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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Korrespondenzadresse
PD Dr. Benedikt Ostendorf
Heinrich-Heine Universität
Düsseldorf
Klinik für Endokrinologie
Diabetologie und Rheumatologie
Moorenstraße 5
40025 Düsseldorf
Telefon: +49/211/811 7817
Fax: +49/211/811 6455
eMail: ostendorf@med.uni-duesseldorf.de
