MR-Angiografie zur Gefäßdiagnostik

Dirk Blondin; Christian Heiss

doi:10.1055/s-0032-1324977

Aktuelle Kardiologie, Table of Contents

Aktuelle Kardiologie 2013; 2(2): 112-118
DOI: 10.1055/s-0032-1324977

Übersichtsarbeit

Georg Thieme Verlag KG Stuttgart · New York

MR-Angiografie zur Gefäßdiagnostik

Vascular Imaging Using MR Angiography

Dirk Blondin

¹Institut für Diagnostische und Interventionelle Radiologie, Medizinische Fakultät der Heinrich-Heine-Universität, Universitätsklinikum Düsseldorf

,

Christian Heiss

²Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Fakultät der Heinrich-Heine-Universität, Universitätsklinikum Düsseldorf

› Author Affiliations

Abstract

Zusammenfassung

Die Magnetresonanzangiografie (MRA) mit gadoliniumhaltigem Kontrastmittel ist mittlerweile ein nicht invasives bildgebendes Standardverfahren, bei der mit üblichen MR-Tomografen unter Verwendung von Oberflächenspulen und 3-D-Gradientenechosequenzen qualitativ hochwertige 3-D-Gefäßrekonstruktionen erstellt werden können. Die Hauptindikationen liegen in der Diagnostik und Behandlungsplanung der peripheren arteriellen Verschlusskrankheit. Mit hoher Sensitivität und Spezifität können klinisch relevante Stenosen erfasst und Kollateralgefäße dargestellt werden. Diagnostische Limitationen liegen vor allem in der Darstellung peripherer kleiner Arterien sowie im Bereich von Stents. Die wichtigsten Kontraindikationen umfassen Herzschrittmacher, implantierte Defibrillatoren und unklare Metallimplantate sowie Schwangerschaft im 1. Trimenon. Bei niereninsuffizienten Patienten mit einer glomerulären Filtrationsrate von < 30 ml/min/1,73 m² sollten gadoliniumhaltige Kontrastmittel vermieden werden, da dann das erhöhte Risiko einer nephrogenen systemischen Fibrose besteht, für die keine Therapieoptionen existieren. Neue, kontrastmittelfreie MRA-Verfahren (z. B. QISS), die auch bei diesen Patienten eingesetzt werden können, sind gegenwärtig in der klinischen Validierung, stehen jedoch noch nicht in allen Zentren zur Verfügung.

Abstract

Contrast enhanced magnetic resonance angiography (MRA) with gadolinium containing contrast media has evolved to a standard non-invasive imaging modality. High quality 3D vessel reconstructions can be acquired using conventional MR scanners together with body surface coils and 3D gradient sequences. The predominant indications for MRAs lie in the diagnostics, planning of vascular interventions and surgery of patients suffering from peripheral artery disease. With high sensitivity and specificity clinically relevant stenoses can be detected and collateral vessels identified. Methodological limitations mainly lie in the imaging of small and peripheral arteries and stented segments. The most important contraindications comprise conventional cardiac pacemakers, implantable defibrillators, paramagnetic implants, and 1st trimester pregnancy. Furthermore, in patients with severe renal failure (glomerular filtration rate of less than 30 ml/min/1.73 m²) gadolinium containing contrast medium should not be used as these patients are at increased risk of development of nephrogenic systemic fibrosis for which no treatment exists. Novel contrast free MRA techniques (e.g. QISS) have been developed and are currently under clinical validation but are not yet widely available.

Schlüsselwörter

Magnetresonanz-Angiografie - CE-MRA - QISS - periphere arterielle Verschlusskrankheit

Key words

magnetic resonance angiography - CE-MRA - QISS - peripheral artery disease

Full Text

References

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