Zusammenfassung.
Der Nachweis von Verkalkungen der Koronargefäßwand zeigt eine koronare Arteriosklerose an. Die Prävalenz von Koronarverkalkungen steigt mit zunehmendem Alter deutlich an. Das Ausmaß der Verkalkungen korreliert mit dem koronaren Gesamtplaquevolumen und bei symptomatischen Patienten mit der Wahrscheinlichkeit eines zukünftigen Myokardinfarkts. Bei asymptomatischen Personen mit Risikofaktoren für einen Myokardinfarkt kann durch den Nachweis von Koronarkalk eine Koronaratherosklerose schon vor ihrer klinischen Manifestation diagnostiziert werden. Eine exakte Koronarkalkquantifizierung (Kalzium-Scoring) ist mit der Elektronenstrahl-Computertomographie (EBCT) oder EKG-getriggerten Subsekunden-CT Scannern möglich geworden. Weitere Verbesserungen im Nachweis von Koronarkalk zeichnen sich mit der Einführung der Mehrschicht-CT ab. Die prognostische Bedeutung der Koronarkalkquantifizierung bei asymptomatischen Risikopatienten ist noch nicht eindeutig geklärt. Auch ist offen, inwieweit neuere, volumenbasierte Quantifizierungsmethoden dem klassischen Kalzium-Score (Agatston-Score) in der Risikoabschätzung und der Verlaufskontrolle überlegen sind.
Detection and Quantification of Coronary Calcification: An Update.
The demonstration of calcification of the coronary arterial wall indicates the presence of coronary heart disease (CHD). The prevalence of coronary calcifications increases with age. The extent of the calcifications correlates with the total coronary plaque burden and with the probability of a future myocardial infarction in symptomatic patients. In asymptomatic subjects with risk factors for a myocardial event demonstration of coronary calcifications is diagnostic for coronary atherosclerotic disease before clinical manifestation of the disease. Exact quantification of coronary arterial calcifications (calcium scoring) has become possible with electron beam computed tomography (EBCT) or ECG triggered subsecond CT scanners. Further improvements in the detection of coronary calcifications can be expected with the introduction of multi-slice CT. The prognostic relevance of coronary calcium scoring in asymptomatic high-risk patients is not yet clearly defined. It remains to be clarified whether newer, volume based methods of calcium quantification will be superior to the classic calcium score (Agatston- Score) for risk assessment and follow-up in this patient group.
Schlüsselwörter:
Koronare Herzkrankheit - - Koronarkalkdetektion - - Elektronenstrahl-CT - - Mehrschicht-CT
Key words:
Coronary Heart Disease - - Coronary Calcification Detection - - Electron-beam CT - - Multi-slice CT
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1 Diese Arbeit ist unserem ersten Lehrer, Herrn Prof. Dr. med. G. Friedmann, zum 75. Geburtstag gewidmet.
Dr. med. R. Fischbach
Institut für Klinische Radiologie Westfälische Wilhelms-Universität
48129 Münster
Phone: 0251-8347301
Fax: 0251-8349656
Email: r.fischbach@topmail.de
