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MRT bei interstitiellen Lungenerkrankungen

Was ist möglich?

MRI of interstitial lung diseases

What is possible?

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Zusammenfassung

Hintergrund

Die MRT der Lunge entwickelt sich zu einer ernstzunehmenden dritten Säule der Thoraxdiagnostik neben dem Thoraxröntgen und der Computertomographie (CT). Ihr Wert in der pädiatrischen Lungendiagnostik oder für den wissenschaftlichen Einsatz, insbesondere wenn eine Strahlenexposition vermieden werden soll, ist unbestritten. Von allen Indikationen stellt die Diagnostik interstitieller Lungenerkrankungen die größte Herausforderung dar.

Ziel der Arbeit

Zusammenfassung des aktuellen Stands zu Möglichkeiten und Perspektiven der MRT für die Diagnostik interstitieller Lungenerkrankungen.

Material und Methoden

Zusammenfassung einer aktuellen Literaturrecherche und Bewertung der Ergebnisse vor dem Hintergrund eigener Erfahrungen mit der Lungen-MRT.

Ergebnisse

Allein aufgrund der geringeren Detailauflösung und der deutlich größeren Anfälligkeit für Artefakte ist die MRT der CT bei der Diagnostik interstitieller Lungenerkrankungen („interstitial lung diseases“, ILD) bei feinen Mustern (feinnetzige Fibrose, Mikronoduli) unterlegen, kann aber gröbere Fibrosen (Honigwabenmuster) detektieren. Zudem wurde an kleinen Fallgruppen gezeigt, dass die MRT diagnostisch wertvolle Informationen zur regionalen Lungenfunktion (Ventilation, Perfusion, mechanische Eigenschaften) und Entzündungsaktivität (natives Signal, Kontrastmitteldynamik) liefern kann.

Diskussion

Aktuell kann die morphologische Lungen-MRT ergänzend zur kardialen Diagnostik bei Sarkoidose für die umfassende kardiothorakale Bildgebung in einer Sitzung oder für Verlaufsbeobachtungen eingesetzt werden. Wenn sich die Möglichkeiten der MRT-basierten Lungenfunktionsdiagnostik und Beurteilung der Entzündungsaktivität klinisch robust umsetzen lassen, ist von einer deutlichen Erweiterung des Anwendungsspektrums auszugehen.

Abstract

Background

Magnetic resonance imaging (MRI) of the lungs is becoming increasingly appreciated as a third diagnostic imaging modality besides chest x-ray and computed tomography (CT). Its value is well acknowledged for pediatric patients or for scientific use particularly when radiation exposure should be strictly avoided. However, the diagnosis of interstitial lung disease is the biggest challenge of all indications. The objective of this article is a summary of the current state of the art for diagnostic MRI of interstitial lung diseases.

Material and methods

This article reflects the results of a current search of the literature and discusses them against the background of the authors own experience with lung MRI.

Results

Due to its lower spatial resolution and a higher susceptibility to artefacts MRI does not achieve the sensitivity of CT for the detection of small details for pattern recognition (e.g. fine reticulation and micronodules) but larger details (e.g. coarse fibrosis and honeycombing) can be clearly visualized. Moreover, it could be shown that MRI has the capability to add clinically valuable information on regional lung function (e.g. ventilation, perfusion and mechanical properties) and inflammation with native signal and contrast dynamics.

Discussion

In its present state MRI can be used for comprehensive cardiopulmonary imaging in patients with sarcoidosis or for follow-up of lung fibrosis after initial correlation with CT. Far more indications are expected when the capabilities of MRI for the assessment of regional lung function and activity of inflammation can be transferred into robust protocols for clinical use.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Biederer, M.O. Wielpütz, B.J. Jobst und J. Dinkel geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Radiologie Darmstadt, Kreisklinik Groß-Gerau, Wilhelm-Seipp-Str. 3, 64521, Groß-Gerau, Deutschland

    J. Biederer

  2. Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    J. Biederer, M.O. Wielpütz, B.J. Jobst & J. Dinkel

  3. Translational Lung Research Center (TLRC) Heidelberg, Deutsches Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland

    J. Biederer, M.O. Wielpütz, B.J. Jobst & J. Dinkel

  4. Klinik für Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    J. Biederer, M.O. Wielpütz, B.J. Jobst & J. Dinkel

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  1. J. Biederer
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  2. M.O. Wielpütz
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Correspondence to J. Biederer.

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Biederer, J., Wielpütz, M., Jobst, B. et al. MRT bei interstitiellen Lungenerkrankungen. Radiologe 54, 1204–1212 (2014). https://doi.org/10.1007/s00117-014-2738-z

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