Zusammenfassung
Die kardiovaskuläre MRT (CMR) stellt ein neues diagnostisches Verfahren dar, das neben der Morphologie- und Funktionsbeurteilung des gesamten kardiovaskulären Systems auch eine nichtinvasive Gewebecharakterisierung des Myokards ermöglicht. Die Gewebecharakterisierung des Myokards erfolgt in erster Linie durch die Kontrast-CMR. Wesentliches Prinzip der Kontrast-CMR ist die Anreicherung von gadoliniumhaltigem Kontrastmittel in Myokardarealen mit vergrößertem Extrazellulärraum z. B. als Folge von Nekrose, Fibrose oder Ansammlung pathologischer Stoffwechselprodukte, bei gleichzeitig fehlender Kontrastanreicherung in gesundem Myokard. Zusammenfassend kann gesagt werden, dass die Kontrast-CMR akute und chronische Myokardinfarkte in der klinischen Routine zuverlässig darstellen und mit guter Genauigkeit voraussagen kann, welche Myokardabschnitte sich nach Revaskularisation wieder erholen können. Des Weiteren kann die Kontrast-CMR entscheidend zur Differenzierung der Genese einer Herzinsuffizienz beitragen. Das Prinzip der Signalanreicherung im Myokard ist zwar eher unspezifisch, das Verteilungsmuster der Signalanreicherung ermöglicht jedoch eine spezifische Zuordnung der zugrunde liegenden Erkrankung, wie es bisher nur dem Pathologen post mortem vorbehalten war. Zusätzlich kann durch diese nichtinvasiv gewonnenen Informationen die Sensitivität von Myokardbiopsien zur Abklärung myokardialer Erkrankungen, wie z. B. der Myokarditis, deutlich verbessert werden.
Abstract
Cardiovascular MR (CMR) is a new diagnostic technique that not only provides morphologic and functional information about the entire cardiovascular system, but also allows non-invasive tissue characterization of the myocardium. Myocardial tissue characterization is mainly based on contrast-enhanced CMR. The main principle of contrast-enhanced CMR is the accumulation of gadolinium-based MR contrast agents in myocardial areas with enlarged extracellular space, such as regions of necrosis, fibrosis or deposits of abnormal proteins (e.g., amyloid), in the absence of contrast enhancement in normal myocardium. Based on the evidence presented in this review article, it is safe to conclude that contrast CMR can reliably detect acute and chronic myocardial infarcts in clinical routine, and that contrast CMR is capable of predicting recovery of wall motion after revascularization with a high degree of accuracy. In addition, contrast CMR is a valuable tool for the work up of new-onset heart failure, since the myocardial distribution of contrast enhancement often points to the underlying disease by providing insight into the myocardium in vivo that could previously only be obtained by postmortem examination. This information about the distribution of abnormal myocardial regions is also important for improving the sensitivity of endomyocardial biopsies that may be necessary in certain myocardial diseases, e.g., myocarditis.
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Mahrholdt, H., Sechtem, U. Gewebedifferenzierung mittels Kontrast-MRT („late enhancement“). Kardiologe 2, 215–226 (2008). https://doi.org/10.1007/s12181-008-0090-0
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DOI: https://doi.org/10.1007/s12181-008-0090-0