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Funktionelle MRT der Niere zur Erfassung strahleninduzierter Nierenschädigungen

Functional magnetic resonance imaging for evaluation of radiation-induced renal damage

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Zusammenfassung

Die Diagnostik strahleninduzierter, insbesondere chronischer Schädigungen der Niere ist nach wie vor schwierig und beruht primär auf der klinischen Beurteilung. Durch die zunehmende Anzahl von Langzeitüberlebenden nach einer Strahlentherapie wird die Bedeutung dieser Diagnostik jedoch weiter zunehmen. In diesem Beitrag wird der Frage nachgegangen, in wieweit hierzu die MRT-Bildgebung und hier besonders die funktionellen Bildgebungsmodalitäten ihren Beitrag leisten können. Die folgenden Verfahren werden kurz vorgestellt und bewertet: die Blood-oxygenation-level-dependent-Bildgebung (BOLD), die diffusionsgewichtete Bildgebung („diffusion-weighted imaging“, DWI) bzw. das „diffusion tensor imaging“ (DTI), die MR-Perfusionsmessungen, und die 23Na-Bildgebung. Insgesamt lässt sich feststellen, dass aktuell lediglich die DWI und die kontrastmittelverstärkte MR-Perfusion für einen weitverbreiteten klinischen Einsatz geeignet erscheinen. Allerdings fehlen auch für diese beiden Techniken valide Daten aus größeren Studien, um ihre Wertigkeit für die Beurteilung strahleninduzierter Nierenschäden abzuschätzen. Techniken wie die BOLD- oder 23Na-Bildgebung haben ein großes Potenzial, sind aktuell jedoch weder hinsichtlich der Fragestellung ausreichend evaluiert noch technisch einfach und zuverlässig zu implementieren.

Abstract

The diagnosis of radiation-induced (especially chronic) renal alterations/damage is difficult and currently relies primarily on clinical evaluation. The importance of renal diagnostic evaluation will increase continuously due to the increasing number of long-term survivors after radiotherapy. This article evaluates the potentia diagnostic contribution of magnetic resonance (MR) imaging with a focus on functional MRI. The following functional MRI approaches are briefly presented and evaluated: blood oxygenation level-dependent imaging (BOLD), diffusion-weighted imaging (DWI) or diffusion tensor imaging (DTI), MR perfusion measurements and 23Na imaging. In summary, only DWI and contrast-enhanced MR perfusion currently seem to be suitable approaches for a broader, clinical implementation. However, up to now valid data from larger patient studies are lacking for both techniques in regard to radiation-induced renal alterations. The BOLD and 23Na imaging procedures have a huge potential but are currently neither sufficiently evaluated with regard to radiation-induced renal alterations nor technically simple and reliable for implementation into the clinical routine.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Beratertätigkeit bei Bayer Healthcare.

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Authors and Affiliations

  1. Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    S. Haneder, S.O. Schoenberg &  H.J. Michaely

  2. Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland

    J. Boda-Heggemann

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  1. S. Haneder
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  2. J. Boda-Heggemann
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  3. S.O. Schoenberg
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  4. H.J. Michaely
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Correspondence to H.J. Michaely.

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Haneder, S., Boda-Heggemann, J., Schoenberg, S. et al. Funktionelle MRT der Niere zur Erfassung strahleninduzierter Nierenschädigungen. Radiologe 52, 243–251 (2012). https://doi.org/10.1007/s00117-011-2195-x

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  • DOI: https://doi.org/10.1007/s00117-011-2195-x

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