Download PDF
Rofo 2006; 178(6): 578-589
DOI: 10.1055/s-2006-926748
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Bildgebung der Enthesitis: Ein neues Feld für den Radiologen?

Imaging of Enthesitis: A New Field for the Radiologist?K.-G A. Hermann1 [ *] , I. Eshed1 [ *] , M. Bollow2
  • 1Institut für Radiologie, Charité - Universitätsmedizin Berlin, Campus Mitte
  • 2Institut für Radiologie, Augusta-Kranken-Anstalt, Bochum
Further Information

Publication History

eingereicht: 16.1.2006

angenommen: 20.3.2006

Publication Date:
15 May 2006 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Als Enthesen werden die Regionen am Knochen bezeichnet, an welchen Sehnen, Ligamente, Gelenkkapseln oder Faszien inserieren. Sie dienen dazu, die Belastungen an diesen Übergangsstellen in den Knochen zu vermindern, indem sie die einwirkende biomechanische Energie verteilen. Zu Erkrankungen an den Enthesen kann es im Rahmen traumatischer, endokrinologischer, metabolischer, degenerativer sowie entzündlicher Prozesse kommen. Insbesondere bei den seronegativen Spondyloarthritiden (SpA) ist die Enthesitis ein wesentliches Merkmal. Das in den letzten Jahren gestiegene Interesse an Veränderungen der Enthesen im Rahmen rheumatischer Erkrankungen hat zu fundamentalen Veränderungen im Verständnis für das klinische Bild, die Pathogenese und die Therapie dieser Erkrankungen geführt. Chronische Veränderungen der Enthesen, wie Weichteilverkalkungen, Erosionen und Enthesiophyten, lassen sich gut mittels konventioneller Röntgendiagnostik oder Computertomographie darstellen. Bei akuten Enthesitiden ist die Magnetresonanztomographie (MRT) die Methode der Wahl, da sie neben den Weichteilveränderungen auch die intraossären pathologischen Prozesse abbildet. In dieser Übersicht sollen die magnetresonanztomographischen Merkmale der Enthesitiden bei SpA-Patienten dargestellt sowie ein morphologischer Überblick über die dabei hauptsächlich betroffenen Enthesen gegeben werden.

Abstract

Entheses are sites where tendons, ligaments, joint capsules, or fasciae attach to bone. Their function is to provide a mechanism for reducing stress at the bony interface by dissipating the biomechanical load acting on the bone. Enthesitis may occur in traumatic, endocrinologic, metabolic, degenerative, or inflammatory conditions and is a major symptom in patients with seronegative spondyloarthritis (SpA). The increasing interest in inflammation of the entheses associated with rheumatoid diseases has fundamentally changed our understanding of the clinical presentation, pathogenesis, and therapy of enthesitis. Conventional radiographs and computed tomography (CT) allow good evaluation of chronic changes of the entheses, such as soft-tissue calcification, erosions, and new bone formation. The method of first choice to evaluate acute enthesitis is magnetic resonance imaging (MRI), which depicts both soft-tissue changes and intraosseous abnormalities. The purpose of this overview is to discuss the MRI appearance of enthesitis in patients with SpA and to provide a morphologic survey of the predominantly affected entheses.

Key words

Inflammation - tendons - skeletal-axial - skeletal-appendicular - MR imaging - enthesitis

