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DOI: 10.1055/s-2006-927204
© Georg Thieme Verlag KG Stuttgart · New York
Muster der späten Kontrastmittelanreicherung in der MRT bei ischämischen und nicht-ischämischen Kardiomyopathien
Patterns of Delayed-Enhancement in MRI of Ischemic and Non-Ischemic CardiomyopathiesPublikationsverlauf
eingereicht: 18.8.2006
angenommen: 26.9.2006
Publikationsdatum:
03. Januar 2007 (online)
![](https://www.thieme-connect.de/media/roefo/200701/lookinside/thumbnails/10.1055-s-2006-927204-1.jpg)
Zusammenfassung
Die Technik der späten Kontrastmittelanreicherung im MRT (delayed-enhancement [DE]-MRT) findet breite Anwendung in der klinischen Routine zur Beurteilung des Myokards. Myokarderkrankungen unterschiedlicher Ätiologie führen zu regionalen Veränderungen im Myokard wie Nekrose, Fibrose, Ödem oder Metaboliteinlagerungen, die mit der DE-MRT dargestellt werden können. Sowohl akute und chronische Myokardischämien auf dem Boden einer koronaren Herzerkrankung als auch nicht-ischämische Kardiomyopathien zeigen DE, häufig mit charakteristischem Anreicherungsmuster. Während das DE ischämischer Ursache subendokardial gelegen ist, zeigen nicht-ischämische Kardiomyopathien oft ein intramyokardiales oder subepikardiales Anreicherungsmuster. Das typische Muster dilatativer Kardiomyopathien ist eine bandförmige, intramyokardiale Anreicherung mit Beteiligung des Septums. Arrhythmogene rechtsventrikuläre Dysplasien/Kardiomyopathien gehen häufig mit einem rechtsventrikulären DE einher. Die kardiale Amyloidose als zumeist restriktive Kardiomyopathie zeigt typischerweise ein zirkuläres, subendokardiales DE. Hypertrophe Kardiomyopathien zeigen in den hypertrophierten Wandabschnitten ein fleckiges, intramyokardiales DE, welches typischerweise anteroseptal liegt. Akute Myokarditiden gehen unter Umständen mit einem intramyokardialen oder subepikardialen DE unter Einbeziehung der Seitenwand einher. Bei chronischen Myokarditiden kann vorwiegend intramyokardiales oder subepikardiales DE beobachtet werden. Bei kardialen Sarkoidosen wird ein fleckförmiges, subepikardiales Anreicherungsmuster mit rechts- und linksventrikulärer Beteiligung beschrieben. Überschneidungen der Anreicherungsmuster innerhalb der Kardiomyopathien bestehen jedoch, sodass die Trennschärfe allein anhand der DE-MRT beschränkt ist. Daher ist die DE-MRT immer in Zusammenschau mit anderen klinischen und MRT-Befunden zu bewerten. Vielfach korreliert die Menge an DE mit klinischen und funktionellen Parametern sowie mit der Häufigkeit an unerwünschten kardialen Ereignissen, sodass die DE-MRT möglicherweise zur Risikostratifizierung von Patienten geeignet ist. Weiterhin kann die DE-MRT zur Planung von Myokardbiopsien und zur Korrelation mit den Ergebnissen aus einer elektrophysiologischen Untersuchung eingesetzt werden.
Abstract
Contrast-enhanced MRI using the delayed-enhancement technique (DE-MRI) is widely applied in the clinical work-up of myocardial diseases. Myocardial diseases of varying etiology result in myocardial changes, such as necrosis, fibrosis, edema and metabolite deposition, which can be visualized by DE-MRI. Acute and chronic ischemic diseases based on a coronary artery disease as well as non-ischemic cardiomyopathies display DE. Cardiomyopathies often show a characteristic enhancement pattern. While ischemic lesions are localized in the subendocardium, non-ischemic cardiomyopathies often display an intramyocardial or subepicardial pattern. The typical pattern for dilated cardiomyopathies is band-like and intramyocardial with septal involvement. Arrhythmogenic right-ventricular dysplasias/cardiomyopathies are frequently associated with right-ventricular DE. In the case of amyloid cardiomyopathies which are often restrictive cardiomyopathies, subendocardial and circular DE is typically observed. Hypertrophic cardiomyopathies display patchy intramyocardial DE usually in the anteroseptal region. Acute myocarditis is typically accompanied by intramyocardial or subepicardial DE affecting the lateral wall. In the case of chronic myocarditis, intramyocardial or subepicardial DE is observed most frequently. Cardiac sarcoidosis typically entails patchy subepicardial DE with right- and left-ventricular involvement. Since there is an overlap between the enhancement patterns of cardiomyopathies, the diagnostic accuracy of DE-MRI is limited and the diagnosis must be based on additional clinical and MRI findings. The amount of DE often corresponds with cardiac functional parameters as well as with the frequency of cardiac events so that DE-MRI may be useful for risk stratification. Furthermore, DE-MRI can be helpful in the planning and evaluation of myocardial biopsies and electrophysiological examinations.
Key words
gadolinium - cardiac - tissue characterization - ischemia/infarction - infection
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Dr. Alexander Stork
Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Hamburg-Eppendorf
Martinistraße 52
20246 Hamburg
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Fax: ++49/40/4 28 03 67 99
eMail: a.stork@uke.uni-hamburg.de