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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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Literatur

  1. Gallagher MJ, Raff GL (2008) Use of multislice CT for the evaluation of emergency room patients with chest pain: the so-called „triple rule-out“. Catheter Cardiovasc Interv 71:92–99

    Article  PubMed  Google Scholar 

  2. White CS, Kuo D, Kelemen M et al (2005) Chest pain evaluation in the emergency department: can MDCT provide a comprehensive evaluation? AJR Am J Roentgenol 185:533–540

    PubMed  Google Scholar 

  3. Vanhoenacker PK, Heijenbrok-Kal MH, van Heste R et al (2007) Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: meta-analysis. Radiology 244:419–428

    Article  PubMed  Google Scholar 

  4. Wildberger JE, Mahnken AH, Das M et al (2005) CT imaging in acute pulmonary embolism: diagnostic strategies. Eur Radiol 15:919–929

    Article  PubMed  Google Scholar 

  5. Wells PS, Anderson DR, Rodger M et al (2000) Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 83:416–420

    PubMed  CAS  Google Scholar 

  6. Ryu JH, Swensen SJ, Olson EJ, Pellikka PA (2001) Diagnosis of pulmonary embolism with use of computed tomographic angiography. Mayo Clin Proc 76:59–65

    Article  PubMed  CAS  Google Scholar 

  7. Perrier A, Roy PM, Aujesky D et al (2004) Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study. Am J Med 116:291–299

    Article  PubMed  Google Scholar 

  8. Schoepf UJ, Savino G, Lake DR et al (2005) The age of CT pulmonary angiography. J Thorac Imaging 20:273–279

    Article  PubMed  Google Scholar 

  9. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group (2003) British Thoracic Society Guidelines for the management of suspected acute pulmonary embolism. Thorax 58:470–483

    Article  Google Scholar 

  10. Ghaye B, Remy J, Remy-Jardin M (2002) Non-traumatic thoracic emergencies: CT diagnosis of acute pulmonary embolism: the first 10 years. Eur Radiol 12:1886–1905

    PubMed  Google Scholar 

  11. Quiroz R, Kucher N, Schoepf UJ et al (2004) Right ventricular enlargement on chest computed tomography: prognostic role in acute pulmonary embolism. Circulation 109:2401–2104

    Article  PubMed  Google Scholar 

  12. He H, Stein MW, Zalta B, Haramati LB (2006) Computed tomography evaluation of right heart dysfunction in patients with acute pulmonary embolism. J Comput Assist Tomogr 30:262–266

    Article  PubMed  Google Scholar 

  13. Garg K, Sieler H, Welsh CH et al (1999) Clinical validity of helical CT being interpreted as negative for pulmonary embolism: implications for patient treatment. AJR Am J Roentgenol 172:1627–1631

    PubMed  CAS  Google Scholar 

  14. Willoteaux S, Lions C, Gaxotte V et al (2004) Imaging of aortic dissection by helical computed tomography (CT). Eur Radiol 14:1999–2008

    Article  PubMed  Google Scholar 

  15. Yu T, Zhu X, Tang L et al (2007) Review of CT angiography of aorta. Radiol Clin North Am 45:461–483

    Article  PubMed  Google Scholar 

  16. Knowles NG, Patel S, Kazerooni EA (2009) Cardiac CT for acute chest pain in the emergency department: advantages of prospective triggering. Int J Cardiovasc Imaging [e-pub]

  17. Rybicki FJ, Otero HJ, Steigner ML et al (2008) Initial evaluation of coronary images from 320-detector row computed tomography. Int J Cardiovasc Imaging 24:535–546

    Article  PubMed  Google Scholar 

  18. Flohr TG, McCollough CH, Bruder H et al (2006) First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol 16:256–268

    Article  PubMed  Google Scholar 

  19. Achenbach S, Anders K, Kalender WA (2008) Dual-source cardiac computed tomography: image quality and dose considerations. Eur Radiol 18:1188–1198

    Article  PubMed  Google Scholar 

  20. Leber AW, Johnson T, Becker A et al (2007) Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease. Eur Heart J 28:2354–2360

    Article  PubMed  Google Scholar 

  21. Stillman AE, Oudkerk M, Ackerman M et al (2007) Use of multidetector computed tomography for the assessment of acute chest pain: a consensus statement of the North American Society of Cardiac Imaging and the European Society of Cardiac Radiology. Eur Radiol 17:2196–2207

    Article  PubMed  Google Scholar 

  22. Meijboom WB, van Mieghem CA, Mollet NR et al (2007) 64-slice computed tomography coronary angiography in patients with high, intermediate, or low pretest probability of significant coronary artery disease. J Am Coll Cardiol 50:1469–1475

    Article  PubMed  Google Scholar 

  23. Johnson TR, Nikolaou K, Wintersperger BJ et al (2007) Optimization of contrast material administration for electrocardiogram-gated computed tomographic angiography of the chest. J Comput Assist Tomogr 31:265–271

    Article  PubMed  Google Scholar 

  24. Litmanovitch D, Zamboni GA, Hauser TH et al (2008) ECG-gated chest CT angiography with 64-MDCT and tri-phasic IV contrast administration regimen in patients with acute non-specific chest pain. Eur Radiol 18:308–317

    Article  PubMed  Google Scholar 

  25. Johnson TRC, Nikolaou K, Becker CR (2008) Vascular extended chest pain protocol. In: Seidensticker P, Hofmann L (eds) Dual Source CT imaging. Springer, Berlin Heidelberg New York, pp 132–139

  26. Wittram C, Yoo AJ (2007) Transient interruption of contrast on CT pulmonary angiography: proof of mechanism. J Thorac Imaging 22:125–129

    Article  PubMed  Google Scholar 

  27. Johnson TR, Nikolaou K, Becker A et al (2008) Dual-Source CT for chest pain assessment. Eur Radiol 18:773–780

    Article  PubMed  Google Scholar 

  28. White CS (2007) Chest pain in the emergency department: potential role of multidetector CT. J Thorac Imaging 22:49–55

    Article  PubMed  Google Scholar 

  29. Kalender WA (2009) The basics of flash technology (oral paper). Eur Radiol 19 [suppl 1]:S528

  30. Ladapo JA, Hofmann U, Bamberg F et al (2008) Cost-effectiveness of coronary MDCT in the triage of patients with acute chest pain. AJR Am J Roentgenol 191:455–463

    Article  PubMed  Google Scholar 

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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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Authors and Affiliations

  1. Department of Radiology, Maastricht University Medical Center (MUMC+), P. Debyelaan 25, NL-6202, Maastricht, Niederlande

    J.E. Wildberger & T. Leiner

  2. Klinik für Radiologische Diagnostik, Universitätsklinikum Aachen, Aachen, Deutschland

    A.H. Mahnken

  3. Angewandte Medizintechnik, Helmholtz-Institut für Biomedizinische Technik, RWTH Aachen, Aachen, Deutschland

    A.H. Mahnken

Authors
  1. J.E. Wildberger
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  2. T. Leiner
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  3. A.H. Mahnken
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Correspondence to J.E. Wildberger.

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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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  • DOI: https://doi.org/10.1007/s00117-008-1806-7

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