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Was passiert eigentlich … in der Hybridbildgebung?

What actually happens … in hybrid imaging?

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Zusammenfassung

Klinisches/methodisches Problem

Dieser Artikel soll die Neuerungen der Perfusionsbildgebung sowie weitere Anwendungsfelder bei der Hybridbildgebung des Herzens beleuchten.

Radiologische Standardverfahren

Die am meisten verwendeten Modalitäten in der Hybridbildgebung sind nach wie vor die Einzelphotonen-Emissions-Computertomographie („single photon emission computed tomography“, SPECT) und die Positronen-Emissions-Tomographie/Computertomographie (PET/CT). Häufig kommen Perfusionstracer und 18F‑Fluordeoxyglukose (FDG) zur Vitalitätsbildgebung zum Einsatz.

Methodische Innovationen

Zunehmende Verbreitung findet auch die Positronen-Emissions-Tomographie/Magnetresonanztomographie (PET/MRT). Zudem wird FDG auch vermehrt in der Bildgebung von infektiösen und inflammatorischen myokardialen Erkrankungen angewendet. Des Weiteren kommen neuartige Tracer, wie Amyloid-spezifische Tracer bei der kardialen Amyloidose, zum Einsatz.

Leistungsfähigkeit

Insgesamt ist ein zunehmender Einsatz hybrider Bildgebungsverfahren zu verzeichnen. Anwendungsgebiete sind die myokardiale Perfusionsbildgebung, aber auch inflammatorische und infektiöse Erkrankungen wie Endokarditis, Myokarditis und Sarkoidose sowie unterschätzte Erkrankungen wie die kardiale Amyloidose. Des Weiteren führt die Verwendung neuartiger Tracer zur Schaffung neuer Anwendungsfelder in der Hybridbildgebung.

Empfehlung für die Praxis

Die Hybridbildgebung aus myokardialer Perfusion und Gefäßdarstellung scheint insbesondere bei komplexen Fällen wie Mehrgefäßerkrankungen vorteilhaft zu sein. Bei infektiösen und inflammatorischen myokardialen Erkrankungen hat die FDG-PET/CT bzw. PET/MRT ihren Mehrwert klar belegt. Neue Anwendungsfelder scheinen sehr vielversprechend, müssen ihren Stellenwert allerdings noch eindeutig belegen.

Abstract

Clinical/methodological issue

The goal of this article is to shed light on innovations in perfusion imaging and the fields of application that have opened up in hybrid imaging of the heart.

Standard radiological methods

As before, the most commonly used modalities in hybrid imaging are single photon emission computed tomography (SPECT) and positron emission tomography/computed tomography (PET/CT). Perfusion tracers and the radioactively labeled glucose analog 18F‑fluorodeoxyglucose (FDG) are commonly used for vitality imaging.

Methodical innovations

Use of PET/MRI (magnetic resonance imaging) is becoming increasingly widespread. In addition, FDG is also increasingly applied in imaging infectious and inflammatory myocardial diseases. Furthermore, novel tracers are used, such as the amyloid-specific tracers in cardiac amyloidosis.

Performance

Overall, this development has led to an increasing use of hybrid imaging techniques. These still include myocardial perfusion imaging, but are also used in inflammatory and infectious diseases such as endocarditis, myocarditis and sarcoidosis, as well as in underestimated diseases such as cardiac amyloidosis. The use of tracers has led to the creation of new fields of application in hybrid imaging.

Practical recommendations

Hybrid imaging combining myocardial perfusion and coronary visualization seems to be particularly advantageous in complex cases such as multivessel disease. In infectious and inflammatory myocardial diseases, FDG PET/CT or PET/MRI has clearly demonstrated its added value. New fields of application are very promising, but their significance has yet to be clearly demonstrated.

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Correspondence to C. Rischpler.

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Interessenkonflikt

C. Rischpler, T. Schlosser, L. Umutlu, T. Rassaf und B.J. Krause geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Rischpler, C., Schlosser, T., Umutlu, L. et al. Was passiert eigentlich … in der Hybridbildgebung?. Radiologe 60, 1153–1161 (2020). https://doi.org/10.1007/s00117-020-00779-y

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