White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application

Jörg Barkhausen; Thomas Kahn; Gabriele A. Krombach; Christiane K. Kuhl; Joachim Lotz; David Maintz; Jens Ricke; Stefan O. Schönberg; Thomas J. Vogl; Frank K. Wacker; German Association of Chairmen in Academic Radiology (KLR)

doi:10.1055/s-0043-110011

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, Table of Contents

Rofo 2017; 189(07): 611-623
DOI: 10.1055/s-0043-110011

Review

White Paper: Interventionelle MRT: Status Quo und Entwicklungspotenzial unter ökonomischen Perspektiven, Teil 1: Generelle Anwendungen

Article in several languages: English | deutsch

Jörg Barkhausen

¹Department of Radiology and Nuclear Medicine, University Hospital Schleswig Holstein Luebeck Campus, Germany

,

Thomas Kahn

²Clinic and Policlinic for Diagnostic and Interventional Radiology, Leipzig, Germany

,

Gabriele A. Krombach

³Department of Radiology, University Hospital Giessen, Justus Liebig University, Giessen, Germany

,

Christiane K. Kuhl

⁴Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany

,

Joachim Lotz

⁵Institute for Diagnostic and Interventional Radiology, Georg-August-University Goettingen, Germany

,

David Maintz

⁶Department of Radiology, University Hospital of Cologne, Cologne, Germany

,

Jens Ricke

⁷Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Germany

,

Stefan O. Schönberg

⁸Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

,

Thomas J. Vogl

⁹Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany

,

Frank K. Wacker

¹⁰Department for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany

,

German Association of Chairmen in Academic Radiology (KLR)

› Author Affiliations

Abstract

Zusammenfassung

Hintergrund Die MRT ist aufgrund des hohen intrinsischen Weichteilkontrasts, der Möglichkeit der multiplanaren Bildaquisition und der Messung physiologischer Parameter (Fluss, Perfusion, Bewegung etc.) für Steuerung und Überwachung von Interventionen attraktiv.

Methoden Diese Arbeit beschreibt den derzeitigen Stellenwert der interventionellen MRT in der klinischen Routine und die Entwicklungsperspektiven.

Ergebnisse Der hohe Aufwand, Überwachungssysteme und MR-sichere Instrumente zu entwickeln, hat trotz der Vorteile dazu geführt, dass diese Methode sich zunächst nur für Indikationen etablieren konnte, die ihrerseits mittels anderer Modalitäten nicht durchgeführt werden können. So wird die interventionelle MRT seit Dekaden für die Biopsie von MR-suspekten Veränderungen in der Brust eingesetzt. Derzeit wird die MRT in ähnlicher Weise für die Prostata etabliert: die Blindbiopsie ist meistenorts bereits durch die MR-geführte gezielte Probenentnahme oder zumindest durch die Fusion von MR-Aufnahmen mit dem Ultraschall ersetzt. Kardiovaskuläre Interventionen werden an einigen Zentren bereits in der Routine zur Ablation bei Vorhofflimmern MR-gesteuert durchgeführt.

Schlussfolgerung Die interventionelle MRT ist für eine Vielzahl von Indikationen bereits in der klinischen Routine etabliert. Aufgrund der Vorteile des Verfahrens im Vergleich zu anderen Techniken ist eine weitere Ausweitung des Einsatzes der interventionellen MRT in Zukunft zu erwarten.

Kernaussagen

Aufgrund des hohen technischen Aufwands sind Interventionen unter MRT-Kontrolle langfristig nur für Bereiche sinnvoll, für welche die MRT die Intervention entweder erst ermöglicht oder in entscheidendem Maße verbessert.
Die Mammabiopsie von anderweitig nicht detektierbaren Zielläsionen ist seit langem in der klinischen Routine etabliert. Die Prostatabiopsie wird momentan aus ähnlichen Gründen in die klinische Routine eingeführt. Andere Verfahren wie der MRT-gesteuerte fokussierte Ultraschall für die Behandlung von Uterusmyomen oder die Tumorablation von Metastasen stellen Alternativverfahren zu anderen Techniken dar und werden vielerorts angeboten.
Endovaskuläre MR-geführte Interventionen bieten für etliche Indikationen Vorteile, und konnten für die Behandlung von Kindern mit angeborenen Herzfehlern und zur Vorhofablation bereits an einzelnen Zentren klinisch etabliert werden. Eine Ausweitung ist zukünftig zu erwarten.

Zitierweise

Barkhausen J, Kahn T, Krombach GA et al. White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application. Fortschr Röntgenstr 2017; 189: 611 – 623

Key words

interventional MRI - MR-guided biopsy - MR-guided ablation - MR-guided endovascular procedures

Full Text

References

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