FDG-PET in der Demenzdiagnostik

Zusammenfassung

Sozioökonomisch gesehen ist die zunehmende Prävalenz der neurodegenerativen Demenzerkrankungen und insbesondere der Alzheimer-Demenz (AD) aufgrund der Zunahme der Lebenserwartung unserer alternden Bevölkerung eines der ernsthaftesten Probleme. Insofern besteht künftig im Rahmen zu entwickelnder neuer Therapiestrategien ein zunehmender Bedarf an Biomarkern, die eine Frühdiagnose der Demenzerkrankungen zulassen und das in Stadien bevor neuronale Schädigungen eingetreten sind. Für die AD, als häufigste Demenzform, ist bekannt das Alzheimer-assozierte neuropathologische Veränderungen im Gehirn bereits Jahrzehnte vor Auftreten erster klinischer Symptome auftreten, was bedeutet, dass klinische kognitive Biomarker, auf denen derzeit die Diagnose einer Demenzerkrankung basiert, es nicht erlauben werden, Frühdiagnostik in präklinischen bzw. asymptomatischen Erkrankungsstadien zu betreiben. Daher besteht ein offensichtlicher Bedarf an zusätzlichen, sensitiveren Biomarkern, wie sie u. a. in der Bildgebung zu finden sind. Die [¹⁸F]FDG-PET ist als Surrogatmarker der neuronalen Funktion, was die Bildgebung betrifft, die am besten validierte Methode, die nicht-invasiv eine frühe und akkurate Bestimmung AD-Pathologie-basierter neuronaler Funktionsstörungen im Hinblick auf die Vorhersagekraft einer Alzheimer-Demenz zulässt. Es existieren derzeit keine vergleichbar hochwertigen, über mehrere Jahrzehnte systematisch erhobenen Daten, was die Hirnbildgebung angeht. Ziel dieses Artikels ist es, die für die unterschiedlichen neurodegenerativen Demenzerkrankungen jeweils typischen [¹⁸F]FDG-PET-Veränderungsmuster aufzuzeigen sowie den Stellenwert der [¹⁸F]FDG-PET in der Frühdiagnostik, Differenzialdiagnose und in der Verlaufskontrolle dieser Erkrankungen darzulegen.

Abstract

Due to an increase of life expectancy in our aging population neurodegenerative dementia diseases and especially Alzheimer’s Dementia (AD) will form one of the most serious medical and social economical problems in the upcoming decades. Therefore there is a need for biomarkers, which allow an early, preclinical diagnosis of neurodegenerative dementia before neuronal loss is evident in order not to delay new treatment strategies. In AD, the most common form of dementia, Alzheimer-associated neuropathological brain changes occur decades before the onset of first clinical symptoms, what implies that the currently established clinical cognitive biomarkers will not allow for an early diagnosis in preclinical/asymptomatical disease stages. This limitation can be overcome by more sensitive i.e. brain imaging biomarkers, which may complement clinical diagnostic work-up. [¹⁸F]FDG-PET, a surrogate marker of neuronal function, is a uniquely well-validated and highly sensitive method for the non-invasive detection of AD-based functional neuronal changes and has a high predictive value concerning conversions in AD.

Aim of the current article is to present the typical [¹⁸F]FDG-PET brain metabolic findings for each of the most common neurodegenerative dementias and to discuss the value of [¹⁸F]FDG-PET in the early diagnosis, differential diagnosis and follow-up of these diseases.·

Schlüsselwörter

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

Key words

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

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