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Bildgebung zerebraler Vaskulitiden

Neuroimaging of cerebral vasculitis

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Zusammenfassung

Die zerebrale Vaskulitis kann viele Ursachen haben. Daher ist die klinische und radiologische Diagnose schwierig, auch weil es etliche vaskulitistypische Symptome und MR-Befunde bei anderen Erkrankungen gibt. Die ZNS-Vaskulitis kann zahlreiche andere neurologische Erkrankungen imitieren, die unterschiedlicher Therapie bedürfen. MRT und MR-Angiographie (MRA) sind die Verfahren der Wahl, mit denen die radiologische Diagnostik begonnen werden sollte, um den Parenchymschaden und den Gefäßbefall zu beurteilen. Bei unklaren Befunden kann eine digitale Subtraktionsangiographie (DSA) ergänzt werden, um auch mittelgroße Gefäße beurteilen zu können. Der Befall kleiner Gefäße kann nur bioptisch nachgewiesen werden. In der folgenden Übersicht stellen wir das diagnostische Herangehen bei zerebraler Vaskulitis vor, präsentieren zahlreiche Befunde und diskutieren die wichtigsten radiologischen Differenzialdiagnosen.

Abstract

Cerebral vasculitis can have a variety of origins. Furthermore, there are no vasculitis-specific symptoms or imaging signs and vasculitis of the CNS can mimic many other neurological diseases, which require different treatment approaches. Thus, the clinical and radiological diagnosis of cerebral vasculitis is challenging. Magnetic resonance imaging (MRI) and MR angiography (MRA) should be the radiological imaging methods of choice to assess the degree of parenchymal damage and to detect vessel wall changes. If the results are unclear digital subtraction angiography (DSA) should be pursued in order to also detect changes in medium sized vessels. Vasculitis of small vessels cannot be detected by vascular imaging and requires brain or leptomeningeal biopsy. In this review we present the current diagnostic approach and a variety of imaging findings in cerebral vasculitis and discuss the main radiological differential diagnoses.

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Authors and Affiliations

  1. Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland

    M. Wengenroth

  2. Institut für klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, München, Deutschland

    M. Wengenroth &  T. Saam

  3. Abteilung Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    S. Hähnel

Authors
  1. M. Wengenroth
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  2. T. Saam
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  3. S. Hähnel
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Correspondence to M. Wengenroth.

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Interessenkonflikt

M. Wengenroth, T. Saam und S. Hähnel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Wengenroth, M., Saam, T. & Hähnel, S. Bildgebung zerebraler Vaskulitiden. Radiologe 56, 52–69 (2016). https://doi.org/10.1007/s00117-015-0053-y

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