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Radiologisch-isoliertes Syndrom

Wenn nur das MRT „Multiple Sklerose“ sagt

Radiologically isolated syndrome

Multiple sclerosis based solely on MRI findings?

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Zusammenfassung

Der zunehmende Einsatz der Magnetresonanztomographie (MRT) in der Neurologie hat auch einen Zuwachs an inzidentellen Befunden mit sich gebracht. Eine adäquate Einschätzung von bislang asymptomatischen Patienten, bei denen für eine Multiple Sklerose (MS) typische zerebrale Läsionen im Sinne eines Zufallsbefundes nachgewiesen wurden, war bislang aufgrund der fehlenden Studienlage nicht hinreichend möglich. Erfüllen die MRT-Befunde auch noch die Kriterien für eine räumliche Dissemination nach Barkhof-Tintoré und können Differenzialdiagnosen der MS nicht bestätigt werden, spricht man von einem sog. radiologisch-isolierten Syndrom.

In dieser Übersichtsarbeit werden die aktuellen Arbeiten zum radiologisch-isolierten Syndrom erörtert sowie Diagnosekriterien und therapeutische Überlegungen vorgestellt. In zwei Studien konnte gezeigt werden, dass ein Teil der Patienten mit einem radiologisch-isolierten Syndrom ein erhöhtes Risiko aufweist, zeitnah sowohl eine radiologische Progression als auch ein klinisches Erstereignis zu erleiden. Das radiologisch-isolierte Syndrom ist daher als mögliches Vorstadium zum Erstereignis einer MS einzustufen und zieht tiefer gehende therapeutische Überlegungen nach sich. Angesichts der unbefriedigenden Datenlage wird auf den Neurologen neben differenzialdiagnostischen Überlegungen eine umfassende Beraterrolle zukommen. In dieser Arbeit fassen wir das Wissen über das radiologisch-isolierte Syndrom zusammen und schlagen ein pragmatisches Vorgehen für die weitere Diagnostik und Therapie vor.

Summary

Incidental brain magnetic resonance imaging (MRI) findings are the result of an increasing usage of MRI in the diagnostic work-up of patients. An adequate assessment of patients in which brain lesions typical for multiple sclerosis (MS) are determined but who have been asymptomatic so far is problematic, especially when Barkhof-Tintoré criteria for spatial dissemination are fulfilled and no other differential diagnosis can be confirmed. This entity, the so-called radiologically isolated syndrome, constitutes a major diagnostic and therapeutic challenge. Two recent studies revealed that a subgroup of patients with radiologically isolated syndrome are at high risk for near-term development of MR-based progression and occurrence of the first clinical event. Hence, the radiologically isolated syndrome has to be classified as a possible preliminary phase of the clinical manifestation of MS in a subgroup of patients and entails in-depth therapeutic considerations. This article covers the current literature for this syndrome and, in the absence of official guidelines, provides a pragmatic diagnostic and therapeutic approach for patient management.

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Danksagung

Wir bedanken uns bei Rechtsanwalt Herbert Wartensleben für die Beratung zur rechtlichen Situation der Kostenübernahme durch die Krankenkassen.

Interessenkonflikte

Der korrespondierende Autor weist auf folgende Beziehungen hin: JS und LS geben an, dass keine Interessenkonflikte bestehen. MM hat finanzielle Mittel für Forschungsprojekte von der Firma Merck-Serono erhalten. BH hat Referentenhonorare und finanzielle Mittel für Forschungsprojekte von den Firmen Bayer, Biogen Idec, Merck-Serono und Teva erhalten.

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  1. Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland

    J. Sellner, L. Schirmer, B. Hemmer & M. Mühlau

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  1. J. Sellner
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  2. L. Schirmer
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Correspondence to J. Sellner.

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Sellner, J., Schirmer, L., Hemmer, B. et al. Radiologisch-isoliertes Syndrom. Nervenarzt 81, 1208–1217 (2010). https://doi.org/10.1007/s00115-010-2998-4

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