Computertomografische Diagnostik der koronaren Herzkrankheit

Zusammenfassung

Die Herz-CT stellt das Verfahren der Wahl für die nicht-invasive Schnittbilduntersuchung der koronaren Herzkrankheit und die Beurteilung des Koronarsystems dar. Dabei ist neben der Ermittlung der Kalklast auch eine Beurteilung von Bypassgefäßen und der Darstellung der kardialen Anatomie des linken Vorhofes vor Intervention etabliert. Neue Arbeitsfelder, wie etwa vor Koronarrevaskularisierung bei Gefäßverschluß oder die Evaluation vor perkutanen Klappeninterventionen runden das derzeitige Spektrum der Herz-CT ab. Die folgende Übersicht gibt eine Zusammenfassung der derzeitigen Möglichkeiten der Herz-CT in der klinischen Routine.·

Abstract

Cardiac computed tomography has become the mainstay for non-invasive cardiac imaging in the diagnostic work-up of coronary heart disease. Beyond calcification imaging and coronary computed tomography angiography, cardiac CT is able to detect coronary bypass graft patency as well as anatomic features of the left atrium prior to intervention. As a relatively new field, vesseltracking prior to revascularization for coronary total occlusion and valvular assessment prior to endovascular valvular interventions has become more and more important. This pictorial review should make the reader familiar with the recent indications and potentials of cardiac computed tomography.

Schlüsselwörter

koronare Herzkrankheit - Computertomografie - nicht-invasive kardiale ­Bildgebung

Key words

coronary heart disease - computed tomography - non-invasive cardiac imaging

• Literatur

• 1 Achenbach S, Barkhausen J, Beer M et al. Consensus recommendations of the German Radiology Society (DRG), the German Cardiac Society (DGK) and the German Society for Pediatric Cardiology (DGPK) on the use of cardiac imaging with computed tomography and magnetic resonance imaging. RoeFo 2012; 18: 345-368
• 2 Achenbach S, Schubäck A, Min JK et al. Determination of the aortic anulus plane in CT imaging – A step-by-step approach. JACC. Cardiovascular imaging 2013; 6: 275-278
• 3 Alkhadi H. CT-Koronarangiographie: Genauigkeit und Indikationen. Aus: Alkhadi H, Leschka S, Marincek B, Flohr T. Praxishandbuch Herz-CT. Springer medizin Verlag; Heidelberg: 2009: 59-66
• 4 Angelini P Hrsg Coronary artery anomalies: a comprehensive approach. Philadelphia: Lippincott Williams& Wilkins; 1992: 42
• 5 Bae KT, heiken JP. Scan and contrast administration principles of MDCT. Eur Radiol 2005; 15: 46-59
• 6 Bazeed MF, Rezk AL, Moselhy MS. Value of cardiac CT in comprehensive aortic valve and root evaluation before percutaneous aortic valve replacement. Acta Radiol 27 2013; [epub ahead of print]
• 7 Becker C. CT-Angiographie der Bypassgefäße. CME-Programm Radiologie, Thieme-Verlag;
• 8 Becker C, Knez A, Ohnesorge B et al. Imaging of non calcified coronary plaques using helical CT with retrospective EKG gating. AJR 175: 423-424
• 9 Brüning R., Küttner A, Flohr T. Mehrschicht-CT. Ein Leitfaden, Band 1: Herz. Springer Verlag; Heidelberg: 2006
• 10 Cadematri F, Niemann K, van der Lugt A et al. Intravenous contrast material administration at 16-detector row helical CT coronary angiography: test bolus versus bolus-tracking technique. Radiology 2004; 233: 817-823
• 11 deGraaf VR, van Velzen JE, Wittkovska AJ et al. Diagnostic performance of 320-slice multidetector computed tomography coronary angiography in patients after coronary artery bypass grafting. Eur Radiol 2011; 21: 2285-2296
• 12 Hoe J. CT coronary angiography of chronic total occlusions of the coronary arteries: how to recognize and evaluate and usefulness for planning percutaneous interventions. Int J Cardiovasc Imaging 2009; 25: 43-54
• 13 Kerl JM, Ravenel JG, Nguyen SA et al. Right heart: split-bolus injectionof diluted contrast medium for visualization at coronary CT angiography. Radiology 2008; 247: 356-364
• 14 Lee AM, Beaudoin J, Engel LC et al. Assessment of image qualitiy and radiation dose of prospectively ECG-triggered adaptive dual-source coronary computed tomography angiography (cCTA) with arrhythmia rejection algorithmus versus diastole: a retrospective cohort study. Int J Cardiovasc Imaging 2013; 24 [epub ahead of print]
• 15 Lee YW, Yang CC, Mok GS et al. Prospectivly versus retrospectively ECG 256-slice CT-angiography to assess coronary artery bypass grafts – comparison of image qualitiy and radiation dose. PLoS One 7 2012; e49212
• 16 Menke J, Unterberg-Buchwald C, Staab W et al. Head-to-head comparison of prospectively triggered versus retrospectively gated coronary computed tomography angiography: Meta-analysis of diagnostic accuracy, image qualitiy, and radiation dose. Am Heart J 2013; 165: 154-163
• 17 Ohnesorge B, Flohr T, Becker C et al. Herzbildgebung mit schneller retrospektiv EKG-synchronisierter Mehrschicht-Spiral-CT. Radiologe 2000; 40: 111-117
• 18 Pelliccia F, Pasceri V, Evangelista A et al. Diagnostic accuracy of 320-row computed tomography as compared with invasive coronary angiography in unselected, consecutive patients with suspected coronary heart disease. Int J Cardiovasc Imaging 2013; 29: 443-452
• 19 Plank F, Friedrich G, Bartel T et al. Benefits of high-pitch 128-slice dual source computed tomography for planning of transcatheter aortic valve implantation. Ann Thorac Surg 2012; 94: 1961-1966
• 20 Schermund A, Möhlenkamp S, Mathes P et al. Bedeutung der Koronarkalkbestimmung in der Primärprävention. Z Kardiol 2005; 94: 79-87
• 21 Takimura H, Muramatsu T, Tsukahara R. CT coronary angiography guided percutaneous intervention for chronic total occlusion combined with retrograde approach. J Invasive Cardiol 2012; 24: 5-9
• 22 Tello R, Hartnell GG, Costello P et al. Coronary artery bypass graft flow: qualitative evaluation with cine single-detector row CT and comparison with findings at angiography. Radiology 2002; 224: 913-918
• 23 Thelen M, Erbel R, Kreitner K et al. Bildgebende Kardiodiagnostik. Georg Thieme-Verlag; Stuttgart New York: 2007