Bedeutung der multimodalen Bildgebung bei Demenz

Sowohl die anatomische strukturelle Bildgebung als auch die physiologische molekulare Bildgebung können heutzutage neurodegenerative Prozesse relativ früh und mit großer Genauigkeit identifizieren. Der vorliegende Beitrag stellt die verschiedenen verfügbaren Bildgebungsmodalitäten vor und erläutert ihre Bedeutung für die multidisziplinäre Behandlung dieser Erkrankungen.

Abstract

Neurodegenerative diseases are a devastating group of disorders that can be difficult to accurately diagnose. Although these disorders are difficult to manage owing to relatively limited treatment options, an early and correct diagnosis can help with managing symptoms and coping with the later stages of these disease processes. Both anatomic structural imaging and physiologic molecular imaging have evolved to a state in which these neurodegenerative processes can be identified relatively early with high accuracy. To determine the underlying disease, the radiologist should understand the different distributions and pathophysiologic processes involved. High-spatial-resolution MRI allows detection of subtle morphologic changes, as well as potential complications and alternate diagnoses, while molecular imaging allows visualization of altered function or abnormal increased or decreased concentration of disease-specific markers. These methodologies are complementary. Appropriate workup and interpretation of diagnostic studies require an integrated, multimodality, multidisciplinary approach. This article reviews the protocols and findings at MRI and nuclear medicine imaging, including with the use of flurodeoxyglucose, amyloid tracers, and dopaminergic transporter imaging (ioflupane). The pathophysiology of some of the major neurodegenerative processes and their clinical presentations are also reviewed; this information is critical to understand how these imaging modalities work, and it aids in the integration of clinical data to help synthesize a final diagnosis. Radiologists and nuclear medicine physicians aiming to include the evaluation of neurodegenerative diseases in their practice should be aware of and familiar with the multiple imaging modalities available and how using these modalities is essential in the multidisciplinary management of patients with neurodegenerative diseases.

Kernaussagen

• Die radiologischen und nuklearmedizinischen Bildgebungsmodalitäten ergänzen sich und ermöglichen durch Einbezug der klinischen Präsentation eine frühzeitige Diagnose neurodegenerativer Erkrankungen.

• Bei Verdacht auf Demenz sollten eine räumlich hochauflösende volumetrische T1w Sequenz mit multiplanarer Reformation und eine koronare T2w Sequenz durchgeführt werden, Letztere zur Beurteilung des mesialen Temporallappens senkrecht zur Längsachse des Hippokampus.

• Die gemeinsame Anwendung von FDG-PET und MRT ist nützlich, um Befunde zu bestätigen und möglicherweise frühe Anomalien zu identifizieren, die sich noch nicht in strukturellen Veränderungen manifestiert haben.

• Bei der β-Amyloid-Bildgebung werden Bereiche mit erhöhter kortikaler Aufnahme als abnorm angesehen und entsprechen der kortikalen Ablagerung von β-Amyloid-Plaques. Als interne Kontrolle wird zur Feststellung eines normalen Aufnahmemusters das Kleinhirn herangezogen.

• Das typische Muster der hypometabolischen Aktivität bei der Alzheimer-Krankheit auf ¹⁸F-FDG-PET-Bildern betrifft die parietotemporale Region, den Präkuneus und den posterioren Gyrus cinguli. Die sensomotorischen Streifen und die okzipitale Region werden ausgespart. Dieses Muster entspricht in der Regel den in der strukturellen Bildgebung dargestellten atrophischen Veränderungen.

• Bei Patienten bzw. Patientinnen mit Demenz mit Lewy-Körpern zeigen ¹⁸F-FDG-PET-Bilder eine asymmetrisch verminderte Aktivität in den frontotemporalen Lappen, ähnlich wie bei der Alzheimer-Krankheit. Der Metabolismus des posterioren zingulären Kortex bleibt jedoch erhalten (zinguläres Inselzeichen). Bei der Alzheimer-Krankheit ist dagegen fast immer der hintere Gyrus cinguli betroffen.

Schlüsselwörter

Demenz - neurodegenerative Erkrankungen - strukturelle Bildgebung - molekulare Bildgebung

Key words

Neurodegenerative diseases - dementia - structural imaging - physiologic molecular imaging

Publication History

Article published online:
03 May 2022

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