MIBG-Szintigrafie des Herzens

Zusammenfassung

^l23Iod-MIBG-Untersuchungen des Myokards können wichtige Informationen über pathophysiologische Prozesse im Hinblick auf die sympathische Innervation des Herzens liefern. Viele Autoren bestätigen die gleichzeitige Existenz eines durch hohe Affinität charakterisierten neuronalen Aufnahmemechanismus für MIBG in die sympathischen, postganglionären präsynaptischen Nervenstrukturen neben einem unspezifischen, jedoch mit hoher Transportleistung ausgestatteten, extraneuronalen Mechanismus. Das szintigrafische Verteilungsmuster bei erhaltenem MIBG-Transportmechanismus stellt zuverlässig die linksventrikuläre sympathische Nervenversorgung und deren pathologische Veränderungen wie beispielsweise bei Myokardischämien, Herzinsuffizienz oder Arrhythmien dar; dazu erlaubt diese Bildgebung die Früherkennung der autonomen Neuropathie im Rahmen des Diabetes mellitus. Für Patienten mit Herzinsuffizienz oder hypertrophischer Kardiomyopathie konnte gezeigt werden, dass durch die MIBG-Szintigrafie solche mit erhöhtem Ri-siko für das Auftreten eines plötzlichen Herztodes identifiziert werden können. Darüber hinaus können therapeutische Effekte verschiedener Behandlungsstrategien evaluiert werden.

Abstract

The sympathetic nervous system plays an important role in cardiovascular physiology. Planar MIBG with or without SPECT can be used to visualize the sympathetic innervation of the heart and the abnormalities in innervation caused by, for example, ischemia, heart failure, and arrhythmogenic disorders. Furthermore, cardiac neuronal imaging allows early detection of autonomic neuropathy in diabetes mellitus. Assessment of sympathetic nerve activity in patients with heart failure has been shown to provide important prognostic information, and cardiac neuronal imaging can potentially identify patients who are at increased risk of sudden death. Moreover, therapeutic effects of different treatment strategies can be evaluated by imaging. To establish the clinical utility of cardiac neuronal imaging, it will be necessary to determine the incremental value of innervation imaging to triage heart failure patients to medical therapy, CRT (with or without ICD), or heart transplantation.

Schlüsselwörter

sympathische Innervation - Szintigrafie - MIBG - kardiale Bildgebung

Key words

sympathetic innervation - scintigraphy - MIBG - cardiac imaging

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