Zusammenfassung
Die Bildgebung spielt bei der Diagnoseerstellung und zur Verlaufskontrolle von Patienten
mit rheumatischen Krankheitsbildern gemeinsam mit der klinischen Untersuchung eine
sehr wichtige Rolle. Im Rahmen einer frühzeitigen Diagnose ist die Detektion von synovialen
Proliferationen wichtig. Dies gelingt mittels Ultraschall. Allerdings kann die Unterscheidung
zwischen Synovitis und Gelenkflüssigkeit schwierig sein, weil beides echoarme bis
echogleiche, manchmal sogar echoreiche Charakteristika im B-Bild zeigen kann. Die
Ultraschallkontrastmittelapplikation erlaubt eine verbesserte Detektion und Differenzierung
von Synovitis und Gelenkflüssigkeit. Dies kann auch bei Therapieverlaufskontrollen
hilfreich sein, wo fibrotischer Pannus weder Vaskularisation noch Kontrastmittel Enhancement
aufweist. Die Entwicklung neuer Behandlungsverfahren, welche auf der mikrovaskulären
Ebene angreifen, machen zudem eine sensitivere Bildgebung notwendig. Der kontrastverstärkte
Ultraschall ist im Vergleich relativ kostengünstig und gut verfügbar für die klinische
Routine und eröffnet damit neue Perspektiven in der rheumatologischen Bildgebung.
Abstract
Imaging in combination with clinical assessment is important to establish the diagnosis
and for follow-up in rheumatic diseases. The detection of synovitis is crucial for
an early diagnosis. Ultrasound is a helpful imaging tool for the detection of synovial
proliferation. However, differentiation between synovitis and joint fluid can be difficult,
as both may show hypoechoic to isoechoic and even hyperechoic characteristics in B-mode
ultrasound. Application of ultrasound contrast media improves the detection of synovitis
and the differentiation between synovitis and joint fluid. It may also be helpful
for therapeutic follow-up, as a fibrotic pannus shows no vascularisation and no contrast
enhancement. The development of new therapeutic approaches that address the microvascular
level requires sensitive, well available and cost effective imaging methods. The costs
of contrast-enhanced ultrasound are relatively low. The method is easily available
in clinical routine and can be performed quickly. Therefore, it opens new perspectives
for the imaging of rheumatic diseases.
Schlüsselwörter
Rheumatische Krankheitsbilder - Synovitis - Gelenkflüssigkeit - B-Bild - Ultraschall-Kontrastmittel
Key words
Rheumatic diseases - synovitis - joint fluid - B-mode ultrasound - ultrasound contrast
media
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Dr. Univ. Doz. Andrea Sabine Klauser
Medizinische Universität Innsbruck, Radiologie II
Anichstraße 35
6020 Innsbruck, Austria
Phone: ++43/5 12/50 42 71 12
Fax: ++43/5 12/50 42 70 06
Email: andrea.klauser@uibk.ac.at
