Der Nervenarzt

, Volume 85, Issue 4, pp 445–458 | Cite as

Ultrahochfeld-MRT im Kontext neurologischer Erkrankungen

  • J. Kuchling
  • T. Sinnecker
  • I. Bozin
  • J. Dörr
  • V.I. Madai
  • J. Sobesky
  • T. Niendorf
  • F. Paul
  • J. Wuerfel
Übersichten
First Online:

Zusammenfassung

Die Ultrahochfeldmagnetresonanztomographie (UHF-MRT) rückt zunehmend in den Fokus des medizinischen Forschungsinteresses. Sie ermöglicht dank des exzellenten Signal-Rausch-Verhältnisses (SRV) bei Feldstärken ab 7 Tesla (T) eine Bildgebung mit hoher räumlicher Auflösung und verbesserten Kontrastmechanismen in vivo. Im Kontext neuroimmunologischer Erkrankungen wie der Multiplen Sklerose (MS), der Neuromyelitis optica (NMO) und des Susac-Syndroms ermöglicht die UHF-MRT eine detaillierte Einsicht in pathologische Prozesse z. B. hinsichtlich der Läsionsmorphologie und Venendichte. Des Weiteren können UHF-MRT-Biomarker wie die Sichtbarkeit einer zentralen Vene zunehmend zur differenzialdiagnostischen Unterscheidung dieser Krankheitsentitäten herangezogen werden. Bei vaskulären Erkrankungen zeichnet sich die UHF-MRT durch eine exzellente Darstellung normaler Gefäße, pathologischer Gefäßveränderungen und der Infarktmorphologie aus. Darüber hinaus können mithilfe der UHF-MRT im Bereich neurodegenerativer Erkrankungen neue diagnostische Marker definiert werden. Beispiele hierfür sind die Alterationen in der hippokampalen Formation bei Morbus Alzheimer und der Substantia nigra bei der Parkinson-Erkrankung. Bisherige Studien weisen jedoch Schwächen auf, wie geringe Fallzahlen, Selektionsbias oder verstärkte Neigung zu Bildartefakten. Ferner berücksichtigt das Studiendesgin vieler veröffentlichter Studien nicht die zunehmende klinische Bedeutung der Bildgebung bei einer Feldstärke von 3 T. Die Herausforderung der nahen Zukunft besteht darin, den bislang erzielten Erkenntnisgewinn, z. B. im Rahmen der Translation der Ergebnisse auf die 3-T-MRT, in der klinischen Routine zu etablieren. Langfristig ist die UHF-MRT als ein „high-end“-Diagnostikum bei sehr gezielten Fragestellungen denkbar, wenngleich diese neue Technologie aktuell nur einigen wenigen Forschungszentren zur Verfügung steht.

Das Potenzial der UHF-MRT in der modernen Diagnostik muss durch zukünftige Studien näher untersucht und ggf. für die moderne Medizin nutzbar gemacht werden.

Schlüsselwörter

Ultrahochfeld MRT 7 Tesla Multiple Sklerose Neurodegenerative Erkrankungen Schlaganfall 

Abkürzungsverzeichnis

3D TOF

3-D time-of-flight

ALS

amyotrophe Lateralsklerose

AQP4-AK

Aquaporin-4-Antikörper

CCSVI

chronische zerebrospinale venöse Insuffizienz

CIS

klinisch isoliertes Syndrom (clinically isolated syndrome)

DIR

double inversion recovery

DSA

digitale Subtraktionsangiographie

EDSS

Expanded Disability Status Scale

FLAIR

fluid attenuated inversion recovery

HF

Hochfeld

KL

kortikale Läsionen

KM

Kontrastmittel

LSA

lentikulostriatale Arterien

MPG

Medizinproduktegesetz

MPRAGE

magnetization prepared rapid gradient echo

MRA

Magnetresonanzangiographie

MRT

Magnetresonanztomographie

MS

Multiple Sklerose

NMO

Neuromyelitis optica

NMOSD

Neuromyelitis-optica-Erkrankungsspektrum (neuromyelitis optica spectrum disorder)

SAR

spezifische Absorptionsrate

SRV

Signal-Rausch-Verhältnis

T

Tesla

UHF

Ultrahochfeld

WML

Läsionen der weißen Hirnsubstanz (white matter lesions)

