Zusammenfassung
Die Kernspintomographie (MRT) hat sich in den letzten Jahren zu einer Referenzmethode
der myokardialen Vitalitätsdiagnostik entwickelt. Erst kürzlich konnte auch das Potenzial
der Mehrschicht-Spiral-Computertomographie (MSCT) für die Vitalitätsdiagnostik gezeigt
werden. In dieser Arbeit werden zunächst ausführlich die einer Myokardischämie folgenden
pathophysiologischen Veränderungen des Herzmuskels einschließlich der Abgrenzung von
stunned und hibernierendem Myokard dargestellt. Als grundlegender Ansatz der Vitalitätsdiagnostik
in MRT und MSCT wird in der Hauptsache das Konzept der myokardialen Spätanreicherung
betrachtet. Als weitere Ansätze werden die Infarktdiagnostik mittels Perfusionsbildgebung
und alternativer Kontrastmittel vorgestellt. Die Beziehung zwischen pathophysiologischen
Veränderungen und dem Erscheinungsbild in MRT und MSCT wird gezeigt. Die klinischen
Konsequenzen der MRT- und MSCT-Befunde werden betrachtet.
Abstract
Over the last decade magnetic resonance (MR) imaging has become a well-established
method for visualizing myocardial viability. Multislice spiral computed tomography
(MSCT) has also recently proven to be a reliable method for assessing the myocardium
for this indication. This review extensively describes the changes in acute and chronic
myocardial infarction including the differentiation of stunned or hibernating myocardium.
This review focuses on delayed myocardial contrast enhancement as a key concept of
viability imaging. Myocardial perfusion imaging as well as the use of alternative
contrast agents are introduced. Pathophysiology is correlated to the changes observed
in MR imaging and MSCT. The clinical impact of the imaging findings is described.
Key words
CT - heart - MRI - viability
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PD Dr. Andreas H. Mahnken
Klinik für Radiologische Diagnostik, Universitätsklinikum der RWTH Aachen
Pauwelsstraße 30
52074 Aachen
Telefon: ++49/2 41/80 88 33 2
Fax: ++49/2 41/8 08 24 99
eMail: mahnken@rad.rwth-aachen.de
