SPECT-Untersuchungen bei Patienten mit Parkinson-Syndromen

Zusammenfassung

Stimuliert durch die kommerzielle Verfügbarkeit spezifischer Radioliganden gewinnt die In-vivo-Charakterisierung des dopaminergen Systems mit der Single-Photon-Emissions-Computertomographie (SPECT) bei der diagnostischen Abklärung von Parkinson-Syndromen zunehmend an Bedeutung. Hierbei stehen zwei Aspekte der dopaminergen Neurotransmission im Blickpunkt des Interesses: Die Bindung von Kokainanaloga an den präsynaptischen Dopamintransporter lässt Rückschlüsse auf die Integrität von Neuronen der Substantia nigra mit ihren zum Corpus striatum projizierenden Axonen (präsynaptische Nervenfasern) zu. Die Funktionsbeurteilung postsynaptischer Zellen erfolgt über Analysen der Bindung spezifischer Rezeptorantagonisten an die postsynaptisch lokalisierten Dopamin-D2-Rezeptoren. In Abhängigkeit von der klinische Fragestellung und der erwarteten Pathologie liefern die beiden Methoden - einzeln oder in Kombination - relevante diagnostische Informationen. Aktuell werden die SPECT-Verfahren zum Nachweis oder Ausschluss eines Parkinson-Syndroms, in der Früh- und Differenzialdiagnostik von Parkinson-Syndromen, deren Verlaufsbeurteilung und Verfolgung der Krankheitsprogression sowie zum Therapiemonitoring z. B. bei Behandlung mit potenziell neuroprotektiven Medikamenten eingesetzt. Diese Arbeit fasst die wichtigsten in der Literatur publizierten Ergebnisse von SPECT-Untersuchungen des dopaminergen Systems bei diesen Fragestellungen zusammen.

Abstract

Stimulated by the commercial availability of specific radioligands in vivo characterization of the dopaminergic system with single-photon emission tomography (SPECT) has gained clinical importance in the diagnostic work-up of patiens with parkinsonism. Currently interest is focused on two aspects of the dopaminergic neurotransmission: Cocaine analogues bind to the presynaptically located striatal dopamine transporter and herewith allow to assess the structural integrity of the presynaptic terminals which are the striatal projections of neurons originating in the substantia nigra. For functional assessment of the postsynaptic aspect of the dopaminergic synapse binding of specific receptor antagonists to postsynaptically located D2 receptors is analyzed. Depending on the clinical question and the pathology expected both methods - either each one alone or a combination of both - provide valuable diagnostic information. Currently those SPECT methods are applied to confirm or exclude a Parkinsonian syndrome, in the early and differential diagnosis of Parkinsonian syndromes, to assess disease severity and measure disease progression, and to monitor the effects of therapy e. g. with potentially neuroprotective drugs. This paper offers a comprehensive summary of the SPECT results reported in the literature dealing with the mentioned clinical applications.

Schlüsselwörter

Single-Photon-Emissions-Computertomographie - Parkinson-Syndrome - Dopaminerges System - Dopamintransporter - Dopamin-D2-Rezeptoren

Key words

Single photon emission tomography - Parkinsonism - Dopaminergic system - Dopamine transporter - Dopamine D2 receptors

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