FDG-PET in der Differenzialdiagnostik neurodegenerativer Demenzerkrankungen

Zusammenfassung

Die PET des Gehirns mit dem Glukoseanalogon [¹⁸F]FDG wird seit Jahrzehnten in der Diagnostik und Differenzialdiagnostik von Demenzerkrankungen eingesetzt, insbesondere bei klinisch unklarem Verdacht auf eine neurodegenerative Ätiologie. Während die FDG-PET in der Frühdiagnostik der Alzheimer-Krankheit künftig wahrscheinlich zunehmend durch spezifische Biomarker für Amyloid-Pathologie, z. B. die Amyloid-PET, ersetzt wird, ist davon auszugehen, dass sie in der Differenzialdiagnostik von Demenzerkrankungen weiterhin eine wichtige Rolle spielen wird.

Im vorliegenden Übersichtsartikel werden daher Grundlagen und aktueller Stellenwert der Hirn-[¹⁸F]FDG-PET in der Differenzialdiagnostik neurodegenerativer Demenzerkrankungen in der klinischen Patientenversorgung dargelegt. Darüber hinaus geht der Artikel auf methodische Aspekte von Patientenvorbereitung, Datenakquisition und (automatischer) Datenanalyse ein. Abschließend werden kurz mögliche Alternativverfahren wie die Hirnperfusions-SPECT und -MRT diskutiert.

Abstract

PET of the brain with the glucose analog [¹⁸F]FDG is successfully used since decades to support the diagnosis and differential diagnosis of dementia, particularly in patients with clinically uncertain suspicion of a neurodegenerative etiology. In the early diagnosis of Alzheimer’s disease, FDG-PET might be replaced by biomarkers of amyloid pathology in the future. However, we expect that FDG-PET will continue to play an important role in the differential diagnosis of dementias.

This review article elucidates the basic principles and the current value of brain-[¹⁸F]FDG-PET in the differential diagnosis of neurodegenerative diseases in everyday clinical patient care. Furthermore, the article discusses some important methodological aspects of patient preparation, data acquisition and (automatic) data analysis, as well as alternative imaging methods such as perfusion SPECT and perfusion MRI of the brain.

Schlüsselwörter

Alzheimer-Demenz - MCI - LKS - PET - [¹⁸F]FDG - Hirnmetabolismus

Key words

Alzheimer’s dementia - MCI - PET - [¹⁸F]FDG - brain metabolism

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