Literatur

  • 1 Francois R J, Eulderink F, Bywaters E G. Commented glossary for rheumatic spinal diseases, based on pathology.  Ann Rheum Dis. 1995;  54 615-625
    PubMedGoogle Scholar
  • 2 Benjamin M, Ralphs J R. Entheses - the bony attachments of tendons and ligaments.  Ital J Anat Embryol. 2001;  106 151-157
    PubMedGoogle Scholar
  • 3 McGonagle D, Marzo-Ortega H, Benjamin M. et al . Report on the Second international Enthesitis Workshop.  Arthritis Rheum. 2003;  48 896-905
    CrossrefPubMedGoogle Scholar
  • 4 La Cava  G. Enthesitis; traumatic disease of insertions.  J Am Med Assoc. 1959;  169 254-255
    PubMedGoogle Scholar
  • 5 Niepel G A, Kostka D, Kopecky S. et al . Enthesopathy.  Acta Rheumatologica et Balneologica Pistiniana. 1966;  1 1-64
    PubMedGoogle Scholar
  • 6 Dougados M, van der Linden S, Juhlin R. et al . The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy.  Arthritis Rheum. 1991;  34 1218-1227
    CrossrefPubMedGoogle Scholar
  • 7 Resnick D, Feingold M L, Curd J. et al . Calcaneal abnormalities in articular disorders. Rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and Reiter syndrome.  Radiology. 1977;  125 355-366
    PubMedGoogle Scholar
  • 8 McGonagle D, Gibbon W, O’Connor P. et al . Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondylarthropathy.  Arthritis Rheum. 1998;  41 694-700
    CrossrefPubMedGoogle Scholar
  • 9 McGonagle D, Marzo-Ortega H, O’Connor P. et al . The role of biomechanical factors and HLA-B27 in magnetic resonance imaging-determined bone changes in plantar fascia enthesopathy.  Arthritis Rheum. 2002;  46 489-493
    CrossrefPubMedGoogle Scholar
  • 10 Lambert R G, Dhillon S S, Jhangri G S. et al . High prevalence of symptomatic enthesopathy of the shoulder in ankylosing spondylitis: deltoid origin involvement constitutes a hallmark of disease.  Arthritis Rheum. 2004;  51 681-690
    CrossrefPubMedGoogle Scholar
  • 11 Erdem C Z, Sarikaya S, Erdem L O. et al . MR imaging features of foot involvement in ankylosing spondylitis.  Eur J Radiol. 2005;  53 110-119
    CrossrefPubMedGoogle Scholar
  • 12 Rufai A, Ralphs J R, Benjamin M. Structure and histopathology of the insertional region of the human Achilles tendon.  J Orthop Res. 1995;  13 585-593
    CrossrefPubMedGoogle Scholar
  • 13 Benjamin M, Ralphs J R. Fibrocartilage in tendons and ligaments - an adaptation to compressive load.  J Anat. 1998;  193 481-494
    CrossrefPubMedGoogle Scholar
  • 14 Gao J, Messner K, Ralphs J R. et al . An immunohistochemical study of enthesis development in the medial collateral ligament of the rat knee joint.  Anat Embryol (Berl). 1996;  194 399-406
    PubMedGoogle Scholar
  • 15 Ralphs J R, Benjamin M, Waggett A D. et al . Regional differences in cell shape and gap junction expression in rat Achilles tendon: relation to fibrocartilage differentiation.  J Anat. 1998;  193 215-222
    CrossrefPubMedGoogle Scholar
  • 16 Benjamin M, McGonagle D. The anatomical basis for disease localisation in seronegative spondyloarthropathy at entheses and related sites.  J Anat. 2001;  199 503-526
    CrossrefPubMedGoogle Scholar
  • 17 Benjamin M, Moriggl B, Brenner E. et al . The „enthesis organ” concept: why enthesopathies may not present as focal insertional disorders.  Arthritis Rheum. 2004;  50 3306-3313
    CrossrefPubMedGoogle Scholar
  • 18 Milz S, McNeilly C, Putz R. et al . Fibrocartilages in the extensor tendons of the interphalangeal joints of human toes.  Anat Rec. 1998;  252 264-270
    PubMedGoogle Scholar
  • 19 McGonagle D, Khan M A, Marzo-Ortega H. et al . Enthesitis in spondyloarthropathy.  Curr Opin Rheumatol. 1999;  11 244-250
    CrossrefPubMedGoogle Scholar
