Die Rolle der Kardio-CT im klinischen Alltag – Update 2010

Zusammenfassung

Die Mehrzeilen-Computertomographie erlaubt bei Anwendung neuester Gerätetechnik, ausreichender Erfahrung und einer gewissen Selektion und Vorbereitung der Patienten die Darstellung des Herzens mit hoher Bildqualität. Wesentliches Anwendungsgebiet ist die Darstellung der Koronararterien. Koronarstenosen lassen sich mit hoher Sensitivität und Spezifität und insbesondere mit einem hohen negativ-prädiktiven Wert detektieren bzw. ausschließen. Sicherlich ist die CT-Koronarangiographie kein klinisches Verfahren, welches unkritisch bei allen Patienten angewendet oder gar zu „Screening”-Zwecken eingesetzt werden sollte. Vor allem aufgrund des hohen negativ prädiktiven Wertes kann sie jedoch – solange gewisse Voraussetzungen gegeben sind – zum sicheren Ausschluss von Koronarstenosen eingesetzt werden mit dem Ziel, eine ansonsten notwendige invasive Koronarangiographie zu vermeiden. Von geringerer klinischer Bedeutung ist der Koronarkalknachweis als Instrument zur Risikostratifikation und die Analyse von Morphologie und Funktion des Herzens. Die CT sollte für letzteres nur zum Zuge kommen, falls Standardverfahren wie Echokardiographie oder Magnetresonanztomographie nicht eingesetzt werden können oder keine ausreichende Bildqualität liefern. Korrekte Patientenselektion und ausreichende Expertise sind jedoch unbedingte Voraussetzungen für den erfolgreichen und sinnvollen klinischen Einsatz der kardialen Computertomographie.

Abstract

Multi Detector CT, the usage of adequate technology, suitable imaging protocols, sufficient experience and strict patient selection provided, allows visualization of the heart with high temporal and spatial resolution. The main application is coronary CT angiography. Coronary artery stenoses can be detected with high sensitivity and specificity. Especially the high negative predictive value is high, but care has to be taken to avoid false-positive results which occur especially when image quality is degraded. Coronary CT angiography should not be considered a widespread replacement of invasive coronary angiography or even a “screening” procedure, but it can be clinically useful to rule out coronary artery stenoses in selected patients. The detection of coronary artery calcification can be used for risk stratification purposes. Finally, CT also allows evaluation of cardiac morphology and function, but will be used for this only when other modalities, such as echocardiography and MR imaging, have failed or are not applicable.

Schlüsselwörter

kardiale Computertomographie - koronare Herzerkrankung - Koronarkalk

Keywords

cardiac computed tomography - coronary heart disease - coronary calcification

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