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Magnetresonanzspektroskopie bei Schizophrenie

Möglichkeiten und Grenzen

Magnetic resonance spectroscopy in schizophrenia

Possibilities and limitations

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Zusammenfassung

Die Magnetresonanzspektroskopie (MRS) stellt ein nichtinvasives Verfahren dar, mit dem in vivo biochemische Veränderungen spezifischer Hirnregionen bei verschiedenen psychiatrischen Erkrankungen untersucht werden können. Dabei werden insbesondere die Protonenmagnetresonanzspektroskopie (1H-MRS) sowie die Phosphormagnetresonanzspektroskopie (31P-MRS) verwendet. In der vorliegenden Übersichtsarbeit werden die methodischen Grundlagen erläutert sowie die Befundlage bei der Schizophrenie referiert. Für die Darstellung der Studien zur 1H-MRS bei schizophrenen Patienten im Vergleich zu einer Kontrollgruppe wurde eine systematische Literaturrecherche durchgeführt. Die insgesamt inkonsistenten Ergebnisse der einzelnen Studien können u. a. auf unterschiedliche Patientenpopulationen, verschiedene Untersuchungstechniken und eine unterschiedliche Selektion der interessierenden Hirnregionen zurückgeführt werden. Zusammenfassend ergeben sich die deutlichsten Hinweise bei schizophrenen Patienten im dorsolateralen präfrontalen Kortex sowie in temporalen Regionen für eine Erhöhung der PDE- sowie eine Reduktion der PME-Konzentration als Ausdruck eines erhöhten Umbaus der membranständigen Phosphoplipide (31P-MRS) und für eine Verminderung der N-Acetyl-Aspartat- (NAA-)Konzentration bzw. des NAA/Cholin-Verhältnisses als Ausdruck einer neuronalen Schädigung (1H-MRS). Damit wird die aus anderen Untersuchungstechniken (z. B. strukturelle MR-Hirnmorphometrie, funktionelle MRT, Neuropsychologie) abgeleitete Hypothese einer fronto-temporo-thalamischen Netzwerkstörung bei Schizophrenie weiter gestützt. Durch die Kombination der MRS mit den genannten Verfahren in Verlaufsuntersuchungen kann es gelingen, spezifischere Einflussfaktoren bei der Entstehung und im Verlauf der Schizophrenie abzugrenzen.

Abstract

Magnetic resonance spectroscopy is a noninvasive investigative technique for in vivo detection of biochemical changes in neuropsychiatric disorders for which especially proton (1H-MRS) and phosphorus (31P-MRS) magnetic resonance spectroscopy have been used. In this review we explain the principles of MRS and summarize the studies in schizophrenia. A systematic literature review was carried out for 1H-MRS studies investigating schizophrenic patients compared to controls. The inconsistent results in the cited studies may be due to different study population, specific neuroimaging technique, and selected brain regions. Frequent findings are decreased PME and increased PDE concentrations (31P-MRS) linked to altered metabolism of membrane phospholipids and decreased N-acetylaspartate (NAA) or NAA/choline ratio (1H-MRS) linked to neuronal damage in frontal (DLPFC) or temporal regions in patients with schizophrenia. These results contribute to the disturbed frontotemporal-thalamic network assumed in schizophrenia and are supported by additional functional neuroimaging, MRI morphometry, and neuropsychological evaluation. The combination of the described investigative techniques with MRS in follow-up studies may provide more specific clues for understanding the pathogenesis and disease course in schizophrenia.

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  1. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum des Saarlandes, Homburg/Saar

    T. Wobrock, H. Scherk & P. Falkai

  2. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum des Saarlandes, 66421 , Homburg/Saar

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Wobrock, T., Scherk, H. & Falkai, P. Magnetresonanzspektroskopie bei Schizophrenie. Radiologe 45, 124–136 (2005). https://doi.org/10.1007/s00117-004-1161-2

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