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Radiologische Diagnostik der posttraumatischen Osteomyelitis

Radiological diagnostics of post-traumatic osteomyelitis

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Trauma und Berufskrankheit

Zusammenfassung

Die bildgebende Diagnostik der Osteomyelitis beinhaltet eine Kombination aus radiologischen und nuklearmedizinischen Verfahren. Als Erstuntersuchung zeigt das Röntgenbild mögliche Knochenstrukturveränderungen, die Hinweise über Lokalisation und Ausdehnung des Entzündungsprozesses geben können. Das sensitivste Nachweisverfahren ist die PET-CT (Positronenemissionscomputertomographie). Sie ermöglicht eine zuverlässige Beurteilung der Ausdehnung und Lokalisation der knöchernen Infektion, den Nachweis von Satellitenherden und Weichteilinfektionen sowie die differenzialdiagnostische Abgrenzung zu Neoplasien. Allerdings ist das Verfahren im klinischen Alltag aufgrund der hohen Untersuchungskosten und der nur selektiven Verfügbarkeit speziellen Fragestellungen vorbehalten. Bei negativem FDG-PET-Befund (FDG: Fluordeoxyglukose) kann eine chronische Osteomyelitis nahezu ausgeschlossen werden. Die weiterführende Diagnostik erfolgt im klinischen Alltag mittels CT, Magnetresonanztomographie und den entsprechenden klinischen und laborchemischen Parametern. Falls damit keine sichere Befundlage erhalten wird, kann eine Knochenszintigraphie zur Diagnose führen.

Abstract

The imaging diagnostics of osteomyelitis contain a combination of radiological and nuclear medicine procedures. The conventional radiographic image as first choice examination shows structural changes of the bone and also can give information about localization and enlargement of an osseous infection. Positron emission tomography/computed tomography (PET/CT) is the most sensitive verification procedure. It allows a reliable verification of extent and localization of the bone infection, the proof of satellite foci and soft tissue infections as well as the differential diagnostic distinction from a neoplasia. However, PET/CT scans in the diagnostic workup of osteomyelitis are reserved for special issues due to the high examination costs and the usually limited availability. In cases of negative fluorodeoxyglucose (FDG) PET findings, a chronic osteomyelitis is almost ruled out. In daily practice further diagnostic procedures include besides clinical and laboratory findings imaging by CT and magnetic resonance imaging (MRI). If these procedures do not provide verified results, bone scintigraphy can lead to the final diagnosis.

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Bula-Sternberg, J., Zöphel, K., Kotzerke, J. et al. Radiologische Diagnostik der posttraumatischen Osteomyelitis. Trauma Berufskrankh 13 (Suppl 1), 3–11 (2011). https://doi.org/10.1007/s10039-011-1718-z

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