Zusammenfassung
Die 64-Zeilen Computertomographie (CT) stellt eine relativ junge Methode zur Abklärung einer stenosierenden koronaren Herzkrankheit (KHK) dar. Nichtinvasiv können die Koronararterien unter Gabe von Kontrastmittel in wenigen Sekunden in oft diagnostisch ausreichender Bildqualität dargestellt werden. Die assoziierte Strahlenbelastung kann bis zu 10 mSV und mehr betragen.
Das Verfahren ist geeignet für symptomatische Patienten mit Vorliegen einer stenosierenden KHK und mittlerem Risikoprofil, bei denen ein nicht verwertbarer oder nicht eindeutig interpretierbarer Stresstest im Rahmen eines Belastungs-EKGs oder einer Stressechokardiographie vorliegt. Der negative prädiktive Wert der CT beträgt für dieses Untersuchungskollektiv >90%.
Hinsichtlich der myokardialen Vitalität und der Myokarditisdiagnostik hat sich die MRT als Goldstandard etabliert. Die Magnetresonanz(MR)-Koronarographie ist für den Ausschluss einer Koronararterienstenose diagnostisch bisher nicht geeignet. Alternativ kann versucht werden, unter Gabe von Adenosin i.v. und MRT-KM i.v. eine Stress-induzierbare myokardiale Ischämie darzustellen (Stress-MRT). Hierbei ist eine medikamentöse Belastung unumgänglich. Ein Hauptproblem im Rahmen der Auswertung ist die Spezifität der MRT.
Im Vergleich MRT vs. CT zeichnet sich für die CT-Koronarographie aufgrund der Option einer nichtinvasiven Gefäßdarstellung bei geringer Anforderung an die Patientencompliance eine vielversprechende Perspektive ab.
Abstract
A rather new modality in the assessment of coronary artery disease (CAD) is 64-slice computer tomography (CT). With the help of a contrast agent, noninvasive imaging of the coronary arteries is possible often with sufficient diagnostic quality. Radiation exposure of up to 10 mSV or more has to be considered a major limitation.
64-Slice CT can be performed in symptomatic patients with an intermediate risk for the disease including an inconclusive stress test. In these cases, the negative predictive value exceeds 90%. Cardiovascular magnetic resonance imaging (CMR) represents the gold standard concerning myocardial viability and in vivo imaging of myocarditis. Currently no CMR protocol of sufficient quality can provide imaging of the coronary arteries in order to exclude CAD. Pharmacological stress testing can be performed by first pass myocardial perfusion magnetic resonance imaging (MRI) after application of adenosine i.v. Data suggest a comparably high negative predictive value; specifity represents a major limitation. When comparing both methods, the future for CT coronary angiography as a modality facilitating non-invasive exclusion of CAD within a few seconds is promising.
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Kadalie, C.T. Abklärung einer stenosierenden KHK: Stress-MRT vs. CT-Koronarographie. Clin Res Cardiol Suppl 4 (Suppl 2), 135–141 (2009). https://doi.org/10.1007/s11789-009-0073-0
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DOI: https://doi.org/10.1007/s11789-009-0073-0