, Henschke CJ (2000) Small pulmonary nodules: volumetrically determined growth rates based on CT evaluation. Radiology 217:251–256

    CAS  PubMed  Google Scholar 

  70. Yuh WTC, Tali ET, Nguyen HD et al.(1995) The effect of contrast dose, imaging time, and lesion size in the MR detection of intracerebral metastasis. Am J Neuroradiol 16:373–380

    CAS  PubMed  Google Scholar 

  71. Zhuang H, Sinha P, Pourdehnad M, Duarte PS, Yamamoto AJ, Alavi A (2000) The role of positron emission tomography with fluorine-18-deoxyglucose in identifying colorectal cancer metastases to liver. Nucl Med Commun 21:793–798

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Abt. für Radiologische Diagnostik, Eberhard-Karls-Universität Tübingen

    A. C. Pfannenberg & C. D. Claussen

  2. Abt. für Nuklearmedizin, Eberhard-Karls-Universität Tübingen

    S. M. Eschmann & R. Bares

  3. Abt. für Radiologische Diagnostik, Eberhard-Karls-Universität Tübingen, Hoppe-Seyler-Straße 3, 72076 , Tübingen

    A. C. Pfannenberg

Authors
  1. A. C. Pfannenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. M. Eschmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. D. Claussen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Bares
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. C. Pfannenberg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pfannenberg, A.C., Eschmann, S.M., Claussen, C.D. et al. Bild gebende Diagnostik von Metastasen in Hirn, Knochen, Leber und Lunge. Onkologe 10, 504–516 (2004). https://doi.org/10.1007/s00761-004-0694-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00761-004-0694-3

Schlüsselwörter

Keywords

Search

Navigation