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Methoden der MRT zur Ventilations- und Perfusionsbildgebung der Lunge

MRI methods for pulmonary ventilation and perfusion imaging

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Zusammenfassung

Klinisches/methodisches Problem

Die separate Beurteilung von Atemmechanik, Gasaustauschprozessen und Lungenzirkulation ist wesentlich für die Diagnose und Therapie von Lungenerkrankungen. Klinische Lungenfunktionstests sind aufgrund ihrer zumeist nur globalen Aussage oft nicht hinreichend spezifisch in der Differenzialdiagnostik oder eingeschränkt sensitiv bei der Detektion früher pathologischer Veränderungen.

Radiologische Standardverfahren

Standardverfahren der bildgebenden Lungendiagnostik sind die Computertomographie (CT) zur morphologischen Darstellung und die Perfusions-/Ventilationsszintigraphie bzw. „single photon emission computed tomography“ (SPECT) zur funktionellen Diagnostik.

Methodische Innovationen

Zur Darstellung der Lungenventilation stehen die MRT mit hyperpolarisierten Gasen, die O2-verstärkte MRT, die MRT mit fluorierten Gasen und die Fourier-Dekompositions-MRT (FD-MRT) zur Verfügung. Zur Perfusionsbestimmung können die dynamische kontrastmittelverstärkte MRT (DCE-MRT), das „arterial spin labeling“ (ASL) und die FD-MRT verwendet werden.

Leistungsfähigkeit

Bildgebende Verfahren erlauben einen genaueren Einblick in die Pathophysiologie der Lungenfunktion auf regionaler Ebene. Vorteile der MRT sind die fehlende Strahlenbelastung, welche die schonende Akquisition dynamischer Daten ermöglicht sowie die Vielfalt der verfügbaren Kontraste und damit zugänglichen Parameter der Lungenfunktion.

Bewertung

Ausreichende klinische Daten existieren nur für bestimmte Anwendungen der DCE-MRT. Für die übrigen Verfahren gibt es lediglich Machbarkeitsstudien und Fallserien mit unterschiedlichem Umfang. Hyperpolarisierte Gase sind technisch bedingt nur eingeschränkt in der Klinik anwendbar.

Empfehlung für die Praxis

Ein klinischer Einsatz der genannten Verfahren sollte mit Ausnahme der DCE-MRT nur innerhalb von Studien erfolgen.

Abstract

Clinical/methodical issue

Separate assessment of respiratory mechanics, gas exchange and pulmonary circulation is essential for the diagnosis and therapy of pulmonary diseases. Due to the global character of the information obtained clinical lung function tests are often not sufficiently specific in the differential diagnosis or have a limited sensitivity in the detection of early pathological changes.

Standard radiological methods

The standard procedures of pulmonary imaging are computed tomography (CT) for depiction of the morphology as well as perfusion/ventilation scintigraphy and single photon emission computed tomography (SPECT) for functional assessment.

Methodical innovations

Magnetic resonance imaging (MRI) with hyperpolarized gases, O2-enhanced MRI, MRI with fluorinated gases and Fourier decomposition MRI (FD-MRI) are available for assessment of pulmonary ventilation. For assessment of pulmonary perfusion dynamic contrast-enhanced MRI (DCE-MRI), arterial spin labeling (ASL) and FD-MRI can be used.

Performance

Imaging provides a more precise insight into the pathophysiology of pulmonary function on a regional level. The advantages of MRI are a lack of ionizing radiation, which allows a protective acquisition of dynamic data as well as the high number of available contrasts and therefore accessible lung function parameters.

Achievements

Sufficient clinical data exist only for certain applications of DCE-MRI. For the other techniques, only feasibility studies and case series of different sizes are available. The clinical applicability of hyperpolarized gases is limited for technical reasons.

Practical recommendations

The clinical application of the techniques described, except for DCE-MRI, should be restricted to scientific studies.

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Authors and Affiliations

  1. Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz

    G. Sommer

  2. Klinik für Radiologie und Nuklearmedizin – Radiologische Physik, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz

    G. Bauman

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Correspondence to G. Sommer.

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Interessenkonflikt

G. Sommer und G. Bauman geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Sommer, G., Bauman, G. Methoden der MRT zur Ventilations- und Perfusionsbildgebung der Lunge. Radiologe 56, 106–112 (2016). https://doi.org/10.1007/s00117-015-0074-6

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  • DOI: https://doi.org/10.1007/s00117-015-0074-6

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