Zusammenfassung
Die Multiple Sklerose (MS) ist die häufigste entzündliche, demyelinisierende Erkrankung des zentralen Nervensystems (ZNS). Sie ist durch multifokale, disseminierte Entzündungsherde, sogenannte Plaques, in den myelinhaltigen Strukturen des ZNS charakterisiert. In der Magnetresonanztomographie (MRT) sind multiple umschriebene, rundlich-ovale Läsionen der weißen Substanz charakteristisch, die bevorzugt im periventrikulären Marklager, an der Mark-Rindengrenze, im Hirnstamm und im Kleinhirn lokalisiert sind. Neuere Untersuchungen zeigen, dass die sichtbaren Entmarkungsherde nur die Spitze des Eisbergs sind: Bereits frühzeitig verursacht die MS neuroaxonale Schäden und zieht zudem das gesamte Hirnparenchym einschließlich der normal erscheinenden weißen Substanz in Mitleidenschaft. Ausdruck dieser Veränderungen sind stark hypointense Läsionen in T1-Gewichtung sowie eine frühzeitig beginnende Hirnvolumenminderung, die Reduktion des neuronalen Markers N-acetylaspartat (NAA) in der Spektroskopie, ein verminderter Magnetisierungstransfer-Quotient „magnetization transfer ratio” (MTR) und erleichterte Diffusion bzw. verminderte Diffusionsanisotropie. Die MRT ist wichtiger Bestandteil der Diagnosestellung u. a. durch den Nachweis der charakteristischen zeitlichen und räumlichen Disseminierung. Diagnostische Kriterien erhöhen die Spezifität der sehr sensitiven MRT und erleichtern die Differenzierung gegenüber anderen Erkrankungen mit multifokalen Veränderungen der weißen Substanz.
Abstract
Multiple sclerosis (MS) is the most common demyelinating inflammatory disease of the central nervous system (CNS), presenting with multifocal, disseminated inflammatory lesions referred to as plaques. Magnetic resonance imaging (MRI) typically depicts multiple, round to oval, circumscript lesions predominantly involving periventricular and subcortical white matter, brainstem and cerebellum. More recent investigations have demonstrated that the macroscopically visible plaques only present the tip of the iceberg: Already early in its course, MS causes neuroaxonal damage and diffusely involves the entire brain parenchyma including normal appearing white matter. These changes are reflected by strongly T1w hypointense lesions and atrophy of early onset, by reduction of the neuronal Marker N-acetylaspartate (NAA) on spectroscopy, by a decrease of the magnetization transfer ratio (MTR), by an increased in diffusibility and decreased anisotropy on diffusion-weighted imaging (DWI). MRI imaging is an important tool in the diagnosis of MS by revealing the characteristic spatial and temporal dissemination of the cerebral and spinal manifestations of this disease. Diagnostic criteria increase the diagnostic specificity and allow better differentiation from other diseases with multifocal white matter abnormalities.
Key words
Multiple sclerosis - inflammatory CNS diseases - demyelination - MRI
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Dr. med. I. Harting
Abteilung Neuroradiologie, Neurologische Klinik, Universitätsklinikum Heidelberg
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