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Nuklearmedizin 1998; 37(07): 245-250
DOI: 10.1055/s-0038-1632342
Originalarbeiten — Original Articles
Schattauer GmbH

Zur klinischen Wertigkeit der zerebralen Dopamin-D2-Rezeptorszintigraphie

On the Clinical Impact of Cerebral Dopamine D2 Receptor Scintigraphy
R. Larisch
1   Klinik für Nuklearmedizin
,
A. Klimke
2   Psychiatrische Klinik der Heinrich-Heine-Universität Düsseldorf. Deutschland
› Author Affiliations
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Publication History

Eingegangen: 19 February 1998

Publication Date:
03 February 2018 (online)

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Zusammenfassung

Die vorliegende Arbeit gibt eine Übersicht über Befunde und klinische Indikationen zur Dopamin-D2-Rezeptorszintigraphie. Methoden zur Untersuchung der D2-Rezeptoren sind die Positronen-Emissions-Tomographie (PET) mit 11C- oder 18F-markierten Butyrophenonen oder Benza- miden oder die Einzelphotonen-Emissions-Tomographie (SPECT) mit 123l-lodobenzamid (IBZM). Die wichtigste neurologische Indikation ist die Differentialdiagnose des Parkinsonismus: In frühen Stadien des Morbus Parkinson findet sich eine Erhöhung der Striatalen D2-Rezeptorbin- dung (D2-RB) im Vergleich zu gesunden Normalpersonen. Patienten mit einem Steele-Richardson-Olszewski-Syndrom oder einer Multisystem- atrophie hingegen, die therapeutisch schwierig einzustellen sind, zeigen eine Verringerung der striatalen D2-RB. Das ebenfalls abzugrenzende medikamentös induzierte Parkinson-Syndrom beruht auf einer Blockade der D2-Rezeptoren, die durch die Dopamin-D2-Rezeptorszintigraphie nachgewiesen werden kann. Weitere mögliche Indikationen bestehen in der Psychiatrie: Bei schizophrenen Patienten, die mit Neuroleptika behandelt werden, ist die Bestimmung der »Receptor Occupancy« sinnvoll, um die optimale Medikamentendosis zu bestimmen. Außerdem ermöglicht die D2-Rezeptorszintigraphie bei diesen Patienten die Differentialdiagnose zwischen dem malignen Neuroleptikasyndrom und der febrilen Katatonie. Bei Suchterkrankungen könnte die Methode möglicherweise zur Prädiktion und Verlaufskontrolle neurochemischer Veränderungen im Rahmen einer Entwöhnungsbehandlung genutzt werden. Bei der Depression schließlich kann die Bestimmung der D2-RB die Wahl der Therapie für den Kliniker vereinfachen: Neue klinische Befunde deuten an, daß Patienten mit niedriger D2-RB gut auf eine medikamentöse Therapie ansprechen, während bei Patienten mit hoher D2-RB u.a. eine Schlafentzugsbehandlung aussichtsreich ist.

Summary

The present review describes findings and clinical indications for the dopamine D2 receptor scintigraphy. Methods for the examination of D2 receptors are positron emission tomography (PET) using 11C- or 18F-labelled butyrophenones or benzamides or single photon emission tomography (SPECT) using 123l-iodobenzamide (IBZM) respectively. The most important indication in neurology is the differential diagnosis of Parkinsonism: patients with early Parkinson’s disease show an increased D2 receptor binding (D2-RB) compared to control subjects. However, patients suffering from Steele-Richardson-Olszewski-Syndrome or Multiple System Atrophy show a decreased D2-RB and are generally non-responsive to treatment. Postsynaptic blockade of D2 receptors results in a drug induced Parkinsonian syndrome, which can be diagnosed by D2 scintigraphy. Further possible indications occur in psychiatry: the assessment of receptor occupancy is useful in schizophrenic patients treated with neuroleptics. Additionally, D2 receptor scintigraphy might help to clarify the differential diagnosis between neuroleptic malignant syndrome and lethal catatonia. The method might be useful for supervising neurobio- chemical changes in drug dependency and during withdrawal. Assessment of dopamine D2 receptor binding can simplify the choice of therapy in depressive disorder: patients showing a low D2 binding are likely to improve following an antidepressive drug treatment whereas sleep deprivation is promising in patients with high D2 binding.

Schlüsselwörter

Dopamin - Neurologie - Psychiatrie - Dopamin-D2-Rezeptoren - PET - SPECT

Keywords

Dopamine - neurology - psychiatry - dopamine D2 receptor - PET - SPECT - Review
 

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