Zerebrales MRT: Relevante Gesichtspunkte für die Nuklearmedizin im klinischen Umfeld

Zusammenfassung

Die klinisch ausgerichtete Nuklearmedizin wird regelmäßig mit Fragestellungen zu neurologischen Krankheitsbildern konfrontiert. Häufig liegt bereits eine Bildgebung mit Magnetresonanztomografie (MRT) vor, die Hinweise auf die zugrunde liegende Erkrankung, deren Lokalisation oder Ausprägung geben kann. Für eine Indikationsstellung und die spätere Auswertung der korrespondierenden nuklearmedizinischen Befunde kann die Interpretation der MRT hilfreich sein. Zu den Krankheiten, für die die MRT häufig keine abschließende Diagnose liefert, von nuklearmedizinischer Seite aber Untersuchungstechniken zur genauen Differenzierung zur Verfügung stehen, gehören die Fokussuche bei Epilepsie, neurodegenerativ-demenzielle Erkrankungen, neurologisch-motorische Erkrankungen mit Parkinson-Symptomatik und maligne Raumforderungen im Gehirn. Für diese Entitäten werden den typischen Veränderungen in der MRT die nuklearmedizinischen Befunde vergleichend gegenübergestellt und der zusätzliche Informationsgewinn der metabolischen Bildgebung über die MRT hinaus herausgearbeitet. Dabei liegt der Schwerpunkt für die MRT bei den T1-, T2- und FLAIR-Standardsequenzen, in der Nuklearmedizin auf den breit verfügbaren SPECT-Tracern (^99mTc-HMPAO, ^99mTc-ECD, ¹²³I-FP-CIT, ²⁰¹Tl) und PET Tracern (¹⁸FDG, ¹⁸FET).

Abstract

Clinical nuclear medicine is involved in a variety of neurological diseases on a regular daily base. Some patients already underwent magnet resonance imaging (MRI) of the brain before referral. This MRI might indicate a probable underlying disease, its localization or state in terms of sev­erity or extent. The decision for a certain nuclear medicine investigation and its subsequent interpretation might be supported by the exact knowledge of the corresponding MRI results. This overview focuses on those neurological pathologies in which brain MRI is often equivocal, but – in contrast – nuclear medicine provides techniques for establishing a final diagnosis. In particular, epilepsies and the identification of a seizure focus to guide neurosurgery, differentiation of dementia, the neurodegenerative movement disorders Parkinson’s disease and Parkinson-plus-syndromes and malignant brain tumors and brain metastases are discussed. For these entities typical MRI changes are present­ed in concert with the complementary nuclear medicine findings, the latter adding substantial information to the diagnostic workup. To achieve high relevance for the daily clinical diagnostic workflow special emphasis is put on basic MRI sequences like T1, T2 and FLAIR on the one hand and on broadly available SPECT and PET radio­tracers like ^99mTc-HMPAO, ^99mTc-ECD, ¹²³I-FP-CIT, ²⁰¹Tl, ¹⁸FDG and ¹⁸FET on the other.

Schlüsselwörter

partielle Epilepsie - dementielle Neurodegene­ration - Parkinson-Erkrankungen - Hirntumore

Key words

partial epilepsy - dementia - parkinsonism - brain tumors

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