MR-tomographische Diagnostik von Kardiomyopathien

Zusammenfassung

Gemäß der Klassifikation der WHO stellen Kardiomyopathien eine Gruppe von Erkrankungen des Myokards dar, welche durch die kardiale Dysfunktion charakterisiert sind und als primäre und sekundäre Kardiomyopathien eingeteilt werden. Ein Teil der primären Kardiomyopathien ist genetisch bedingt, oft bleibt die Ätiologie jedoch unklar. Der Begriff „sekundäre Kardiomyopathie” wird für Erkrankungen verwendet, die unter dem klinischen Bild einer Kardiomyopathie auftreten, denen aber eine spezifische Ursache (toxische Schäden, Systemerkrankungen, metabolische Störungen etc.) zugeordnet werden kann. Anhand morphologischer und pathophysiologischer Kriterien erfolgt eine Einteilung in hypertrophische Kardiomyopathie (HCM), dilatative Kardiomyopathie (DCM), arrhythmogene rechtsventrikuläre Kardiomyopathie (ARVC) und restriktive Kardiomyopathie (RCM).

Die MR-Tomographie bietet eine Vielzahl von Möglichkeiten in der Diagnostik von Kardiomyopathien. Sie erlaubt präzise morphologische und funktionelle Aussagen und kann veränderte Myokardareale durch pathologisches Kontrastverhalten oder alterierte T1- und T2-Signalintensität detektieren. Sowohl für funktionelle Untersuchungen als auch den Nachweis struktureller Myokardveränderungen wird die MRT daher zunehmend im klinischen Alltag eingesetzt. In der vorliegenden Arbeit werden charakteristische Gesichtspunkte verschiedener Kardiomyopathien beschrieben und MR-tomographischen Möglichkeiten zur Diagnostik gegenübergestellt.

Abstract

According to the WHO classification, cardiomyopathies are a group of diseases which are associated with myocardial dysfunction and can be classified either as primary or secondary cardiomyopathies. Genetic disorders have been identified in certain primary cardiomyopathies, however often the etiology remains unknown. The term “secondary cardiomyopathy” is used to specify diseases with the clinical indications of a cardiomyopathy, but can be attributed to a certain pathophysiological mechanism such as exposure to toxic substances, metabolic syndromes or systemic diseases. Based on morphological and functional criteria, primary cardiomyopathies are divided into dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC) and restrictive cardiomyopathy (RCM).

During the last two decades MR imaging has emerged to a well established diagnostic tool for the understanding and treatment of cardiomyopathies. Morphological and functional information can be achieved with a high level of accuracy and reproducibility. Tissue alteration of the myocardium can be detected assessing regional contrast enhancement, T1- and T2-signal intensities and chemical shift phenomena. This article describes characteristic aspects of MR imaging for the diagnosis of primary and secondary cardiomyopathies.

Key words

MR imaging - cardiac - heart

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