Download PDF
Radiologie up2date 2005; 5(1): 13-24
DOI: 10.1055/s-2005-861184
Pulmonale und kardiovaskuläre Radiologie
© Georg Thieme Verlag KG Stuttgart · New York

Diagnostik der koronaren Herzkrankheit mit CT und MRT

Diagnostics of Coronary Artery Disease with CT and MRIJ.  Bremerich1 , P.  Buser2 , G.  Bongartz1
  • 1Universitätsspital Basel, Departement für Radiologie
  • 2Universitätsspital Basel, Klinik für Kardiologie
Further Information

Publication History

Publication Date:
31 March 2005 (online)

Also available at
    Permissions and Reprints All articles of this category

Zusammenfassung

Die sozioökonomische Bedeutung der koronaren Herzkrankheit und der Wunsch nach nichtinvasiver Diagnostik möglichst ohne ionisierende Strahlen sind Motive für kardiale Anwendungen der CT und MRT. Noch vor wenigen Jahren war eine Koronarangiographie mit der CT undenkbar, heute ist sie bei ausgewählten Fragestellungen bereits Routine. Die MRT ist Referenzstandard für zahlreiche Funktionsparameter wie Pumpfunktion, Auswurffraktion, Ventrikelvolumina und Schlagvolumen. Die Vitalität des Herzmuskels wird mit höchster Ortsauflösung zuverlässig beurteilt. Die Perfusionsuntersuchung ist ebenfalls mit der MRT möglich, muss allerdings noch validiert werden.

Dieser Artikel gibt eine Übersicht über klinische Fragestellungen, gegenwärtige und zukünftige Anwendungen sowie Grenzen der kardialen CT und MRT bei der Diagnostik der koronaren Herzkrankheit.

Abstract

The socioeconomic importance of coronary artery disease and the desire for noninvasive imaging with less or no ionizing radiation are incentives for computed tomography (CT) and magnetic resonance imaging (MRI) of the heart. Coronary arteriography with CT is now routine for selected clinical questions. MRI is the gold standard for analyzing several functional parameters, such as pump function, ejection fraction, ventricular volumes and stroke volumes. It is a robust tool for imaging myocardial viability at high spatial resolution. Moreover, perfusion imaging with MRI is possible, but still requires validation in larger series. This article reviews clinical applications, limitations and future aspects of cardiac CT and MRI in the diagnosis of coronary artery disease.

