Differenzialdiagnose bei beidseitigen Veränderungen von Basalganglien und Thalamus

Zusammenfassung

Basalganglien und Thalamus sind paarweise vorkommende, in der tiefen grauen Substanz liegende Hirnstrukturen, die bei einer Vielzahl von Krankheitsbildern betroffen sein können. Die Basalganglien sind sehr stoffwechselaktiv und bei Vergiftungen, Stoffwechselstörungen und Neurodegeneration mit Eisenablagerung im Gehirn häufig symmetrisch betroffen. Sowohl die Basalganglien als auch der Thalamus können aber auch von anderen systemischen oder Stoffwechselkrankheiten, degenerativen Erkrankungen und Gefäßleiden betroffen sein. Auch herdförmige Flavivirus-Infektionen, Toxoplasmose und primäre Lymphome des ZNS können Auswirkungen auf beide Strukturen der tiefen grauen Substanz haben. Der Thalamus ist typischerweise häufiger durch herdförmige Erkrankungen betroffen als durch systemische Leiden. Beidseitige Veränderungen der Basalganglien und des Thalamus sind in verschiedenen akuten und chronischen klinischen Situationen radiologisch nachweisbar. Obwohl die Magnetresonanztomografie (MRT) das Bildgebungsverfahren der Wahl ist, kann eine zweifelsfreie Diagnose nur unter Berücksichtigung aller relevanten klinischen und labortechnischen Daten gestellt werden. Die neuroradiologische Diagnostik erfolgt nicht nur auf der Grundlage spezifischer Merkmale im MRT, wie beispielsweise einer eingeschränkten Diffusion und dem Nachweis von Blutungen, sondern auch durch die Feststellung von Veränderungen anderer Hirnbereiche, z. B. der Großhirnrinde, des Hirnstamms und der weißen Substanz. Eine umsichtige und sorgfältige Bewertung von weiteren neuroradiologischen Befunden, insbesondere einer diffusionsgewichteten Bildgebung, der MR-Angiografie, der MR-Venografie und der MR-Spektroskopie im Rahmen derselben Untersuchung, könnte die Charakterisierung der Veränderungen verbessern und die Differenzialdiagnose weiter eingrenzen.

Abstract

The basal ganglia and thalamus are paired deep gray matter structures that may be involved by a wide variety of disease entities. The basal ganglia are highly metabolically active and are symmetrically affected in toxic poisoning, metabolic abnormalities, and neurodegeneration with brain iron accumulation. Both the basal ganglia and thalamus may be affected by other systemic or metabolic disease, degenerative disease, and vascular conditions. Focal flavivirus infections, toxoplasmosis, and primary central nervous system lymphoma may also involve both deep gray matter structures. The thalamus is more typically affected alone by focal conditions than by systemic disease. Radiologists may detect bilateral abnormalities of the basal ganglia and thalamus in different acute and chronic clinical situations, and although magnetic resonance (MR) imaging is the modality of choice for evaluation, the correct diagnosis can be made only by taking all relevant clinical and laboratory information into account. The neuroimaging diagnosis is influenced not only by detection of specific MR imaging features such as restricted diffusion and the presence of hemorrhage, but also by detection of abnormalities involving other parts of the brain, especially the cerebral cortex, brainstem, and white matter. Judicious use of confirmatory neuroimaging investigations, especially diffusion-weighted imaging, MR angiography, MR venography, and MR spectroscopy during the same examination, may help improve the characterization of these abnormalities and help narrow the differential diagnosis.

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1 © 2011 The Radiological Society of North America. All rights reserved. Originally published in RadioGraphics 2011; 31: 5 – 30. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.