Zusammenfassung
In der Differenzialdiagnostik kardialer Raumforderungen spielt die Magnetresonanztomografie
(MRT) neben der Echokardiografie eine bedeutende Rolle. Verschiedene kardiale Tumoren
zeigen ein gehäuftes Auftreten in den Vorhöfen. Ziel dieser Übersichtsarbeit ist die
Beschreibung dieser verschiedenen Vorhoftumoren, ihrer Eigenschaften und Klinik sowie
ihrer kernspintomografischen Morphologie. Allgemein sind Herztumoren mit einer Prävalenz
von ca. 0,001 – 0,03 % in Autopsiestudien eine sehr seltene Erkrankung und mit ca.
75 % überwiegend benigner Natur. Das Myxom ist der häufigste Herztumor, der die Vorhöfe
bevorzugt. Charakteristisch ist eine starke T 2-Hyperintensität bei ansonsten inhomogenem,
teils hyper-, teils hypointensem Signalverhalten, das mit dem uneinheitlichen histologischen
Erscheinen korreliert. Lipome liegen subendokardial und zeigen ein fettisointenses
Signalverhalten, das sich durch Fettsuppressionstechniken minimieren lässt. Fibroelastome
sind die häufigsten Tumoren der Herzklappen und bestehen aus avaskulärem Bindegewebe,
das sich relativ signalarm darstellt. Auf ihrer faserigen Oberfläche lagern sich leicht
Thromben auf, sodass auch sehr kleine Tumoren früh durch Embolien symptomatisch werden
können. Bei den selteneren malignen Tumoren überwiegen Sarkome, wobei vor allem Angiosarkome
und Rhabdomyosarkome kardial am häufigsten auftreten und eine Präferenz für die Vorhöfe
aufweisen. Sekundäre Malignome des Herzens sind ca. 20- bis 40-fach häufiger als primäre
und treten bei einer bestehenden Malignomerkrankung in ca. 10 % der Fälle im späten
Krankheitsverlauf auf. Lymphogene Metastasen bevorzugen das Perikard, die hämatogene
Metastasierung befällt vor allem das Myokard. Von den eigentlichen Vorhoftumoren müssen
zudem auch Thromben oder anatomische Normvarianten unterschieden werden.
Abstract
Cardiac magnetic resonance imaging (MRI) is an important tool for the diagnosis of
cardiac masses. Various cardiac tumors are predisposed to occurring in atrial structures.
The aim of this review article is the description of atrial tumors and their morphological
features in MRI. In general, cardiac tumors are rare: approximately 0.001 – 0.03 %
in autopsy studies. About 75 % of them are benign. The most common cardiac tumor is
the myxoma. They are predisposed to occur in the atria and show a characteristically
strong hyperintense signal on T 2-wieghted images in MRI. In other sequences a heterogeneous
pattern reflects its variable histological appearance. Lipomas exhibit a signal behavior
identical to fatty tissue with a typical passive movement in cine imaging. Fibroelastomas
are the most common tumors of the cardiac valves. Consisting of avascular fibrous
tissue, they often present with hypointense signal intensities. Thrombi attached to
their surface can cause severe emboli even in small tumors. Amongst primary cardiac
malignancies, sarcomas are most common and favor the atria. Secondary malignancies
of the heart are far more common than primary ones (20 – 40 times). In case of known
malignancies, approximately 10 % of patients develop cardiac metastasis at the end
of their disease. Lymphogenic metastases favor the pericardium, while hematogenic
spread prefers the myocardium. Since they are not real atrial tumors, thrombi and
anatomical structures of the atria have to be differentiated from other pathologies.
Key words
heart - MR imaging - atrium - myxoma - tipoma - tumor
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Dr. Nils Kraemer
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