Zusammenfassung
Aortenerkrankungen können je nach Krankheitsbild und Akuität mit unterschiedlichen bildgebenden Verfahren untersucht werden. Modalitäten und Qualität der Bildgebung haben sich in den vergangenen Jahren rasant weiterentwickelt. Gemeinsam mit der klinischen Einschätzung eines betroffenen Patienten ist sie wegweisend für das weitere Management. Neben der eigentlichen Diagnosestellung sind die erhobenen Befunde auch Basis für die weitere Indikationsstellung, Therapieplanung, Therapiekontrolle und Verlaufsbeurteilung. Während die Katheterangiographie und der intravaskuläre Ultraschall nur noch in Ausnahmefällen und dann in Kombination mit einer interventionellen Therapie zur Anwendung kommen, stehen heute Schnittbildverfahren wie die kontrastverstärkte computertomographische Angiographie und die Magnetresonanztomographie im Zentrum der diagnostischen Abklärung. Den sich stetig verbessernden sonographischen Verfahren kommt vor allem im Rahmen von Screeninguntersuchungen, aber auch in der prä- und posttherapeutischen Verlaufsbeobachtung eine immer wichtigere Rolle zu. Therapeutisch relevante Zusatzinformationen können mithilfe der molekularen Bildgebung in der Positronenemissionstomographie/Computertomographie gewonnen werden.
Abstract
Depending on the type and acuteness, diseases of the aorta can be imaged by a variety of techniques. Modalities and quality of imaging have developed rapidly in recent years. In combination with the clinical assessment of patients, the results obtained by imaging determine the further management. They not only establish the underlying diagnosis but provide the information essential for indications, planning and reassessment of therapy, as well as for evaluation of the clinical course and surveillance. Whereas conventional catheter-guided angiography and intravascular ultrasound are only used in exceptional cases and then in conjunction with interventional therapy, cross-sectional imaging modalities, such as contrast-enhanced computed tomography (CT) angiography and magnetic resonance imaging (MRI) are nowadays the mainstay of diagnostics. Ultrasound techniques are improving steadily and are gaining increasing importance, e. g. for screening purposes and for pretherapeutic and posttherapeutic surveillance. Additional information of therapeutic relevance may be acquired by means of molecular imaging with positron emission tomography (PET) CT.
Literatur
Gawenda M, Brunkwall J (2012) Das rupturierte abdominelle Aortenaneurysma: Aktueller Stand. Dtsch Arztebl Int 109:727–732
Azhar B, Patel SR, Holt PJ, Hinchliffe RJ, Thompson MM, Karthikesalingam A (2014) Misdiagnosis of ruptured abdominal aortic aneurysm: systematic review and meta-analysis. J Endovasc Ther 21:568–575
Brecht G, Harder T (1981) Aortenaneurysma und Aortendissektion. Computertomographie – Angiographie – Sonographie. Rofo 135:388–398
Torsello G, Debus ES, Schmitz-Rixen T, Grundmann RT (2016) Ultraschall-Screening für das abdominelle Aortenaneurysma – eine effective Maßnahme zur Verhinderung der plötzlichen Ruptur. Dtsch Med Wochenschr 141:1030–1034
Wanhainen A, Hultgren R, Linné A, Holst J, Gottsäter A, Langenskiöld M, Smidfelt K, Björck M, Svensjö S (2016) Outcome of the Swedish Nationwide Abdominal Aortic Aneurysm Screening Program. Swedish Aneurysm Screening Study Group (SASS). Circulation 134:1141–1148
Schermerhorn ML, Giles KA, Sachs T, Bensley RP, O’Malley AJ, Cotterill P, Landon BE (2011) Defining perioperative mortality after open and endovascular aortic aneurysm repair in the US Medicare population. J Am Coll Surg 212:349–355
Riambau V, Böckler D, Brunkwall J et al (2017) Management of descending thoracic aorta diseases: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 53:4–52
ESC Committee for Practice Guidelines, Erbel R, Aboyans V, Boileau C et al (2014) 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 35:2873–2926
Dias NV, Riva L, Ivancev K, Resch T, Sonesson B, Malina M (2009) Is there a benefit of frequent CT follow-up after EVAR? Eur J Vasc Endovasc Surg 37:425–430
Nordon IM, Karthikesalingam A, Hinchliffe RJ, Holt PJ, Loftus IM, Thompson MM (2010) Secondary interventions following endovascular aneurysm repair (EVAR) and the enduring value of graft surveillance. Eur J Vasc Endovasc Surg 39:547–554
Garg T, Baker LC, Mell MW (2015) Postoperative surveillance and long-term outcomes after endovascular aneurysm repair among medicare beneficiaries. JAMA Surg 150:957–963
Leurs LJ, Laheij RJ, Buth J, EUROSTAR Collaborators (2005) What determines and are the consequences of surveillance intensity after endovascular abdominal aortic aneurysm repair? Ann Vasc Surg 19:868–875
American College of Cardiology Foundation, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, American Heart Association Task Force on Practice Guidelines, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, Society for Vascular Medicine, Hiratzka LF, Bakris GL, Beckman JA et al (2010) 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Catheter Cardiovasc Interv 76:E43–E86
European Association of Echocardiography, Evangelista A, Flachskampf FA, Erbel R et al (2010) Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr 11:645–658
Reeps C, Pelisek J, Bundschuh RA, Gurdan M, Zimmermann A, Ockert S, Dobritz M, Eckstein HH, Essler M (2010) Imaging of acute and chronic aortic dissection by 18 F–FDG PET/CT. J Nucl Med 51:686–689
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C. Reeps, S. Schellong und R.T. Hoffmann geben an, dass kein Interessenkonflikt besteht.
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Reeps, C., Schellong, S. & Hoffmann, R.T. Bildgebende Darstellung der Aorta. Internist 58, 766–774 (2017). https://doi.org/10.1007/s00108-017-0289-x
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DOI: https://doi.org/10.1007/s00108-017-0289-x