Funktionelle Diagnostik von Wirbelsäulenerkrankungen in der MRT

Zusammenfassung

Die Magnetresonanztomographie (MRT) ist der Goldstandard in der Diagnostik von Wirbelsäulenerkrankungen. Konventionelle T1- und T2-Sequenzen sind jedoch oft unspezifisch und korrelieren nur bedingt mit den zugrundeliegenden mikrostrukturellen Veränderungen. Moderne MRT-Techniken wie quantitatives MRT (qMRT), funktionelle MRT (fMRT), Magnetresonanzspektroskopie (MRS) und die transmagnetische Stimulation (TMS) bieten die Möglichkeit, quantifizierbare Veränderungen zu erfassen, die mit der mikrostrukturellen und funktionalen Integrität des Rückenmarks korrelieren. Dadurch werden neue Einblicke in die Pathophysiologie von Wirbelsäulenerkrankungen geliefert und somit ein umfassenderes Bild des Krankheitsbildes wie auch Schwere ermöglicht. Modalitätsspezifische Parameter, welche mit dem Ausmaß der Verletzung und der neurologischen Erholung korrelieren, können als wichtige Biomarker in der Zukunft dienen. Sie haben das Potenzial die diagnostische Genauigkeit zu verbessern, eine individuelle Prognoseabschätzung zu liefern wie auch Risikogruppen zu definieren und im Rahmen von randomisierten klinischen Studien als Endpunkte zu dienen, um den Effekt neuer Therapien zu evaluieren. Davor gilt es technische Herausforderungen zu überwinden und im Rahmen größerer, multizentrischer Studien die vielversprechenden Ergebnisse zu validieren, bevor es zu einer klinischen Translation kommt.

Abstract

Magnetic Resonance Imaging (MRI) is the gold standard in diagnosing spinal diseases. However, conventional T1- and T2-weighted sequences are often non-specific and correlate only partially with the underlying microstructural changes. Modern MRI techniques such as quantitative MRI (qMRI), functional MRI (fMRI), Magnetic Resonance Spectroscopy (MRS), and Transcranial Magnetic Stimulation (TMS) offer the possibility to detect quantifiable changes that correlate with the microstructural and functional integrity of the spinal cord. This provides new insights into the pathophysiology of spinal diseases, offering a more comprehensive understanding of the condition and its severity. Modality-specific parameters that correlate with the extent of injury and neurological recovery may serve as important biomarkers in the future. They have the potential to improve diagnostic accuracy, provide individual prognostic assessments, define risk groups, and serve as endpoints in randomized clinical trials to evaluate the effects of new therapies. Before clinical translation, however, technical challenges must be overcome, and promising results must be validated in larger, multicenter studies.

Schlüsselwörter

MRT - DTI - Quantitatives MRT - TMS - fMRT

Keywords

MRI - DTI - quantitative MRI - TMS - fMRI

Publication History

Article published online:
21 October 2024

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