Nuklearmedizinische Differenzialdiagnostik der Parkinson-Syndrome: Update 2016

Zusammenfassung

In der neuen S3-Leitlinie zur Diagnostik und Therapie des idiopathischen Parkinson-Syndroms (Morbus Parkinson, PD) werden dezidierte Empfehlungen zur Differenzialdiagnose des unklaren neurodegenerativen Parkinson-Syndroms (PS) mit nuklearmedizinischen Verfahren gegeben. In der vorliegenden Übersichtsarbeit wird die diagnostische Wertigkeit der betreffenden Verfahren anhand der aktuellen Literaturlage vorgestellt und im Kontext der Leitlinienempfehlung bewertet. Die [¹²³I]FP-CIT-SPECT der präsynaptischen Dopamintransporter-Verfügbarkeit und die [¹²³I]IBZM-SPECT der vorrangig postsynaptischen Dopamin-D2/D3-Rezeptor-Verfügbarkeit erlauben keine ausreichende diagnostische Trennung zwischen PD und den sog. atypischen Parkinson-Syndromen (APS). Sie sollten somit für diese Fragestellung nicht eingesetzt werden. Die Szintigrafie der sympathischen myokardialen Innervation erlaubt eine Trennung zwischen PD und der Multisystematrophie (MSA) mit moderater diagnostischer Genauigkeit und kann somit für diese Fragestellung eingesetzt werden. Eine sehr genaue Differenzierung zwischen PD und APS bzw. den APS untereinander ermöglicht hingegen die [¹⁸F]FDG-PET, die entsprechend der aktuellen Leitlinie zur bestmöglichen differenzialdiagnostischen Zuordnung eines PS eingesetzt werden kann. Zudem besitzt die [¹⁸F]FDG-PET entsprechend aktueller Studien wahrscheinlich eine hohe prognostische Aussagekraft bez. des Gesamtüberlebens von Patienten mit einem PS bzw. der Entwicklung einer kognitiven Störung bei PD.

Abstract

Recent German S3 guidelines for the diagnosis and treatment of Parkinson’s disease (PD) provide recommendations for the differential diagnosis of neurodegenerative parkinsonian syndromes (PS) of uncertain etiology by radionuclide imaging techniques. In the present review, we will critically discuss the diagnostic value of these methods with reference to the current literature and in the context of the recommendation of the recent guidelines. [¹²³I]FP-CIT SPECT of presynaptic dopamine transporter availability and [¹²³I]IBZM SPECT of predominantly postsynaptic dopamine D2/D3 receptor availability do not allow for a sufficient differentiation between PD and the so-called atypical PS (APS). Thus, they should not be applied for this purpose. [¹²³I]MIBG scintigraphy of sympathetic myocardial innervation permits a differentiation between PD and multiple system atrophy (MSA) with moderate diagnostic accuracy. Thus, it might be applied for his purpose. In contrast, [¹⁸F]FDG PET achieves a very accurate differentiation between PD and APS as well as between different APS variants. Thus, according to the recent guidelines, [¹⁸F]FDG PET might be applied to achieve optimal differential diagnosis of PS. Furthermore, recent publications indicate a probable prognostic value of [¹⁸F]FDG PET concerning overall survival of PS patients and development of cognitive impairments in PD patients.

Schlüsselwörter

Leitlinie - Parkinson-Syndrom - SPECT - PET - Dopaminrezeptor - Dopamintransporter - myokardiale Innervation - zerebraler Glukosemetabolismus

Key words

guideline - parkinsonism - SPECT - PET - dopamine receptor - dopamine transporter - myocardial innervations - cerebral glucose metabolism

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