Leitlinien
Differentialindikation für verschiedene radioaktive Arzneimittel bei unterschiedlichen entzündlichen Erkrankungen
J. Meller, Abteilung Nuklearmedizin der Universität Göttingen und V. Ivančevic´, Nuklearmedizinische Gemeinschaftspraxis im Allgemeinen Krankenhaus, Celle; Leitlinienausschuss der DGN vertreten durch: H Lerch (Wuppertal) , R Bares (Tübingen), HJ Biersack (Bonn), M Clausen (Hamburg), M Dietlein (Köln), M Fischer (Kassel), CM Kirsch (Homburg/Saar), W Knapp (Hannover), E Moser (Freiburg), C Reiners (Würzburg), H Schicha (Köln), O Schober (Münster), C Schümichen (Rostock).
Überarbeitet nach: W. Becker , Abteilung Nuklearmedizin der Universität Göttingen
Überarbeitet nach: W. Becker , Abteilung Nuklearmedizin der Universität Göttingen
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- Zielsetzung und Hintergrund
Ziel dieser Leitlinien ist die Unterstützung nuklearmedizinisch tätiger Ärzte bei der Indikationsstellung zur Entzündungsszintigraphie in verschiedenen klinischen Situationen.
- Hintergrund:
Es gibt kein optimales radioaktives Arzneimittel, das für alle klinischen Situationen bei entzündlichen Erkrankungen geeignet wäre. Die Auswahl eines Radiopharmazeutikums zur Entzündungsdiagnostik richtet sich primär nach der Pathophysiologie des entzündlichen Prozesses und der Biodistribution des eingesetzten Tracers unter kritischer Bezugnahme auf die zu erwartende Strahlenexposition des Patienten. Unter Berücksichtigung dieser Parameter, sowie evidenzbasierter Ergebnisse der Literatur ergeben sich die folgenden Empfehlungen zum Einsatz unterschiedlicher entzündungsaffiner Radiopharmaka.
- Empfehlungen zum Einsatz
(Reihenfolge nach Nützlichkeit der Untersuchung bei einer bestimmten Indikation).
Fieber unklarer Genese ( FUO)
- F-18-FDG
- Ga-67-Zitrat
- Tc-99m-markierte Antigranulozytenantikörper oder Tc-99m- Leukozyten
- In-111-Oxin-markierte Leukozyten
Nosokomiales Fieber, okkulte Sepsis oder FUO nach Operationen innerhalb der letzten 6 Monate
- Tc-99m-markierte Antigranulozytenantikörper oder Tc-99m- markierte Leukozyten
- F-18-FDG
- In-111-Oxin-markierte Leukozyten
Osteomyelitis peripherer unverletzter Knochen (akute Form, unverletzter Knochen)
- Dreiphasen-Skelettszintigraphie
- Tc-99m-markierte Antigranulozytenantikörper oder Tc-99m- markierte Leukozyten
Osteomyelitis peripherer Knochen (posttraumatische und postoperative Situation; chronische Verlaufsformen, Z.n Knie und Hüft-TEP)
- FDG-PET
- Tc-99m-markierte Antigranulozytenantikörper oder Tc-99m-markierte Leukozyten (in Kombination mit der Dreiphasen-Skelettszintigraphie)
- 111-Oxin-markierte autologe Leukozyten
- Ga-67-Zitrat
- Tc-99m-Nanokolloid (Notfalldiagnostik)
Osteomyelitis Wirbelsäule
- F-18-FDG
- Ga-67-Zitrat
Vaskulitis der großen und mittelgroßen Arterien
- F-18-FDG
In-111-Oxin-markierte Leukozyten
Gefäßprotheseninfektion
- Tc-99m-markierte Leukozyten
- Tc-99m-markierte Antigranulozytenantikörper
- In-111-Oxin-markierte Leukozyten
Endokarditis
- Tc-99m-markierte Antigranulozytenantikörper
- Tc-99m- markierte Leukozyten
Renale Infektionen
- In- 111-Oxin-markierte autologe Leukozyten
Rationale: In-111-Oxin-markierte Leukozyten werden als einziges Radiopharmazeutikum nicht renal eliminiert und können für die Diagnostik renaler Infektionen eingesetzt werden (Übersicht über die Literatur in 1, 59).
Entzündliche Darmerkrankungen
- Tc-99m-markierte Leukozyten
- In- 111-Oxin-markierte Leukozyten
Appendicitis
- Tc-99m-markierte Antigranulozytenantikörper oder Fab`-Fragmente
- Tc-99m-markierte Leukozyten
- F-18-FDG
- Literatur
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