Differenzialdiagnostik des neurodegenerativen Parkinson-Syndroms mit nuklearmedizinischen Verfahren

 

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Zusammenfassung

Die korrekte Differenzierung der atypischen Parkinson-Syndrome (APS; Multisystematrophie, MSA; progressive supranukleäre Blickparese, PSP; kortikobasale Degeneration, CBD) vom idiopathischen Parkinson-Syndrom (Morbus Parkinson, PD) ist von herausragender therapeutischer und prognostischer Bedeutung. In der vorliegenden Übersichtsarbeit werden die typischen Befunde, ihre neuropathologischen Korrelate und die diagnostische Wertigkeit der in der klinischen Routine eingesetzten nuklearmedizinischen Verfahren erörtert und kritisch bewertet. Nach aktuellem Kenntnisstand erlaubt die [¹⁸F]FDG-PET eine sehr genaue Trennung zwischen PD und APS und ist hierbei der [¹²³I]FP-CIT- und [¹²³I]IBZM-SPECT sowie [¹²³I]MIBG-Szintigrafie deutlich überlegen. Zudem ermöglicht die [¹⁸F]FDG-PET als einziges der vorgenannten Verfahren eine zuverlässige Differenzierung zwischen den APS-Subgruppen. Aktuelle Studien untersuchen zudem den möglichen Nutzen der [¹⁸F]FDG-PET für die Risikostratifizierung hinsichtlich Demenz bei PD-Patienten. Ist die [¹⁸F]FDG-PET nicht verfügbar, bietet sich nach Meinung der Autoren vorrangig die [¹²³I]IBZM-SPECT oder die SPECT der regionalen zerebralen Perfusion an, wobei der diagnostische Nutzen der letzteren bisher nur unzureichend untersucht wurde.

Abstract

Correct differentiation between atypical parkinsonian syndromes (APS; multiple system atrophy, MSA; progressive supranuclear palsy, PSP; corticobasal degeneration, CBD) from idiopathic Parkinson’s disease (PD) is of paramount therapeutic and prognostic importance. In the present review article typical imaging findings, their neuropathological correlates and the diagnostic values of routinely used nuclear medicine procedures are discussed and critically evaluated. According to current knowledge, [¹⁸F]FDG-PET provides a very high diagnostic accuracy in differentiating PD and APS, which is clearly superior to the accuracy of [¹²³I]FP-CIT- or [¹²³I]IBZM-SPECT and [¹²³I]MIBG szintigraphy. Furthermore, [¹⁸F]FDG-PET is the only of the aforementioned techniques that allows for a reliable differentiation also between APS sub-groups. Current studies investigate the possible value of [¹⁸F]FDG-PET for risk stratification for dementia in PD. If [¹⁸F]FDG-PET is not available, in the authors’ opinion [¹²³I]IBZM-SPECT or SPECT imaging of regional cerebral perfusion should be preferred instead, although the diagnostic value of perfusion SPECT has not been properly validated so far.

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