MRT-Sakroiliitis – Einfluss von Geschlecht und Anatomie auf Läsionen

Zusammenfassung

Die MRT-Bildgebung der Sakroiliakalgelenke spielt eine zentrale Rolle in der Differentialdiagnostik des entzündlichen Rückenschmerzes. In der Interpretation der Bildgebung gibt es jedoch wesentliche Unterschiede zwischen Männern und Frauen zu beachten. Dies betrifft sowohl die Abgrenzung echter entzündlicher von rein degenerativ-entzündlichen Veränderungen als auch die tendenziell unterschiedlichen bildgebenden Verläufe einer axialen Spondyloarthritis (axSpA). Aufgrund anatomisch-biomechanischer Gegebenheiten haben Frauen ein höheres Risiko, mechanisch-degenerative Erkrankungen der Sakroiliakalgelenke zu entwickeln; diese können in der klinischen Praxis schwer von einer Sakroiliitis zu unterscheiden sein. Im Rahmen einer axialen Spondyloarthritis finden sich bei Frauen häufiger Sklerosen und bei Männern häufiger Ankylosen und postentzündliche Fettmetaplasien. Die diagnostische Genauigkeit der MRT der Sakroiliakalgelenke ist bei Frauen niedriger als bei Männern. Eine Kenntnis der anatomisch-biomechanischen Unterschiede zwischen Männern und Frauen ermöglicht somit eine präzisere radiologische Diagnostik bei Verdacht auf axiale Spondyloarthritis.

Abstract

MRI imaging of the sacroiliac joints plays a central role in the differential diagnosis of inflammatory back pain. However, some significant differences between men and women need to be considered when interpreting imaging results. This applies both to the differentiation between real inflammatory changes and purely degenerative inflammatory changes and the tendency of axial spondyloarthritis (axSpA) to follow different imaging patterns. Due to anatomical and biomechanical conditions, women have a higher risk of developing mechanical or degenerative diseases of the sacroiliac joints; these can be difficult to distinguish from sacroiliitis in clinical practice. In the context of axial spondyloarthritis, sclerosis is found more frequently in women, while ankylosis and post-inflammatory fatty metaplasia are more frequently found in men. The diagnostic accuracy of MRI of the sacroiliac joints is lower in women than in men. Knowledge of the anatomical biomechanical differences between men and women therefore allows for a more precise radiological diagnosis of suspected axial spondyloarthritis.

Schlüsselwörter

Axiale Spondyloarthritis - Magnetresonanztomographie - Geschlechtsunterschiede

Keywords

axial spondyloarthritis - magnetic resonance imaging - sex differences

Publication History

Received: 05 August 2024

Accepted: 01 November 2024

Article published online:
10 December 2024

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