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MRT oder Sonographie – welche Bildgebung brauchen wir?

MRI or ultrasound—which imaging technique do we need?

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Zusammenfassung

Die bildgebende Diagnostik der Epikondylitis erfolgt primär durch den breitflächig verfügbaren und strahlungsfreien Ultraschall. Die dynamische Untersuchung erlaubt eine schnelle Point-of-Care-Aussage. Typische Bildbefunde einer Epikondylitis umfassen echoarme Strukturstörungen innerhalb des Sehnenursprungs am Humerus, Ossifikationen im Ursprungsbereich, intratendinöse Kalzifikationen oder (partielle) Rissbildungen. Insbesondere die Dopplersonographie erhöht die Sensitivität durch die Beurteilung einer Neovaskularisation. Die Magnetresonanztomographie kommt dann zur Anwendung, wenn der Ultraschall unklare oder sehr ausgeprägte Befunde ergibt bzw. entweder Gerätschaften oder Erfahrungen für die Sonographie des Ellenbogens nicht verfügbar sind. Hier ist die Nutzung von protonendichtegewichteten Sequenzen zur Beurteilung von Weichteil- und Knochenmarködemen und Rissbildung geeignet, wobei Ossifikationen in der T1-gewichteten Sequenz am besten abgrenzbar sind. Projektionsradiographie und Computertomographie können bei groben Ossifikationen hilfreich sein, sind aber keine bildgebenden Standardverfahren.

Abstract

Diagnostic imaging of epicondylitis is primarily performed using widely available, radiation-free ultrasound. The dynamic examination allows a rapid point-of-care assessment. Typical imaging findings of epicondylitis include intratendinous hypoechogenic foci at the humeral origin, ossification at the enthesis, intratendinous calcifications, or (partial) rupture. In particular, Doppler sonography increases sensitivity by assessing possible neovascularization within the tendon. When sonographic findings are unclear or extensive, or when ultrasound machines or the required expertise in elbow examinations are not available, magnetic resonance imaging is indicated. Here, the use of proton density-weighted sequences is appropriate for assessing bone marrow and soft tissue edema and tendon tears, while ossifications are best delineated in T1weighted sequences. Projection radiography and computed tomography can be helpful for larger ossifications, although they are not part of the standard imaging protocol.

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Abbreviations

CT:

Computertomographie

DGMSR:

Deutsche Gesellschaft für Muskuloskeletale Radiologie

ECRB:

Extensor carpi radialis brevis

MRT:

Magnetresonanztomographie

MSK:

Muskuloskeletal

PDw:

Protonendichtegewichtet

T1/T2w:

T1/T2-gewichtet

US:

Ultraschall

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Authors and Affiliations

  1. Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Deutschland

    Markus H. Lerchbaumer &  Torsten Diekhoff

  2. Interdisziplinäres Ultraschallzentrum und US-Forschungslabor, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin, Deutschland

    Markus H. Lerchbaumer

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  1. Markus H. Lerchbaumer
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Correspondence to Torsten Diekhoff.

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Interessenkonflikt

M. H. Lerchbaumer bezog Vortragshonorare von Canon Medical Imaging. T. Diekhoff bezog Vortragshonorare von Novartis, Canon MS, MSD, UCB, BerlinFlame.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Das Bildmaterial entstand aus den klinischen Untersuchungen nach rechtfertigender Indikationsstellung.

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Lerchbaumer, M.H., Diekhoff, T. MRT oder Sonographie – welche Bildgebung brauchen wir?. Orthopädie 52, 349–358 (2023). https://doi.org/10.1007/s00132-023-04368-4

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