ZNS

Zentralnervensystem

Ultrahigh field MRI in context of neurological diseases

Summary

Ultrahigh field magnetic resonance imaging (UHF-MRI) has recently gained substantial scientific interest. At field strengths of 7 Tesla (T) and higher UHF-MRI provides unprecedented spatial resolution due to an increased signal-to-noise ratio (SNR). The UHF-MRI method has been successfully applied in various neurological disorders. In neuroinflammatory diseases UHF-MRI has already provided a detailed insight into individual pathological disease processes and elucidated differential diagnoses of several disease entities, e.g. multiple sclerosis (MS), neuromyelitis optica (NMO) and Susac’s syndrome. The excellent depiction of normal blood vessels, vessel abnormalities and infarct morphology by UHF-MRI can be utilized in vascular diseases. Detailed imaging of the hippocampus in Alzheimer’s disease and the substantia nigra in Parkinson’s disease as well as sensitivity to iron depositions could be valuable in neurodegenerative diseases. Current UHF-MRI studies still suffer from small sample sizes, selection bias or propensity to image artefacts. In addition, the increasing clinical relevance of 3T-MRI has not been sufficiently appreciated in previous studies. Although UHF-MRI is only available at a small number of medical research centers it could provide a high-end diagnostic tool for healthcare optimization in the foreseeable future. The potential of UHF-MRI still has to be carefully validated by profound prospective research to define its place in future medicine.

Keywords

Ultrahigh field MRI 7 Tesla Multiple sclerosis Stroke Neurodegenerative disease 
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Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Wuerfel ist Mitglied eines Beratungsgremiums für Novartis Pharma GmbH und erhielt in der Vergangenheit Reiseunterstützungen von Bayer Vital GmbH, Novartis Pharma GmbH und Genzyme GmbH. T. Sinnecker erhielt innerhalb der letzten 2 Jahre eine Reiseunterstützung von Bayer. T. Niendorf ist Geschäftsführer der MRI.TOOLS GmbH. J. Dörr erhält finanzielle Unterstützung von Forschungsprojekten durch Novartis Pharma GmbH und Bayer Vital GmbH, Vortragshonorare von Novartis Pharma GmbH, Bayer Vital GmbH, Teva GmbH und Genzyme GmbH, Reisekostenunterstützung durch Novartis Pharma GmbH, Merck-Serono GmbH, Teva GmbH. F. Paul erhielt Honorare für Vorträge, Reisekostenunterstützung und finanzielle Unterstützung von Forschungsprojekten durch Teva/Sanofi-Aventis, Bayer Schering, Merck Serono, Biogen Idec, Novartis, Unterstützung von Forschungsprojekten und Reisekostenvergütung durch die Guthy-Jackson Charitable Foundation und durch das Bundesministerium für Bildung und Forschung (BMBF – Kompetenznetz Multiple Sklerose). J. Kuchling, I. Bozin, V.I. Madai und J. Sobesky: keine Angaben. Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • J. Kuchling
    • 1
  • T. Sinnecker
    • 1
    • 2
  • I. Bozin
    • 1
  • J. Dörr
    • 1
    • 3
  • V.I. Madai
    • 4
    • 8
  • J. Sobesky
    • 4
    • 8
  • T. Niendorf
    • 5
    • 6
  • F. Paul
    • 1
    • 3
    • 4
    • 6
  • J. Wuerfel
    • 1
    • 5
    • 6
    • 7
  1. 1.NeuroCure Clinical Research CenterCharité – Universitätsmedizin Berlin, Campus MitteBerlinDeutschland
  2. 2.Klinik für Neurologie und Neurophysiologie, Asklepios Fachklinikum TeupitzTeupitzDeutschland
  3. 3.Klinisches und Experimentelles Forschungszentrum für Multiple Sklerose, Klinik für NeurologieCharité – Universitätsmedizin Berlin, Campus MitteBerlinDeutschland
  4. 4.Klinik und Poliklinik für NeurologieCharité – Universitätsmedizin Berlin, Campus MitteBerlinDeutschland
  5. 5.Berlin Ultrahigh Field Facility (B.U.F.F.)Max Delbrück Centrum für Molekulare MedizinBerlinDeutschland
  6. 6.Experimental and Clinical Research CenterCharité – Universitätsmedizin Berlin und Max Delbrück Centrum für Molekulare Medizin, Campus BuchBerlinDeutschland
  7. 7.Institut für NeuroradiologieUniversitätsmedizin GöttingenGöttingenDeutschland
  8. 8.Center for Stroke Research Berlin (CSB)Charité – Universitätsmedizin Berlin, Campus MitteBerlinDeutschland

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