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Update Knorpelbildgebung der kleinen Gelenke

Fokus Hochfeld-MRT

Update cartilage imaging of the small joints

Focus on high-field MRI

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Zusammenfassung

Hintergrund

Die Knorpeldiagnostik der kleinen Gelenke gewinnt zunehmend an klinischer Beachtung, da eine frühzeitige Erkennung von Knorpelschäden wichtig für die optimale Therapieplanung ist.

Ziel

Ziel dieser Übersichtsarbeit ist ein Update bezüglich moderner Knorpelbildung von kleinen Gelenken mit Betonung der MRT und Diskussion von Spezialuntersuchungen mittels CT-Arthrographie, der kompositionellen und der Hochfeld-MR-Bildgebung.

Material und Methoden

Es erfolgte eine PubMed-Literaturrecherche für den Zeitraum 2008–2018.

Ergebnisse

Die Darstellung chondraler Defekte an kleinen Gelenken stellt weiterhin eine Herausforderung dar. Die konventionelle MRT bei 3 T kann in der klinischen Routine weiterhin als Referenz in der Knorpelbildgebung angesehen werden. Hinsichtlich der Sensitivität ist die MR-Arthrographie (MR-A) und computertomographische Arthrographie (CT-A) der nativen MRT bei 1,5 T in der Detektion chondraler Defekte überlegen. Fortgeschrittene degenerative Veränderungen der Finger und Zehen werden meist ausreichend mittels konventioneller Röntgendiagnostik detektiert. MRT bei 3 T oder bei 7 T können neben der rein morphologischen Information auch quantifizierbare, funktionelle und metabolische Informationen liefern.

Schlussfolgerung

Eine standardisierte Knorpelbildgebung spielt am oberen Sprunggelenk aufgrund der Verfügbarkeit unterschiedlicher therapeutischer Konzepte eine wichtige Rolle in der klinischen Diagnostik. Im Gegensatz dazu erfolgt die schnittbildbasierte Knorpelbildgebung der übrigen kleinen Gelenke aktuell meist im Rahmen klinischer Studien und ist im klinischen Alltag bisher kaum etabliert. Hinsichtlich der Anwendung neuer Verfahren sind weiterführende Studien mit größeren Patientenkollektiven notwendig. Der radiologischen Diagnostik wird im Zusammenhang mit zunehmender Etablierung neuer Therapiekonzepte eine noch bedeutsamere Rolle in der Diagnostik von Knorpelläsionen kleiner Gelenke zukommen.

Abstract

Background

Cartilage imaging of small joints is increasingly of interest, as early detection of cartilage damage may be relevant regarding individualized surgical therapies and long-term outcomes.

Purpose

The aim of this review is to explain modern cartilage imaging of small joints with emphasis on MRI and to discuss the role of methods such as CT arthrography as well as compositional and high-field MRI.

Materials and methods

A PubMed literature search was performed for the years 2008–2018.

Results

Clinically relevant cartilage imaging to detect chondral damage in small joints remains challenging. Conventional MRI at 3 T can still be considered as a reference for cartilage imaging in clinical routine. In terms of sensitivity, MR arthrography (MR-A) and computed tomography arthrography (CT-A) are superior to non-arthrographic MRI at 1.5 T in the detection of chondral damage. Advanced degenerative changes of the fingers and toes are usually sufficiently characterized by conventional radiography. MRI at field strengths of 3 T and ultrahigh-field imaging at 7 T can provide additional quantifiable, functional and metabolic information.

Conclusion

Standardized cartilage imaging plays an important role in clinical diagnostics in the ankle joint due to the availability of different and individualized therapeutic concepts. In contrast, cartilage imaging of other small joints as commonly performed in clinical studies has not yet become standard of care in daily clinical routine. Although individual study results are promising, additional studies with large patient collectives are needed to validate these techniques. With rapid development of new treatment concepts radiological diagnostics will play a more significant role in the diagnosis of cartilage lesions of small joints.

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Authors and Affiliations

  1. Institute of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Deutschland

    R. Heiss, R. Janka, M. Uder, A. M. Nagel & F. W. Roemer

  2. Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Deutschland

    A. M. Nagel

  3. High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Wien, Österreich

    S. Trattnig

  4. CD Laboratory for Clinical Molecular MR Imaging, Medical University of Vienna, Wien, Österreich

    S. Trattnig

  5. Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA

    F. W. Roemer

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  1. R. Heiss
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Correspondence to R. Heiss.

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Interessenkonflikt

R. Heiss, R. Janka, M. Uder, A.M. Nagel, S. Trattnig und F.W. Roemer geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Heiss, R., Janka, R., Uder, M. et al. Update Knorpelbildgebung der kleinen Gelenke. Radiologe 59, 732–741 (2019). https://doi.org/10.1007/s00117-019-0521-x

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