Klinischer Stellenwert der Bildgebung der Neuroinflammation

Zusammenfassung

Die Neuroinflammation ist ein komplexer und dynamischer Prozess, der an zahlreichen Erkrankungen des Gehirns beteiligt ist, von demyelinisierenden Erkrankungen über neurodegenerative Erkrankungen, psychiatrische Erkrankungen bis hin zu Hirntumorerkrankungen. Diagnostisch sind das Vorliegen und Ausmaß der Neuroinflammation mitunter schwer zu erfassen. In der konventionellen MRT werden Prozesse mit massiver Entzündungsaktivität durch Störungen der Blut-Hirn-Schranke dargestellt, während inflammatorische Prozesse auf geringerem Level häufig nicht nachzuweisen sind oder nicht von einem nach abgelaufener Entzündung verbleibenden Glioseareal zu differenzieren sind. Die PET stellt eine sinnvolle Bildgebungsmethode zur direkten Darstellung der Neuroinflammation dar, die insbesondere bei der Diagnosestellung, Prognoseeinschätzung und Therapieantwort inflammatorischer ZNS-Erkrankungen hilfreich sein kann. Der Artikel soll eine Übersicht über verfügbare Tracer zur Darstellung der Neuroinflammation geben und den bisherigen klinischen Einsatz sowie die Aussagekraft der Untersuchungen beleuchten.

Abstract

Neuroinflammation is a complex and dynamic process that is implicated in numerous diseases of the brain, from demyelinating diseases to neurodegenerative diseases, psychiatric diseases and brain tumour diseases. However, its depiction and measurement of extent or activation level is highly challenging based on conventional methods. On standard MRI, only lesions with a high inflammatory activity are associated with a disrupted blood-brain-barrier and can be depicted by contrast enhancement, while neuroinflammation at a lower level may not be detected or not be distinguished from glial scar tissue. Therefore, PET imaging targeting components of the inflammatory process represent a promising diagnostic tool to depict neuroinflammation, which can help in the diagnosis, prognostication and response assessment of various diseases of the brain. This article is intended to provide an overview of available PET tracers for the imaging of neuroinflammation, their clinical use to date as well as the significance of the investigations.

Schlüsselwörter

Neuroinflammation - Mikroglia - Hirnbildgebung - PET - entzündliche ZNS-Erkrankungen

Keywords

Neuroinflammation - microglia - brain imaging - PET - inflammatory CNS diseases

Publication History

Article published online:
02 December 2022

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