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Sinnvolle Diagnostik: Bildgebung

Meaningful diagnostics: imaging


Die Bildgebung der subklinischen Atherosklerose wird in einem präventivmedizinischen Algorithmus auf der Grundlage einer vorausgehenden kardiovaskulären Risikostratifikation eingebunden. Für eine weitergehende Bildgebung qualifizieren sich insbesondere Patienten mit niedrigem und intermediärem Risiko (cave: Bayes-Theorem). Die bildgebenden Verfahren bei der subklinischen Atherosklerose haben eines gemeinsam: Sie bilden die Atherosklerose direkt ab, wofür sich die kardiale Mehrschichtcomputertomographie (MSCT; koronares Kalzium-Scoring [CACS]) und der Ultraschall der Gefäße (Arteria carotis und/oder femoralis) zum Nachweis der Plaque-Last eignen. Der Befund wird als ein „risk modifier“ betrachtet. Die Risikoabschätzung ist nicht an Symptomatik gebunden. Neben der Aufdeckung und Lokalisierung der Atherosklerose erlaubt sie auch die Bestimmung des „Risikoalters“ nach den Tabellen der European Society of Cardiology (ESC) und sogar des biologischen Alters, welches anhand von Nomogrammen abgeschätzt werden kann. Diese Kenntnisse tragen dazu bei, die Compliance des Patienten und die Adhärenz zur Medikation zu fördern.


Imaging of subclinical atherosclerosis is an integrated component of a preventive medicine algorithm; i.e. on the basis of a cardiovascular risk stratification patients with a low and intermediate risk qualify for further imaging (cave: Bayesʼ theorem). Imaging procedures for subclinical atherosclerosis have one thing in common: atherosclerosis is detected and localized directly, for which cardiac multidetector computed tomography (MDCT; coronary calcium scoring, CACS) and vascular ultrasound (carotid and/or femoral arteries) are used to measure the plaque burden. The result is viewed as a risk modifier. The risk assessment is not related to symptoms. In addition to the detection and localization of atherosclerosis this also enables assessment of the “risk age” according to the tables of the European Society of Cardiology (ESC) and even the biological age, which can be estimated based on nomograms. This knowledge can be used to promote patient compliance and adherence to medication.

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Correspondence to Prof. Dr. med. Uwe Nixdorff FESC.

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U. Nixdorff gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Nixdorff, U. Sinnvolle Diagnostik: Bildgebung. Herz 45, 17–23 (2020).

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  • Atherosklerose
  • Kardiovaskuläre Bildgebung
  • Koronares Kalzium-Scoring
  • Karotisultraschall
  • Compliance


  • Atherosclerosis
  • Cardiovascular imaging
  • Coronary calcium scoring
  • Carotid ultrasound
  • Compliance