Empfehlung zum differenzierten Einsatz nuklearmedizinischer Diagnostik bei Parkinson-Syndromen

Zusammenfassung

Die vorliegende Arbeit gibt einen Überblick über die verschiedenen nuklearmedizinischen Verfahren in der Diagnostik bei neurodegenerativen Parkinson-Syndromen sowie ihre Evidenzlage und soll praxistaugliche Entscheidungshilfen in der Anwendung und Interpretation der Methoden und Befunde ermöglichen. Die Wertigkeit der Verfahren unterscheidet sich erheblich in Bezug auf die beiden relevanten diagnostischen Fragestellungen. Dies ist zum einen die Frage, ob überhaupt ein neurodegeneratives Parkinson-Syndrom vorliegt, zum anderen die Frage, welches. Während zur Beantwortung der ersten Frage das DAT-SPECT unter Berücksichtigung gewisser Parameter in der Praxis unbestritten die Methode der Wahl ist, eignet sich dieses Verfahren nicht zur Beantwortung der zweiten Fragestellung. Zur Unterscheidung der Parkinson-Syndrome in idiopathisch oder atypisch werden im klinischen Alltag mit der MIBG-Szintigraphie und dem FDG-PET verschiedene Verfahren angewendet. Wir legen dar, warum das FDG-PET von diesen Methoden nicht nur die geeignetste ist, um ein idiopathisches Parkinson-Syndrom von einem atypischen Parkinson-Syndrom abzugrenzen, sondern auch ausreichend valide ermöglicht, die verschiedenen atypischen neurodegenerativen Parkinson-Syndrome (d. h. MSA, PSP und CBD) voneinander zu unterscheiden, und deshalb in den Leistungskatalog der GKV aufgenommen werden sollte.

Abstract

The present work provides an overview of the various nuclear medicine methods in the diagnosis of neurodegenerative parkinsonian syndromes and their respective evidence and is intended to enable practical decision-making aids in the application and interpretation of the methods and findings. The value of the procedures differs considerably in relation to the two relevant diagnostic questions. On the one hand, it is the question of whether there is a neurodegenerative parkinsonian syndrome at all, and on the other hand the question of which one. While the DAT-SPECT is undisputedly the method of choice for answering the first question (taking certain parameters into account), this method is not suitable for answering the second question. To categorise parkinsonian syndromes into idiopathic (i. e. Parkinson´s disease) or atypical, various procedures are used in everyday clinical practice including MIBG scintigraphy, and FDG-PET. We explain why FDG-PET currently is not only the most suitable of these methods to differentiate an idiopathic parkinsonian syndrome, from an atypical Parkinson’s syndrome, but also enables sufficiently valid to distinguish the various atypical neurodegenerative Parkinson’s syndromes (i. e. MSA, PSP and CBD) from each other and therefore should be reimbursed by health insurances.

Schlüsselwörter

Parkinson-Syndrom - idiopathisch - atypisch - Nuklearmedizin - DAT-SPECT - FDG-PET

Key words

Parkinsonian syndrome - idiopathic - atypical - nuclear medicine - DAT-SPECT - FDG-PET

Publication History

Received: 03 March 2020

Accepted: 10 June 2020

Article published online:
21 September 2020

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