  • 20 Olivieri I, Barozzi L, Favaro L. et al . Dactylitis in patients with seronegative spondylarthropathy. Assessment by ultrasonography and magnetic resonance imaging.  Arthritis Rheum. 1996;  39 1524-1528
    CrossrefPubMedGoogle Scholar
  • 21 Braun J, Khan M A, Sieper J. Enthesitis and ankylosis in spondyloarthropathy: what is the target of the immune response?.  Ann Rheum Dis. 2000;  59 985-994
    CrossrefPubMedGoogle Scholar
  • 22 McGonagle D, Marzo-Ortega H, O’Connor P. et al . Histological assessment of the early enthesitis lesion in spondyloarthropathy.  Ann Rheum Dis. 2002;  61 534-537
    CrossrefPubMedGoogle Scholar
  • 23 Economou J S, McBride W H, Essner R. et al . Tumour necrosis factor production by IL-2-activated macrophages in vitro and in vivo.  Immunology. 1989;  67 514-519
    PubMedGoogle Scholar
  • 24 Bollow M, Fischer T, Reisshauer H. et al . Quantitative analyses of sacroiliac biopsies in spondyloarthropathies: T cells and macrophages predominate in early and active sacroiliitis- cellularity correlates with the degree of enhancement detected by magnetic resonance imaging.  Ann Rheum Dis. 2000;  59 135-140
    CrossrefPubMedGoogle Scholar
  • 25 Anandarajah A P, Ritchlin C T. Pathogenesis of psoriatic arthritis.  Curr Opin Rheumatol. 2004;  16 338-343
    CrossrefPubMedGoogle Scholar
  • 26 Olivieri I, Barozzi L, Padula A. Enthesiopathy: clinical manifestations, imaging and treatment.  Baillieres Clin Rheumatol. 1998;  12 665-681
    PubMedGoogle Scholar
  • 27 Resnick D, Niwayama G. Entheses and enthesopathy. Anatomical, pathological, and radiological correlation.  Radiology. 1983;  146 1-9
    PubMedGoogle Scholar
  • 28 Francois R J, Braun J, Khan M A. Entheses and enthesitis: a histopathologic review and relevance to spondyloarthritides.  Curr Opin Rheumatol. 2001;  13 255-264
    CrossrefPubMedGoogle Scholar
  • 29 Mander M, Simpson J M, McLellan A. et al . Studies with an enthesis index as a method of clinical assessment in ankylosing spondylitis.  Ann Rheum Dis. 1987;  46 197-202
    CrossrefPubMedGoogle Scholar
  • 30 Heuft-Dorenbosch L, Spoorenberg A, van Tubergen A. et al . Assessment of enthesitis in ankylosing spondylitis.  Ann Rheum Dis. 2003;  62 127-132
    CrossrefPubMedGoogle Scholar
  • 31 Kumar N, Kay L J, Walker D J. The treatment of enthesitis in psoriatic arthritis.  J Rheumatol. 2004;  31 2311-2312
    PubMedGoogle Scholar
  • 32 Bollow M, Braun J, Taupitz M. et al . CT-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with spondyloarthropathy: indication and follow-up with contrast-enhanced MRI.  J Comput Assist Tomogr. 1996;  20 512-521
    CrossrefPubMedGoogle Scholar
  • 33 Fritz J, König C W, Günaydin I. et al . Magnetresonanzgesteuerte Kortikosteroid-Infiltration der Sakroiliakalgelenke: Schmerztherapie der Sakroiliitis bei Patienten mit Spondylitis ankylosans.  Fortschr Röntgenstr. 2005;  177 555-563
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Karim M R, Fann A V, Gray R P. et al . Enthesitis of biceps brachii short head and coracobrachialis at the coracoid process: a generator of shoulder and neck pain.  Am J Phys Med Rehabil. 2005;  84 376-380
    CrossrefPubMedGoogle Scholar
  • 35 Paavola M, Kannus P, Jarvinen T A. et al . Treatment of tendon disorders. Is there a role for corticosteroid injection?.  Foot Ankle Clin. 2002;  7 501-513
    CrossrefPubMedGoogle Scholar
  • 36 Marzo-Ortega H, McGonagle D, O’Connor P. et al . Efficacy of etanercept in the treatment of the entheseal pathology in resistant spondylarthropathy: a clinical and magnetic resonance imaging study.  Arthritis Rheum. 2001;  44 2112-2117
    CrossrefPubMedGoogle Scholar
