Bildgebende Diagnostik bei pulmonaler Hypertonie

Die pulmonale Hypertonie (PH) ist ein häufiges und komplexes Krankheitsbild. Unabhängig von ihrer Ätiologie geht sie mit einer hohen Morbidität und Mortalität einher. Im multidisziplinären diagnostischen Algorithmus und Management der PH kommt dem Radiologen bei der frühzeitigen Diagnosestellung, der Subklassifikation und der Prognoseabschätzung eine wegweisende Rolle zu.

Kernaussagen

• Die PH ist definiert als eine Erhöhung des mPAP >20 mmHg. Klinisch werden 5 Krankheitsgruppen unterschieden. Unabhängig von der Ätiologie ist die PH mit einer hohen Morbidität und Mortalität assoziiert.

• Es gibt kein bildgebendes Kriterium, um die Diagnose einer PH sicher stellen zu können. Der Durchmesser des TP und der TP/A-Quotient sollten, angepasst an die klinische Vortestwahrscheinlichkeit, interpretiert werden. Multiparametrische Ansätze mit verschiedenen auf Basis von CT-Aufnahmen abgeleiteten Größen (TP-Durchmesser, Wanddicke des RVOT, Septumdeviation oder RV/LV-Quotient) bieten eine höhere diagnostische Genauigkeit.

• Die CT sollte bei allen Patienten mit Verdacht auf eine PH erwogen werden und kann wichtige Hinweise auf deren Ätiologie liefern.

• Die V/Q-Szintigrafie ist weiterhin der Goldstandard zum Screening auf eine CTEPH. Eine unauffällige Thoraxröntgenaufnahme und eine unauffällige V/Q-Szintigrafie schließen eine CTEPH faktisch aus.

• Die DECT erlaubt neben der morphologischen CT-Information die Beurteilung und Quantifizierung der Jodaufnahme des Lungenparenchyms als Surrogat für die pulmonale Perfusion. Als „One-Stop-Shop“-Untersuchung hat die DECT das Potenzial, multimodale Diagnostikansätze der PH zukünftig zu ersetzen.

• Die CMR ist der Goldstandard zur Beurteilung der rechtsventrikulären Volumina und Funktion bei Patienten mit PH und liefert für die Prognoseabschätzung der PAH wichtige Parameter (RVEF, SVI, RVESVI).

Schlüsselwörter

pulmonale Hypertonie - Diagnostik - Bildgebung

Publication History

Article published online:
10 June 2024

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