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DOI: 10.1055/s-2001-14990
© Georg Thieme Verlag Stuttgart · New York
Creutzfeldt-Jakob-Krankheit:
Stellenwert der MRT
Creutzfeldt-Jakob Disease: The Value of MRI
Publikationsverlauf
Publikationsdatum:
31. Dezember 2001 (online)
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Zusammenfassung.
Ziel: Bestimmung des Stellenwerts der MRT in der Diagnostik der Creutzfeldt-Jakob-Krankheit (CJK). Methoden: Analyse der MRTs von 14 innerhalb von drei Jahren mit Verdacht auf CJK zugewiesenen Patienten. Korrelation der MRTs mit den entsprechend den WHO-Diagnosekriterien etablierten Untersuchungsverfahren (Klinik, EEG, Liquor mit 14-3-3 Protein-Nachweis). Ergebnisse: 12 Patienten hatten eine CJK, jeweils ein Patient hatte eine Hashimoto-Enzephalitis bzw. einen ALS-Demenz-Komplex. Bei 9 der 12 CJK-Patienten fanden sich beidseits Signalerhöhungen des Striatum (n = 8), des Pulvinar thalami (n = 5) und/oder des Kleinhirn- bzw. Großhirnkortex (n = 3). Die Signalerhöhungen waren am deutlichsten auf FLAIR-Aufnahmen erkennbar; 6 mit diffusionsgewichteter MRT untersuchte Patienten wiesen eine eingeschränkte Diffusion dieser Areale auf. Beide Patienten ohne CJK wiesen die o. g. Signalveränderungen nicht auf (Sensitivität 75 %, Spezifität und positiver Vorhersagewert 100 %). Schlussfolgerung: Werden CJK-Patienten mit FLAIR- und diffusionsgewichteten Sequenzen untersucht, so lässt sich die Erkrankung mit hoher Sicherheit nachweisen bzw. ausschließen. Typische MRT-Befunde engen die Differenzialdiagnose ein und sollten in die WHO-Diagnosekriterien einbezogen werden.
Creutzfeldt-Jakob Disease: The Value of MRI.
Purpose: To define the role of MRI in the diagnosis of Creutzfeldt-Jakob disease (CJD). Methods: 14 patients with suspected CJD were studied within 3 years. MRI findings were correlated with WHO established diagnostic criteria (clinical findings, EEG, CSF with 14-3-3 protein assay). Results: 12 patients had CJD. One patient each suffered from Hashimoto's encephalitis and ALS dementia complex, respectively. Nine of 12 CJD patients had increased signal intensity of the striatum (n = 8), pulvinar thalami (n = 5) and/or cerebellar and cerebral cortex (n = 3), respectively. Signal intensity was most pronounced on FLAIR sequences; six patients were studied with diffusion-weighted MRI and showed impaired diffusion in these areas. Both patients without CJD did not show the abovementioned signal changes (sensitivity 75 %, specificity and positive predictive value 100 %, respectively). Conclusion: If patients with suspected CJD are studied with FLAIR and diffusion-weighted sequences, this disorder can reliably be proven or ruled out. Typical MRI findings narrow down the differential diagnosis and should be included in the WHO diagnostic criteria.
Schlüsselwörter:
Creutzfeldt-Jakob-Krankheit - Magnetresonanztomographie - MRT
Key words:
Creutzfeldt-Jakob Disease - CJD - Magnetic resonance imaging - MRI
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PD Dr. H. Urbach
Radiologische Klinik, Neuroradiologie, Universität Bonn
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