Kardiovaskuläre MRT in der Bewertung von Kardiomyopathien – ein aktueller Überblick

Zusammenfassung

Dieser Artikel beschreibt den klinischen Nutzen der kardiovaskulären Magnetresonanztomografie (Kardio-MRT) bei Patienten mit Kardiomyopathien. Die Kardio-MRT hat sich aufgrund ihrer hohen räumlichen Auflösung, 3-D-Fähigkeiten und der Abwesenheit ionisierender Strahlung als unverzichtbares Werkzeug bei der Beurteilung von Kardiomyopathien erwiesen und ist besonders geeignet für Diagnose und Management. Sie wird in Richtlinien für ihre Präzision bei der Diagnose und Differenzierung verschiedener Formen von Kardiomyopathien anerkannt und zur Beurteilung von Ventrikelvolumen, -masse und -funktion verwendet. MRT-Techniken wie T1- und T2-Mapping, Late Gadolinium Enhancement (LGE) und Protonenspektroskopie bieten Einblicke in akute und chronische Myokardschäden. Ihre Rolle bei der Risikostratifizierung wird durch die Korrelation von LGE-Präsenz und -Ausmaß mit dem Risiko schwerwiegender Komplikationen hervorgehoben. Die Entwicklung von hochauflösender Bildgebung, 4-D-Flow und künstlicher Intelligenz erweitert weiterhin ihr diagnostisches Potenzial. Insbesondere die akute Myokarditis, eine diagnostisch herausfordernde Erkrankung, profitiert von der nicht invasiven und inzwischen auch kontrastmittelfreien Visualisierung von Myokardödem und Nekrose durch die MRT.

Der Artikel beschreibt den spezifischen Nutzen der Kardio-MRT, insbesondere für die quantitative Beurteilung der Funktion und nicht invasive Charakterisierung des Myokardgewebes bei dilatativer Kardiomyopathie, hypertropher Kardiomyopathie, kardialer Amyloidose, Morbus Fabry, Eisenüberladung und Sarkoidose sowie stressinduzierter Kardiomyopathie und arrhythmogener ventrikulärer Kardiomyopathie. Auch neue MRT-Techniken und künstliche Intelligenz zur verbesserten Diagnose und Risikostratifizierung werden diskutiert.

Abstract

This article reviews the clinical utility of Cardiovascular Magnetic Resonance (CMR) in patients with suspected or known cardiomyopathies. CMR has become an indispensable tool in assessing cardiomyopathies due to its high spatial resolution, 3D capabilities, and absence of ionizing radiation, making it especially suitable for diagnosis and management. It is recognized in guidelines for its precision in diagnosing and differentiating various forms of cardiomyopathies and is used for ventricular volume, mass, and function assessment. MRI techniques such as T1 and T2 mapping, Late Gadolinium Enhancement (LGE), and Proton Spectroscopy offer insights into acute and chronic myocardial damage. Its role in risk stratification is highlighted by the correlation of LGE presence and extent with the risk of severe complications. The evolution of high-resolution imaging, 4D-flow, and artificial intelligence continues to expand its diagnostic potential.

Especially acute myocarditis, a challenging diagnostic condition, benefits from MRI’s non-invasive visualization of myocardial edema and necrosis.

The article describes the specific utility of CMR, especially for quantitatively assessing function and non-invasive myocardial tissue characterisation in dilated cardiomyopathy, hypertrophic cardiomyopathy, cardiac amyloidosis, Fabry disease, iron overload and sarcoidosis, as well as stress-induced cardiomyopathy and arrhythmogenic ventricular cardiomyopathy.

Novel MRI techniques and artificial intelligence for enhanced diagnosis and risk stratification are also discussed.

Was ist wichtig?

Die Kardio-MRT ist heute unverzichtbar in der Diagnostik der Kardiomyopathien. Neben der exakten quantitativen Auswertung von Morphologie, Volumina und Funktion ist es vor allem die Gewebecharakterisierung, die einen entscheidenden Vorteil der MRT gegenüber allen anderen bildgebenden Verfahren darstellt. Die MRT leistet dies nicht invasiv, ohne radioaktive Belastung und, falls benötigt, mit gut verträglichen Kontrastmitteln.

Ihr früher Einsatz kann die diagnostische Aufarbeitung von Patienten mit Verdacht auf Kardiomyopathie verkürzen, vergünstigen und qualitativ verbessern.

Schlüsselwörter

kardiovaskuläre MRT - kardiale Bildgebung - Kardiomyopathien

Keywords

cardiovascular MRI - cardiac imaging - cardiomyopathies

Publication History

Article published online:
29 May 2024

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