Aktuelle Entwicklungen der strukturellen MRT zur Frühdiagnostik der Alzheimer-Demenz

Zusammenfassung

Die Magnetresonanztomographie(MRT)-basierte Volumetrie bietet in vivo Verfahren für die Detektion der Atrophie in den Anfangsstadien der Alzheimer-Krankheit (AD) und stellt potenziell eine geeignete Methode für die klinische Früherkennung und Untersuchung des Krankheitsverlaufs dar. Das Gros der volumetrischen Studien berichtete signifikante Volumenverluste bereits in prädemenziellen Stadien der AD. Die manuelle Volumetrie ist allerdings durch einen hohen Zeitaufwand und die Festlegung auf a priori ausgewählte Gehirnregionen hinsichtlich der klinischen Relevanz limitiert. In den letzten Jahren ist eine Vielzahl automatischer Verfahren zur Volumetrie einzelner Gehirnstrukturen und der Detektierung von Atrophiemustern im Gesamtgehirn entwickelt worden, die Gegenstand der vorliegenden Übersichtsarbeit sind. Ergebnisse semi-automatischer Hippokampus-Volumetrie konnten erfolgreich die Befunde manueller Volumetrie replizieren. Mittels Voxelbasierter Morphometrie und hochparametrischer Fluidregistrierung konnten krankheitsspezifische Atrophiemuster im Gesamthirn sichtbar gemacht werden. Die Bestimmung von Atrophiemustern ist besonders aus differenzialdiagnostischer Perspektive interessant, bedarf aber noch einer klinischen Validierung.

Summary

The development of biomarkers for the early detection is currently a major focus in clinical research on Alzheimer’s disease. Magnetic resonance imaging (MRI) based approaches may be useful to detect early diseasespecific neurodegeneration and thus may aid in the clinical detection of Alzheimer’s disease. Manual delineation of brain regions selected a priori such as the hippocampus, shows high sensitivity for AD but is limited in its clinical applicability due to being time-consuming and susceptible to inter- and intrarater variability. Therefore, recent research efforts have focused on automatic methods, resulting in a plethora of new methods. These state-of-the-art methods are the focus of the present review. Semi-automatic volumetric measures for the hippocampus are now available, but remain partially dependent on manual identification of anatomical landmarks. New voxel-based methods provide for the first time the possibility to explore local atrophic processes within the whole brain. On the basis of voxel-based morphometry disease-specific atrophy patterns have been successfully detected in AD. High-dimensional fluid registration allows to detect subtle atrophic changes within the brain. Voxel-based methods however still require the development of clinical diagnostic criteria and warrant further assessment of the clinical utility.

Schlüsselwörter

Alzheimer-Krankheit - Morphometrie - Fluidregistrierung

Keywords

Alzheimer’ disease - morphometry - fluid registration

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