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Magnetresonanzangiographie in der Rheumatologie

Magnetic resonance angiography in rheumatology

Zeitschrift für Rheumatologie volume 71, pages 430–435 (2012)Cite this article

Zusammenfassung

Diese Übersicht fasst die Möglichkeiten und Limitierungen der Magnetresonanztomographie (MRT) und Magnetresonanzangiographie (MRA) zur Diagnostik der Großgefäßvaskulitiden zusammen. Dank der detaillierten Darstellung des Lumens und der Wand großer und mittelgroßer Arterien und der typischerweise kräftigen, muralen Kontrastmittelaufnahme vaskulitischer Prozesse sind die MRT und MRA besonders für die Diagnostik der Großgefäßvaskulitiden geeignet. Das kranielle, intrakranielle und extrakranielle Verteilungsmuster kann in einer kombinierten Untersuchung der thorakalen Aorta mit ihren supraaortalen Ästen und der hochauflösenden Darstellung der oberflächlichen Kopfarterien bestimmt werden. Typische Sequenzprotokolle für die monophasische und die zeitaufgelöste MRA bei 3 T werden exemplarisch aufgeführt. Die MR-Bildgebung hat das Potenzial, die Gefäßsegmente mit den stärksten Entzündungszeichen für die Biopsie zu bestimmen und die Erfolge der Therapie zu kontrollieren. Die ersten Ergebnisse multizentrischer Studien zum Stellenwert dieser neuen Verfahren werden in den nächsten Jahren erwartet. Zur Beurteilung einer ZNS-Vaskulitis stellt die MRA ein interessantes, nichtinvasives Verfahren dar, das insbesondere bei pathologischem Befund die invasive Katheterangiographie ersetzen kann.

Abstract

The potentials and pitfalls of magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) in the diagnosis of large vessel vasculitis are summarized in this review article. With the ability to visualize the lumen and vessel walls of large and medium sized arteries, MRI and MRA have great potential to play a unique role in the diagnosis of large vessel vasculitis. This is underlined by the fact that mural inflammatory changes typically involve uptake of contrast agent that can be visualized with MRI. The cranial, intracranial and extracranial involvement pattern can be studied in a combined approach including an MRI examination of the superficial cranial arteries and an MRA examination of the thoracic aorta with its major supra-aortic branches. Typical MRI sequence parameters are given including monophasic MRA and time-resolved MRA protocols at 3 T. The MRI and MRA techniques have the potential to determine the most suitable (inflamed) segment for temporal artery biopsy and to monitor treatment. Initial results of multicenter studies for the diagnostic accuracy of these relatively new methods are expected soon. The MRA technique is recognized as an interesting alternative to invasive catheter angiography for the evaluation of central nervous system (CNS) vasculitis.

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Abbreviations

DSA:

digitale Subtraktionsangiographie

FDG:

Fluorodeoxyglukose

FKDS:

farbkodierte Duplexsonographie

KM:

Kontrastmittel

MRA:

Magnetresonanzangiographie

MRT:

Magnetresonanztomographie

NSF:

nephrogene systemische Fibrose

PET:

Positronenemissionstomographie

RZA:

Riesenzellarteriitis

SSFP:

„steady state free precession“

TA:

Takayasu-Arteriitis

TOF:

„time of flight“

ZNS:

zentrales Nervensystem

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: Speaker: Bayer, GE, Bracco, Guerbet.

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Affiliations

  1. Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Hamburg – Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    T.A. Bley

  2. Klinik für Endokrinologie, Diabetologie u. Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    B. Ostendorf

  3. Institut für diagnostische und interventionelle Radiologie, Heinrich-Heine-Universität Düsseldorf, Medizinische Fakultät, Düsseldorf, Deutschland

    A. Scherer

  4. Internist - Rheumatologe - Gastroenterologe - Physikalische Medizin, München-Nymphenburg, Deutschland

    H, Kellner

  5. Rheumaklinik Berlin – Buch, Immanuel Krankenhaus Berlin, Berlin, Deutschland

    W.A. Schmidt

Authors
  1. T.A. Bley
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  2. B. Ostendorf
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  3. A. Scherer
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  4. H, Kellner
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  5. W.A. Schmidt
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Correspondence to T.A. Bley.

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Bley, T., Ostendorf, B., Scherer, A. et al. Magnetresonanzangiographie in der Rheumatologie. Z. Rheumatol. 71, 430–435 (2012). https://doi.org/10.1007/s00393-012-0975-y

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  • DOI: https://doi.org/10.1007/s00393-012-0975-y

Schlüsselwörter

  • Magnetresonanztomographie
  • Magnetresonanzangiographie
  • Vaskulitis
  • Riesenzellarteriitis
  • Takayasu-Arteriitis

Keywords

  • Magnetic resonance tomography
  • Magnetic resonance angiography
  • Vasculitis
  • Giant cell arteritis
  • Takayasu arteritis