Bildgebung der Enthesitis: Ein neues Feld für den Radiologen?

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

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