Kontrastangehobene MRT und MSCT zur kardialen Vitalitätsdiagnostik

Zusammenfassung

Die Kernspintomographie (MRT) hat sich in den letzten Jahren zu einer Referenzmethode der myokardialen Vitalitätsdiagnostik entwickelt. Erst kürzlich konnte auch das Potenzial der Mehrschicht-Spiral-Computertomographie (MSCT) für die Vitalitätsdiagnostik gezeigt werden. In dieser Arbeit werden zunächst ausführlich die einer Myokardischämie folgenden pathophysiologischen Veränderungen des Herzmuskels einschließlich der Abgrenzung von stunned und hibernierendem Myokard dargestellt. Als grundlegender Ansatz der Vitalitätsdiagnostik in MRT und MSCT wird in der Hauptsache das Konzept der myokardialen Spätanreicherung betrachtet. Als weitere Ansätze werden die Infarktdiagnostik mittels Perfusionsbildgebung und alternativer Kontrastmittel vorgestellt. Die Beziehung zwischen pathophysiologischen Veränderungen und dem Erscheinungsbild in MRT und MSCT wird gezeigt. Die klinischen Konsequenzen der MRT- und MSCT-Befunde werden betrachtet.

Abstract

Over the last decade magnetic resonance (MR) imaging has become a well-established method for visualizing myocardial viability. Multislice spiral computed tomography (MSCT) has also recently proven to be a reliable method for assessing the myocardium for this indication. This review extensively describes the changes in acute and chronic myocardial infarction including the differentiation of stunned or hibernating myocardium. This review focuses on delayed myocardial contrast enhancement as a key concept of viability imaging. Myocardial perfusion imaging as well as the use of alternative contrast agents are introduced. Pathophysiology is correlated to the changes observed in MR imaging and MSCT. The clinical impact of the imaging findings is described.

Key words

CT - heart - MRI - viability

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