Zusammenfassung
Die Mehrzeilen-Computertomographie erlaubt bei Anwendung neuester
Gerätetechnik, ausreichender Erfahrung und einer gewissen
Selektion und Vorbereitung der Patienten die Darstellung des Herzens
mit hoher Bildqualität. Wesentliches Anwendungsgebiet ist
die Darstellung der Koronararterien. Koronarstenosen lassen sich mit
hoher Sensitivität und Spezifität und insbesondere
mit einem hohen negativ-prädiktiven Wert detektieren bzw.
ausschließen. Sicherlich ist die CT-Koronarangiographie
kein klinisches Verfahren, welches unkritisch bei allen Patienten angewendet
oder gar zu „Screening”-Zwecken eingesetzt werden
sollte. Vor allem aufgrund des hohen negativ prädiktiven
Wertes kann sie jedoch – solange gewisse Voraussetzungen
gegeben sind – zum sicheren Ausschluss von Koronarstenosen
eingesetzt werden mit dem Ziel, eine ansonsten notwendige invasive
Koronarangiographie zu vermeiden. Von geringerer klinischer Bedeutung
ist der Koronarkalknachweis als Instrument zur Risikostratifikation
und die Analyse von Morphologie und Funktion des Herzens. Die CT
sollte für letzteres nur zum Zuge kommen, falls Standardverfahren
wie Echokardiographie oder Magnetresonanztomographie nicht eingesetzt
werden können oder keine ausreichende Bildqualität
liefern. Korrekte Patientenselektion und ausreichende Expertise
sind jedoch unbedingte Voraussetzungen für den erfolgreichen
und sinnvollen klinischen Einsatz der kardialen Computertomographie.
Abstract
Multi Detector CT, the usage of adequate technology, suitable imaging protocols, sufficient experience and strict patient selection provided, allows visualization of the heart with high temporal and spatial resolution. The main application is coronary CT angiography. Coronary artery stenoses can be detected with high sensitivity and specificity. Especially the high negative predictive value is high, but care has to be taken to avoid false-positive results which occur especially when image quality is degraded. Coronary CT angiography should not be considered a widespread replacement of invasive coronary angiography or even a “screening” procedure, but it can be clinically useful to rule out coronary artery stenoses in selected patients. The detection of coronary artery calcification can be used for risk stratification purposes. Finally, CT also allows evaluation of cardiac morphology and function, but will be used for this only when other modalities, such as echocardiography and MR imaging, have failed or are not applicable.
Schlüsselwörter
kardiale Computertomographie - koronare Herzerkrankung - Koronarkalk
Keywords
cardiac computed tomography - coronary heart disease - coronary calcification
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Prof. Dr. med. Stephan Achenbach
Medizinische Klinik 2
Universitätsklinikum
Erlangen
Ulmenweg 18
91054 Erlangen
Telefon: 09131/8535-000
Fax: 09131/8535-303
eMail: stephan.achenbach@uk-erlangen.de
