Magnetresonanztomographie von Skelettmuskulatur und Sehnen in der Kleintiermedizin^[*]

Zusammenfassung:

In einer retrospektiven Analyse der MRT-Untersuchungen von Hundeund Katzenpatienten der Chirurgischen und Gynäkologischen Kleintierklinik der LMU München wurde nach Patienten gesucht, bei denen MR-Signalveränderungen im Muskelparenchym oder in Sehnen chirurgisch, zytologisch oder histopathologisch bestätigt werden konnten. Die Untersuchungen wurden hinsichtlich Untersuchungstechnik sowie MR-Erscheinungsbild verschiedener Erkrankungen und traumatischer Veränderungen des Muskelund Sehnengewebes evaluiert. Fettsupprimierende und flüssigkeitssensitive Sequenzen sowie T1-gewichtete Bilder mit Fettsuppression nach Kontrastmittelgabe sind für die Interpretation des Muskelund Sehnengewebes besonders hilfreich. Neben den Folgen schwerer Muskelund Sehnentraumata, die mit morphologischen Architekturveränderungen einhergehen, lassen sich MR-Signalveränderungen des Muskelparenchyms ohne Zusammenhangstrennungen in drei Gruppen einteilen. Veränderungen mit Muskelödem, z. B. als Folge geringgradiger Traumata oder bei Myositiden, zeigen in flüssigkeitssensitiven Sequenzen eine diffuse Signalsteigerung, während in T1-gewichteten Sequenzen Signalveränderungen fehlen. Hochgradige Muskelatrophien mit diffuser Fettinfiltration weisen als Charakteristikum eine generalisierte Signalanhebung in der Muskulatur in T1und T2-gewichteten Sequenzen auf. Davon abzugrenzen sind raumfordernde Strukturen wie intramuskuläre Hämatome, Abszesse oder Neoplasien, die die normale Architektur und Textur des Muskelparenchyms verändern und unterschiedliche Signalcharakteristika aufweisen können. Da sich die MR-Erscheinungsbilder einzelner Erkrankungen in einer Gruppe stark überschneiden können, ist eine definitive Diagnose anhand der MR-Signalveränderungen allein oft nicht zu stellen. Zusammen mit Anamnese und klinischen Befunden ergibt sich aber meist eine Verdachtsdiagnose. Ferner können die Veränderungen mit der MRT klar lokalisiert und Ausdehnung sowie Grad visualisiert werden, was eine gezielte Biopsie und dadurch eine histologische Diagnose ermöglicht.

Summary

A retrospective study was performed in the Clinic of Small Animal Surgery and Reproduction of the Ludwig Maximilian University Munich. MR-examinations and MR-reports of dogs and cats were reviewed for findings in muscles and tendons that were confirmed by surgery, cytology or histopathology. Imaging techniques and MR-appearances of normal and diseased muscles and tendons were assessed. Fluid sensitive sequences combined with fat suppression techniques and T1-weighted fat suppressed images after application of contrast medium are most valuable for the detection and interpretation of lesions in muscles and tendons. In addition to severe muscle and tendon trauma, which is associated with morphologic architectural changes, there are three general types of magnetic resonance signal changes in the musculature. Edematous changes are seen as a diffuse increase in signal intensity in fluid-sensitive sequences without signal changes in T1-weighted images and may be found as a result of minor trauma, myositis or myopathy. Severe muscle atrophy with concurrent diffuse fatty infiltration shows a characteristic generalized signal increase of the musculature in T1und T2-weighted sequences. This needs to be distinguished from masses such as intramuscular haematomas, abscesses or neoplasia that change normal muscle architecture and can have varying signal characteristics. Due to overlapping of appearance of many diseases in MRI, it is often not possible to make a specific diagnosis by signal changes in the musculature. However, in combination with the history and the results of physical examination a tentative diagnosis can often be made. Furthermore, magnetic resonance imaging enables clear localization and visualization of the size and severity of the changes. This facilitates a targeted biopsy and histopathologic diagnosis.

Schlüsselwörter

Magnetresonanztomographie - MRT - Myopathien - Tendopathien - Hund - Katze

Key words

Magnetic resonance imaging - MRI - myopathies - tendinopathies - trauma - dog - cat

^* * Herrn Prof. Dr. Dr. h. c. mult. H. Bostedt zum 70. Geburtstag gewidmet.

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