Nichtinvasive Koronarangiographie: aktueller Stand und Perspektiven

Zusammenfassung

Die Darstellung der Koronararterien mit nichtinvasiven Verfahren (so genannte „nichtinvasive Koronarangiographie”) ist wegen der kleinen Abmessungen und der schnellen Bewegung der Koronargefäße technisch schwierig. Mit der Echokardiographie gelingt die Visualisierung der Koronararterien nur abschnittsweise. Mittels Kernspintomographie lassen sich die Herzkranzgefäße zwar darstellen, Ortsauflösung und Bildqualität gestatten aber die zuverlässige Detektion von Koronarstenosen derzeit nicht. Lediglich zur Diagnostik von Koronaranomalien spielt die Kernspintomographie eine gewisse Rolle. Die Mehrzeilen-Computertomographie hingegen erlaubt bei Anwendung neuester Gerätetechnik, ausreichender Erfahrung und einer gewissen Selektion und Vorbereitung der Patienten eine recht zuverlässige Darstellung der Koronararterien. Stenosen lassen sich mit hoher Sensitivität und Spezifität und insbesondere mit einem hohen negativ-prädiktiven Wert detektieren. Daher beginnt sich die CT-Koronarangiographie als klinisches Verfahren bei derzeit noch streng selektierten Patienten zu etablieren. Anwendungen sind am sinnvollsten im Bereich der „Ausschlussdiagnostik” bei niedriger bis intermediärer prä-Test Wahrscheinlichkeit, um eine ansonsten notwendige invasive Koronarangiographie zu vermeiden.

Summary

Non-invasive visualization of the coronary arteries is technically challenging because of the small dimensions and rapid motion of the coronary vessels. Echocardiography only allows assessment of very short coronary segments. Magnetic resonance imaging has been proposed for coronary imaging, but limitations especially of spatial resolution prevent routine clinical applications, with the possible exception of its use in patients with suspected coronary anomalies. Recent generations of multi-detector computed tomography (MDCT) scanners, on the other hand, allow increasingly accurate visualization of the coronary arteries. With the prerequesite of appropriate patient selection and preparation, high sensitivity and specificity for the detection of coronary artery stenoses can be achieved. Numerous studies have demonstrated highly negative predictive values to rule out coronary stenoses, which makes CT coronary angiography potentially useful specially in the setting of low to intermediate likelihood of coronary artery disease. A CT coronary angiogram that clearly demonstrates absence of stenoses may in this situation help avoid „negative” invasive coronary angiograms.

Schlüsselwörter

Koronarangiographie - Koronararterien - koronare Herzkrankheit - Computertomographie - Kernspintomographie - Bildgebung

Key words

coronary angiography - coronary arteries - coronary artery disease - computed tomography - magnetic resonance imaging - imaging

Literatur

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