Update Amyloid-Bildgebung in der Diagnostik der Neurodegeneration

Zusammenfassung

Die Amyloid-PET Bildgebung stellt ein modernes, zugelassenes Verfahren der molekularen Bildgebung dar, welches den Nachweis der für die Alzheimer-Erkrankung (AE) typischen Amyloid-Plaque-Ablagerungen im Gehirn in vivo ermöglicht. Diese Methode hat erstmals die Möglichkeit eröffnet, neurodegenerative Erkrankungen durch den direkten nicht invasiven Nachweis oder Ausschluss einer spezifischen Neuropathologie ätiologisch diagnostisch näher einzuordnen. Ein positiver Amyloid-Scan kann auf das Vorliegen einer für die AE typischen Pathologie hinweisen, ist aber nicht gleichbedeutend mit der Diagnose einer Demenz. Ein negativer Amyloid-Scan macht das Vorliegen einer ablaufenden AE dagegen sehr unwahrscheinlich. Das bildgebende Verfahren ist dabei alleine nicht ausreichend für eine Diagnosestellung, sondern muss im Kontext mit der klinisch/neuropsychologischen Information interpretiert werden. Die Amyloid-Bildgebung kann das Vorliegen von Amyloid-Ablagerungen schon in frühen Erkrankungsstadien, wie bei der leichten kognitiven Störung, visualisieren und damit auch von prognostischem Nutzen sein. Differenzialdiagnostisch kann die Amyloid-Bildgebung einerseits symptomatisch atypische Erscheinungsformen der AE identifizieren und andererseits auch klinisch fälschlich als Alzheimer-Demenz imponierende Erkrankungen anderer Ursache ausschließen. Einen klaren Stellenwert hat die Amyloid-Bildgebung darüber hinaus als Einschlusskriterium für neue Therapieverfahren, die sich gegen die Amyloid-Ablagerungen richten.

Abstract

Amyloid PET imaging represents an approved molecular imaging technique allowing the detection of amyloid plaque deposits in the brain in vivo, which are representing a hallmark of Alzheimer's disease. This method has for the first time opened up the possibility to approach neurodegenerative diseases by direct non-invasive detection or exclusion of specific neuropathology. A positive amyloid scan may indicate the presence of pathology typical of Alzheimer's disease, but is not synonymous with a diagnosis of dementia. A negative amyloid scan, on the other hand, makes the presence of ongoing Alzheimer's disease very unlikely. In this regard, imaging alone is not sufficient to make a diagnosis, but must be interpreted in the context of clinical/neuropsychological information. Amyloid imaging may detect amyloid deposits in early stages of disease, such as in mild cognitive impairment, and thus also can be of prognostic value. With respect to differential diagnosis, amyloid imaging can identify atypical manifestations of Alzheimer’s disease on the one hand, and on the other hand, exclude diseases of other causes that clinically falsely appear as Alzheimer’s dementia. Furthermore, amyloid imaging has a clear value as an inclusion criterion for new therapeutic procedures directed against amyloid deposits.

Schlüsselwörter

Alzheimer Demenz - ß-Amyloid - Plaques - Amyloid-Bildgebung - Tangles - Tau-Bildgebung - PET

Keywords

Alzheimer’s disease - ß-Amyloid - plaques - Amyloid imaging - tangles - Tau imaging - PET

Publication History

Article published online:
02 December 2022

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