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Nachweis von pneumonischen Infiltraten mit der MRT

Magnetic resonance imaging in the evaluation of pneumonia

  • MRT der Lunge
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Zusammenfassung

Die MRT des Lungenparenchyms ist wegen des extrem niedrigen Protonengehalts des Lungengewebes und den starken Grenzflächen zwischen Luft und Parenchym prinzipiell sehr problematisch. Allerdings liegt bei pathologischen Lungengewebeveränderungen eine andere Situation vor, da infolge von Ödem, Entzündung bzw. Tumorwachstum der Protonengehalt erhöht und die Grenzflächen reduziert sind. Viele Erkrankungen der Lunge führen dazu, dass der Patient den Atem nicht lange anzuhalten vermag. Daher sind MRT-Pulssequenzen erforderlich, die eine Datenakquisition in wenigen Sekunden gestatten. Aus technischer Sicht werden die vom CT bekannten Submillimeterschichten vielleicht nie realisierbar sein, sodass sicher auch in Zukunft kleine Rundherde mit einem Durchmesser deutlich unterhalb der Schichtdicke nicht mehr zuverlässig erfasst werden können. Auch Verkalkungen sind nicht mit der gleichen Sicherheit wie im CT zu identifizieren. Gleiches gilt für den Nachweis von Luftsicheln und -einschlüssen in Läsionen. Mit Hilfe der parallelen Bildgebung können beide Lungenflügel in 1–2 Atemstillständen mit einer Ortsauflösung von 6 mm in der z-Achse und Submillimeterauflösung in der x- und y-Ebene untersucht werden. Raumzeiten <10 min lassen sich so realisieren. Insbesondere für die Verlaufsbeurteilung von pneumonischen Infiltraten bei immunsupprimierten Patienten kann die MRT geeignet sein und zu einer geringeren Dosisexposition der Patienten beitragen.

Abstract

Magnetic resonance imaging (MRI) of the lung is challenging because of substantial drawbacks. However, lung pathologies that are associated with increased attenuation values in CT enhance visualization in MRI: proton density is increased and tissue-air interfaces, resulting in susceptibility artifacts, are reduced in pneumonia, pneumonitis, edema, and carcinoma. On the other hand, many lung diseases result in shortness of breath, so that patients cannot hold their breath for long periods. Therefore, fast imaging techniques are required which should also allow for high spatial resolution so that small lesions can be detected. Calcifications and air pockets within lesions are not readily recognized with MRI. Thin section CT is standard for the diagnosis of pneumonia. With parallel imaging techniques, MRI examination of the lungs can be performed with short periods of breath holding, which allow for sub-centimeter resolution in the z-axis. Especially for follow-up examinations in immunocompromised patients and, in some instances, for the staging of malignant diseases (malignant pleural mesothelioma, lung cancer, respectively), MRI is very promising and may contribute to a decrease in the radiation exposure of the patients.

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Authors and Affiliations

  1. Institut für Klinische Radiologie, Ludwig-Maximilians-Universität München

    R. Eibel, P. Herzog, O. Dietrich, M. Reiser & S. O. Schoenberg

  2. Abteilung für Hämatologie/Onkologie, Klinikum Großhadern, Ludwig-Maximilians-Universität München

    C. Rieger & H. Ostermann

  3. Institut für Klinische Radiologie, Klinikum Innenstadt, Ludwig-Maximilians-Universität München, Ziemssenstraße 1, 80336 , München

    R. Eibel

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  1. R. Eibel
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  2. P. Herzog
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  4. C. Rieger
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Correspondence to R. Eibel.

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Eibel, R., Herzog, P., Dietrich, O. et al. Nachweis von pneumonischen Infiltraten mit der MRT. Radiologe 46, 267–274 (2006). https://doi.org/10.1007/s00117-005-1326-7

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  • DOI: https://doi.org/10.1007/s00117-005-1326-7

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