Konsensusempfehlungen der DRG/DGK/DGPK zum Einsatz der Herzbildgebung mit Computertomographie und Magnetresonanztomographie

Purpose: Marfan syndrome (MFS) is a genetic disorder of the connective tissue. Aortic root dilation is a main criterion of the Ghent Nosology. Dural ectasia and the presence of mitral valve prolapse (MVP) contribute to its systemic score. The purpose of this study was to investigate the frequency of dural ectasia and its correlation with cardiovascular manifestations in a pediatric study population. Patients and methods: 119 pediatric patients with confirmed or suspected MFS were examined in the local Marfan Clinic. 31 children with MFS who underwent magnetic resonance imaging (MRI) were included. Each patient was evaluated according to the Ghent nosology. Echocardiography was used to measure the aortic root diameter and assess the presence of MVP and mitral regurgitation. Z-scores were calculated for the evaluation of the aortic root diameters. MRI was performed to determine the dural sac ratio (DSR). Results: The prevalence of dural ectasia was 90.3?%, of aortic root dilation 32.2?%, of MVP 64.5?% and of mitral regurgitation 51.6?%. DSR at L5 correlated with the intraindividual z-scores (slope, 3.62???1.5 [0.56; 6.68]; r?=?0.17; p?=?0.02; F?=?5.84). Z-scores ??2 were accompanied by dural ectasia in 100?%, MVP in 95?% and mitral regurgitation in 100?% of cases. MVP was accompanied by mitral regurgitation in 70?% of cases. Conclusion: As the examined cardiac manifestations show a coincidence with dural ectasia in 95???100?% of cases, MRI for diagnostic dural sac imaging should be reserved for MFS suspicions with the absence of those manifestations in order to establish the diagnosis according to the Ghent criteria. Thus, the present study supports the recent downgrading of dural ectasia to a contributor to the systemic score. Citation Format:

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confidence: 51%

“…In particular, the examination of very young children is dependent on their cooperation and safe reproducibility of single exams cannot be guaranteed. MRI might be a useful alternative for ensuring consistent imaging quality but can be difficult to use on very young children due to the need for sedation [31].…”

Section: Study Limitationsmentioning

confidence: 99%

Pediatric Patients with Marfan Syndrome: Frequency of Dural Ectasia and its Correlation with Common Cardiovascular Manifestations

Veldhoen

Stark

Mueller

et al. 2013

“…ED values of multi-slice computed tomography coronary angiography (CTCA) with the use of retrospective ECG-gating -representing noninvasive CA -are reported to vary from 8 to 28 mSv [4, 20,21] and yield the considerable calculated LAR of cancer incidence for a representative 50-year-old subject with a range between 0.10 and 0.17 % for males and between 0.23 and 0.37 % for females [22]. The use of automatic dose control reduced the ED in chest scans by 36 % [23], and in conformity with actual recommendations [24], ECG-triggered, singleand two-heartbeat CTCA enabled lower EDs of 2.2 to 8.6 mSv, without affecting diagnostic performance [21,[25][26][27]. For the specific subgroup of non-obese patients with a low and stable heart rate, furthermore, values even on the submillisievert level for CTCA have been achieved [28].…”

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confidence: 71%

Long-Term Efficacy of a Mini-Course in Radiation-Reducing Techniques in Invasive Cardiology

Kuon¹,

Empen

Weitmann

et al. 2013

Purpose: To validate the long-term efficacy of a 90-min. educational mini-course in less-irradiating cardiac interventional techniques. Materials and Methods: Before, two months after, and two years after the mini-course (periods I, II, and III), we analyzed the following radiation dose parameters for ten coronary angiographies (CA), performed by each of 7 cardiologists: total dose-area product (DAP), radiographic and fluoroscopic DAP fractions, number of radiographic frames and runs, and fluoroscopy time. Results: The median patient DAP for periods I, II and III was 31.4, 15.8 and 8.5?Gy ? cm2, respectively. The long-term effect was related to shorter median fluoroscopy times (180, 172, and 120?s), shorter (57, 52, and 45) and fewer (12, 12, and 10) radiographic runs, consistent collimation and restriction to an adequate image quality. Both radiographic DAP/frame (28.7, 17.0, and 18.4?mGy???cm2) and fluoroscopic DAP/second (45.7, 24.2, and 10.0?mGy???cm2) decreased significantly. The multivariate linear regression analysis confirmed the increasing efficacy of the mini-course itself (?44.6 and ?60.7?%), and revealed a decreasing influence of the interventionalist?s experience (?8.6?% and ?4.9?% per 1,000 CAs, lifelong performed until the mini-course). The number of CAs performed after the mini-course did not influence the long-term DAP results. Conclusion: The presented educational mini-course allows a significant, long-lasting, and apparently ongoing reduction of patient radiation exposure due to CA. A self-surveillant documentation of relevant radiation parameters is well suited to monitor and improve each operator?s individual long-term radiation-reducing efforts.

“…Over the last decades, cardiac magnetic resonance (CMR) has emerged as an important diagnostic tool in the setting of MC [17,18]. According to the EuroCMR and MRCT registry [19,20], MC represents one of the leading indications for a CMR examination.…”

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confidence: 99%

Modern Imaging of Myocarditis: Possibilities and Challenges

Baeßler

Schmidt

Lücke

et al. 2016

Self Cite

▼Myocarditis is known as the chameleon of cardiac diseases. The symptoms and the course of disease vary greatly so that it is often challenging to establish a diagnosis. Early and accurate diagnosis is of utmost importance, since myocarditis is one of the leading causes of sudden cardiac death in young adults and represents an important precursor to dilated cardiomyopathy. Due to the constraints of the routinely used diagnostic approach, including clinical history and examination, laboratory testing, and electrocardiogram, different imaging modalities have emerged over the last decades as contributors to the noninvasive diagnosis of myocarditis. With this interdisciplinary review we would like to present the current state-of-the-art imaging of myocarditis across all available imaging modalities (i. e., echocardiography, cardiac magnetic resonance, cardiac computed tomography, and nuclear medicine). Furthermore, we present novel imaging techniques that might become useful in the near future for easier and more accurate diagnosis of this highly relevant disease.