Moderne Bildgebung in der Rheumatologie

Zusammenfassung

Moderne bildgebende Verfahren spielen in der Rheumatologie eine zunehmend wichtigere Rolle und werden heute bei der initialen Diagnosestellung und Therapiekontrolle regelhaft eingesetzt. Hierbei stellt die Sonografie die „rechte Hand“ des Rheumatologen dar. Durch die heutzutage verfügbare hohe Auflösung können pathologische Veränderungen der Gelenke und angrenzender Strukturen detailliert dargestellt und verlaufskontrolliert werden. Neben der Sonografie wird auch die MRT durch die voranschreitende technische Entwicklung und die bessere Verfügbarkeit zunehmend häufig auch im klinischen Alltag angewendet. Die Weiterentwicklung der CT-Diagnostik bietet am Beispiel der HR-pQCT die Möglichkeit, bereits kleinste ossäre Mikroläsionen zu erkennen. Als weiteres CT-Verfahren ist die DECT zu nennen, welche durch die Anordnung von zwei unabhängigen Strahlungsquellen in der Lage ist, Gichtkristalle bildlich darzustellen. Neben diesen Modalitäten befinden sich zahlreiche innovative bildgebende Verfahren in der Entwicklung und Prüfung (fluoreszenzoptische Bildgebung, hybride Bildgebung, neue und innovative Sequenzen der MRTBildgebung [z. B. Knorpelbildgebung, dynamische MRT]) und sind Gegenstand intensiver Forschung.

Summary

Modern imaging techniques play an increasingly important role in diagnosis and therapy-control in rheumatic diseases. The ultra-sound is today due to its high resolution able to detect pathological changes of the joints and adjacent structures reliably. In addition to ultrasound, MRI is increasingly often applied based on technical development and better availability in clinical practice. The advancement of CT-diagnosis (HR-pQCT) offers today the possibility to detect micro-lesions which cannot be discovered in conventional x-rays. Through the arrangement of two radiation sources the DECT can detect mono -sodium urate (MSU) crystals to diagnose gout without the need of a joint-puncture. In addition to these procedures there are numerous imaging-techniques under development (fluorescence optical imaging, hybrid-techniques like PET-CT/PET-MRI, new and innovative MRI-Sequences [Cartilage-Imaging, Dynamic-MRI]) and are subject of intense research.

Schlüsselwörter

Rheumatologie - bildgebende Verfahren - HRpQCT - DECT - MRT

Keywords

Rheumatology - imaging techniques - HRpQCT - DECT - MRI

• Literatur

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