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Erwartungen des Rheumatologen an die Bildgebung

Expectations of rheumatologists on imaging results

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Zusammenfassung

Klinisches/methodisches Problem

Klinik und Labor reichen oft nicht aus, um therapeutische Entscheidungen zu treffen.

Radiologische Standardverfahren

Neben Klinik und Labor bietet eine diagnosespezifische und organbezogene Bildgebung für den Rheumatologen wichtige Zusatzinformationen zu Erst-/Differenzialdiagnose, Verlaufsbeurteilung und Prognose. Insbesondere die Frühdiagnostik mittels funktioneller Bildgebungsmethoden wie Ultraschall und Magnetresonanztomographie gewinnt zunehmend an Bedeutung.

Methodische Innovationen

Die Bildgebung wird bereits in einigen rheumatologischen Klassifikationskriterien berücksichtigt. Magnetresonanztomographie und Ultraschall sind zudem in die neuen Klassifikationskriterien zur axialen Spondyloarthritis bzw. Polymyalgia rheumatica integriert.

Leistungsfähigkeit

Für differenzialdiagnostische Überlegungen sind spezifische Befunde besonders hilfreich. Zur Verlaufsbeurteilung interessieren sowohl Krankheitsstatus als auch Progression der strukturellen Schädigungen. Bei ausgewählten Erkrankungen ermöglicht die Bildgebung sowohl bzgl. der Krankheitsprogression als auch dem Ansprechen auf die medikamentöse Therapie prognostische Aussagen.

Bewertung

Es besteht meist sehr differente Evidenz für den Einsatz der bildgebenden Verfahren bei rheumatologischen Fragestellungen.

Empfehlung für die Praxis

Rheumatologische Fragestellungen sind höchst unterschiedlich und erfordern deshalb einen differenzierten Einsatz der bildgebenden Verfahren.

Abstract

Clinical/methodical issue

Clinical examination and laboratory results are often insufficient to support therapeutic decisions.

Standard radiological methods

Diagnosis and organ-related imaging may provide important additional information for initial diagnosis (differential diagnoses), follow-up and prognosis. Especially functional imaging techniques, such as ultrasound and magnetic resonance imaging are becoming more and more important for early diagnosis.

Methodical innovations

Imaging is already recognized in the classification criteria of several rheumatic diseases and new criteria for spondyloarthritis and polymyalgia rheumatica aim more and more at early diagnosis using functional imaging techniques, such as ultrasound and magnetic resonance imaging.

Performance

Specific imaging findings are helpful for eliminating differential diagnoses. During follow-up disease control the status as well as progression of structural damage can be documented. In selected diseases imaging allows prognostic statements on both disease progression and therapeutic response to specific medication.

Achievements

The evidential value of imaging results varies with the rheumatological expectations.

Practical recommendations

Overall rheumatological expectations on imaging differ widely and therefore support a differentiated use of imaging techniques.

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Authors and Affiliations

  1. Klinik für Innere Medizin, Univ.-Klinikum Innsbruck, Anichstr. 35, A-6020, Innsbruck, Österreich

    C. Dejaco, C. Duftner &  M. Schirmer

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  1. C. Dejaco
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  2. C. Duftner
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  3. M. Schirmer
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Correspondence to M. Schirmer.

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Dejaco, C., Duftner, C. & Schirmer, M. Erwartungen des Rheumatologen an die Bildgebung. Radiologe 52, 110–115 (2012). https://doi.org/10.1007/s00117-011-2231-x

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