Klinische Anwendung der Flachdetektor-CT im Angio-OP

Zusammenfassung

Die Einsatz von modernen Flachdetektoren in angiografischen C-Bogensystemen eröffnet die Möglichkeit, CT-ähnliche Untersuchungen direkt am Angiografietisch zu akquirieren. In dieser Übersichtsarbeit werden nach einer kurzen Beschreibung der Prinzipien der Datenakquisition bei der Flachdetektor-CT(FD-CT) mit deren Vorteilen und Limitationen im Vergleich zur Mehrzeilenspiral-CT (MSCT) die am besten etablierten und evaluierten Anwendungspektren der FD-CT beschrieben. Insbesondere bei neurointerventionellen Eingriffen ist die FD-CT zu einer wichtigen ergänzenden Bildgebungsmethode geworden. Aber auch bei Embolisationen, besonders von Lebertumoren und bei muskuloskelettalen Eingriffen hat sich die FD-CT als aussagekräftige Untersuchung erwiesen. Bei peripheren vaskulären Eingriffen und bei Stent-Graft-Prozeduren kann die FD-CT wichtige Zusatzinformationen bei komplizierten Fällen und beim Komplikationsmanagement liefern. Insgesamt ist das Anwendungsspektrum der FD-CT weit gefächert und hängt nicht zuletzt vom Einfallsreichtum des Untersuchers ab. Es darf jedoch nicht außer Acht gelassen werden, dass durch die FD-CT eine zusätzliche Strahlenbelastung entsteht, die bei grober Abschätzung derzeit zumindest der Strahlenbelastung einer normalen MSCT-Spirale der interessierenden Region entspricht.

Abstract

The introduction of flat-panel detectors in modern angiographic C-arm systems makes it possible to acquire CT-like images in the angiographic suite (flat-panel CT; FD-CT). In this review, after a short technical introduction of FD-CT including the discussion of the advantages and disadvantages of this new imaging modality, the most commonly and best evaluated indications for FD-CT will be described. FD-CT has become an important adjunctive imaging modality in neurointerventional procedures and embolizations, especially during liver embolization. Another attractive indication for FD-CT is musculoskeletal interventions. FD-CT may provide important additional information in complicated peripheral vascular interventions and stent-graft procedures. FD-CT has a broad spectrum of possible applications, which finally depends on the experience and innovative thinking of the operator. However, it has to be kept in mind that FD-CT causes additional radiation exposure. Roughly, it can be assumed that currently one FD-CT sequence causes at least the same radiation exposure as one spiral CT sequence of the corresponding body region.

Key words

brain - aorta - CT - CT spiral - embolization - interventional procedures - flat-panel CT

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