Zerebrale Mikroblutungen: Leitfaden für den Nachweis und die klinische Relevanz bei verschiedenen Krankheitsbildern^[1]

Zusammenfassung

Zerebrale Mikroblutungen sind mittlerweile ein wichtiger neuer Bildgebungsmarker für zerebrale Mikroangiopathien. Die Entwicklung von magnetresonanztomografischen Methoden, die besonders empfindlich für paramagnetische Blutprodukte sind, wie beispielsweise T2*-gewichtete Gradientenecho- und suszeptibilitätsgewichtete Sequenzen, hat den Nachweis von Mikroblutungen bei einer zunehmend größeren Zahl von Patienten in Schlaganfall- und Gedächtnissprechstunden sowie bei gesunden älteren Menschen und bei einer Vielzahl von anderen, selteneren Erkrankungen und Syndromen ermöglicht. Der Nachweis zerebraler Mikroblutungen ist für die Diagnose der zugrunde liegenden Mikroangiopathie, für die Sicherheit der Behandlung mit Antithrombotika und bezüglich der Gefahr einer symptomatischen intrazerebralen Blutung, aber auch bei kognitiver Beeinträchtigung und Demenz von klinischer Bedeutung. Dieser Fortbildungsbeitrag beruht auf einer umfassenden Literaturrecherche und eigenen Befunden aus Forschung und klinischer Praxis und bietet einen Leitfaden für den Nachweis und die klinische Relevanz von zerebralen Mikroblutungen bei verschiedenen Krankheitsbildern.

Abstract

Cerebral microbleeds have emerged as an important new imaging marker of cerebral small vessel disease. With the development of MRI techniques that are exquisitely sensitive to paramagnetic blood products, such as T2*-weighted gradient-recalled echo and susceptibility-weighted sequences, microbleeds have been detected in ever-increasing numbers of patients in stroke and cognitive clinics, as well as in healthy older people and in a variety of other rarer diseases and syndromes. Detection of cerebral microbleeds has clinical implications with respect to the diagnosis of the underlying small vessel disease, the safety of antithrombotic use, and the risk of symptomatic intracerebral haemorrhage, cognitive impairment and dementia. This article provides a guide to the detection and clinical relevance of cerebral microbleeds in different conditions based on a comprehensive review of the literature and own findings in research and clinical practice.

Kernaussagen

• Zerebrale Mikroblutungen sind auf T2*w GRE- oder SWI-MRT-Sequenzen als kleine, rundliche, homogene, hypointense Herde definiert.

• Zerebrale Mikroblutungen gehen vorwiegend mit 2 Arten sporadischer Mikroangiopathie einher: hypertoner Arteriopathie oder zerebraler Amyloidangiopathie.

• Zerebrale Mikroblutungen sind in der allgemeinen älteren Bevölkerung sehr häufig und stehen mit einer Reihe von Erkrankungen in Zusammenhang, darunter ischämischer Schlaganfall, spontane intrazerebrale Blutung, Morbus Alzheimer, vaskuläre kognitive Beeinträchtigung sowie eine Vielzahl anderer, seltenerer Krankheitsbilder.

• Die immer besser funktionierende Erkennung von zerebralen Mikroblutungen hat klinische Konsequenzen für die Diagnose der zugrunde liegenden Mikroangiopathie, für die Sicherheit der Behandlung mit Antithrombotika und anderer therapeutischer Maßnahmen sowie für das Risiko einer intrazerebralen Blutung und einer kognitiven Beeinträchtigung.

¹ © 2013 Springer-Verlag Berlin Heidelberg. All rights reserved. Originally published in English in Neuroradiology 2013; 55: 655 – 674. Online published in 10.1007/s00234-013-1175-4. Translated and reprinted with permission of Springer-Verlag Berlin Heidelberg. Springer-Verlag Berlin Heidelberg is not responsible for any inaccuracy or error arising from the translation from English to German.

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