Radiologie up2date 2014; 14(03): 191-207
DOI: 10.1055/s-0034-1377574
Pulmonale und kardiovaskuläre Radiologie
© Georg Thieme Verlag KG Stuttgart · New York

Kardiale CT beim akuten Koronarsyndrom

Cardiac computed tomography in patients with acute coronary syndrome
C. L. Schlett
,
H. Alkadhi
,
F. Bamberg
Further Information

Publication History

Publication Date:
15 September 2014 (online)

Zusammenfassung

Die kardiale CT wird aufgrund des rasanten technischen Fortschritts der letzten Jahre zunehmend in klinische Algorithmen integriert. Dabei gilt aufgrund der bestehenden wissenschaftlichen Evidenz der Einsatz der kardialen CT bei Patienten mit Verdacht auf ein akutes Koronarsyndrom als besonders vielversprechend. Die Durchführung der kardialen CT erfordert spezifische Kenntnisse über die Untersuchungsprotokolle, adäquate Patientenvorbereitung und die diagnostischen Befunde, welche auch nichtkardiale Nebenbefunde umfasst. Der vorliegende Artikel gibt einen Überblick über die spezifischen Aspekte zum Einsatz der kardialen CT bei Patienten mit Verdacht auf ein akutes Koronarsyndrom.

Abstract

Currently, cardiac computed tomography (CT) is increasingly being implemented into clinical algorithms, primarily due to substantial technical advances over the last decade. Its use in the setting of suspected acute coronary syndrome is of particular relevance, given the high degree of accumulating scientific evidence of improving patient outcomes. Performing cardiac CT requires specific knowledge on the available scan acquisitions and patient preparation. Also, expertise is required in order to interpret the coronary and extra-coronary findings adequately. The present article provides an overview of the different aspects on the use of cardiac CT in the setting of acute coronary syndrome.

Kernaussagen
  • Die kardiale CT ist ein technisch hochentwickeltes Verfahren, welches zunehmend in die klinischen Algorithmen integriert wird.

  • Insbesondere der Einsatz bei Patienten mit Verdacht auf auf ein AKS ist dabei von besonderer Relevanz im klinischen Umfeld, da hier der Nutzennachweis umfangreich erfolgt ist. Auch ist der klinische Bedarf einer schnelleren Diagnostik in dieser Patientengruppe am höchsten.

  • Zur adäquaten Befundung bei guter Bildqualität sind Kenntnisse bei Patientenauswahl und -vorbereitung sowie über die Untersuchungsprotokolle und Möglichkeiten der Dosisreduktion wesentlich.

  • Bei der Patientenauswahl sollten die Vortestwahrscheinlichkeiten berücksichtigt werden und jüngere Patienten mit atypischen Beschwerden und ohne etablierte KHK vorgezogen werden.

  • Der Befund sollte spezielle Aussagen über das Vorliegen von Plaques (kalzifiziert und oder nicht kalzifiziert) und/oder Stenosen in allen 3 Koronargefäßen beinhalten sowie Nebenbefunde erfassen.

  • Die aktuellen Leitlinien erfassen die Wertigkeit der kardialen CT als vergleichbar gegenüber anderen Verfahren bei Patienten mit normalem Troponin und EKG, wobei zu erwarten ist, dass die kardiale CT zukünftig aufgewertet wird.

 
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