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Diagnostik der koronaren Herzerkrankung mit Computer- und Magnetresonanztomographie

Cardiac computed tomography and magnetic resonance imaging in patients with coronary artery disease

Der Internist volume 51, pages 625–640 (2010)Cite this article

Zusammenfassung

Bei symptomatischen Patienten wird die Indikation zur Koronarangiographie mittels Computertomographie (CT) dann gesehen, wenn eine stenosierende koronare Herzkrankheit (KHK) als Ursache der Beschwerden ausgeschlossen werden soll und der Patient eine mittlere Vortestwahrscheinlichkeit für eine KHK hat. Angemessen erscheint der Einsatz der CT-Koronarangiographie auch dann, wenn ein Belastungstest nicht eindeutig ausfiel, sodass der weitere therapeutische Weg nicht klar ist. Mitunter kann bei einem Patienten, der trotz hoher Wahrscheinlichkeit einer invasiv behandlungsbedürftigen KHK die eigentlich notwendige invasive Koronarangiographie ablehnt, durch das Ergebnis einer CT-Koronarangiographie die Bereitschaft zur invasiven Diagnostik gebahnt werden.

Die Indikation zur kardialen Magnetresonanztomographie (CMR) besteht in erster Linie, wenn eine pharmakologische Belastungsuntersuchung indiziert ist. Mit Dobutamin durchgeführt ist die CMR dann eine Alternative zur Echokardiographie, während die Adenosin-Perfusions-CMR die strahlenfreie Alternative zur Myokardszintigraphie darstellt. Die CMR-Spätaufnahme nach Kontrastmittelgabe stellt den Goldstandard für die Darstellung myokardialer Narben und die Vorhersage einer Erholung der myokardialen Funktion nach Revaskularisierung (Vitalitätsuntersuchung) dar.

Abstract

Coronary angiography by computed tomography (CTCA) is most suitable for symptomatic patients with an intermediate likelihood to exclude a coronary stenosis as the cause of the symptoms. It would also be appropriate in a patient in whom an equivoval stress test result has led to uncertainty about the patient’s further management. CTCA may occasionally be acceptable in a high risk symptomatic patient who refuses the necessary invasive coronary angiography if the results of CTCA are likely to alter patient management.

The main indication for cardiac magnetic resonance imaging (CMR) is for pharmacologic stress testing. If such a test is indicated, dobutamine stress CMR is an alternative to stress echocardiography and adenosine perfusion CMR is the alternative to nuclear myocardial perfusion imaging but without radiation. Late gadolinium enhancement CMR is the current gold standard for the assessment of myocardial scars and hence is well suited to predict recovery of function in dysfunctional myocardial regions following revascularisation (viability testing).

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Affiliations

  1. Abteilung für Kardiologie, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Deutschland

    U. Sechtem, A. Athanasiadis, P. Ong & H. Mahrholdt

  2. Abteilung für Radiologie und Nuklearmedizin, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Deutschland

    A. Geissler

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  1. U. Sechtem
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  2. A. Geissler
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  3. A. Athanasiadis
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  4. P. Ong
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  5. H. Mahrholdt
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Correspondence to U. Sechtem.

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Sechtem, U., Geissler, A., Athanasiadis, A. et al. Diagnostik der koronaren Herzerkrankung mit Computer- und Magnetresonanztomographie. Internist 51, 625–640 (2010). https://doi.org/10.1007/s00108-010-2585-6

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  • DOI: https://doi.org/10.1007/s00108-010-2585-6

Schlüsselwörter

  • Computertomographie
  • Koronararterien
  • CT-Angiographie
  • Myokardperfusion
  • Kardiale Magnetresonanztomographie

Keywords

  • Computed tomography
  • Coronary arteries
  • CT angiography
  • Myocardial perfusion
  • Cardiovascular magnetic resonance