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MRT bei kardialer Sarkoidose und Amyloidose

MRI in cardiac sarcoidosis and amyloidosis

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Zusammenfassung

Klinisches/methodisches Problem

Die Sarkoidose und Amyloidose sind Multisystemerkrankungen, in deren Verlauf es zu einer kardialen Beteiligung kommen kann.

Radiologische Standardverfahren

Bildgebend wird als primäres Verfahren die Echokardiographie eingesetzt. Zur weiteren Diagnostik wird neben der Biopsie und nuklearmedizinischen Verfahren v. a. die MRT herangezogen.

Methodische Innovationen

Als neuere Technik zur Darstellung globaler diffuser Kontrastmittelanreicherungen, wie sie im Rahmen der Amyloidose vorkommen, wird z. Z. das T1-Mapping evaluiert.

Leistungsfähigkeit

Durch den Einsatz der MRT, insbesondere des Late-Gadolinium-Enhancements (LGE), können die Sensitivität und Spezifität in der Diagnostik der kardialen Sarkoidose und Amyloidose entscheidend verbessert werden. Bei der Sarkoidose stellt das Vorhandensein eines LGE einen prognostischen Faktor bzgl. des Outcomes dar, während bei der kardialen Amyloidose durch Analyse des T1-Mappings eine bessere Abschätzung der Prognose möglich erscheint.

Empfehlung für die Praxis

Bei Verdacht auf kardiale Beteiligung im Rahmen einer Sarkoidose oder Amyloidose sollte als bildgebendes Verfahren eine MRT mit Kontrastmittel durchgeführt werden.

Abstract

Clinical/methodical issue

Sarcoidosis and amyloidosis are both multisystem disorders, which may involve the heart; however, isolated cardiac disease is rare. Diagnosis of cardiac sarcoidosis and amyloidosis is crucial because the patient prognosis is dependent on cardiac involvement and early treatment.

Standard radiological methods

Echocardiography is the first line imaging modality in the diagnostic work-up of both diseases, possibly giving hints towards the correct diagnosis. Besides myocardial biopsy and radionuclide studies cardiac magnetic resonance imaging (MRI) is routinely performed in patients suspect of having infiltrative cardiomyopathy.

Methodical innovations

The T1 mapping procedure is currently being evaluated as a new technique for detection and quantification of global myocardial enhancement, as seen in cardiac amyloidosis.

Performance

Sensitivities and specificities for detection of cardiac sarcoidosis and amyloidosis can be significantly improved by MRI, especially with late gadolinium enhancement (LGE) imaging. In cardiac sarcoidosis the use of LGE is outcome-related while in amyloidosis analysis of T1-mapping may be of prognostic value.

Practical recommendations

If cardiac involvement in sarcoidosis or amyloidosis is suspected cardiac MRI including LGE should be performed for establishing the diagnosis.

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Authors and Affiliations

  1. Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    K.U. Bauner & B. Wintersperger

  2. Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Kanada

    B. Wintersperger

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  1. K.U. Bauner
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  2. B. Wintersperger
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Correspondence to K.U. Bauner.

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Bauner, K., Wintersperger, B. MRT bei kardialer Sarkoidose und Amyloidose. Radiologe 53, 54–60 (2013). https://doi.org/10.1007/s00117-012-2386-0

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  • DOI: https://doi.org/10.1007/s00117-012-2386-0

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