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MRT-Untersuchungen bei axialer und peripherer Spondyloarthritis

MRI examinations for axial and peripheral spondyloarthritis

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Zusammenfassung

Die Diagnose der ankylosierenden Spondylitis (AS) wird anhand der modifizierten New-York-Kriterien und somit auf der Basis von bereits sichtbaren radiographischen strukturellen Veränderungen gemacht. Konventionelle Röntgenbilder sind allerdings nicht geeignet, entzündliche Prozesse in frühen Erkrankungsphasen rechtzeitig zu erkennen. Die Konsequenz ist, dass der im Verlauf der Erkrankung wichtige Zeitraum, in dem irreversible strukturelle Schäden noch nicht aufgetreten sind, für die Diagnostik verloren geht. Deshalb hat sich mit der Magnetresonanztomographie (MRT), mit der charakteristische entzündliche Läsionen bei Patienten mit axialen und peripheren Spondyloarthritiden (SpA), einschließlich der AS, frühzeitig abgebildet werden können, ein diagnostischer Paradigmenwechsel ergeben. Die Fähigkeit der MRT, entzündliche und, wenn auch begrenzt, strukturelle Veränderungen sichtbar zu machen, begründet den zunehmenden Stellenwert in der Diagnostik von Patienten mit SpA. Zur Erfassung von Strukturschäden gilt aber das konventionelle Röntgenbild immer noch als das Standardverfahren. Daher ist eine vernünftig abgestufte Indikation beider Techniken essenziell für ein optimales Management der Patienten.

Abstract

The diagnosis of ankylosing spondylitis (AS) is based on the modified New York criteria and therefore on defined structural changes in the sacroiliac joint as detected by conventional radiographs. However, x-rays are not able to detect early stages of the disease in which inflammation predominates and irreversible structural changes have not yet taken place. This probably contributes to a substantial time delay until a diagnosis is made. Magnetic resonance imaging (MRI) is able to visualize active and chronic changes in axial and peripheral spondyloarthritis (SpA) even before the occurrence of structural changes. The ability to demonstrate both active and, in a limited way, also structural changes makes MRI a diagnostic tool of increasing importance in the management of SpA. However, conventional radiographs are still the gold standard for the assessment of structural changes in SpA. A combination of both imaging techniques is recommended in clinical practice.

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  1. Rheumazentrum Ruhrgebiet Herne, Ruhr Universität Bochum, Landgrafenstr. 15, 44652, Herne, Deutschland

    X. Baraliakos & J. Braun

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  1. X. Baraliakos
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  2. J. Braun
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Correspondence to X. Baraliakos.

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Baraliakos, X., Braun, J. MRT-Untersuchungen bei axialer und peripherer Spondyloarthritis. Z. Rheumatol. 71, 27–37 (2012). https://doi.org/10.1007/s00393-011-0894-3

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