Infektiöse Hirnerkrankungen: Bildgebung und differenzialdiagnostische Aspekte

Zusammenfassung

Infektionen des Zentralnervensystems müssen häufig in differenzialdiagnostische Erwägungen einbezogen werden, vor allem bei immungeschwächten Personen. Die neuroradiologische Bildgebung, darunter fortgeschrittene Techniken wie diffusionsgewichtete MRT und Perfusions-MRT, leisten einen entscheidenden Beitrag zur Abgrenzung der verschiedenen Hirninfektionen untereinander und gegenüber anderen, z. B. neoplastischen Erkrankungen. In dieser Übersicht stellen wir die radiologischen Phänomene der wichtigsten Infektionen des Gehirns bei Erwachsenen und Kindern vor und diskutieren ausführlich differenzialdiagnostische Aspekte.

Abstract

Infectious diseases of the central nervous system have to be considered in differential diagnosis particularly in immunocompromised persons. Neuroimaging, specifically advanced techniques such as diffusion weighted MRI and perfusion MRI contribute much to the differentiation of brain infections and for differentiating brain infections from other, for instance, neoplastic diseases. In this review we present the imaging criteria of the most important brains infections in adults and in pediatric patients and discuss differential diagnostic aspects in detail.

Key words

Central nervous system; Brain; infectious diseases; Meninges; Inflammation; Imaging

