Anwendung von Kontrastmitteln für die kardiale Magnetresonanztomographie

Zusammenfassung

MR Kontrastmittel können die diagnostische Aussagekraft der MRT verbessern und werden erfolgreich zur Differenzierung von vitalem und nekrotischem Myokard, transmuralem und nicht-transmuralem Infarkt, reperfundiertem und nicht-reperfundiertem Infarkt sowie für myokardiale Perfusionsmessungen eingesetzt. Derzeit sind klinische Studien nahezu ausschließlich auf die Anwendung extrazellulärer Kontrastmittel beschränkt (z. B. Gd-DTPA, Gd-DTPA-BMA, Gd-BOPTA, Gd-D03A). Die Differenzierung und Charakterisierung ischämisch geschädigten Myokards mittels exogener Substanzen wie intravaskulärer, nekroseaffiner und intrazellulärer Kontrastmittel oder die Nutzung endogener Substrate als Kontrastgeber konnte jedoch in experimentellen Untersuchungen gezeigt werden. Intravaskuläre Kontrastmittel (z. B. MS-325 oder Eisenpartikel) erlauben die Untersuchung der Integrität des Kapillarsystems sowie die MR-Angiographie. Nekroseaffine Kontrastmittel (z. B. Gadophrin) wurden zur selektiven Darstellung infarzierten Gewebes eingesetzt. Intrazelluläre Kontrastmittel (z. B. Mn-DPDP) ermöglichen die Darstellung vitalen Myokards. Endogene Substanzen (z. B. Deoxyhämoglobin, Na⁺ oder K⁺) wurden zur Darstellung der veränderten Ionenhomöostase und für Perfusionsmessungen in ischämisch geschädigtem Myokard erprobt.

Abstract

MR contrast media improve the diagnostic capability of MRI and MRA. They are used in the discrimination of viable and non-viable myocardium, transmural and non-transmural infarction, occlusive and reperfused infarction and for measurement of myocardial perfusion. Currently, clinical studies are almost completely restricted to the use of extracellular non-specific MR contrast media (i. e., Gd-DTPA, Gd-DTPA,-BMA, Gd-BOPTA, Gd-D03A). However, the feasibility of using intravascular, necrosis specific or intracellular MR contrast media or endogeneous substrates as specific MR contrast media in cardiovascular imaging has been demonstrated in experimental and a few clinical studies. Intravascular contrast media (i. e., MS-325 or NC100150 Injection) allow assessment of microvascular integrity and performance of MR angiography. Necrosis specific contrast media (i. e., Gadophrin-2) have been used for sizing the extent of infarcted myocardium while intracellular contrast media (i. e., Mn-DPDP) delineate viable myocardium. Endogenous contrast media (i. e., Deoxyhemoglobin, Na⁺ or K⁺) have been tested for detecting the alterations in concentrations of these ions in infarcted myocardium and for perfusion measurements. Furthermore, intravascular MR contrast media may be useful for MRA and MRI guided cardiovascular interventions.

MRT Kontrastmittel - Kardiovaskuläre MRT - Myokardinfarkt - Myokardvitalität - Interventionelle kardiovaskuläre Magnetresonanztomographie

MRI contrast media - Cardiovascular MRI - Myocardial infarction - Myocardial viability - Interventional magnetic resonance imaging

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