Aspekte der Bildgebung des Hippokampus

Der Hippokampus kann von einer Vielzahl von Erkrankungen betroffen sein, die ähnliche klinische Befunde aufweisen. Ein Bildgebungsalgorithmus zur Einteilung in noduläre (raumfordernde) und nicht noduläre Erkrankungen kann bei der Eingrenzung der Differenzialdiagnostik helfen. Ein solcher Algorithmus wird im vorliegenden Beitrag vorgestellt.

Kernaussagen

• Die MRT ist das bevorzugte bildgebende Verfahren zur Beurteilung des Hippokampus, aber auch die CT und die Nuklearmedizin können zur Analyse beitragen. Bei Läsionen des Hippokampus bietet die FDG-PET in der Regel eine größere Genauigkeit als die Perfusions-SPECT. Die FDG-PET ist der SPECT als Ergänzung zur MRT bei der Differenzialdiagnose von neurodegenerativen Erkrankungen überlegen.

• Der von den Autoren vorgeschlagene Algorithmus zur Differenzialdiagnose von Läsionen des Hippokampus berücksichtigt morphologische Aspekte: nicht noduläre gegenüber nodulären Läsionen, unilaterale gegenüber bilateralen Läsionen und das Muster von Volumenveränderungen oder von Diffusionseinschränkungen.

• Eine bilaterale Hippokampusbeteiligung spricht für eine systemische Ursache wie eine toxisch-metabolische, degenerative, inflammatorische (z.B. Autoimmunerkrankung) oder infektiöse Erkrankung (z.B. Herpesenzephalitis). Eine unilaterale Beteiligung wird häufiger mit einer Neoplasie, einer degenerativen Ursache (z.B. FTD), mesialer Temporalsklerose, Ischämie oder transitorischer globaler Amnesie in Verbindung gebracht.

• Eine Volumenreduktion findet sich z.B. bei der Alzheimer-Krankheit oder der FTLD, eine Veränderung der DWI-Signalintensität u.a. bei Herpes-simplex-Enzephalitis, iktalen Veränderungen oder transienter globaler Amnesie.

• Bei nodulären Läsionen wird zwischen zystischen Läsionen (z.B. Fissura-choroidea-Zyste oder Gangliogliom), nicht zystischen Läsionen (z.B. Neurofibromatose Typ 1) und solchen mit T1w Hyperintensität (u.a. neurokutane Melanose und angiozentrisches Gliom) unterschieden.

Schlüsselwörter

Hippokampus - Bildgebung - Differenzialdiagnose - Algorithmus

Publikationsverlauf

Artikel online veröffentlicht:
13. Juli 2023

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