  • 37 Tan A L, Marzo-Ortega H, O’Connor P. et al . Efficacy of anakinra in active ankylosing spondylitis: a clinical and magnetic resonance imaging study.  Ann Rheum Dis. 2004;  63 1041-1045
    CrossrefPubMedGoogle Scholar
  • 38 Kamel M, Eid H, Mansour R. Ultrasound detection of heel enthesitis: a comparison with magnetic resonance imaging.  J Rheumatol. 2003;  30 774-778
    PubMedGoogle Scholar
  • 39 Romanus R, Yden S. Destructive and ossifying spondylitic changes in rheumatoid ankylosing spondylitis.  Acta Orthop Scand. 1952;  22 89-99
    PubMedGoogle Scholar
  • 40 Jevtic V, Kos-Golja M, Rozman B. et al . Marginal erosive discovertebral „Romanus” lesions in ankylosing spondylitis demonstrated by contrast enhanced Gd-DTPA magnetic resonance imaging.  Skeletal Radiol. 2000;  29 27-33
    CrossrefPubMedGoogle Scholar
  • 41 Hermann K G, Althoff C E, Schneider U. et al . Magnetic resonance imaging of spinal changes in patients with spondyloarthritis and correlation with conventional radiography.  Radiographics. 2005;  25 559-570
    CrossrefPubMedGoogle Scholar
  • 42 Bollow M, Enzweiler C, Taupitz M. et al . Use of contrast enhanced magnetic resonance imaging to detect spinal inflammation in patients with spondyloarthritides.  Clin Exp Rheumatol. 2002;  20 S167-174
    PubMedGoogle Scholar
  • 43 Hermann K G, Bollow M. Magnetic resonance imaging of the axial skeleton in rheumatoid disease.  Best Pract Res Clin Rheumatol. 2004;  18 881-907
    CrossrefPubMedGoogle Scholar
  • 44 Andersson O. Röntgenbilden vid spondylarthris ankylopoetica.  Nord Med Tidskr. 1937;  14 2000-2003
    PubMedGoogle Scholar
  • 45 Kabasakal Y, Garrett S L, Calin A. The epidemiology of spondylodiscitis in ankylosing spondylitis: A controlled study.  Br J Rheumatol. 1996;  35 660-663
    CrossrefPubMedGoogle Scholar
  • 46 Bollow M. Magnetresonanztomographie bei ankylosierender Spondylitis (Morbus Marie-Strümpell-Bechterew).  Fortschr Röntgenstr. 2002;  174 1489-1499
    Article in Thieme ConnectPubMedGoogle Scholar
  • 47 Jevtic V. Magnetic resonance imaging appearances of different discovertebral lesions.  Eur Radiol. 2001;  11 1123-1135
    CrossrefPubMedGoogle Scholar
  • 48 Hermann K G, Bollow M. Magnetresonanztomographie bei Spondylarthropathien.  Akt Rheumatol. 2002;  27 323-331
    Article in Thieme ConnectPubMedGoogle Scholar
  • 49 Jurik A G. Anterior chest wall involvement in seronegative arthritides. A study of the frequency of changes at radiography.  Rheumatol Int. 1992;  12 7-11
    PubMedGoogle Scholar
  • 50 Fournie B, Boutes A, Dromer C. et al . Prospective study of anterior chest wall involvement in ankylosing spondylitis and psoriatic arthritis.  Rev Rhum Engl Ed. 1997;  64 22-25
    PubMedGoogle Scholar
  • 51 Kasperczyk A, Freyschmidt J. Pustulotic arthroosteitis: spectrum of bone lesions with palmoplantar pustulosis.  Radiology. 1994;  191 207-211
    PubMedGoogle Scholar
  • 52 Hermann K G, Braun J, Fischer T. et al . Magnetresonanztomographie der Sakroiliitis: Anatomie, Pathohistologie, MR-Morphologie und Graduierung.  Radiologe. 2004;  44 217-228
    CrossrefPubMedGoogle Scholar
  • 53 Bollow M, Hermann K GA, Biedermann T. et al . Very early spondyloarthritis: where the inflammation in the sacroiliac joints starts.  Ann Rheum Dis. 2005;  64 1644-1646
    CrossrefPubMedGoogle Scholar
  • 54 Muche B, Bollow M, Francois R J. et al . Anatomic structures involved in early- and late-stage sacroiliitis in spondylarthritis: a detailed analysis by contrast-enhanced magnetic resonance imaging.  Arthritis Rheum. 2003;  48 1374-1384
    CrossrefPubMedGoogle Scholar
