Koronararterienanomalien: Diagnostik und Klassifikation auf Basis der CT und MRT des Herzens – von ALCAPA bis Terminationsanomalie

Zusammenfassung

Hintergrund Die Koronararterienanomalien umfassen ein klinisch variables und anatomisch variantenreiches Spektrum von Koronargefäßanlagevarianten bis hin zu pathophysiologisch relevanten Anomalien. Ein Großteil der Anlagevarianten ist hämodynamisch ohne Relevanz und wird häufig inzidentell nachgewiesen. Die große Bedeutung der Diagnostik von Koronararterienanomalien leitet sich aus den wenigen Anomalien ab, die pathophysiologisch entweder einen Shunt mit der Folge von Myokardischämien begründen oder die insbesondere ventrikuläre Tachyarrhythmien mit dem erhöhten Risiko eines plötzlichen Herztodes verursachen können.

Methode Die Übersichtsarbeit basiert auf einer Literaturrecherche in PubMed mit den Stichwörtern „coronary artery” und/oder “anomaly“ und/oder „anomalous origin“ und/oder „myocardial bridging“ und/oder „coronary artery fistula“ und/oder „Bland-White-Garland“ und/oder „ALCAPA“.

Ergebnisse und Schlussfolgerung Anatomisch kann man die Koronararterienanomalien in Abgangsanomalien, in Verlaufsanomalien und Terminationsanomalien unterteilen. Bildgebende anatomische Diagnostik der Wahl ist die EKG-getriggerte oder -gegatete Multislice-CT (MSCT) des Herzens, die alle drei genannten Koronargefäßabschnitte aufgrund einer hohen Ortsauflösung und der Möglichkeit der multiplanaren Reformatierungen darstellen kann und somit die Zuordnung zu vorgenannten Klassifikationskategorien ermöglicht. Die Bedeutung der Magnetresonanztomografie (MRT) liegt neben der strukturellen insbesondere in der funktionellen Beurteilung des Herzens. Grundlage hierfür ist die Analyse der myokardialen Kontraktilität und der Perfusion in Ruhe sowie unter medikamentöser Belastung. Ferner können potenzielle Shuntvolumina phasenkontrastbasiert oder planimetrisch quantifiziert werden.

Kernaussagen

• Koronararterienanomalien werden in Abgangs-, Verlaufs- und Terminationsanomalien unterteilt.

• Hauptaufgabe in der bildgebenden Diagnostik ist die Unterscheidung hämodynamisch relevanter Koronararterienanomalien von reinen Normvarianten.

• Bildgebungsmodalität der Wahl zur anatomischen Darstellung ist die MSCT, wohingegen die MRT des Herzens zur strukturellen und funktionellen Untersuchung durchgeführt wird.

Zitierweise

• Heermann P, Heindel W, Schülke C. Coronary Artery Anomalies: Diagnosis and Classification based on Cardiac CT and MRI (CMR) – from ALCAPA to Anomalies of Termination. Fortschr Röntgenstr 2017; 189: 29 – 38

Key words

coronary artery anomalies - Bland-White-Garland syndrome - ALCAPA syndrome - anomalous origin of a coronary artery - myocardial bridging - coronary artery fistula - Cardiac CT - Cardiac MRI (CMR)

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