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Nervenheilkunde 2013; 32(10): 725-732
DOI: 10.1055/s-0038-1633362
Demenz
Schattauer GmbH

Molekulare Bildgebung in der Diagnostik von Demenzen

Molecular imaging techniques in the diagnosis of dementia
J. Kurth
1   Universitätsmedizin Rostock Klinik und Poliklinik für Nuklearmedizin
,
I. Kilimann
2   Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Standort Rostock-Greifswald
3   Universitätsmedizin Rostock Zentrum für Nervenheilkunde Klinik und Poliklinik für Psychosomatische Medizin
,
B. J. Krause
1   Universitätsmedizin Rostock Klinik und Poliklinik für Nuklearmedizin
,
S. Teipel
2   Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Standort Rostock-Greifswald
3   Universitätsmedizin Rostock Zentrum für Nervenheilkunde Klinik und Poliklinik für Psychosomatische Medizin
› Author Affiliations
Further Information

Publication History

eingegangen am: 10 May 2013

angenommen am: 17 May 2013

Publication Date:
02 February 2018 (online)

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Zusammenfassung

Durch die Entwicklung molekularer Marker der zerebralen Amyloidablagerung in vivo hat die Positronenemissionstomografie (PET) eine zentrale Rolle für die Definition präklinischer und prädemenzieller Stadien der Alzheimer Krankheit erlangt. Darüber hinaus haben länger etablierte nuklearmedizinische Marker eine wichtige Funktion bei der Differenzial- und Frühdiagnose demenzieller Erkrankungen. Untersuchungen mit FDG-PET zeigen typische Muster eines kortikalen Hypo metabolismus, der die Ausprägung kognitiver Defizite in klinischen Verlauf prädiziert und eine hohe diagnostische Trennschärfe zwischen Frühstadien einer Alzheimer Krankheit und einer Erkrankung aus dem Formenkreis der frontotemporalen Lobärdegenerationen aufweist. Dopamin-PET, Dopamintransporter-SPECT und Dopaminrezeptor-Tracer für PET und SPET sind frühe Indikatoren einer extrapyramidalmotorischen Beteiligung beim Parkinson-Syndrom. Der Beitrag erläutert die technischen Grundlagen der Verfahren und wesentliche klinische Befunde sowie diagnostische Anwendungen aus monozentrischen und multizentrischen Studien für die Früh und Prädemenzdiagnostik. Besonderes Gewicht legen wir auf die klinische Frage, die ein molekularer Marker beantworten kann, und die methodischen und heuristischen Grenzen der Verfahren, die insbesondere gegen einen unkritischen Einsatz der demnächst klinisch verfügbaren Amyloid-PET-Tracer für das Screenen asymptomatischer Personen außerhalb klinischer Studien sprechen.

Summary

The development of novel amyloid PET tracers has fuelled the definition of preclincial and predementia stages of Alzheimer’s disease. In addition, more widely established radioligands play an important role in the early and differential diagnosis of dementia. FDG-PET allows discrimination between Alzheimer’s disease dementia and frontotemporal lobe degeneration in very early stages of disease, patterns of regional cerebral hypometabolism predict the decline of cognitive functions in clinical follow-up. Dopamine PET, dopamine transporter SPECT and PET and SPECT tracers of dopamine receptor binding allow the detection of the extrapyramidal component in very early stages of Parkinson’s syndrome. The following article describes key methodology of molecular imaging techniques, including amyloid PET, FGD-PET, and dopamine PET and SPECT. A special emphasize is laid on the clinical application of a marker and the findings from recent mono- and multicenter diagnostic trials. We also point out the limitations of a given methodology, arguing for a context specific use of novel and established molecular markers that would preclude the use of amyloid PET for screening of asymptomatic subjects outside of well-defined clinical trials.

Schlüsselwörter

Amyloid - kortikaler Stoffwechsel - dopaminerges System - Prädemenzdiagnose

Keywords

Amyloid - cerebral hypometabolism - dopamine system - diagnosis of predementia
 

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