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Rolle der MRT zur Detektion und Abklärung pulmonaler Rundherde

Role of MRI for detection and characterization of pulmonary nodules

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Zusammenfassung

Hintergrund

Mit den technischen Weiterentwicklungen in den vergangenen Jahren hat sich die MRT zu einem methodisch ausgereiften und für spezifische pulmonale Fragestellungen bereits auch klinisch bewährten Untersuchungsverfahren entwickelt. Ohne Strahlenexposition kombiniert sie morphologische und funktionelle Diagnostik und ergänzt das Spektrum der etablierten Verfahren für die bildgebende Diagnostik der Lunge.

Ziel der Arbeit und Methoden

Diese Arbeit gibt einen Überblick über die aktuell verwendeten Sequenzen und Techniken zur Darstellung pulmonaler Rundherde und analysiert deren klinischen Stellenwert anhand der aktuellen Studienlage. In Zentrum stehen dabei die Detektion pulmonaler Metastasen, die Detektion primär pulmonaler Malignome bei Personen mit Risikoprofil und die Abklärung pulmonaler Rundherde hinsichtlich ihrer Dignität.

Ergebnisse und Diskussion

Die MRT besitzt im Vergleich zum Referenzstandard Niedrigdosis-CT eine Sensitivität von ca. 80 % für die Detektion maligner pulmonaler Rundherde und ist der CT damit etwas unterlegen. Vorteile der MRT gegenüber der Niedrigdosis-CT sind andererseits die höhere Spezifität bei der Differenzierung maligner und benigner pulmonaler Rundherde sowie die fehlende Strahlenexposition. Außerhalb von Studien kann ein breiter Einsatz der MRT als Screeningverfahren zur Detektion und Abklärung pulmonaler Rundherde aufgrund der noch ungenügenden Datenlage derzeit noch nicht empfohlen werden. Das diagnostische Potenzial der MRT für die Früherkennung und das Staging pulmonaler Malignome rechtfertigt aber die weitere Evaluation der MRT als sekundäre Modalität im Rahmen von Studien.

Abstract

Background

Due to physical and technical limitations, magnetic resonance imaging (MRI) has hitherto played only a minor role in image-based diagnostics of the lungs. However, as a consequence of important methodological developments during recent years, MRI has developed into a technically mature and clinically well-proven method for specific pulmonary questions.

Objectives and methods

The purpose of this article is to provide an overview on the currently available sequences and techniques for assessment of pulmonary nodules and analyzes the clinical significance according to the current literature. The main focus is on the detection of lung metastases, the detection of primary pulmonary malignancies in high-risk individuals and the differentiation between pulmonary nodules of benign and malignant character.

Results and conclusion

The MRI technique has a sensitivity of approximately 80 % for detection of malignant pulmonary nodules compared to the reference standard low-dose computed tomography (CT) and is thus somewhat inferior to CT. Advantages of MRI on the other hand are a higher specificity in differentiating malignant and benign pulmonary nodules and the absence of ionizing radiation exposure. A systematic use of MRI as a primary tool for detection and characterization of pulmonary nodules is currently not recommended due to insufficient data. The diagnostic potential of MRI for early detection and staging of malignant pulmonary diseases, however, seems promising. Therefore, further evaluation of MRI as a secondary imaging modality in clinical trials is highly warranted.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. G. Sommer, M. Koenigkam-Santos, J. Biederer und M. Puderbach geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz

    G. Sommer

  2. Department of Radiology, University Hospital of the School of Medicine of Ribeirao Preto – University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brasilien

    M. Koenigkam-Santos

  3. Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    J. Biederer

  4. Abteilung für Diagnostische und Interventionelle Radiologie, Hufeland-Klinikum GmbH, Bad Langensalza, Deutschland

    M. Puderbach

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  1. G. Sommer
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  2. M. Koenigkam-Santos
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  3. J. Biederer
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  4. M. Puderbach
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Correspondence to G. Sommer.

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Sommer, G., Koenigkam-Santos, M., Biederer, J. et al. Rolle der MRT zur Detektion und Abklärung pulmonaler Rundherde. Radiologe 54, 470–477 (2014). https://doi.org/10.1007/s00117-013-2604-4

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  • DOI: https://doi.org/10.1007/s00117-013-2604-4

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