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Klinische Neurophysiologie 2003; 34(4): 176-181
DOI: 10.1055/s-2003-812579
Originalia
© Georg Thieme Verlag Stuttgart · New York

Stellenwert der Positronenemissionstomographie (PET) in der Epilepsiediagnostik

Ranking of Positron Emission Tomography (PET) in Epilepsy DiagnosticsM.  J.  Koepp1 , A.  Hammers1
  • 1Department of Clinical and Experimental Epilepsy, Institute of Neurology, and National Hospital for Neurology and Neurosurgery, London, and MRC Clinical Sciences Centre, Hammersmith Hospital, London, UK
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Publication History

Publication Date:
09 January 2004 (online)

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Zusammenfassung

Untersuchungen mittels Positronenemissionstomographie (PET) haben zum pathophysiologischen und biochemischen Verständnis fokaler und generalisierter Epilepsien wesentlich beigetragen. H2 15O PET erlaubt Aussagen zum regionalen zerebralen Blutfluss (rZBF) und 18F-Fluorodeoxyglukose(FDG)-PET zum Glukosestoffwechsel. Iktale PET-Aufnahmen mit H2 15O sind wegen der 2-minütigen Halbwertszeit üblicherweise nicht planbar. Iktale 18F-FDG-PET-Aufnahmen sind wegen der protrahierten Aufnahme von FDG schwer zu interpretieren. Untersuchungen des rZBF und Glukosestoffwechsels geben nur indirekte Hinweise auf synaptische Aktivität. Neurotransmitter sind direkt verantwortlich für die Steuerung neuronaler Aktivität und PET erlaubt die quantitative Erfassung spezifischer Liganden-Rezeptor-Verhältnisse, die für die Entstehung und Weiterleitung epileptischer Aktivität von Bedeutung sind. Klinisch von Bedeutung sind: 1. 11C-Flumazenil (FMZ), das den GABAA-Rezeptor darstellt, und 2. 11C-Diprenorphin (DPN), das mit ähnlicher Affinität an μ-, κ- und δ-Opioidrezeptoren bindet. Die Koregistrierung struktureller Informationen ist zur genauen Interpretation funktioneller PET-Daten notwendig. Falls pathologische Strukturveränderungen in der MRT vorliegen, wie beispielsweise Hippokampussklerosen, muss für Teilvolumeneffekte korrigiert werden. Teilvolumeneffekte sind nichtlinear und betreffen bevorzugt kleinere Strukturen, so dass diese eine scheinbare Aktivitätsminderung oder sogar Aktivitätssteigerung („spill-over”) aufweisen. In dieser Übersichtsarbeit stellen wir zunächst PET-Untersuchungen bei idiopathisch-generalisierten Epilepsien (IGE) vor, gefolgt von einer nach Glukosestoffwechsel, Blutfluss und Neurotransmitterveränderungen gegliederten Auflistung von PET-Untersuchungen bei fokalen Epilepsiesyndromen.

Abstract

Studies using positron emission tomography (PET) have advanced our pathophysiological and biochemical understanding of focal and generalised epilepsies. H2 15O PET allows quantification of cerebral blood flow (rCBF), and 18F-fluorodeoxyglucose (FDG)-PET quantification of cerebral glucose metabolism. Ictal H2 15O PET studies are difficult because of its short half-life (2 min), ictal 18F-FDG-PET are difficult to interpret due to its prolonged uptake. H2 15O and 18F-FDG-PET are only indirect markers of neuronal activity. Neurotransmitters are directly responsible for modulating synaptic activity and PET allows quantification of specific ligand-receptor relationships which are important for epileptogenesis and spread of epileptic activity. Clinically important are: (1) 11C-flumazenil (FMZ), which images GABAA-receptors, and (2) 11C-diprenorphin (DPN), which has similar affinity to μ-, κ- and δ-opioid receptors. Co-registration of structural information is essential for the exact interpretation of functional PET data. Correction for partial volume effects is important if there are structural pathological changes, e. g. hippocampal sclerosis. Partial volume effects are non-linear and are of particular importance for small structures, leading to under- or even overestimation (spill-over) of true activity. In this review, we first present PET studies in idiopathic generalised epilepsies, followed by a summary of PET studies investigating glucose metabolism, rCBF and neurotransmitter changes in focal epilepsies.

Key words

PET - rCBF - glucose metabolism - neurotransmitter - epilepsies

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Dr. Matthias J. Koepp

Chalfont Centre for Epilepsy · Chalfont St. Peter

Chesham Lane · Gerrards Cross

Buckinghamshire SL9 0RJ · U. K.

Email: mkoepp@ion.ucl.ac.uk