Bildgebende Verfahren in der Rheumatologie

Axel Schmid

doi:10.1055/s-0037-1618498

Arthritis und Rheuma, Inhaltsverzeichnis

Arthritis und Rheuma 2005; 25(03): 123-129
DOI: 10.1055/s-0037-1618498

Innovationen auf dem Prüfstand

Schattauer GmbH

Bildgebende Verfahren in der Rheumatologie

Aktueller Stand und EntwicklungenImaging in Rheumatology – Current Role and New DevelopmentsCurrent Role and New Developments

Autoren

Axel Schmid

¹Radiologisches Institut der Universität Erlangen-Nürnberg (Leiter: Prof. Dr. W. A. Bautz)

Abstract

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

Volltext

Referenzen

Literatur
1 Arnett FC., Edworthy SM. et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315-24.
2 McQueen FM., Stewart N. et al Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals a high prevalence of erosion at four months after symptom onset. Ann Rheum Dis 1998; 57 (06) 350-6.
3 van der Heijde DMFM., van Leeuwen MA. et al Biannual radiographic assessments of hands and feet in a three-year prospective followup of patients with early rheumatoid arthritis. Arthritis Rheum 1992; 35: 26-34.
4 Lard LR., Visser H. et al Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies. Am J Med 2001; 111: 446-51.
5 Brower AC. Use of radiograph to measure the course of rheumatoid arthritis. The gold standard versus fools gold. Arthritis Rheum 1990; 33: 316-24.
6 Manger B. Imaging in early rheumatoid arthritis: roles of magnetic resonance imaging, ultra-sonography, conventional radiography and computed tomography. Best Practice & Research Clinical Rheumatology 2004; 18 (06) 773-81.
7 Kainberger F., Peloschek P. et al Differential diagnosis of rheumatic disease using conventional radiography. Best Practice & Research Clinical Rheumatology 2004; 18 (06) 783-811.
8 Kaarela K. Prognostic factors and diagnostic criteria in rheumatoid arthritis. Scand J Rheumatol 1985; 14 (Suppl. 57) suppl 1-54.
9 Visser H., le Cessie S. et al How to diagnose rheumatoid arthritis early. A predictor model for persistant (erosive) arthritis. Arthritis Rheum 2002; 46: 357-65.
10 Möttönen TT. Prediction of erosiveness and rate of development of new erosions in early rheumatoid arthritis. Ann Rheum Dis 1988; 47: 648-53.
11 van der Heijde DMFM. Joint erosions and patients with early rheumatoid arthritis. Br J Rheumatol 1995; 34 (Suppl. 02) suppl 74-8.
12 Uffmann M., Schaefer-Prokop C. et al Skeletal applications for flatpanel versus storage-phosphor radiography: effect of exposure on detection of low-contrast details. Radiology 2004; 231: 506-14.
13 van der Heijde D. How to read radiographics according to the Sharpe/van der Heijde method. Journal of Rheumatology 2000; 27: 261-3.
14 van der Heijde D., Dankert T. Reliability and sensitivity to change a simplification of the Sharpe/van der Heijde radiological assessment in rheumatoid arthritis. Rheumatology 1999; 38: 941-7.
15 østergaard M., Stoltenberg M. et al. Quantification of synovitis by MRI: correlation between dynamic and static gadolinium-enhanced magnetic resonance imaging and microscopic and macroscopic signs of synovial inflammation. Magn Reson Imaging 1998; 16: 743-54.
16 Lindegaard H., Vallø J. et al. Low field dedicated magnetic resonance imaging in untreated rheumatoid arthritis of recent onset. Ann Rheum Dis 2001; 60: 770-6.
17 McQueen FM., Benton N. Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis. Arthritis Rheum 2003; 48: 1814-27.
18 Peterfy CG., van Dijke CF. et al Quantification of the volume of articular cartilage in the metacarpophalangeal joints of the hand: accuracy and precision of three-dimensional MR imaging. Am J Roengenology 1995; 165: 371-5.
19 Hermann KGA., Bollow M. Magnetic resonance imaging of the axial skeleton in rheumatoid disease. Best Practice & Research Clinical Rheumatology 2004; 18 (06) 881-907.
20 Reijnierse M., Dijkmans BA. et al Neurologic dysfunction in patients with rheumatoid arthritis of the cervical spine: predictive value of clinical, radiographic and MR imaging parameters. Eur Radiol 2001; 11: 467-73.
21 Sugimoto H., Takeda A. et al Early stage rheumatoid arthritis: prospective study of the effectiveness of MR imaging for diagnosis. Radiology 2000; 216: 569-75.
22 østergaard M., Duer A. et al. Magnetic resonance imaging of peripheral joints in rheumatic diseases. Best Practice & Research Clinical Rheumatology 2004; 18 (06) 861-79.
23 Tanaka N., Sakahashi H. et al Synovial membrane enhancement and bone erosion by magnetic resonance imaging for prediction of radiologic progression in patients with early rheumatoid arthritis. Rheumatol Int 2003 Published online Nov 27^th 2003
24 østergaard M., Hansen M. et al New radiographic bone erosions in the wrists of patients with rheumatoid arthritis are detectable with magnetic resonance imaging a median of two years earlier. Arthritis Rheum 2003; 48: 2128-31.
25 McQueen FM., Steward N. et al Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement. Ann Rheum Dis 1999; 58: 156-63.
