White Paper: Interventionelle MRT: Status Quo und Entwicklungspotenzial unter ökonomischen Perspektiven, Teil 1: Generelle Anwendungen

Zusammenfassung

Hintergrund Die MRT ist aufgrund des hohen intrinsischen Weichteilkontrasts, der Möglichkeit der multiplanaren Bildaquisition und der Messung physiologischer Parameter (Fluss, Perfusion, Bewegung etc.) für Steuerung und Überwachung von Interventionen attraktiv.

Methoden Diese Arbeit beschreibt den derzeitigen Stellenwert der interventionellen MRT in der klinischen Routine und die Entwicklungsperspektiven.

Ergebnisse Der hohe Aufwand, Überwachungssysteme und MR-sichere Instrumente zu entwickeln, hat trotz der Vorteile dazu geführt, dass diese Methode sich zunächst nur für Indikationen etablieren konnte, die ihrerseits mittels anderer Modalitäten nicht durchgeführt werden können. So wird die interventionelle MRT seit Dekaden für die Biopsie von MR-suspekten Veränderungen in der Brust eingesetzt. Derzeit wird die MRT in ähnlicher Weise für die Prostata etabliert: die Blindbiopsie ist meistenorts bereits durch die MR-geführte gezielte Probenentnahme oder zumindest durch die Fusion von MR-Aufnahmen mit dem Ultraschall ersetzt. Kardiovaskuläre Interventionen werden an einigen Zentren bereits in der Routine zur Ablation bei Vorhofflimmern MR-gesteuert durchgeführt.

Schlussfolgerung Die interventionelle MRT ist für eine Vielzahl von Indikationen bereits in der klinischen Routine etabliert. Aufgrund der Vorteile des Verfahrens im Vergleich zu anderen Techniken ist eine weitere Ausweitung des Einsatzes der interventionellen MRT in Zukunft zu erwarten.

Kernaussagen 

• Aufgrund des hohen technischen Aufwands sind Interventionen unter MRT-Kontrolle langfristig nur für Bereiche sinnvoll, für welche die MRT die Intervention entweder erst ermöglicht oder in entscheidendem Maße verbessert.

• Die Mammabiopsie von anderweitig nicht detektierbaren Zielläsionen ist seit langem in der klinischen Routine etabliert. Die Prostatabiopsie wird momentan aus ähnlichen Gründen in die klinische Routine eingeführt. Andere Verfahren wie der MRT-gesteuerte fokussierte Ultraschall für die Behandlung von Uterusmyomen oder die Tumorablation von Metastasen stellen Alternativverfahren zu anderen Techniken dar und werden vielerorts angeboten.

• Endovaskuläre MR-geführte Interventionen bieten für etliche Indikationen Vorteile, und konnten für die Behandlung von Kindern mit angeborenen Herzfehlern und zur Vorhofablation bereits an einzelnen Zentren klinisch etabliert werden. Eine Ausweitung ist zukünftig zu erwarten.

Zitierweise

• Barkhausen J, Kahn T, Krombach GA et al. White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application. Fortschr Röntgenstr 2017; 189: 611 – 623

Key words

interventional MRI - MR-guided biopsy - MR-guided ablation - MR-guided endovascular procedures

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