Zusammenfassung
l23Iod-MIBG-Untersuchungen des Myokards können wichtige Informationen über pathophysiologische
Prozesse im Hinblick auf die sympathische Innervation des Herzens liefern. Viele Autoren
bestätigen die gleichzeitige Existenz eines durch hohe Affinität charakterisierten
neuronalen Aufnahmemechanismus für MIBG in die sympathischen, postganglionären präsynaptischen
Nervenstrukturen neben einem unspezifischen, jedoch mit hoher Transportleistung ausgestatteten,
extraneuronalen Mechanismus. Das szintigrafische Verteilungsmuster bei erhaltenem
MIBG-Transportmechanismus stellt zuverlässig die linksventrikuläre sympathische Nervenversorgung
und deren pathologische Veränderungen wie beispielsweise bei Myokardischämien, Herzinsuffizienz
oder Arrhythmien dar; dazu erlaubt diese Bildgebung die Früherkennung der autonomen
Neuropathie im Rahmen des Diabetes mellitus. Für Patienten mit Herzinsuffizienz oder
hypertrophischer Kardiomyopathie konnte gezeigt werden, dass durch die MIBG-Szintigrafie
solche mit erhöhtem Ri-siko für das Auftreten eines plötzlichen Herztodes identifiziert
werden können. Darüber hinaus können therapeutische Effekte verschiedener Behandlungsstrategien
evaluiert werden.
Abstract
The sympathetic nervous system plays an important role in cardiovascular physiology.
Planar MIBG with or without SPECT can be used to visualize the sympathetic innervation
of the heart and the abnormalities in innervation caused by, for example, ischemia,
heart failure, and arrhythmogenic disorders. Furthermore, cardiac neuronal imaging
allows early detection of autonomic neuropathy in diabetes mellitus. Assessment of
sympathetic nerve activity in patients with heart failure has been shown to provide
important prognostic information, and cardiac neuronal imaging can potentially identify
patients who are at increased risk of sudden death. Moreover, therapeutic effects
of different treatment strategies can be evaluated by imaging. To establish the clinical
utility of cardiac neuronal imaging, it will be necessary to determine the incremental
value of innervation imaging to triage heart failure patients to medical therapy,
CRT (with or without ICD), or heart transplantation.
Schlüsselwörter
sympathische Innervation - Szintigrafie - MIBG - kardiale Bildgebung
Key words
sympathetic innervation - scintigraphy - MIBG - cardiac imaging
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Korrespondenzadresse
PD Dr. M. Hacker
Klinik und Poliklinik für Nuklearmedizin
Marchioninistr.15
81377 München
Phone: +49/89/7095 46 30
Fax: +49/89/7095 76 46
Email: marcus.hacker@med.uni-muenchen.de
