Zusammenfassung
Die diffusionsgewichtete Magnetresonanztomographie (MRT) hat inzwischen einen festen Platz in der radiologischen Diagnostik bei Erkrankungen des Zentralnervensystems (ZNS). Sie misst die Molekularbewegung von Wasser und erlaubt so die Charakterisierung der Mikrostruktur von Geweben. Ihre wichtigste Anwendung ist derzeit in der Frühdiagnostik der zerebralen Ischämie. Hier markiert sie das geschädigte Gewebe schon kurz nach dem Gefäßverschluss und liefert außerdem für die Therapie entscheidende Informationen über das bedrohte Gewebe. Auch bei vielen anderen ZNS-Erkrankungen ist die diffusionsgewichtete MRT diagnostisch bedeutsam. Sie wird daher zunehmend Bestandteil einschlägiger klinischer Untersuchungsprotokolle, etwa bei Hirntumoren, bei Schädelhirntraumen, bei De- und Dysmyelinisierungskrankheiten sowie bei entzündlichen oder degenerativen Erkrankungen. Obwohl Änderungen der MR-tomographisch gemessenen Diffusion kaum je pathognomonisch sind, erhält man doch pathophysiologisch aufschlussreiche Daten. Außerdem werden Gewebeveränderungen oft früher registriert als mit MR-Standardsequenzen. Ein weiteres wichtiges Anwendungsgebiet sind die Planung und Verfolgung von Biopsien und resektiven Operationen. Vor allem die Diffusionstensor-Bildgebung (Diffusion Tensor Imaging, DTI), die die Orientierung der Faserbündel der weißen Hirnsubstanz wiedergibt, lässt sich gewinnbringend bei der Operationsplanung einsetzen. Mithilfe des DTI kann aber auch eine veränderte Konnektivität zwischen zerebralen Funktionszentren nachgewiesen werden. Daher ist dieses MR-Verfahren hochrelevant für die Diagnostik von Erkrankungen der weißen Hirnsubstanz wie auch für Grundlagenstudien zur Reifung und zur Alterung des Gehirns.
Abstract
Diffusion magnetic resonance imaging (MRI) has become an important tool in the radiologic diagnosis of diseases of the brain as it measures molecular motion of water that characterizes the microstructure of tissues. Its most important clinical use to date is the early detection of cerebral ischemia by revealing the ischemic injury shortly after vessel occlusion and simultaneously providing therapy-relevant information on the tissue at risk. Furthermore, diffusion MRI is diagnostically promising in other diseases of the brain and is thus increasingly becoming part of routine clinical protocols in the diagnosis of tumors, inflammation, trauma, demyelination, dysmyelination and neurodegeneration. Although abnormalities of diffusion are generally not pathognomonic, diffusion MRI affords information about tissue changes for specific disorders that complements information obtained with standard MR techniques and frequently shows pathology earlier. In addition, diffusion MRI can be applied to plan, guide and follow-up biopsies or resective surgery. Particularly diffusion tensor imaging (DTI), which displays the orientation of white matter fibers, holds promise for improved surgical planning. Moreover, DTI can be used to detect changes in connectivity between functional brain areas. Therefore, DTI is highly relevant not only in advancing the knowledge of white matter diseases but also in stimulating research on normal brain development and brain aging.
Key words
Magnetic resonance imaging - diffusion - brain - edema
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Prof. Dr. Klaus Sartor
Abteilung Neuroradiologie, Neurologische Klinik, Universitätsklinikum Heidelberg
Im Neuenheimer Feld 400
69120 Heidelberg
Phone: 06221/567566
Fax: 06221/564673
Email: klaus_sartor@med.uni-heidelberg.de
