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MSCT bei thorakalen Notfällen

Multidetector-row spiral computed tomography in chest emergencies

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Zusammenfassung

Die Weiterentwicklung der Mehrschichtspiralcomputertomographie (MSCT) mit EKG-Synchronisation ermöglicht differenzierte Untersuchungsprotokolle zur Abklärung unklarer thorakaler Schmerzereignisse, erfordert jedoch aufgrund der gegenüber einer herkömmlichen CT des Thorax ca. 3-fach höheren Strahlenexposition eine enge Indikationsstellung. Fragestellungen, die isoliert die Lungengefäße, den Aortenbogen bzw. die deszendierende Aorta betreffen, können meist bereits mit einem Standard-CT-Datensatz beantwortet werden, für Pathologien der Aorta ascendens und zum Ausschluss einer koronaren Herzerkrankung (KHK) ist eine Submillimeterkollimation mit EKG-Synchronisation hingegen unerlässlich. Erste Studienergebnisse bescheinigen der MSCT bei der Abklärung des akuten Thoraxschmerzes hohe negative prädiktive Vorhersagewerte. Mit der neuesten Scannergeneration ist eine medikamentöse Vorbereitung der Patienten, mit Ausnahme einer sublinguale Nitroglyceringabe, nicht mehr nötig. Die erforderliche zeitgleiche Kontrastierung von Pulmonalarterien, der thorakalen Aorta und der Herzkranzgefäße stellt jedoch hohe Anforderungen an die Kontrastmittelapplikation.

Ob die Methode sich auch unter evidenzbasierten Gesichtspunkten weiter durchsetzen wird und kosteneffizient ist, bleibt weiteren prospektiven Studien vorbehalten.

Abstract

With ongoing advances in multidetector-row computed tomography (MDCT) using ECG gating, differentiated examination protocols have become technically feasible. For acute chest pain assessment a strict triage of patients is indispensable, as the radiation dose is approximately 3 times higher for a dedicated protocol compared to a standard chest MDCT. Clinical requests considering pathologies of the pulmonary arteries, the aortic arch and the descending aorta can safely be answered with a standard CT data set. However, for the coronary arteries as well as for the ascending aorta, ECG synchronization of the data set is required. Initial reports regarding MDCT assessment for acute chest pain report a high negative predictive value. With the latest MDCT platforms available, medical preparation is no longer necessary with the exception of sublingual application of nitroglycerine. Dedicated contrast injection protocols, however, are necessary for simultaneous opacification of the pulmonary arteries as well as of the aorta and the coronary arteries.

Further prospective studies will have to provide more evidence-based data for acute chest pain assessment with MDCT and will also have to outline the cost-effectiveness of this imaging technique.

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Interessenkonflikt

Prof. Dr. Wildberger hat Honorare für Vorträge von Bayer Schering Pharma, GE Healthcare und Boston Scientific Medizintechnik GmbH bzw. Studienunterstützungen oder andere Drittmittel von Siemens Medical Solutions sowie Bayer Schering Pharma erhalten.

Dr. Leiner hat Honorare für Vorträge von Bayer Schering Pharma und GE Healthcare bzw. Studienunterstützungen oder andere Drittmittel von Bayer Schering Pharma erhalten.

Prof. Dr. Mahnken hat Honorare für Vorträge von Bayer Schering Pharma, GE Healthcare, Celon AG und Boston Scientific Medizintechnik GmbH bzw. Studienunterstützungen oder andere Drittmittel von Siemens Medical Solutions sowie Bayer Schering Pharma erhalten.

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Wildberger, J., Leiner, T. & Mahnken, A. MSCT bei thorakalen Notfällen. Radiologe 49, 492–500 (2009). https://doi.org/10.1007/s00117-008-1806-7

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