Zusammenfassung.
Im Gegensatz zu anderen Anwendungsgebieten spielt die Lungen-MRT bis jetzt in der klinischen Routinediagnostik keine Rolle. Die für die niedrige Bildqualität der Lungen-MRT verantwortlichen Faktoren (niedrige Ortsauflösung, Bewegungsartefakte, niedriges Signal-Rausch-Verhältnis) sind jedoch durch die technischen Fortschritte in der MR-Bildgebung deutlich verbessert worden. Im Vergleich zum Spiral-CT zeigen bewegungskompensierte T2-gewichtete Turbo-Spin-Echo-Sequenzen gute Ergebnisse; sie sollten daher als Basis-Sequenz dienen. Bei wichtigen Fragestellungen (Primärstaging von Lungentumoren, Verlaufskontrollen von Lungenmetastasen/Infiltraten) ist die MRT der CT ebenbürtig oder aufgrund ihrer multiplanaren Eigenschaften bzw. besseren Kontrasteigenschaften überlegen. Für einige Indikationen kann der Wert der MRT nicht abschließend beurteilt werden, da größere Studien im Vergleich zum Spiral-CT fehlen (Dignitätseinschätzung fokaler Lungenläsionen, Frühdiagnostik von Pneumonien). Der Einsatz der Lungen-MRT erscheint aufgrund der vorliegenden Erfahrungen jedoch vielversprechend. Bei chronisch infiltrativen Lungenerkrankungen ist die MRT der CT aufgrund der niedrigeren Ortsauflösung unterlegen. Insgesamt bietet die MRT für viele Fragestellungen eine zuverlässige Alternative zur CT; im Einzelfall kann sie zusätzlich sinnvoll sein, z. B. in der artdiagnostischen Zuordnung kleiner fokaler Lungenläsionen.
MRI of the pulmonary parenchyma.
Up to now the role of lung imaging in routine diagnostic work-up of pulmonary diseases has remained rather limited. However, the well-known technical problems of lung MRI (low spatial resolution, motion artifacts, low signal-to-noise ratio of the lung parenchyma) have been reduced by recent technical advances, thus leading to a significantly improved image quality in MRI of the lungs. Compared to helical CT good results have been demonstrated using a cardiac and respiratory triggered T2 weighted turbo spin echo sequence which should be included in every imaging protocol. Recent studies have proven that MRI is comparable or even better than the gold-standard helical CT regarding the staging of bronchogenic cancer and follow-up examinations of pneumonia and lung metastases. For other indications like the assessment of pulmonary nodules and the early diagnosis of pneumonia MRI has shown promising results; however these results need to be confirmed in larger patient groups. In patients with chronic infiltrative lung disease, CT scanning remains the superior imaging modality due to the inferior spatial resolution of MRI. In conclusion MRI is a reliable alternative imaging method to helical CT for many indications; in some cases it may be a promising additional examination method.
Schlüsselwörter:
MRT - Lungenparenchym - Lungentumor - Pneumonie - CT
Key words:
MRI - Lung parenchyma - Pulmonary nodule - Pneumonia - CT
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MD Claudia C. Leutner
Radiologische Klinik, Universität Bonn
Sigmund-Freud-Straße 25, 53127 Bonn
Phone: 0049-228-2875960
Fax: 0049-228-2875589
Email: leutner@uni-bonn.de
