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Rofo 2017; 189(11): 1047-1054
DOI: 10.1055/s-0043-112336
Interventional Radiology
© Georg Thieme Verlag KG Stuttgart · New York

White Paper: Interventionelle MRT: Status Quo und Entwicklungspotenzial unter ökonomischen Perspektiven, Teil 2: Therapeutische und onkologische Anwendungen

Article in several languages: English | deutsch
Jörg Barkhausen
1   Department of Radiology and Nuclear Medicine, University Hospital Schleswig Holstein Luebeck Campus, Germany
,
Thomas Kahn
2   Clinic and Policlinic for Diagnostic and Interventional Radiology, Leipzig, Germany
,
Gabriele A. Krombach
3   Department of Radiology, University Hospital Giessen, Justus Liebig University, Giessen, Germany
,
Christiane K. Kuhl
4   Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
,
Joachim Lotz
5   Institute for Diagnostic and Interventional Radiology, Georg-August-University Goettingen, Germany
,
David Maintz
6   Department of Radiology, University Hospital of Cologne, Cologne, Germany
,
Jens Ricke
7   Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Germany
,
Stefan O. Schönberg
8   Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
,
Thomas J. Vogl
9   Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
,
Frank K. Wacker
10   Department for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
,
German Association of Chairmen in Academic Radiology (KLR)
› Author Affiliations
Further Information

Publication History

15 February 2017

08 May 2017

Publication Date:
01 September 2017 (online)

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Zusammenfassung

Hintergrund Die interventionelle MRT mit den Vorteilen des hohen Weichteilkontrasts und der Temperatursensitivität sowie der freien Wahl der Schichtebene bietet Eigenschaften, die auch für die Behandlung von Patienten mit benignen Tumoren und mit Malignomen von besonderer Bedeutung sind.

Methoden Wir beschreiben die klinisch etablierten Verfahren der interventionellen MRT und die Entwicklungsperspektiven zur Behandlung von Patienten mit Malignomen und den Einsatz des HIFU für die Behandlung von benignen Tumoren wie Uterusmyomen.

Ergebnisse Technische Lösungen sind mittlerweile für alle prozeduralen Abläufe einschließlich der Bildsteuerung, und Instrumentensicherheit und Patientenüberwachung entwickelt worden. Dies hat dazu geführt, dass die Anwendungsfelder in der klinischen Routine erweitert wurden. Die interventionelle MRT spielt nun für die Behandlung onkologischer Patienten eine zunehmend wichtige Rolle. Tumore sind aufgrund des hohen Weichteilkontrastes im Vergleich zu anderen Modalitäten besser erkennbar und punktierbar. Ablationen können hierdurch gewebeschonend durchgeführt werden. Zudem ermöglicht der Einsatz temperatursensitiver Messmethoden die gezielte Einhaltung eines Sicherheitsabstandes (A-0 Ablation).

Schlussfolgerung Die interventionelle MRT ist im Rahmen der Biopsie und der ablativen Tumorbehandlung bereits in der klinischen Routine etabliert. Die genaue Kostenkalkulation und Gegenüberstellung zur Erlössituation zeigt, dass dieses Verfahren in seiner Gesamtheit kostendeckend durchgeführt werden kann. Aufgrund dieser ökonomischen Voraussetzungen und der Möglichkeit der Senkung von Mortalität und Morbidität für Patienten mit benignen und malignen Tumoren ist eine weitere Ausweitung des Einsatzes der interventionellen MRT in Zukunft zu erwarten.

Kernaussagen 

  • Insbesondere für die Behandlung onkologischer Patienten ist die interventionelle MRT durch die Möglichkeit Tumorgrenzen exakt zu bestimmen und die Ablationsgröße aufgrund der MR-Temperaturquantifizierung zu visualisieren und zu steuern, anderen Verfahren hinsichtlich der minimalen Invasivität und Gewebeschonung überlegen.

  • Aufgrund der besseren Darstellung der Ziele sowie der Effekte einer Ablation im Gewebe kann die interventionelle MRT für viele Indikationen die mit diesen Eingriffen verbundene Mortalität und Morbidität senken.

  • Die komplexe Gegenüberstellung von Kosten und Erlösen zeigt, dass diese Anwendung kostendeckend durchgeführt werden kann und lässt für die Zukunft einen breiten Einsatz erwarten.

Zitierweise

  • Barkhausen J, Kahn T, Krombach GA et al. White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 2: Liver and Other Applications in Oncology. Fortschr Röntgenstr 2017; 189: 1047 – 1054

Key words

MR-guided interventions - MR-guided biopsy - MR-guided ablation - HIFU
 

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