Zerebrale Bildgebung bei Demenzen: State-of-the-Art

Zusammenfassung

Neben der klinischen und neuropsychologischen Untersuchung sowie der Liquoranalytik ist die zerebrale Bildgebung ein zentraler Baustein in der Differenzialdiagnostik von Demenzen. Mithilfe moderner Bildgebungsverfahren können die pathophysiologischen Korrelate von Demenzerkrankungen direkt auf der Struktur- und Funktionsebene nachgewiesen werden. In der Forschung gehört die individuelle ätiologische Differenzierung primärer Demenzerkrankungen mittels bildbasierter Biomarker bereits zum Standard, ebenso die Identifikation prodromaler (prädemenzieller) Erkrankungsstadien sowie die Verlaufs- und Therapiekontrolle mit bildbasierten Progressionsmarkern. Die hierzu entwickelten Protokolle und Verfahren gelangen jetzt zunehmend in die klinische Routine und finden neben der früher im Vordergrund stehenden Ausschlussdiagnostik Eingang in nationale und internationale Leitlinien zur Demenzdiagnostik. Die vorliegende Übersichtsarbeit fasst den aktuellen Stand der Demenzbildgebung in der klinischen Routine unter Berücksichtigung etablierter magnetresonanztomografischer und nuklearmedizinischer Untersuchungstechniken zusammen.

Abstract

Beside the clinical examination, neuropsychological testing and cerebrospinal fluid analysis imaging of the brain is a vital component in the diagnostic work-up of dementias. Using state-of-the-art imaging techniques it is possible to visualise pathophysiological correlates of primary dementias at a structural and even functional level. In a scientific context the individual differentiation of neurodegenerative disorders, as well as the identification of prodromal states and the monitoring of progression using imaging biomarkers are already standard practice. These validated protocols are now entering clinical routine. This development away from the diagnosis by an exclusion approach of former days is increasingly reflected in national and international guidelines and assists an earlier individual dementia screening. This review aims to give a survey about the current state of these imaging routines for the most prevalent types of dementia focusing on magnetic resonance and nuclear imaging.

Schlüsselwörter

primäre Demenzerkrankungen - Differenzialdiagnostik - bildbasierte Biomarker - Magnetresonanztomografie - Nuklearmedizin

Keywords

primary dementias - differential diagnosis - imaging biomarkers - magnetic resonance imaging - nuclear imaging

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