Magnetresonanztomografie

Zusammenfassung

Die Therapie entzündlich rheumatischer Gelenk- und Wirbelsäulenerkrankungen hat in den letzten Jahren einen Paradigmenwechsel erfahren. Diese Entwicklung basierte zum einen auf dem Aufkommen neuer Therapien (z. B. TNF-α-Blocker), zum anderen auf neuen Erkenntnissen zur Pathogenese, Progression, und zur verbesserten Beurteilungsmöglichkeit von Krankheitsaktivität. Ein ähnlicher Wandel zeichnet sich bei der Bildgebung ab. Neue Verfahren wie z. B. die Magnetresonanztomografie (MRT) haben eine Vielzahl von Möglichkeiten zur Visualisierung pathologischer Veränderungen verfügbar gemacht und dadurch neue Einblicke in Krankheitsprozesse und strukturelle Schäden am Bewegungssystem ermöglicht. Der Vorteil der MRT liegt neben der fehlenden Strahlenbelastung und Untersucherunabhängigkeit auf dem hohen Weichteilkontrast, der die genaue und sensitive Abbildung von Knochenmark, Knorpel, Knochen, Enthesen, Bändern, Sehnen, Bandscheiben sowie der Synovialis – als pathomorphologisches Substrat vieler entzündlich rheumatischer Erkrankungen – sichert. Durch diese Qualitäten hat die MRT insbesondere bei der Frühdiagnostik, Differenzialdiagnostik sowie der Verlaufskontrolle z. B. innerhalb von Therapiestudien eine immense Entwicklung erfahren und gewinnt für die Rheumatologie immer mehr an Bedeutung.

Summary

There has been a paradigm change in recent years regarding the therapy of inflammatory rheumatic diseases of joints and spine. This development is based on emerging new therapies, for example TNF-alpha-inhibitors, on new insights into pathogenesis and disease progression, and an improved assessment of disease activity. Imaging is another rapidly advancing field in rheumatology. Novel methods like MRI have enabled a multitude of possibilities for visualising pathologic changes, thus allowing new insights into the disease process and into structural damage of the muscular-skeletal system. Besides a total lack of radiation and examiner-independency another advantage is a high softtissue contrast which ensures exact and sensitive images of bone marrow, cartilage, bones, entheses, ligaments, tendons, spinal discs as well as synovitis – the pathomorphologic substance of many inflammatory rheumatic diseases. These qualities have resulted in an immense development of MRI, especially in early diagnosis, differential diagnosis and disease monitoring in clinical trials. Thus MRI is becoming increasingly important in rheumatology.

Schlüsselwörter

Magnetresonanztomografie - Rheumatologie - rheumatoide Arthritis - Spondyloarthritis

Keywords

Magnetic resonance imaging - rheumatology - rheumatoid arthritis - spondyloarthritis

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