Nuklearmedizinische Diagnostik beim Parkinson-Syndrom

Zusammenfassung

Mittels Positronen-Emissions-Tomografie (PET) bzw. Single-Photonen-Emissions-Computer-Tomografie (SPECT) und radioaktiven Markern können Veränderungen auf molekularer Ebene in vivo dargestellt werden. So lässt sich mittels Dopamin-Transporter-SPECT die Degeneration nigrostriataler dopaminerger Projektionen bei Patienten mit einer Parkinson-Krankheit (Morbus Parkinson, MP) sensitiv erfassen. Diese Verfahren haben jedoch nicht nur zum Verständnis der Pathophysiologie des MP beigetragen, sondern bieten mittlerweile in Fällen schwieriger differenzialdiagnostischer Entscheidungen eine valide Hilfe in der klinischen Routine, so zum Beispiel in der Abgrenzung des MP vom essenziellen Tremor, von einem arzneimittelinduzierten Parkinson-Syndom (PS), in der Differenzialdiagnostik atypischer PS bzw. in der Unterscheidung einer Demenz vom Lewy-Körperchen-Typ und einer Alzheimer-Demenz. Der vorliegende Artikel gibt eine Übersicht zur diagnostischen Wertigkeit der Dopamin-Transporter- und -D₂-Rezeptor-SPECT in Klinik und Praxis unter Berücksichtigung weiterer bildgebender Verfahren.

Abstract

By means of positron emission tomography (PET) or, respectively, single photon emission computed tomography (SPECT) with labelled markers, changes at the molecular level can be demonstrated in vivo. For example, dopamine transporter SPECT can sensitively detect the degeneration of nigrostriatal dopaminergic projections in patients with Parkinson's disease (PD). However, these procedures have not only contributed to our understanding of the pathophysiology of PD but also now offer a valid aid in difficult differential diagnostic decisions in clinical routine. Some such examples are the delineation of PD from essential tremor, from a drug-induced Parkinsonian syndrome (PS), in the differential diagnosis of atypical PS or for distinguishing between dementia of the Lewy body type and one of Alzheimer's disease. The present article presents a review of the diagnostic utility of dopamine transporter and D2-receptor SPECT in clinical routine with consideration of other imaging procedures.

Schlüsselwörter

Parkinson-Syndrom - Dopamin - Dopamin-Transporter - SPECT - nuklearmedizinische Bildgebung

Key words

Parkinsonian syndrome - dopamine - dopamine transporter - SPECT - radionuclide imaging

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