Literatur

• 1 Maschke M, Kastrup O, Forsting M, Diener H C. Update on neuroimaging in infectious central nervous system disease.  Curr Opin Neurol. 2004;  17 (4) 475-480
• 2 Kennedy P G. Neurological infection.  Lancet Neurol. 2004;  3 (1) 13
• 3 Struffert T, Reith W. Herpes simplex virus encephalitis: neuroradiologic differential diagnosis.  Radiologe. 2000;  40 (11) 1011-1016
• 4 Launes J, Siren J, Valanne L, Salonen O, Nikkinen P, Seppalainen A M, Liewendahl K. Unilateral hyperfusion in brain-perfusion SPECT predicts poor prognosis in acute encephalitis.  Neurology. 1997;  48 (5) 1347-1351
• 5 Falcone S, Post M J. Encephalitis, cerebritis, and brain abscess: pathophysiology and imaging findings.  Neuroimaging Clin N Am. 2000;  10 (2) 333-353
• 6 Roos K L. Encephalitis.  Neurol Clin. 1999;  17(4) 813-833
• 7 Weber W, Henkes H, Felber S, Janisch W, Schaper J, Kuhne D. Diagnostic imaging in viral encephalitis.  Radiologe. 2000;  40 (11) 998-1010
• 8 Post M J, Yiannoutsos C, Simpson D, Booss J, Clifford D B, Cohen B, McArthur J C, Hall C D. Progressive multifocal leukoencephalopathy in AIDS: are there any MR findings useful to patient management and predictive of patient survival? AIDS Clinical Trials Group, 243 Team.  AJNR Am J Neuroradiol. 1999;  20 (10) 1896-1906
• 9 Happe S, Lunenborg N, Rickert C H, Heese C, Reichelt D, Schuierer G, Schul C, Husstedt I W. Progressive multifocal leukoencephalopathy in AIDS. Overview and retrospective analysis of 17 patients.  Nervenarzt. 2000;  71 (2) 96-104
• 10 Bakshi R. Neuroimaging of HIV and AIDS related illnesses: a review.  Front Biosci. 2004;  9 632-646
• 11 de Luca A, Cingolani A, Linzalone A, Ammassari A, Murri R, Giancola M L, Maiuro G, Antinori A. Improved detection of JC virus DNA in cerebrospinal fluid for diagnosis of AIDS-related progressive multifocal leukoencephalopathy.  J Clin Microbiol. 1996;  34 (5) 1343-1346
• 12 Kaiser R. The clinical and epidemiological profile of tick-borne encephalitis in southern Germany 1994 - 98: a prospective study of 656 patients.  Brain. 1999;  122 (Pt 11) 2067-2078
• 13 Hähnel S, Jost G, Knauth M, Sartor K. Current use and possible future applications of the magnetization transfer technique in neuroradiology.  Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2004;  176 (2) 175-182
• 14 Ernst T, Chang L, Witt M, Walot I, Aronow H, Leonido-Yee M, Singer E. Progressive multifocal leukoencephalopathy and human immunodeficiency virus-associated white matter lesions in AIDS: magnetization transfer MR imaging.  Radiology. 1999;  210 (2) 539-543
• 15 Kennedy P G. Viral encephalitis: causes, differential diagnosis, and management.  J Neurol Neurosurg Psychiatry. 2004;  75 (Suppl 1) 10-15
• 16 Poeck K, Hacke W. Neurologie. Vol. 11. Heidelberg; Springer-Verlag 2001: 758
• 17 Frey T K. Neurological aspects of rubella virus infection.  Intervirology. 1997;  40 (2 - 3) 167-175
• 18 Hartmann M, Heiland S, Sartor K. Functional MRI procedures in the diagnosis of brain tumors: Perfusion- and diffusion-weighted imaging.  Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2002;  174 (8) 955-964
• 19 Calfee D P, Wispelwey B. Brain abscess.  Semin Neurol. 2000;  20 (3) 353-360
• 20 Harting I, Hartmann M, Sartor K. Tumor simulating lesions on cranial MR imaging.  Rofo. 2004;  176 (3) 302-312
• 21 Sartor K, Hartmann M, Fiebach J, Harting I, Wilhelm T, Heiland S. Normal and abnormal water diffusion in the brain.  Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2003;  175 (10) 1317-1329
• 22 Hartmann M, Jansen O, Heiland S, Sommer C, Munkel K, Sartor K. Restricted diffusion within ring enhancement is not pathognomonic for brain abscess.  AJNR Am J Neuroradiol. 2001;  22 (9) 1738-1742
• 23 Moller-Hartmann W, Herminghaus S, Krings T, Marquardt G, Lanfermann H, Pilatus U, Zanella F E. Clinical application of proton magnetic resonance spectroscopy in the diagnosis of intracranial mass lesions.  Neuroradiology. 2002;  44 (5) 371-381
• 24 Bernaerts A, Vanhoenacker F M, Parizel P M, Van Goethem J W, Van Altena R, Laridon A, De Roeck J, Coeman V, De Schepper A M. Tuberculosis of the central nervous system: overview of neuroradiological findings.  Eur Radiol. 2003;  13 (8) 1876-1890
• 25 Shah G V. Central nervous system tuberculosis: imaging manifestations.  Neuroimaging Clin N Am. 2000;  10 (2) 355-374
• 26 Chang K H, Han M H. MRI of CNS parasitic diseases.  J Magn Reson Imaging. 1998;  8(2) 297-307
• 27 Del Brutto O H, Rajshekhar V, White A C jr, Tsang V C, Nash T E, Takayanagui O M, Schantz P M, Evans C A, Flisser A, Correa D, Botero D, Allan J C, Sarti E, Gonzalez A E, Gilman R H, Garcia H H. Proposed diagnostic criteria for neurocysticercosis.  Neurology. 2001;  57 (2) 177-183
• 28 Dumas J L, Visy J M, Belin C, Gaston A, Goldlust D, Dumas M. Parenchymal neurocysticercosis: follow-up and staging by MRI.  Neuroradiology. 1997;  39 (1) 12-18
• 29 Halperin J J. Neuroborreliosis: central nervous system involvement.  Semin Neurol. 1997;  17 (1) 19-24
• 30 Steinbach J P, Melms A, Skalej M, Dichgans J. Delayed resolution of white matter changes following therapy of B burgdorferi encephalitis.  Neurology. 2005;  64 (4) 758-759
• 31 Hengge U R, Tannapfel A, Tyring S K, Erbel R, Arendt G, Ruzicka T. Lyme borreliosis.  Lancet Infect Dis. 2003;  3 (8) 489-500
• 32 Collins S J, Lawson V A, Masters C L. Transmissible spongiform encephalopathies.  Lancet. 2004;  363 (9402) 51-61
• 33 Knight R S, Will R G. Prion diseases.  J Neurol Neurosurg Psychiatry. 2004;  75 (Suppl 1) 36-42
• 34 Prusiner S B. The prion diseases.  Brain Pathol. 1998;  8 (3) 499-513
• 35 Urbach H, Paus S, Tschampa H J, Keller E, Schild H H. [Creutzfeldt-Jakob disease: value of MRI].  Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 2001;  173 (6) 509-514
• 36 Collie D A, Summers D M, Sellar R J, Ironside J W, Cooper S, Zeidler M, Knight R, Will R G. Diagnosing variant Creutzfeldt-Jakob disease with the pulvinar sign: MR imaging findings in 86 neuropathologically confirmed cases.  AJNR Am J Neuroradiol. 2003;  24 (8) 1560-1569
• 37 Go J L, Kim P E, Ahmadi J, Seagall H D, Zee C S. Fungal infections of the central nervous system.  Neuroimaging Clin N Am. 2000;  10 (2) 409-425