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Radiologie up2date 2020; 20(04): 343-359
DOI: 10.1055/a-1133-9290
Neuroradiologie

Diagnosekriterien bei Multipler Sklerose: ein Update

Multiple Sclerosis Diagnostic Criteria – an Update
Stefan Weidauer
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Widmung

Herrn Prof. Dr. med. W. Firnhaber zum 90. Geburtstag gewidmet.

Zusammenfassung

Neben der klinisch-neurologischen Untersuchung spielt auch die MRT in der Diagnostik und der Verlaufsbeurteilung der Multiplen Sklerose eine wesentliche Rolle. In dieser Übersicht werden die mit der 2017er-Revision der McDonald-Kriterien einhergehenden Änderungen erläutert und differenzialdiagnostische Aspekte, sog. „green flags“ und „red flags“, dargestellt.

Abstract

In addition to clinical neurological examination, MRI is of major importance in the diagnosis and assessment of the course of multiple sclerosis. In this overview, the changes associated with the current 2017 revision of the McDonald criteria are explained and differential diagnostic aspects, so-called green and red flags, are presented.

Kernaussagen

  • Die McDonald-Kriterien sollen nur bei Patienten im Alter zwischen 18 und 50 Jahren mit dem klinischen Verdacht einer MS und sorgfältiger Abklärung der Differenzialdiagnosen angewendet werden.

  • Für die Prognose der MS ist die möglichst frühe und korrekte Diagnose entscheidend.

  • Es werden typische neurologische („green flags“) und atypische („red flags“) klinische Befunde für die Verdachtsdiagnose einer MS definiert.

  • Eine MS-assoziierte hyperintense Läsion in der MRT (T2w Aufnahmen) muss definierte bildmorphologische Kriterien erfüllen, insbesondere ≥ 3 mm in der Längsachse messen.

  • Zur Bestimmung der räumlichen Dissemination (DIS) können nicht nur juxtakortikale, sondern auch kortikale Läsionen gewertet werden.

  • Die Anzahl der 4 ZNS-Kompartimente (juxta-/kortikal, periventrikulär, infratentoriell, spinal) bei Beurteilung der räumlichen Dissemination (DIS) ist gleich geblieben.

  • MRT-Läsionen im N. opticus werden in den McDonald-Kriterien nicht berücksichtigt.

  • Zur Bestimmung der zeitlichen Dissemination (DIT) wird nicht mehr zwischen symptomatischen und asymptomatischen Läsionen unterschieden.

  • Bei fehlender zeitlicher Dissemination (DIT) in der MRT kann dies durch den Nachweis spezifischer oligoklonaler Banden (OKB) im Liquor ersetzt werden.

  • Die differenzialdiagnostische Abgrenzung der Neuromyelitis optica Spectrum Disorders (NMOSD) mit Nachweis von AQP4-IgG-Antikörpern und spezifischen Läsionsmustern in der MRT ist essenziell.

Schlüsselwörter

Multiple Sklerose - McDonald-Kriterien

Key words

multiple sclerosis - McDonald criteria


Publication History

Article published online:
27 November 2020

© 2020. Thieme. All rights reserved.

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