Zusammenfassung
Die Bestimmung der Krankheitsausdehnung und die Festlegung der Krankheitsaktivität
stehen im Vordergrund der bildgebenden Diagnostik von Vaskulitiden. Für die eigentliche
Diagnosefindung ist die Radiologie von untergeordneter Bedeutung. Die verschiedenen
radiologischen Methoden weisen jeweils spezifische Indikationen auf. Die Magnetresonanztomographie
(MRT) hat sich als hilfreich für die Diagnostik von Granulomen und Schleimhautentzündungen
im HNO-Bereich erwiesen. Ossäre Veränderungen im Bereich des Gesichtsschädels werden
zuverlässig mit der Computertomographie erkannt. Aufgrund der hohen Sensitivität ist
die MRT ein anerkanntes Screeningverfahren für ZNS-Vaskulitiden, dagegen bestehen
Einschränkungen hinsichtlich der Spezifität. Zur radiologischen Diagnosesicherung
von ZNS-Vaskulitiden wird zurzeit noch die selektive zerebrale Angiographie gefordert,
deren Treffsicherheit gleichermaßen Limitationen aufweist. Die Perfusions-MRT verbindet
grundsätzlich die Vorteile der MRT und der Angiographie, jedoch ist die Methode bei
Vaskulitiden noch ungenügend validiert. Die Gefäßdiagnostik bei der Takayasu-Arteriitis
und der Riesenzellarteriitis mit bevorzugtem Befall großer und mittelgroßer Arterien
erfolgt mit der nicht invasiven Magnetresonanzangiographie. Die perkutane transluminale
Angioplastie der Extremitäten- und Nierenarterien sowie der Aorta ist eine sichere
und effektive Therapieoption bei vaskulären Stenosen und Verschlüssen. Das Standardverfahren
für die radiologische Lungendiagnostik ist die Thoraxübersichtsaufnahme in zwei Ebenen.
Die Feindiagnostik des Lungenparenchyms erfolgt bei den pulmonalen Vaskulitiden mit
der hochauflösenden Computertomographie. Die vorgestellten radiologischen Methoden
stellen eine wertvolle Ergänzung in der interdisziplinären Betreuung von Vaskulitispatienten
dar.
Abstract
Determination of disease extension and disease activity are in the foreground of diagnostic
imaging in vasculitides. There are several radiologic modalities available each having
specific indications. Magnetic resonance imaging (MRI) readily depicts granulomas
and mucosal inflammations in the paranasal sinuses, nasal cavity and orbits. Computed
tomography detects osseous lesions of the skull. Due to its superb sensitivity MRI
is an established screening modality for CNS vasculitides, although there are limitations
with regard to specificity. In spite of its limited accuracy in most institutions
angiography is still required for radiological confirmation of CNS vasculitis. Perfusion
and diffusion MR-imaging may combine the advantages of “conventional” MRI and angiography.
By now the method is not fully validated for vasculitides, however. Vascular disease
in Takayasu's arteritis and in giant cell arteritis involving predominantly large
and medium sized vessels is readily diagnosed by non invasive magnetic resonance angiography.
Percutaneous transluminal angioplasty has proven to be an effective and save therapeutic
modality for the cure of vascular stenoses and occlusions. Plain film radiography
in two planes is the established modality for pulmonary imaging. In pulmonary vasculitides
a more thorough analysis of lung disease is provided by high resolution computed tomography.
Diagnostic imaging does substantially assist in the interdisciplinary management of
patients suffering from vasculitides.
Key words
Vasculitides - computed tomography - magnetic resonance imaging - digital subtraction
angiography - percutaneous transluminal angioplasty
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PD Dr. med. M. Reuter
Klinik für Diagnostische Radiologie, Universitätsklinikum Kiel
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