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Diagnostik und Verlaufsbeurteilung der Multiplen Sklerose

Stellenwert der optischen Kohärenztomographie

Diagnosis and monitoring of multiple sclerosis

The value of optical coherence tomography

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Zusammenfassung

Neben der Schubaktivität und dem neurologischen Untersuchungsbefund spielt die magnetresonanztomographische (MRT-)Bildgebung bei der Verlaufsbeurteilung der Multiplen Sklerose (MS) derzeit eine Schlüsselrolle. Letztere ist jedoch zeit- und kostenintensiv und selbst in Deutschland nicht immer kurzfristig verfügbar. Vor allem diskriminiert das Routine-MRT aber nur unzureichend zwischen Demyelinisierung und Neurodegeneration und weist eine Diskrepanz zwischen Läsionslast und Behinderungsgrad auf. Die optische Kohärenztomographie (OCT) ist eine in der Ophthalmologie inzwischen gut validierte, nichtinvasive Methode zur Darstellung und Quantifizierung neurodegenerativer Prozesse der Retina, wie sie auch bei der MS und zahlreichen anderen neurologischen Erkrankungen auftreten. Darüber hinaus ist die OCT-Untersuchung im klinisch-ophthalmologischen Einsatz kostengünstig, mit geringem Zeitaufwand durchführbar, gut reproduzierbar und für den Patienten nicht belastend, mithin ideale Voraussetzungen für eine Anwendung als Verlaufsparameter bei neurologischen Erkrankungen. In dieser Übersicht werden die Hintergründe der OCT-Technik und ihre Bedeutung für die Diagnostik und Verlaufsevaluation der MS vorgestellt.

Summary

Besides the relapse rate and neurological examination, magnetic resonance imaging (MRI) plays a key role in multiple sclerosis (MS) monitoring. However, MRI is costly and even in Germany not always readily available. Additionally, routine MRI scans are not sensitive enough regarding differentiation between demyelination and neurodegeneration and show a discrepancy between lesion load and the degree of disability. In contrast, optical coherence tomography (OCT) is a validated non-invasive method for the quantification of neurodegenerative processes in the retina, as they appear in MS and other neurological diseases. The OCT is inexpensive, easy to handle and highly reproducible. Additionally, it is well tolerated and thus represents a promising tool for monitoring of neurodegenerative disorders. This article describes in detail the OCT technique and its usefulness for both diagnosis and monitoring of MS.

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Danksagung

Die in Abb. 1a verwendete histologische Darstellung der Retina wurde uns durch Dr. med. Andreas Winkelmann MSc. Institut für Vegetative Anatomie Centrum für Anatomie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, D-10117 Berlin zur Verfügung gestellt. Wir danken Susan Pikol für die exzellente logistische Unterstützung.

Interessenskonflikte

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: Markus Bock erhält Forschungsunterstützungen von „Das Myelin Projekt Deutschland e.V.“ und von der „Familie-Ernst-Wendt Stiftung“. Prof. Dr. med. Friedemann Paul ist aktiv im Steering Committee der OCTIMS-Studie (Novartis), erhält Forschungsunterstützung, Reisekostenunterstützung und Vortragshonorare von Teva, Sanofi Aventis, Bayer, Merck-Serono, Biogen, Novartis, Forschungsunterstützung von der Arthur Arnstein Stiftung und Reisekostenübernahme von der Guthy Jackson Charitable Foundation. Dr. med. Jan Dörr erhält finanzielle Unterstützung zu Forschungsprojekten von Novartis Pharma und Bayer Vital, erhielt Vortragshonorare von Novartis Pharma, Bayer Vital und TEVA und Reisekostenunterstützung von Novartis Pharma und Merck-Serono.

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Authors and Affiliations

  1. Experimental and Clinical Research Center, Charité – Universitätsmedizin Berlin und Max-Delbrück-Centrum für Molekulare Medizin (MDC), Campus Berlin Buch, Lindenberger Weg 80, 13125, Berlin, Deutschland

    M. Bock & F. Paul

  2. NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Campus Berlin Mitte, Berlin, Deutschland

    F. Paul & J. Dörr

  3. Klinisches und Experimentelles Forschungszentrum für Multiple Sklerose, Charité – Universitätsmedizin Berlin, Berlin Mitte, Berlin, Deutschland

    F. Paul & J. Dörr

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  1. M. Bock
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  2. F. Paul
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  3. J. Dörr
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Correspondence to M. Bock.

Zusatzmaterial online

115_2012_3707_MO1_ESM.mov

Video 1: En-face Scanüberlagerung des (peri)-papillären 2D-Fundusbildes mit dem korrespondierenden 3D-Würfelscan. Die Querschnittscanbilder stellen die retinalen Substrukuren entlang der z-Achse (axial) dar. (QuickTime mov 3,1MB)

115_2012_3707_MO2_ESM.mov

Video 2: Hochauflösender 3D-Würfelscan des (peri)-makulären Areals entlang der x-Achse in der schnellen B-Scan Ebene. (QuickTime mov 2,7MB)

115_2012_3707_MO3_ESM.mov

Video 3: Zwei hochauflösende 3D-Würfelscans des (peri)-papillären Areals zum Vergleich zwischen MS-Patient und Gesundem. Die Querschnittscanbilder stellen die retinalen Substrukuren entlang der y-Achse (langsame B-Scan Ebene) in temporal–nasaler Abfolge dar. Die roten Kreise deuten auf Unterschiede im Reflektivitätsgrad und der Schichtdicke. (QuickTime mov 3,9MB)

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Bock, M., Paul, F. & Dörr, J. Diagnostik und Verlaufsbeurteilung der Multiplen Sklerose. Nervenarzt 84, 483–492 (2013). https://doi.org/10.1007/s00115-012-3707-2

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