Bildgebende Verfahren in der Rheumatologie

Zusammenfassung

Ein früher Therapiebeginn mit langwirksamen Antirheumatika führt zu einer verbesserten Langzeitprognose bei Pa-tienten mit rheumatoider Arthritis (RA). Die Verfügbarkeit neuer, gezielter Therapieformen unterstreicht den Bedarf an sensitiven bildgebenden Verfahren, die in der Lage sind, auch frühe Stadien der Erkrankung zuverlässig zu erfassen, eine Prognose zu erheben und die Wirksamkeit der eingesetzten Therapien zu dokumentieren. Die konventionellen Röntgenaufnahme als etablierter Goldstandard kann Gelenkdestruktionen bei Patienten mit bereits bekannter RA nachweisen, häufig entgehen jedoch frühe Krankheitsmanifestationen wie Weichteilentzündungen oder begin-nende knöcherne Erosionen der Diagnose. Magnetresonanztomographie (MRT) und Sonographie erfassen durch unmittelbare Darstellung von Weichteilstrukturen hochsensitiv frühe entzündliche und destruktive Veränderungen. Durch einen Überblick über veröffentliche Daten zu Rönt-gen, Computertomographie, MRT, Sonographie und Szintigraphie erörtert der folgende Artikel den aktuellen Stand sowie die zukünftige Rolle einzelner bildgebender Verfahren in der Diagnostik entzündlicher Gelenkerkrankungen.

Summary

Early treatment with disease-modifying antirheumatic drugs leads to a better long-term outcome in patients with rheumatoid arthritis (RA). The availability of new targeted biological therapies has increased the need for powerful, sensitive imaging techniques that can accurately diagnosein early stage of disease, indicate the prognosis and monitor the efficacy of treatment. Conventional radiography as the traditional gold standard is able to visualize structural joint damage in patients with established disease but it is not sensitive to the detection of early disease manifestations such as soft tissue inflammation and bone erosions at their earliest stages. There is evidence for magnetic resonance imaging (MRI) and sonography being highly sensitive for early inflammatory and destructive changes in RA joints by directly visualising soft tissue inflammation. Reviewing the data on X-ray, computed tomography, MRI, sonography and scintigraphy this paper discusses the potential for current and future roles of these imaging modalities in clinical management of patients with inflammatory joint disease.

Schlüsselwörter

Rheumatoide Arthritis - Röntgen - MRT - Sonographie - CT - Szintigraphie

Keywords

Rheumatoid arthritis - radiography - MRI - sonography - CT - scintigraphy

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