Key Words

Coronary artery disease - Computed tomography - Magnetic resonance imaging

Literatur

  • 1 Fischbach R, Wichter T, Ohnesorge B. Mehrschicht-CT des Herzens: Untersuchungstechniken und Indikationen.  Radiologie up2date. 2001;  1 48-66
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Lotz J, Miller S, Sandstede J. Pulmonale und kardiovaskuläre Radiologie.  Radiologie up2date. 2001;  1 21-45
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Ropers D, Moshage W, Daniel W G, Jessl J, Gottwik M, Achenbach S. Visualization of coronary artery anomalies and their anatomic course by contrast-enhanced electron beam tomography and three-dimensional reconstruction.  Am J Cardiol. 2001;  87 193-197
    CrossrefPubMedGoogle Scholar
  • 4 Ropers D, Ulzheimer S, Wenkel E, Baum U, Giesler T, Derlien H, Moshage W, Bautz W, Daniel W, Kalender W, Achenbach S. Investigation of coronary artery bypass grafts by multislice spiral computed tomography with electrocardiographic-gated image reconstruction.  Am J Cardiol. 2001;  88 792-795
    CrossrefPubMedGoogle Scholar
  • 5 Nieman K, Cademartiri F, Raaijmakers R, Pattynama P, de Feyter P. Nichtinvasive angiographische Beurteilung von Coronarstents mit dem Multi-Slice-Spiral-CT.  Herz. 2003;  28 388
    PubMedGoogle Scholar
  • 6 Hoffmann M HK, Shi H, Manzke R, Schmid F T, de Vries L, Grass M, Brambs H J, Aschoff A J. Noninvasive Coronary Angiography with 16-Detector Row CT: Effect of Heart Rate.  Radiology. 2005;  234 86-97
    CrossrefPubMedGoogle Scholar
  • 7 Ropers D, Baum R, Pohle K. et al . Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction.  Circulation. 2003;  107 664-666
    CrossrefPubMedGoogle Scholar
  • 8 Becker C, Knez A. Past, Present, and Future Perspective of Cardiac Computed Tomography.  J Magn Reson Imaging. 2004;  19 676-685
    CrossrefPubMedGoogle Scholar
  • 9 Agatston A S, Janowitz W R, Hildner F J, Viamonte M, Detrano R. Quantification of caronary artery calcium using ultrfast computed tomography.  J Am Coll Cardiol. 1990;  15 827-832
    CrossrefPubMedGoogle Scholar
  • 10 Kondos G T, Hoff J A, Sevrukov A. et al . Electron-beam tomography coronary artery calcification on coronary artery calcium and cardiac events: a 37 months follow-up of 5635 initially asymptomatic low-to-intermediate-risk adults.  Ciculation. 2003;  107 2571-2576
    CrossrefPubMedGoogle Scholar
  • 11 O’Malley P, Taylor A, Jackson J, Doherty T, Detrano R. Prognostic value of coronary electron-beam computed tomography for coronary heart disease events in asymptomatic populations.  Am J Cardiol. 2000;  85 945-984
    CrossrefPubMedGoogle Scholar
  • 12 Manning W J, Li W, Edelman R R. A preliminary report comparing magnetic resonance coronary angiography with conventional angiography.  N Engl J Med. 1993;  328 828-832
    CrossrefPubMedGoogle Scholar
  • 13 Li D, Zheng J, Weinmann H J. Contrast-enhanced MR Imaging of Coronary Arteries: Comparison of Intra- and Extravascular Contrast Agents in Swine.  Radiology. 2001;  218 670-678
    PubMedGoogle Scholar
  • 14 Slavin G S, Riederer S J, Ehman R L. Two-dimensional multishot echo-planar coronary MR angiography.  Magn Reson Med. 1998;  40 883-889
    PubMedGoogle Scholar
  • 15 Meyer C H, Hu B S, Nishimura D G. et al . Fast spiral coronary artery imaging.  Magn Reson Med. 1992;  28 202-213
    PubMedGoogle Scholar
  • 16 Mc C onnell, Ganz P, Selwyn A P, Li W, Edelman R R, Manning W J. Identification fo anomalous coronary arteries and their anatomic course by magnetic resonance coronary angiography.  Circulation. 1995;  92 3158-3162
    PubMedGoogle Scholar
  • 17 Post J C, van Rossum A C, Bronzwaer J G. et al . Magnetic resonance angiography of anomalous coronary arteries: a new gold standard for delineating the proximal course?.  Circulation. 1995;  92 3163-3171
    CrossrefPubMedGoogle Scholar
  • 18 Wolff S D, Schwitter J, Coulden R, Friedrich M G, Bluemke D A, Biederman R W, Martin E T, Lansky A J, Kashanian F, Foo T K, Licato P E, Comeau C R. Myocardial first-pass perfusion magnetic resonance imaging: a multicenter dose-ranging study.  Circulation. 2004;  110 732-737
    CrossrefPubMedGoogle Scholar
  • 19 Ali R aza, Reeves W C, Movahed A. Pharmacological stress agents for evaluation of ischemic heart disease.  Int J Cardiol. 2001;  81 157-167
    CrossrefPubMedGoogle Scholar
  • 20 Semelka R C, Tomei E, Wagner S. et al . Interstudy reproducibility of dimensional and functional measurements between cine magnetic resonance studies in the morphologically abnormal left ventricle.  Am Heart J. 1990;  119 1367-1373
    CrossrefPubMedGoogle Scholar
  • 21 Semelka R C, Tomei E, Wagner S. et al . Normal left ventricular dimensions and function: interstudy reproducibility of measurements with cine MR imaging.  Radiology. 1990;  174 763-768
    PubMedGoogle Scholar
  • 22 Baer F M, Voth E, Schneider C A, Theissen P, Schicha H, Sechtem U. Comparison of low-dose dobutamine-gradient-echo magnetic resonance imaging and positron emission tomography with [18F]fluorodeoxyglucose in patients with chronic coronary artery disease. A functional and morphological approach to the detection of residual myocardial viability.  Circulation. 1995;  91 1006-1015
    PubMedGoogle Scholar
  • 23 Grundy S M, Pasternak R, Greenland P, Smith S, Fuster V. Assessment of Cardiovascular Risk by use of Multiple Risk Factor assessment equations: A statement for the healthcare professionals from the american heart Association and the American College of Cardiology.  J Am Coll Cardiol. 1999;  34 1348-1359
    CrossrefPubMedGoogle Scholar
  • 24 Wilson P W, D’Agostino R B, Levy D, Belanger A M, Silbershatz H, Kannel W B. Prediction of coronary heart disease using risk factor categories.  Circulation. 1998;  97 1837-1847
    CrossrefPubMedGoogle Scholar
  • 25 Kim R J, Wu E, Rafael A, Chen E L, Parker M A, Simonetti O, Klocke F J, Conow R O, Judd R M. The use of contrast enhanced magnetic resonance imaging to identify reversible myocardial dysfunction.  N Engl J Med. 2000;  343 1445-1453
    CrossrefPubMedGoogle Scholar
  • 26 Knollmann F, Pfoh A. Coronary artery imaging with flat panel computed tomography.  Circulation. 2003;  107 1209
    CrossrefPubMedGoogle Scholar
  • 27 Morin R L, Gerber T C, McCollough C H. Radiation Dose in Computed Tomography of the Heart.  Circulation. 2003;  107 917-922
    CrossrefPubMedGoogle Scholar
  • 28 Stuber M, Botnar R M, Fischer S E. et al . Preliminary report on in vivo coronary MRA at 3 Tesla in humans.  Mang Reson Med. 2002;  48 425-429
    CrossrefPubMedGoogle Scholar

Dr. med. PD Jens Bremerich

Departement Medizinische Radiologie, Universitätsspital Basel

Petersgraben 4 · 4031 Basel · Schweiz

Phone: +41 612652525

Fax: +41 612654354

Email: Jens.Bremerich@unibas.ch

      >