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Magnetresonanztomographie der Lunge

Stand der Dinge

Magnetic resonance imaging of the lung

State of the art

  • CME
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Zusammenfassung

Die Lunge war lange Zeit aufgrund der geringen Protonendichte des Parenchyms sowie des schnellen Signalzerfalls an den Luft-Gewebe-Grenzen der Magnetresonanztomographie (MRT) schwer zugänglich. Technische Neuerungen haben diese Anforderungen größtenteils adressiert. Pulmonale Veränderungen, welche mit Gewebevermehrung einhergehen („Plus-Pathologien“), lassen sich nun aufgrund der lokal vermehrten Protonendichte mit einer hohen diagnostischen Genauigkeit darstellen. Die MRT bietet im Vergleich zur Computertomographie (CT) ein umfassendes Spektrum funktioneller Bildgebungsverfahren (Atemmechanik, Perfusion, Ventilation) sowie – als strahlungsfreie, nicht-invasive Untersuchungsmodalität – die Möglichkeit wiederholter Untersuchungen für Verlaufsbeurteilungen oder die Überwachung von Therapieeffekten, auch bei Kindern. In diesem Artikel besprechen wir technische Aspekte, geben Protokollvorschläge und erörtern die Rolle der Lungen-MRT in der routinemäßigen Beurteilung verschiedener Erkrankungen.

Abstract

Due to the low proton density of the lung parenchyma and the rapid signal decay at the air-tissue interfaces, for a long time the lungs were difficult to access using magnetic resonance imaging (MRI); however, technical advances could address most of these obstacles. Pulmonary alterations associated with tissue proliferation (“plus pathologies”), can now be detected with high diagnostic accuracy because of the locally increased proton density. Compared to computed tomography (CT), MRI provides a comprehensive range of functional imaging procedures (respiratory mechanics, perfusion and ventilation). In addition, as a radiation-free noninvasive examination modality, it enables repeated examinations for assessment of the course or monitoring of the effects of treatment, even in children. This article discusses the technical aspects, gives suggestions for protocols and explains the role of MRI of the lungs in the routine assessment of various diseases.

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Förderung

Gefördert durch das Bundesministerium für Bildung und Forschung (82DZL004A1).

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Authors and Affiliations

  1. Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland

    Lena Wucherpfennig,  Hans-Ulrich Kauczor,  Monika Eichinger &  Mark O. Wielpütz MHBA EDIR EBIR

  2. Translational Lung Research Center Heidelberg (TLRC), Deutsches Zentrum für Lungenforschung (DZL), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland

    Lena Wucherpfennig,  Hans-Ulrich Kauczor,  Monika Eichinger &  Mark O. Wielpütz MHBA EDIR EBIR

  3. Klinik für Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland

    Lena Wucherpfennig,  Hans-Ulrich Kauczor,  Monika Eichinger &  Mark O. Wielpütz MHBA EDIR EBIR

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  1. Lena Wucherpfennig
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  2. Hans-Ulrich Kauczor
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  3. Monika Eichinger
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  4. Mark O. Wielpütz MHBA EDIR EBIR
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CME-Fragebogen

CME-Fragebogen

Was ist keine Herausforderung bei der Magnetresonanztomographie der Lunge?

Atembewegungen

Gefäßbewegungen

Suszeptibilitätsartefakte

Darmbewegungen

Herzbewegungen

Welches der folgenden Phänomene ist eine sog. Minus-Pathologie in der Magnetresonanztomographie der Lunge?

Atelektase

Emphysembulla

Tumor

Infiltrat

Erguss

Was ist ein großer Vorteil der Magnetresonanztomographie gegenüber anderen bildgebenden Verfahren?

Kostengünstig

Leicht verfügbar

Schnelle Untersuchungszeit

Kein Problem bei klaustrophoben Patienten

Kombination von morphologischer und funktioneller Bildgebung

Welche Scanner sind zur Lungenbildgebung besonders gut geeignet?

< 1 Tesla (T)

1 T

1,5 T

3 T

7 T

Welches ist keine Basissequenz der Magnetresonanztomographie (MRT) der Lunge?

T1/T2-bSSFP („balanced steady-state free precession“)

T1-TSE (Turbo-Spin-Echo)

T1-GRE (Gradientenecho)

T2-FSE („fast spin echo“)

3He-MRT

Welches ist keine Indikation für eine Magnetresonanztomographie der Lunge bei Kindern?

CF („cystic fibrosis“)

Interstitielle Lungenerkrankung

Pneumonie

Akute Lungenarterienembolie

Lungensequester

Bei welcher Erkrankung ist die Magnetresonanztomographie der Lunge die First-line-Untersuchung?

Rundherd

Interstitielle Lungenerkrankung

Akute Lungenarterienembolie

Pancoast-Tumor

Pneumonie

Welche Pathologie wird nicht primär durch funktionelle Magnetresonanztomographietechniken visualisiert?

Konsolidierung

Störung der Atemmechanik

Luftröhren‑/Atemwegsinstabilität

Perfusionsstörung

Ventilationsstörung

Wozu könnte die Magnetresonanztomographie zukünftig bei der Bildgebung der interstitiellen Lungenerkrankungen von Nutzen sein?

Darstellung subtiler subpleuraler fibrotischer Veränderungen

Darstellung kleiner Knötchen

Darstellung von Minus-Pathologien

Lymphadenopathie bei Sarkoidose

Bewertung der Entzündungsaktivität

Bei welchen Patienten stellt die Magnetresonanzangiographie bei der Bildgebung einer akuten Lungenarterienembolie keine wertvolle Alternative zur Computertomographie dar?

Schwangere

Instabile Patienten

Junge Patienten

Patienten mit Kontrastmittelallergie

Patienten mit Niereninsuffizienz

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Wucherpfennig, L., Kauczor, HU., Eichinger, M. et al. Magnetresonanztomographie der Lunge. Radiologie 63, 849–862 (2023). https://doi.org/10.1007/s00117-023-01229-1

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  • DOI: https://doi.org/10.1007/s00117-023-01229-1

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