Myokarditis in der kardialen MRT

Zusammenfassung

Die Myokarditis stellt eine entzündliche Erkrankung des Herzmuskels dar, die verschiedenste Verläufe zeigen kann und klinisch oft schwierig zu diagnostizieren ist. Mittels endomyokardialer Biopsie (EMB) lässt sich die Diagnose (immun-)histologisch sichern, in der PCR ist auch der Nachweis von Virusgenomen, die als Auslöser vermutet werden, möglich. Allerdings wird die EMB oft aus verschiedenen Gründen nicht durchgeführt.

Die kardiale MRT bietet als nicht invasive Methode zunächst die Möglichkeit, die linksventrikuläre Funktion präzise zu bestimmen. Mittels LGE lassen sich auch Narben oder Nekrosen, vornehmlich als intramurale und epikardiale Kontrastmittelanreicherungen nachweisen. Ein in der MRT nachweisbares LGE ist dabei nachweislich mit einer ungünstigeren Prognose und einer erhöhten Rate kardialer Ereignisse assoziiert. Bei akuten Verlaufsformen kann optional auch mit T2-gewichteten Bildern (vor Gabe von KM) das akute Ödem dargestellt werden.

Abstract

Myocarditis is an inflammatory condition affecting the myocardium. The presentation and clinical course of myocarditis can be highly variable which makes it difficult to diagnose the disease. EMB can ascertain the diagnosis by (immuno-) histologic methods, PCR may in addition detect the presence of viral genomes which often play a pathogenic role in myocarditis. However, EMB is not often performed.

CMR is a non-invasive technique that offers the possibility to analyze left ventricular function with great precision. Myocardial scars or necroses can be visualized by LGE. In myocarditis the typical pattern of LGE is epicardial or intramural. LGE in patients with myocarditis is associated with an unfavourable prognosis and an increased rate of cardiac events. In acute myocarditis T2-weighted images performed before administration of contrast agents may show myocardial oedema.

Schlüsselwörter

Myokarditis - kardiale Magnetresonanztomografie

Key words

myocarditis - cardiac magnetic resonance

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