Klinische funktionelle Magnetresonanztomographie (fMRT): Physiologische Grundlagen, technische Aspekte und Anforderungen für die klinische Anwendung

Zusammenfassung

Leistungsfähige Gradientensysteme und ultraschnelle Echo-Planar-Imaging (EPI-)MR-Sequenzen ermöglichen heute die nichtinvasive Messung und Abbildung von Hirnfunktionen mit hoher räumlicher und zeitlicher Auflösung in klinisch vertretbaren Untersuchungszeiten. Die funktionelle Magnetresonanztomographie (fMRT) erschließt damit der Radiologie und Neuroradiologie ein neues diagnostisches Feld mit einem Paradigmenwechsel von der rein morphologischen Abbildung von Hirnstrukturen hin zur Messung und Visualisierung von Hirnfunktionen. Auch wenn die fMRT bereits erfolgreich bei neurochirurgischen, neurologischen, psychiatrischen, neuropädiatrischen und Schmerzpatienten eingesetzt wurde, kann die Untersuchungsmethode derzeit noch nicht als klinisch-diagnostisch etabliert angesehen werden. Voraussetzung ist die Entwicklung praktikabler Stimulationssysteme, standardisierter Untersuchungsprotokolle und medizinisch zugelassener Auswertungsprogramme. Außerdem werden die Vermittlung von Spezialkenntnissen an diagnostisch tätige Ärzte und die Schulung des medizinisch-technischen Assistenzpersonals eine Schlüsselrolle bei der Weiterentwicklung der klinischen fMRT einnehmen. Diese Arbeit gibt einen Überblick über die neurophysiologischen Grundlagen der fMRT und über die Anforderungen an Messtechnik und Datenauswertung im Hinblick auf klinische Anwendungen. Die klinische Bedeutung der fMRT wird am Beispiel der prächirurgischen Diagnostik bei Patienten mit Hirntumoren dargestellt.

Summary

The advent of powerful gradient systems and ultrafast echo-planar imaging (EPI) offers the opportunity to use magnetic resonance imaging to measure and to localize brain function with high spatio-temporal resolution in clinically feasible scanning times. Functional magnetic resonance imaging (fMRI) opens up a new diagnostic field in radiology and neuroradiology with a change from pure morphological brain imaging to the measurement and visualization of brain function. Despite its successful application in neurosurgical, neurological, psychiatric, neuropediatric and pain patients fMRI has not yet reached the status of an established clinical diagnostic procedure. To this end special stimulation systems, standardized fMRI protocols and medically approved software, all dedicated to clinical application, are necessary. The training and teaching of doctors and radiographers will also be crucial for the progress of clinical fMRI. This paper gives an overview of the neurophysiological background, the technical requirements and the data processing strategies that are relevant for the clinical application of fMRI. Presurgical fMRI in patients with brain tumors is used as an example for the clinical relevance of the method.

fMRT - Klinische Anwendung - Neuroradiologie - Operation - Hirntumor

fMRI - Clinical application - Neuroradiology - Operation - Brain tumor

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