Zusammenfassung.
Ziel: Ermittlung von Altersgrenzen für die MR-tomographisch erfassbare Myelinisierung des kindlichen Gehirns in T1- und T2-gewichteten Aufnahmen (T1w, T2w). Methode: Vergleich bisher publizierter Zeitangaben (Barkovich et al 1988, Grodd 1993, Hayakawa et al 1990, Hittmair et al 1994, Martin et al 1988/1990/1991, Nakagawa et al 1998, Staudt et al 1993/1994, Stricker et al 1990). Ergebnisse: Trotz deutlicher technischer und methodischer Unterschiede zwischen den einzelnen Studien konnten für die meisten Hirnregionen weitgehend übereinstimmende Zeitangaben gefunden werden. Demnach müssen im Alter von einem Monat bereits folgende Regionen in T1w und T2w myelintypisches Signal aufweisen: Medulla oblongata, Tegmentum pontis, Pedunculi cerebellares, Vermis cerebelli, Tectum mesencephali, Decussatio pedunculorum cerebelli superiorum, Thalamus, Crus posterius capsulae internae, Radiatio optica, Corona radiata. Danach sollte myelintypisches Signal in den einzelnen Hirnregionen zu folgenden Zeitpunkten erkennbar sein (M = Lebensalter in Monaten): Vorderschenkel der Capsula interna (2 M: T1w; 7 M: T2w), Splenium corporis callosi (4 M: T1w; 6 M: T2w), Genu corporis callosi (6 M: T1w; 8 M: T2w), Centrum semiovale (2 M: T1w; 7 M: T2w). Im Großhirn wird eine Aufzweigung des myelintypischen Signals in die einzelnen Gyri (= Arborisation) spätestens zu folgenden Zeitpunkten sichtbar: Okzipitallappen (5 M: T1w; 12 M: T2w) und Frontallappen (7 M: T1w; 14 M: T2w). Schlussfolgerung: Retardierungen der Myelinisierung können mit diesen übereinstimmenden Zeitangaben aus mehreren Arbeiten mit höherer Sicherheit als pathologisch gewertet werden als mit Angaben aus Einzelarbeiten.
Normal Myelination of the Child Brain on MRI - A Meta-Analysis.
Purpose: To establish age limits for the assessment of normal myelination of the brain on T1-weighted (T1w) and T2-weighted (T2w) images. Method: Comparison of previous publications (Barkovich et al. 1988, Grodd 1993, Hayakawa et al. 1990, Hittmair et al. 1994, Martin et al. 1988/1990/1991, Nakagawa et al. 1998, Staudt et al. 1993/1994, Stricker et al. 1990). Results: Despite technical and methodological differences, these studies principally agreed on the timing of myelination for most regions of the brain. Thus, a common time-table could be established: At 1 month, myelin is visible on both T1w and T2w in the medulla oblongata, tegmentum pontis, cerebellar peduncles and vermis, quadrigeminal plate, decussation of superior cerebellar peduncles, thalamus, posterior limb of internal capsule, optic radiation, corona radiata. Thereafter, the myelin-typical signal in the different regions of the brain should be present at the following ages (M = months): anterior limb of internal capsule (2 M: T1w; 7 M: T2w), splenium of corpus callosum (4 M: T1w; 6 M: T2w), genu of corpus callosum (6 M: T1w; 8 M: T2w), centrum semiovale (2 M: T1w; 7 M: T2w). Branching of myelin into the gyri of the telencephalon (= arborization) appears at the latest at: occipital lobe (5 M: T1w; 12 M: T2w) and frontal lobe (7 M: T1w; 14 M: T2w). Conclusion: These extracted age limits can be used for a more reliable assessment of myelination than the time-tables from a single study.
Schlüsselwörter:
Myelinisierung - Magnetresonanztomographie - Altersgrenzen - Metaanalyse
Key words:
Myelination - Magnetic resonance imaging - Age limits - Meta-analysis
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26 Staudt M, Grodd W. Normale Entwicklung des kindlichen Gehirns. In: Reiser M, Semmler W (eds.) Magnetresonanztomographie. Berlin, Heidelberg, New York; Springer Verlag (im Druck) 3. Auflage
Dr. med. Martin Staudt
Universitäts-Kinderklinik, Abteilung 3
Hoppe-Seyler-Straße 1
72 076 Tübingen
Phone: 07071/2981320
Fax: 07071/295473
Email: martin.staudt@med.uni-tuebingen.de
