Magnetresonanztomografie

Zusammenfassung

Die Bedeutung und Anwendung bildgebender Verfahren in der Rheumatologie, insbesondere bei der Diagnostik entzündlicher Gelenk- und Wirbelsäulenerkrankungen, hat sich in den letzten Jahrzehnten signifikant geändert. Diente die konventionelle Radiologie bislang ausschließlich der Diagnostik und der Absicherung von Klassifikationskriterien, so stellen radiologische Strukturveränderungen heutzutage einen wesentlichen Outcome-Parameter und Endpunkt für klinische Studien dar. Neben dem Erreichen der klinischen Remission gilt inzwischen auch das Therapieziel, den radiologischen Progress zu stoppen. Ein Aufhalten der radiologischen Progression bedeutet Verbesserung der Funktionalität, der Lebensqualität, respektive eine Reduzierung von Arbeitsunfähigkeit und nicht zuletzt somit eine signifikante Reduktion von Kosten. Neue bildgebende Verfahren wie die Magnetresonanztomografie (MRT) setzen genau an dieser Entwicklung an und haben einen Paradigmenwechsel der Diagnostik eingeleitet. Mit der MRT können heutzutage knöcherne Veränderungen (z. B. Erosion) frühzeitiger im Krankheitsverlauf detektiert werden, desweiteren sind auch entzündliche Weichteilveränderungen (z. B. Synovialitis) als auch Knorpelpathologien (z. B. durch dGEMRIC-Technik) diagnostizierbar. Ausschließlich mit der MRT gelingt es ferner das Knochenmarködem (Osteitis) als frühe Entzündungsreaktion abzubilden, welches als Prädiktor für Erosivität im Gelenk, als auch für die Knochenneubildung (z. B. Syndesmophyten) an der Wirbelsäule gilt. Aufgrund dieser Vorteile ist der Einschluss der MRT als Diagnosekriterium (wie z. B. für die ankylosierende Spondylitis (AS) bei den ASAS-Kriterien bereits stattgefunden) die logische Konsequenz. Bildgebende Techniken wie die MRT finden aber auch zunehmend Bedeutung bei der Therapiekontrolle, da sie ein genaueres und individuelleres Monitoring des Krankheitsverlaufes erlauben. Technischen Weiterentwicklungen der MRT (z. B. Niederfeld-MRT), sowie die mittlerweile vereinfachte und standardisierte Befundinterpretation durch Scoringmethoden haben inzwischen zu einer breiteren Anwendung der MRT, respektive zu neuen Indikationen in Klinik und Praxis geführt.

Abstract

The relevance and use of imaging methods in rheumatology have significantly changed in recent decades, especially with regard to the diagnosis of inflammatory joint and spinal diseases. Nowadays, structural changes in X-ray images are significant outcome parameters and endpoints for clinical studies, whereas conventional radiology so far solely served as a diagnostic tool and to ensure classification criteria. Besides achieving clinical remission, the therapeutic goal is to stop radiological progression. Stopping radiological progression means functional improvement, quality of life improvement, reduction of inability to work, and, last not least, a significant reduction of costs. Novel imaging methods like the magnetic resonance imaging (MRI) follow this trend and have led to a paradigm shift in diagnosis. Using MRI we can detect bony changes, e. g., erosions, inflammatory soft tissue changes, e. g., synovitis, and cartilage pathologies (e. g., by the dGEMRIC method) much earlier during the course of a disease. Only MRI is able to show marrow oedema (osteitis), which is an early sign for inflammation and a predictor for erosivity in the joint, as well as new bone formation at the spine, e. g., syndesmophytes. The implementation of MRI findings as a new parameter for classification criteria is the logical consequence of these advantages [as it has already been performed for ankylosing spondylitis (AS) in the ASAS criteria]. Imaging methods like MRI are becoming increasingly important in therapy control, since they allow for a more detailed and more individual monitoring of the disease course. Technical advancements of MRI like the low-field MRI and the simplified and standardised interpretation of findings with scoring methods have led to an expanded use of MRI as well as to new indications in clinic and practice.

Schlüsselwörter

Magnetresonanztomografie - Rheumatologie - Frühdiagnostik - Prognose - Therapiekontrolle

Key words

magnetic resonance imaging - rheumatology - early diagnosis - prognosis - therapy monitoring

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