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DOI: 10.1055/s-0033-1345201
Muskelultraschall – ein sinnvolles Werkzeug bei der Diagnosestellung der amyotrophen Lateralsklerose
Sonography of Muscles – A Useful Tool in the Diagnosis of Amyotrophic Lateral SclerosisPublikationsverlauf
Publikationsdatum:
20. Juni 2013 (online)
![](https://www.thieme-connect.de/media/klinneuro/201302/lookinside/thumbnails/10.1055-s-0033-1345201-1.jpg)
Zusammenfassung
Die Modifizierung der El-Escorial Kriterien von 2008 (sog. Awaji-Shima-Kriterien) hat den Stellenwert der Elektrophysiologie in der Diagnosestellung der amyotrophen Lateralsklerose erweitert. Elektromyografisch festgestellten Fibrillationen und positiv scharfen Wellen, aber auch Faszikulationen wird bei chronisch neurogen veränderten oder klinisch betroffenen Muskeln ein pathologischer Stellenwert in der Feststellung einer Schädigung des 2. Motoneurons (Abbkürzung MN) zuteil. Neben der elektrophysiologischen Untersuchung erfährt in den letzten Jahren die Muskelultraschalluntersuchung ein vermehrtes Interesse. Die Kombination von statischer und dynamischer Bilddarstellung gibt Möglichkeiten, die sonst kein anderes bildgebendes Verfahren der Muskulatur bietet. Darüber hinaus ist das Verfahren nicht invasiv und bietet die Möglichkeit, zahlreiche und vor allem elektromyografisch schwer zugängliche Muskelgruppen in toto darzustellen. Während die Detektion von Faszikulationen mittels Ultraschall schon längere Zeit sicher möglich ist, ist dank verbesserter Technologie und hochauflösender Ultraschallsonden bis 18 MHz nun auch die Erkennung von Fibrillationen möglich. B-Bild-Darstellungen der Muskulatur mit Messung von Muskelvolumen, Echogenität und Atrophie können darüber hinaus wichtige Informationen in allen Krankheitsstadien bieten. Ergebnisse der letzten Jahre weisen daraufhin, dass der Ultraschall der Muskulatur in Ergänzung zur EMG die Diagnosestellung beschleunigen und die Sensitivität in der Diagnostik erhöhen kann. Der folgende Artikel soll eine Übersicht über die Methode des Muskelultraschalls in der Diagnosestellung der amyotrophen Lateralsklerose liefern.
Abstract
The modification of the El-Escorial criteria of 2008 (so-called Awaji-Shima criteria) has increased the value of electrophysiology in the diagnostics for amyotrophic lateral sclerosis. Fibrillations detected by electromyography and positive sharp waves as well as fasciculations in chronic neurogenically altered or clinically afflicted muscles are considered to be of pathological relevance in the determination of damage to the 2nd motor neurons (abbreviated as MN). Beside electrophysiological examinations, sonographic examinations of muscles have attracted increasing interest in the past years. The combination of static and dynamic imaging provides possibilities that are not available by any other imaging processes of the musculature. Furthermore. the procedure is non-invasive and, above all, makes possible the in toto visualisation of muscle groups that are only difficultly accessible with electromyography. Although the detection of fasciculations by ultrasound has been possible for some time, improved technology and high-resolution ultrasound scanners of up to 18 MHz have now also made the recognition of fibrillations possible. B mode representations of the musculature with measurements of muscle volume, echogenicity and atrophy provide additional important information in all stages of the disease. Recently acquired results have demonstrated that sonography of muscles as supplement to EMG speeds up the diagnosis process and increases the diagnostic sensitivity. The present article is intended to provide an overview of the methods of muscle sonography as used in the diagnostics for amyotrophic lateral sclerosis.
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