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Fortschr Neurol Psychiatr 2020; 88(09): 609-619
DOI: 10.1055/a-1207-0515
Übersicht

Empfehlung zum differenzierten Einsatz nuklearmedizinischer Diagnostik bei Parkinson-Syndromen

Recommendation for the differentiated use of nuclear medical diagnostic for parkinsonian syndromes
Thilo van Eimeren
1   Uniklinik Köln, Klinik und Poliklinik für Nuklearmedizin; Klinik und Poliklinik für Neurologie; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)
,
Joseph Claßen
2   Klinik und Poliklinik für Neurologie, Universitätsklinikum Leipzig
,
Alexander Drzezga
3   Uniklinik Köln, Klinik und Poliklinik für Nuklearmedizin; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE); Institut für Neurowissenschaften und Medizin (INM-2), Forschungszentrum Jülich
,
Carsten Eggers
11   Klinik für Neurologie, Universitätsklinikum Gießen und Marburg, Standort Marburg; Center for Mind, Brain & Behavior, Marburg
,
Rüdiger Hilker-Roggendorf
4   Klinikum Vest, Recklinghausen / Marl
,
Jochen Klucken
5   Molekulare Neurologie, Universitätsklinikum Erlangen
,
Jiri Koschel
6   Parkinson-Klinik Wolfach
,
Philipp Tobias Meyer
7   Klinik für Nuklearmedizin, Universitätsklinikum Freiburg
,
Christoph Redecker
8   Klinik für Neurologie, Klinikum Lippe Standort Lemgo
,
Hendrik Theis
9   Uniklinik Köln, Klinik und Poliklinik für Neurologie
,
Carsten Buhmann
10   Ambulanzzentrum und Neurologische Klinik, Universitätsklinikum Hamburg-Eppendorf
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Zusammenfassung

Die vorliegende Arbeit gibt einen Überblick über die verschiedenen nuklearmedizinischen Verfahren in der Diagnostik bei neurodegenerativen Parkinson-Syndromen sowie ihre Evidenzlage und soll praxistaugliche Entscheidungshilfen in der Anwendung und Interpretation der Methoden und Befunde ermöglichen. Die Wertigkeit der Verfahren unterscheidet sich erheblich in Bezug auf die beiden relevanten diagnostischen Fragestellungen. Dies ist zum einen die Frage, ob überhaupt ein neurodegeneratives Parkinson-Syndrom vorliegt, zum anderen die Frage, welches. Während zur Beantwortung der ersten Frage das DAT-SPECT unter Berücksichtigung gewisser Parameter in der Praxis unbestritten die Methode der Wahl ist, eignet sich dieses Verfahren nicht zur Beantwortung der zweiten Fragestellung. Zur Unterscheidung der Parkinson-Syndrome in idiopathisch oder atypisch werden im klinischen Alltag mit der MIBG-Szintigraphie und dem FDG-PET verschiedene Verfahren angewendet. Wir legen dar, warum das FDG-PET von diesen Methoden nicht nur die geeignetste ist, um ein idiopathisches Parkinson-Syndrom von einem atypischen Parkinson-Syndrom abzugrenzen, sondern auch ausreichend valide ermöglicht, die verschiedenen atypischen neurodegenerativen Parkinson-Syndrome (d. h. MSA, PSP und CBD) voneinander zu unterscheiden, und deshalb in den Leistungskatalog der GKV aufgenommen werden sollte.

Abstract

The present work provides an overview of the various nuclear medicine methods in the diagnosis of neurodegenerative parkinsonian syndromes and their respective evidence and is intended to enable practical decision-making aids in the application and interpretation of the methods and findings. The value of the procedures differs considerably in relation to the two relevant diagnostic questions. On the one hand, it is the question of whether there is a neurodegenerative parkinsonian syndrome at all, and on the other hand the question of which one. While the DAT-SPECT is undisputedly the method of choice for answering the first question (taking certain parameters into account), this method is not suitable for answering the second question. To categorise parkinsonian syndromes into idiopathic (i. e. Parkinson´s disease) or atypical, various procedures are used in everyday clinical practice including MIBG scintigraphy, and FDG-PET. We explain why FDG-PET currently is not only the most suitable of these methods to differentiate an idiopathic parkinsonian syndrome, from an atypical Parkinson’s syndrome, but also enables sufficiently valid to distinguish the various atypical neurodegenerative Parkinson’s syndromes (i. e. MSA, PSP and CBD) from each other and therefore should be reimbursed by health insurances.

Schlüsselwörter

Parkinson-Syndrom - idiopathisch - atypisch - Nuklearmedizin - DAT-SPECT - FDG-PET

Key words

Parkinsonian syndrome - idiopathic - atypical - nuclear medicine - DAT-SPECT - FDG-PET


Publication History

Received: 03 March 2020

Accepted: 10 June 2020

Article published online:
21 September 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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