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Radiologie up2date 2017; 17(04): 307-320
DOI: 10.1055/s-0043-119184
Pulmonale und kardiovaskuläre Radiologie
Georg Thieme Verlag KG Stuttgart · New York

Neue Möglichkeiten der Ischämiediagnostik: CT-FFR und CT-Perfusion

New possibilities in the diagnosis of ischemia: CT-FFR and CT-Perfusion
Lukas Lehmkuhl
,
Christian Krieghoff
,
Matthias Gutberlet
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Publication History

Publication Date:
19 December 2017 (online)

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Zusammenfassung

Die koronare CT-Angiografie hat in den Leitlinien und in der Klinik einen immer höheren Stellenwert in der Primärdiagnostik der koronaren Herzkrankheit – mit einer hohen Sensitivität und einem hohen negativen prädiktiven Wert. Die Spezifität der Methode kann jedoch noch besser werden – z. B. mit neuen Methoden der Ischämiediagnostik wie der CT-FFR und der CT-Perfusion.

Abstract

Coronary CT-angiography (CCTA) plays an increasing role in the primary diagnostics of coronary artery disease (CAD) according to the present guidelines but also in clinical reality. The sensitivity and negative predictive value of CCTA is very high, but the specificity could still be improved. Newer techniques to assess myocardial ischemia like CT-FFR and CT-Perfusion may help to achieve that goal.

Kernaussagen

  • Sensitivität und Spezifität verschiedener bildgebender Verfahren in der Primärdiagnostik der KHK sind sehr unterschiedlich. Ihre Aussagekraft ist bei intermediärer Vortestwahrscheinlichkeit am größten.

  • Die koronare CT-Angiografie (CCTA) hat eine hohe Sensitivität bei relativ niedriger Spezifität. Mithilfe der CT-FFR oder der Ischämiediagnostik als ergänzendem Verfahren kann diese niedrige Spezifität erhöht werden. Die CCTA wird vor allem für Patienten mit niedriger mittlerer Vortestwahrscheinlichkeit (15 – 50%) empfohlen.

  • Bei der CT-Ischämiediagnostik wird eine pharmakologische Belastung durchgeführt, wobei die Belastung mit Regadenoson für den Einsatz in der CT-Perfusion besonders geeignet ist. Die Bildakquisition ist dynamisch während der Kontrastmittelpassage mittels wiederholter Aufnahmen möglich oder statisch jeweils zum Zeitpunkt des Peak Enhancements.

Schlüsselwörter

koronare CT-Angiografie - koronare Herzkrankheit - Sensitivität - Spezifität

Key words

coronary CT-angiography - coronary artery disease - sensitivity - specificity
 

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