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Nachweis von Thrombenbildung

  • M. Friedrich
Part of the Handbuch der Medizinischen Radiologie / Encyclopedia of Medical Radiology book series (HDBRADIOL, volume 15 / 2)

Zusammenfassung

Die Häufigkeit tödlicher Lungenembolien hat sich in den letzten 20 Jahren mehr als verdoppelt (Doran et al., 1970). Fast immer geht der Embolie eine tiefe Venenthrombose, zu 85% im Zustromgebiet der V. cava caudalis, voraus (Sevitt u. Gallagher, 1960/61). Der größte Teil dieser Thrombosen bleibt aber klinisch unerkannt (Mayer, 1967; Haeger, 1969). Dies ist bedauerlich, weil bei rechtzeitiger Diagnosestellung heute eine erfolgreiche Behandlung möglich ist. Die sog. „klinischen Frühzeichen“ sind für eine zuverlässige Thrombosefrüherkennung unzureichend (Haeger, 1969; Coon u. Coller, 1959; McLachlin et al., 1962). Die Phlebographie gilt zwar als die zur Zeit sicherste diagnostische Methode (Nicolaides et al., 1971; Browse, 1969; Negus et al., 1968), für eine systematische Untersuchung sämtlicher Risikopatienten ist sie jedoch zu aufwendig und belastend. Dies führte zur Entwicklung wenig belastender, generell anwendbarer und empfindlicher nuklearmedizinischer Nachweismethoden zur Thrombosefrüherkennung. Zum Thrombosenachweis mit Isotopen ist eine selektive Etiquettierung des Thrombus in vivo notwendig; dies ist auf vier Weisen möglich:
  1. a)

    Applikation von radioaktiv markiertem Fibrinogen, welches wie körpereigenes in Thromben eingebaut wird.

     
  2. b)

    Gabe von radioaktiv markierten Fibrinolytika (Plasmin, Streptokinase, Urokinase), die im Zuge der Fibrinolyse in Thromben eindringen und sich dort anreichern.

     
  3. c)

    Verabreichung von radioaktiv markierten Fibrin-(ogen)-Antikörpern.

     
  4. d)

    Applikation von radioaktiv markierten Blutzellen (Erythrozyten, Leukozyten) oder Albumin-Partikeln (Albumin-Makroaggregate, -Mikrosphären), die sich im Fibrinmaschenwerk eines Thrombus verfangen („entrapment“).

     

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© Springer-Verlag Berlin · Heidelberg 1978

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  • M. Friedrich

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