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Yıl:2016; Cilt: 6; Sayı: 1>> Özet
Psikiyatride Güncel; 2016;6(1):49-57
Psikiyatride Radyolojik Beyin GörüntülemeYöntemleri: Heves mi, Zorunluluk mu?
MÇ Eker
Ege Üniversitesi, İzmir
Beyin görüntüleme yöntemleri psikiyatri alanındaki çalışmalarda çok yaygın kullanılmasına karşın günlük psikiyatri uygulamalarında tanı koyma sürecine dahil edilememektedir. Çalışmalarda kullanılan beyin görüntüleme yöntemleri kabaca yapısal ve işlevsel beyin görüntüleme olarak ikiye ayrılabilir. Sık kullanılan yapısal beyin görüntüleme yöntemleri bilgisayarlı tomografi (BT), manyetik rezonans görüntüleme (MRG), manyetik rezonans spektroskopi (MRS) ve difüzyon tensor görüntülemedir (DTG). İşlevsel görüntüleme yöntemleri arasında ise tek foton emisyon bilgisayarlı tomografisi (SPECT), pozitron emisyon tomografisi (PET), işlevsel MRG ve perfüzyon MRG bulunmaktadır. Klinik uygulamada travma ve akut kanamaları belirlemede BT; kafa içi yer kaplayan oluşumlar, enfeksiyon ve demyelinize lezyonların görüntülenmesinde ise MRG tercih edilmelidir. Hastalık öyküsü, aile öyküsü ve iyi bir ruhsal muayene ile birlikte klinik öngörü, genel tıbbi duruma bağlı ruhsal bozuklukların tanısı ve tedavisinde beyin görüntülemeyi tamamlayıcı bir konuma getirmektedir. Nörolojik bazı durumlarda bazen tek belirti kümesi psikiyatrik olabilmektedir. Beklenmedik bir yaşta ve ani gelişen ruhsal belirtiler, anasognozi, anomi, apati, kişilik değişiklikleri, dezinhibisyon, yeni başlangıçlı parafililer, demans, beden algısında bozulmanın eşlik etmediği yeme bozuklukları ve tedaviye dirençli olgular beyin görüntülemenin öncelik taşıdığı durumları oluşturmaktadır. Kuşku uyandıran belirtilere yol açan lezyonlar çoğunlukla limbik ve fronto-temporal yerleşimli olmakla birlikte hipotalamik ve pituiter yerleşimli tümörler yeme bozukluklarıyla ilişkilendirilmektedir. Beyin görüntüleme yöntemleri demans tanısında ön planda değildir ancak, geri döndürülebilir demans nedenlerinin belirlenmesinde önem taşımaktadır. Dahası, hafif bilişsel bozuklukta medial temporal yapıların atrofisi bozukluğun demansa ilerlemesini öngörücü nitelik taşımaktadır. Beyin görüntüleme yöntemleri günümüz tanı sistemleri içinde ayırt edici ve tanı koydurucu olmaktan uzaktır. Buna karşılık, beyin görüntüleme çalışmaları tanı sistemlerinin değişmesi ve daha yüksek geçerliğe kavuşmasına yardımcı olacaktır.
Radiological Imaging Methods in Psychiatry: Is It Desire or Necessity?
While neuroimaging is widely used in psychiatric research, it cannot be used in the daily practice of clinical psychiatry for diagnostic purposes. Brain imaging techniques in brain research can be divided into two as structural and functional. Most frequently used structural neuroimaging methods are computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance spectroscopy and diffusion tensor imaging (DTI). Functional neuroimaging includes single-photon emission computed tomography (SPECT), positron emission tomography (PET), functional MRI (fMRI) and perfusion MRI (pMRI). In clinical practice, CT is more accurate to detect head trauma and acute hemorrhage, while MRI is modality of choice for intracranial masses, infections and demyelinated lesions. Neuroimaging is supplementary to personal and family history, clinical observation in the diagnosis of psychiatric disorders due to medical conditions with a clinically meaningful suspicion. In some cases the only manifestation of the neurological illness may be psychiatric symptoms. Relevant conditions that require neuroimaging are abrupt onset at an unusual age, anasognosia, anomia, apathy, personality changes, disinhibition, new onset of paraphilias, dementia, eating disorders without any distortion of body image, and treatment resistant cases. Lesions leading to clinically meaningful suspicion are mostly found in the limbic and frontal-temporal regions, however, brain tumors related to eating disorders are localized in hypothalamus and pituitary, most frequently. Neuroimaging techniques are not fundamental in the diagnosis of dementia, nevertheless, have importance to determine reversible causes of dementia. Moreover, atrophy of medial temporal structures may predict a progression to dementia from mild cognitive deficit. Although neuroimaging do not have an elemental value in current diagnostic systems of psychiatry, it may help to transform the diagnostic process for higher validity.

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