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Differenzialdiagnose der Parkinson-Syndrome mittels MRT

Differential diagnosis of parkinsonian syndromes using MRI

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Zusammenfassung

Die Differenzialdiagnose der Parkinson-Syndrome ist auch für den Erfahrenen schwierig zu stellen. Trotz Leitlinien, die die Diagnose der unterschiedlichen Parkinson-Syndrome (PS) wie die des Morbus Parkinson (MP) und der atypischen Parkinson-Syndrome (aPS), welche die Multisystematrophie (MSA), die progressive supranukleäre Blickparese (PSB) und die kortikobasale Degeneration (CBD) beinhalten, erleichtern sollen, gibt es eine hohe Rate an Fehldiagnosen. Jedoch ist eine frühe Differenzierung zwischen diesen neurodegenerativen Erkrankungen mit jeweils sehr unterschiedlichen Krankheitsverläufen insbesondere in Hinblick auf Prognose und Therapie sehr wichtig. Die Magnetresonanztomographie (MRT) hat trotz gewisser Einschränkungen die Differenzialdiagnose der neurodegenerativen Parkinson-Syndrome zweifellos erleichtert. In der klinischen Praxis ist die konventionelle MRT mit T1- und T2-gewichteten Sequenzen als Methode zum Ausschluss symptomatischer Ursachen etabliert, sie kann aber auch bildmorphologische Hinweise für das Vorliegen eines aPS geben. Des Weiteren können auch neuere Verfahren wie die diffusionsgewichtete Bildgebung hilfreich in der Abgrenzung von aPS sein.

Summary

The differential diagnosis of parkinsonian syndromes is considered one of the most challenging in clinical neurology. Despite published consensus operational criteria for the diagnosis of Parkinson’s disease (PD) and the various atypical parkinsonian disorders (APD), such as progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and corticobasal degeneration (CBD), the clinical separation of APDs from PD carries a high rate of misdiagnosis. However, the early differentiation between APD and PD, each characterized by a very different natural history, is crucial for determining the prognosis and choosing a treatment strategy. Despite limitations the various modern magnetic resonance imaging (MRI) techniques have undoubtedly added to the differential diagnosis of neurodegenerative parkinsonism. In clinical practice conventional MRI with visual assessment of T2 and T1-weighted imaging is a well established method for the exclusion of symptomatic parkinsonism due to other pathologies and may also point to the diagnosis of APD. Furthermore, advances in MRI techniques, such as diffusion-weighted imaging (DWI), have enabled abnormalities in the basal ganglia and infratentorial brain structures in APD to be quantitatively illustrated.

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Authors and Affiliations

  1. Universitätsklinik für Neurologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich

    P. Mahlknecht &  K. Seppi

  2. Universitätsklinik für Radiologie 1, Medizinische Universität Innsbruck, Innsbruck, Östterreich

    M. Schocke

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  1. P. Mahlknecht
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Correspondence to K. Seppi.

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Mahlknecht, P., Schocke, M. & Seppi, K. Differenzialdiagnose der Parkinson-Syndrome mittels MRT. Nervenarzt 81, 1168–1179 (2010). https://doi.org/10.1007/s00115-010-3022-8

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