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Kontrastverstärkter Ultraschall der Skelettmuskulatur

Contrast-enhanced ultrasound of skeletal muscle

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Zusammenfassung

Funktionelle Bildgebungstechniken tragen zur wachsenden Rolle der Bildgebung bei Muskelerkrankungen bei, da Änderungen in der Morphologie des Skelettmuskels alleine als nicht spezifisch für eine bestimmte Erkrankung gelten. Ein gutes Beispiel dieser funktionellen Bildgebungstechniken ist der kontrastverstärkte Ultraschall (CEUS) zur Visualisierung und Quantifizierung (patho-)physiologischer Informationen zur Mikrozirkulation des Skelettmuskels in vivo. Die Perfusion, d. h. der kapilläre Blutfluss pro Gewebeeinheit ist ein wichtiger funktioneller Parameter. Eine pathologisch veränderte Skelettmuskelperfusion findet man bei verschiedenen Erkrankungen wie degenerativen und entzündlichen Myopathien sowie der peripheren arteriellen Verschlusskrankheit (pAVK). Dieser Artikel gibt eine Übersicht der technischen Grundlagen und fokussiert sich dann auf klinisch viel versprechende Anwendungen der mikrovaskulären Bildgebung mittels CEUS, die bereits die Diagnostik dieser muskulären Erkrankungen verbessert haben.

Zur Diagnostik einer Myositis ist der CEUS besser geeignet als der konventionelle B-Mode-Ultraschall, weil der CEUS die entzündlich induzierte muskuläre Hyperperfusion in einer akuten Myositis quantifizieren kann. Dies konnte schon mit hochenergetischen („High-mechanical index“-)Techniken unter Verwendung eines Ultraschallkontrastmittels der ersten Generation demonstriert werden. Niederenergetische CEUS-Techniken („low-mechanical index“) erfordern die Verwendung eines Ultraschallkontrastmittels der zweiten Generation und erlauben darüber hinaus die Echtzeitquantifizierung der muskulären Mikrozirkulation in Ruhe und während Belastung. Mit dieser CEUS-Methode lässt sich der Einfluss verschiedener Belastungsintensitäten auf die Mikrozirkulation des belasteten Muskels analysieren. Zudem kann die arterielle Perfusionsreserve bei einer pAVK adäquat mit Low-mechanical-index-CEUS-Techniken untersucht werden. Ersten Ergebnissen zufolge ist die arterielle Perfusionsreserve bei Patienten mit pAVK im Vergleich zu gesunden Probanden reduziert. Schlussfolgernd lässt sich konstatieren, dass moderne CEUS-Techniken über unspezifische morphologische Veränderungen hinaus, wie z. B. ödematöse oder lipomatöse Veränderungen bzw. Hyper- oder Atrophie, einen Einblick in die muskuläre Pathophysiologie erlauben.

Abstract

Functional imaging can increase the role of imaging in muscular diseases, as alterations of muscle morphology alone are non-specific for a particular disease. A good example for these functional imaging techniques is to use contrast-enhanced ultrasound (CEUS) to visualize and quantify in vivo (patho-) physiological information about the skeletal muscle microcirculation. Perfusion, i.e. the blood flow per tissue unit including capillary flow, is an important functional parameter. Pathological changes of skeletal muscle perfusion can be found in various clinical conditions, such as degenerative or inflammatory myopathy or peripheral arterial disease (PAD). This article reviews the theoretical basics of functional radiological techniques for assessing skeletal muscle perfusion and focuses on applications of microvascular imaging by CEUS which has improved the diagnosis of these muscular disorders. For evaluation of myositis, CEUS is more efficient in the diagnostic work-up than routine b-mode ultrasound because CEUS can detect inflammation-induced muscular hyperperfusion in acute myositis. This has already been demonstrated by high-mechanical index techniques using a first generation ultrasound contrast agent. Low-mechanical index CEUS techniques that require the use of a second generation contrast agent allow real-time quantification of muscular microcirculation at rest and during exercise. Using this CEUS method, the influence of different exercise intensities on the microcirculation of the exercising muscle becomes detectable. Moreover, the arterial perfusion reserve in PAD can be adequately examined using low-mechanical index CEUS. Initial findings have shown that the arterial perfusion reserve in patients suffering from PAD is reduced in comparison to healthy volunteers. In conclusion, modern CEUS techniques can offer deeper insights in muscular (patho-) physiology than just illustrating unspecific myopathic manifestations using conventional diagnostic imaging, such as edematous or lipomatous changes, hypertrophy or atrophy.

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Interessenkonflikt

Die Autoren weisen auf folgende Beziehungen hin: Prof. Dr. Krix ist Mitarbeiter der Firma Bracco Imaging Germany, Konstanz, die das Ultraschallkontrastmittel SonoVue® vertreibt. Prof. Dr. Weber und Frau Wormsbecher geben an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Abteilung Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    M.-A. Weber M.Sc.

  2. Abteilung Radiologie, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland

    M.-A. Weber M.Sc., S. Wormsbecher & M. Krix

  3. Bracco Imaging Germany, Konstanz, Deutschland

    M. Krix

Authors
  1. M.-A. Weber M.Sc.
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  2. S. Wormsbecher
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  3. M. Krix
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Correspondence to M.-A. Weber M.Sc..

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Weber, MA., Wormsbecher, S. & Krix, M. Kontrastverstärkter Ultraschall der Skelettmuskulatur. Radiologe 51, 497–505 (2011). https://doi.org/10.1007/s00117-010-2106-6

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  • DOI: https://doi.org/10.1007/s00117-010-2106-6

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