Tau-PET Bildgebung der Demenzerkrankungen

Zusammenfassung

Die Ablagerung von Tau-Proteinen ist ein grundlegendes pathophysiologisches Merkmal vieler neurodegenerativer Demenzerkrankungen. Die Entwicklung sensitiver Tau-PET Tracer in den letzten Jahren hat die Lokalisation von Tau-Ablagerungen in unterschiedlichen klinischen neurodegenerativen Phänotypen in vivo ermöglicht. Bei der Alzheimer Demenz sind die räumlichen Muster der Tau-Pathologie in temporalen, parietalen und frontalen Regionen mit der Neurodegeneration und klinischen Symptomatik korreliert. Des Weiteren zeigen sich Zusammenhänge mit der Schwere der kognitiven Beeinträchtigung und der gemessenen Tau-Last, sodass Tau-PET in Zukunft einen hohen Nutzen in der klinischen Anwendung zugesprochen werden könnte. Bei primären Tauopathien, neurodegenerative Erkrankungen wie z.B. PSP und CBD, deren dominantes pathophysiologisches Merkmal die Ansammlung von Tau-Proteinen im Gehirn sind, steht die Validierung der wissenschaftlich genutzten Tau-PET Tracer noch aus, aber erste Hinweise aus Studien mit Tau-PET Tracern der zweiten Generation sind vielversprechend. Diese zeigen, dass die räumliche Verteilung der Tracer-Anreicherung bei primären Tauopathien von dem räumlichen Verteilungsmuster bei der Alzheimer Demenz unterschieden werden kann.

Dennoch fehlen aktuell wichtige Validierungsstudien, die in größeren Kohorten den direkten klinischen Nutzen der Tau-PET Bildgebung belegen. Auf der anderen Seite haben die bisherigen wissenschaftlichen Erkenntnisse, die durch die Tau-PET Bildgebung gewonnen wurden, bereits einen wesentlichen Beitrag zum Zusammenhang von Tau-Pathologie und Neurodegeneration geleistet.

Abstract

Tauopathies are a fundamental pathophysiological feature of many neurodegenerative disorders. The development of sensitive tau-PET tracers in recent years has enabled the study of pathophysiological tau deposition in different clinical neurodegenerative phenotypes. In Alzheimer’s dementia (AD), patterns of tau pathology in temporal, parietal, and frontal regions are associated with measures of neurodegeneration and clinical symptomatology. Furthermore, correlations with the severity of cognitive impairment in AD patients and the measured tau load could be established, underscoring the potential utility of tau-PET Imaging in the clinical routine. For primary tauopathies, validation of the currently available tau-PET tracers is still pending, but initial indications from studies with second-generation tau-PET tracers seem promising. Accumulative initial evidence shows that the spatial distribution of tracer activity in primary tauopathies (i.e., PSP or CBD) can be distinguished from the spatial distribution pattern of in vivo tau-PET in AD. Nevertheless, important validation studies demonstrating the direct clinical utility of tau-PET imaging in larger cohorts are currently lacking. On the other hand, the scientific knowledge gained by tau-PET imaging has made a significant contribution to our understanding of the relationship between tau pathology and neurodegeneration.

Schlüsselwörter

Tauopathien - Alzheimer Demenz - Tau-PET Tracer - Bildgebung

Keywords

Tauopathies - Alzheimer’s Disease - tau PET tracers - imaging

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