  • 55 Shichikawa K, Tsujimoto M, Nishioka J. et al .Histopathology of early sacroiliitis and enthesitis in ankylosing spondylitis: advances in inflammation research. Ziff M, Cohen SB The spondyloarthropathies New York; Raven 1985: 15-24
    Google Scholar
  • 56 Francois R J, Gardner D L, Degrave E J. et al . Histopathologic evidence that sacroiliitis in ankylosing spondylitis is not merely enthesitis.  Arthritis Rheum. 2000;  43 2011-2024
    CrossrefPubMedGoogle Scholar
  • 57 Dihlmann W. Röntgendiagnostik der Sakroiliakalgelenke und ihrer nahen Umgebung. Stuttgart; Thieme 1978
    Google Scholar
  • 58 Scarpa R, Ames P R, della V alle G. et al . A rare enthesopathy in psoriatic oligoarthritis.  Acta Derm Venereol Suppl (Stockh). 1994;  186 74-75
    PubMedGoogle Scholar
  • 59 Taylor P W, Stoecker W. Enthesitis of the elbow in psoriatic arthritis.  J Rheumatol. 1997;  24 2268-2269
    PubMedGoogle Scholar
  • 60 Olivieri I, Salvarani C, Cantini F. et al . Fast spin echo-T2-weighted sequences with fat saturation in dactylitis of spondylarthritis. No evidence of entheseal involvement of the flexor digitorum tendons.  Arthritis Rheum. 2002;  46 2964-2967
    CrossrefPubMedGoogle Scholar
  • 61 McGonagle D. Imaging the joint and enthesis: insights into pathogenesis of psoriatic arthritis.  Ann Rheum Dis. 2005;  64 ii58-60
    CrossrefPubMedGoogle Scholar
  • 62 Tan A L, Grainger A J, Tanner S F. et al . High-resolution magnetic resonance imaging for the assessment of hand osteoarthritis.  Arthritis Rheum. 2005;  52 2355-2365
    CrossrefPubMedGoogle Scholar
  • 63 Olivieri I, Padula A, Pierro A. et al . Late onset undifferentiated seronegative spondyloarthropathy.  J Rheumatol. 1995;  22 899-903
    PubMedGoogle Scholar
  • 64 Amor B, Santos R S, Nahal R. et al . Predictive factors for the longterm outcome of spondyloarthropathies.  J Rheumatol. 1994;  21 1883-1887
    PubMedGoogle Scholar
  • 65 Lehtinen A, Taavitsainen M, Leirisalo-Repo M. Sonographic analysis of enthesopathy in the lower extremities of patients with spondylarthropathy.  Clin Exp Rheumatol. 1994;  12 143-148
    PubMedGoogle Scholar
  • 66 al-Mayouf S M, Babyn P, Schneider R. et al . Patellar enthesopathy in childhood: a new clinical and radiographic observation.  J Rheumatol. 1997;  24 1186-1188
    PubMedGoogle Scholar
  • 67 Olivieri I, Gemignani G, Bini C. et al . Diffuse Achilles tendon thickening in juvenile onset seronegative HLA-B27 positive spondyloarthropathy.  J Rheumatol. 1988;  15 381-382
    PubMedGoogle Scholar
  • 68 Olivieri I, Barozzi L, Padula A. et al . Retrocalcaneal bursitis in spondyloarthropathy: assessment by ultrasonography and magnetic resonance imaging.  J Rheumatol. 1998;  25 1352-1357
    PubMedGoogle Scholar
  • 69 Burgos-Vargas R, Pacheco-Tena C, Vazquez-Mellado J. A short-term follow-up of enthesitis and arthritis in the active phase of juvenile onset spondyloarthropathies.  Clin Exp Rheumatol. 2002;  20 727-731
    PubMedGoogle Scholar
  • 70 Olivieri I, Barozzi L, Pierro A. et al . Toe dactylitis in patients with spondyloarthropathy: assessment by magnetic resonance imaging.  J Rheumatol. 1997;  24 926-930
    PubMedGoogle Scholar
  • 71 Remplik P, Schukai O, Roemer F W. et al . Einfluss klinischer Informationen auf die diagnostische Wertigkeit der MRT bei der Frage nach einer abakteriellen Sakroiliitis.  Fortschr Röntgenstr. 2005;  177 842-848
    Article in Thieme ConnectPubMedGoogle Scholar

1 Beide Autoren haben zu gleichen Teilen zu dieser Arbeit beigetragen.

Dr. Kay-Geert A. Hermann

Institut für Radiologie, Charité - Universitätsmedizin Berlin, Campus Mitte

Schumannstr. 20/21

10117 Berlin

Phone: ++49/30/4 50 52 70 82

Fax: ++49/30/4 50 52 79 05

Email: kgh@charite.de

      >