26 østergaard M., Klarlund M. et al Interreader agreement in the assessment of magnetic resonance images of rheumatoid arthritis wrist and finger joints – An international multicenter study. J Rheumatol 2001; 28: 143-50.
27 Ejbjerg B., Narvestad E. et al Magnetic resonance imaging of wrist and finger joints in healthy subjects occasionally shows changes resembling erosions and synovitis as seen in rheumatoid arthritis. Arthritis Rheum 2004; 50: 1097-1106.
28 østergaard M., Peterfy C. et al. OMERACT rheumatoid arthritis magnetic resonance imaging studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol 2003; 30: 1385-6.
29 østergaard M., Conaghan P. et al Reducing costs, duration and invasiveness of magnetic resonance imaging in rheumatoid arthritis by omitting intravenous gadolinium injection – does it affect assessments of synovitis, bone erosions and bone edema?. Ann Rheum Dis 2003; 62 (Suppl. 01) suppl 67 Abstract
30 Savnik A., Malmskov H. et al MRI of the arthritic small joints: Comparison of extremity MRI (0.2 T) vs. high-field MRI (1.5 T). Eur Radiol 2001; 11: 1030-8.
31 Grassi W., Cervini C. et al. Ultrasonography in rheumatology: an evolving technique. Ann Rheum Dis 1998; 57: 268-71.
32 Newman JS., Laing TJ. et al Power Doppler Sonography of synovitis: assessment of therapuetic response. Preliminary observations. Radiology 1996; 198: 582-4.
33 Terslev L., Trop-Pedersen S. et al. Doppler ultrasound and magnetic resonance imaging of synovial inflammation of the hand in rheumatoid arthritis: a comparative study. Arthritis Rheum 2003; 48: 2434-41.
34 Backhaus M., Kamradt T. et al. Arthritis of the finger joints. A comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 1999; 42: 1232-45.
35 østergaard M., Ejbjerg B. et al. Imaging in early arthritis: roles of magnetic resonance imaging, ultrasonogaphy, conventional radiography and computed tomography. Best Practice & Research Clinical Rheumatology 2005; 19 (01) 91-116.
36 Klauser A., Frauscher F. et al The value of contrast-enhanced color Doppler ultrasound in the detection of vascularization of finger joints in patients with rheumatoid arthritis. Arthritis Rheum 2002; 46: 647-53.
37 Balint PV., Kane D. et al Ultrasound guided versus conventional joint and soft tissue fluid aspiration in rheumatology practice: a pilot study. Journal of Rheumatology 2002; 29: 2209-13.
38 Braun J., Bollow M. Computed tomography guided corticosteroid injection of the sacroiliac joints in patients with spondyloarthropathy with sacroiliitis: clinical outcome and followup by dynamic magnetic resonance imaging. J Rheumatol 1996; 23: 659-64.
39 Mottonen TT., Hannonen P. et al. Value of joint scintigraphy in the prediction of erosiveness in early rheumatoid arthritis. Ann Rheum Dis 1988; 47: 183-9.
40 Shearman J., Esdaile J. et al Predictive value of radionuclide joint scintigraphy. Arthritis Rheum 1982; 25: 83-6.
41 Palmer AM., Mc Grae F. et al ^99mTc imaging to access the effect of imaging in arthritis. Nucl Med Com 1993; 14: 299.
42 Berna L., Torres G. et al Technetium-^99mhuman polyclonal immunoglobulin G studies and conventional bone scans to detect active joint inflammation in chronic rheumatoid arthritis. Eur J Nucl Med 1992; 19: 173-6.
43 De Bois MH., Tak PP. et al. Joint scintigraphy for quantification of synovitis with 99mTc-labelled human immunoglobulin G compared to histological examination. Clin Experimental Rheum 1995; 13: 155-9.
44 De Bois MH., Arndt JW. et al Technetium-^99m labelled human immunoglobulin scintigraphy predicts rheumatoid arthritis in patients with athralgia. Scand J Rheum 1996; 25: 155-8.
45 De Bois Mh, Westedt ML. et al Technetium-^99m labelled polyclonal human IgG scintigraphy before and 26 weeks after initiation of parenteral gold treatment in patients with rheumatoid arthritis. J Rheumatol 1995; 22: 1461-5.
46 Hanly JG., Barnes DC. et al Single photon emission computed tomography in the diagnosis of inflammatory spondylarthropathies. J Rheumatol 1993; 20: 2062-8.
47 Collier BD., Carrera GF. et al Detection of femoral head avascular necrosis in adults by SPECT. J Nucl Med 1985; 26: 979-87.
48 Rubbert A., Marienhagen J. et al. SPECT analysis of cerebral blood flow in the evaluation of CNS involvement in patients with SLE. Arthritis Rheum 1993; 36: 1253-63.
49 Trotta F., Bajocchi G. et al Cerebral hypoperfusion detected by SPECT in early neuro-Behcet syndrome. Nucl Med Communications 1998; 19: 777-80.
50 Kao CH., Lan JL. et al Technetium-^99m-HMPAObrain SPECT in Sjogren’s syndrome. J Nucl Med 1998; 39: 773-7.
51 Colamussi P., Prandini N. et al. Scintigraphy in rheumatic disease. Best Practice & Research Clinical Rheumatology 2004; 18 (06) 909-26.
52 Franssen MJ., Boerbooms AM. et al Treatment of pigmented villonodular synovitis of the knee with yttrium-90 silicate: prospective evaluations by arthroscopy, histology, and ^99mTc pertechnetate uptake measurements. Ann Rheum Dis 1989; 48: 1007-13.