Transkranielle Sonografie des Hirnparenchyms: etablierte Anwendungen bei Erwachsenen

 

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Zusammenfassung

Die transkranielle B-Bild-Sonografie (TCS) ist eine Bildgebungsmodalität, die das Hirnparenchym und das intrakranielle Ventrikelsystem bei intakter Schädelkalotte darstellt. Im Vergleich zur Magnetresonanztomografie kann die TCS tiefe echogene Hirnstrukturen mit höherer Bildauflösung darstellen und hat zudem die Vorteile hoher Mobilität, gesundheitlicher Unbedenklichkeit und geringer Störbarkeit durch Patientenbewegungen. Das eigenständige Bildgebungsprinzip der TCS erlaubt die Visualisierung charakteristischer Veränderungen bei diversen neurodegenerativen Erkrankungen, die mit anderen Verfahren nur schwierig darstellbar sind, wie die Hyperechogenität der Substantia nigra bei idiopathischem Parkinson-Syndrom und die Hyperechogenität des Nucleus lentiformis bei atypischen Parkinson-Syndromen. Etablierten Anwendungen der TCS sind das bettseitige Monitoring raumfordernder Läsionen (intrakranielle Blutungen, maligne Hirninfarkte) bei akuten Schlaganfallpatienten, die Früh- und Differenzialdiagnose des Parkinson-Syndroms, und die postoperative Positionskontrolle von Tiefenhirnstimulations-Elektroden. Neue Technologien wie die Echtzeit-MRT-TCS-Fusionsbildgebung und die digitalisierte Bildanalyse versprechen eine breitere Anwendung der TCS in den kommenden Jahren.

Abstract

Transcranial B-mode sonography (TCS) is a neuroimaging technique that displays the brain parenchyma and the intracranial ventricular system through the intact skull. In comparison to magnetic resonance tomography, TCS can currently achieve a higher image resolution of echogenic deep brain structures, and has the advantages of high mobility, non-invasiveness, and low susceptibility to movement artefacts. The different imaging principle of TCS allows visualization of characteristic changes in several neurodegenerative diseases, such as substantia nigra hyperechogenicity in Parkinson’s disease (PD), and lenticular nucleus hyperechogenicity in atypical Parkinsonian syndromes, that can hardly be visualized with other imaging methods. Established applications of TCS include the bedside monitoring of space-occupying lesions (intracranial hematomas, malignant brain infarctions) in acute stroke patients, the early and differential diagnosis of PD, and the postoperative position control of deep brain stimulation electrodes. Novel technologies such as real-time TCS-MRI fusion imaging and digitized images analysis promise a wider application of TCS in the coming years.

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