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Chondrale und osteochondrale Defekte

Darstellung mittels bildgebender Verfahren

Chondral and osteochondral defects

Representation by imaging methods

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Zusammenfassung

Die hochauflösende morphologische Bildgebung von chondralen und osteochondralen Läsionen ist heutzutage die Domäne der Magnetresonanztomographie. Weitere bildgebende Verfahren, wie die konventionelle Röntgendiagnostik, die Computertomographie, die Sonographie und die optische Kohärenztomographie, werden lediglich ergänzend in der Abklärung von Knorpelpathologien eingesetzt und spielen eine entsprechend untergeordnete Rolle. Der vorliegende Beitrag diskutiert klinisch-diagnostische Aspekte der Knorpelbildgebung. Es wird der aktuelle klinische und wissenschaftliche Stand der Diagnostik von Knorpelpathologien in Bezug auf die Grundlagen, Anforderungen, Techniken und die Bildinterpretation dargestellt. Darüber hinaus werden aktuelle technische Neuerungen, insbesondere funktionelle MRT-Techniken, die mittel- bis langfristig Anwendung in der Klinik finden können, in ihren Grundlagen erörtert.

Abstract

Morphological imaging of cartilage at high resolution allows the differentiation of chondral and osteochondral lesions. Nowadays, magnetic resonance imaging is the principal diagnostic tool in the assessment of cartilage structure and composition. Conventional radiography, computed tomography, ultrasound or optical coherence tomography are adjunct diagnostic modalities in the assessment of cartilage pathologies. The present article discusses the up-to-date diagnostic practice of cartilage imaging in terms of its scientific basis and current clinical status, requirements, techniques and image interpretation. Innovations in the field such as functional MRI are discussed as well due to their mid- to long-term clinical perspective.

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Abbreviations

ACT:

Autologe Chondrozytentransplantation

AMIC:

Autologe matrixinduzierte Chondrogenese

CT:

Computertomographie

dGEMRIC:

„Delayed gadolinium-enhanced MRI of cartilage“

DTPA:

Diethylentriaminpentaessigsäure

gagCEST:

„Glycosaminoglycan chemical exchange-dependent saturation transfer“

ICRS:

International Cartilage Repair Society

MACT:

Matrixinduzierte autologe Chondrozytentransplantation

MRT:

Magnetresonanztomographie

OCT:

Optische Kohärenztomographie

SPIR:

„Spectral presaturation with inversion recovery“

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Authors and Affiliations

  1. Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    S. Nebelung, C. Kuhl & S. Schrading

  2. Klinik für Orthopädie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    B. Rath & M. Tingart

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S. Nebelung, B. Rath, M. Tingart, C. Kuhl und S. Schrading geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor. Zusätzlich haben alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, hierzu ihre schriftliche Einwilligung gegeben.

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Nebelung, S., Rath, B., Tingart, M. et al. Chondrale und osteochondrale Defekte. Orthopäde 46, 894–906 (2017). https://doi.org/10.1007/s00132-017-3472-9

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