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Der Orthopäde

, Volume 48, Issue 1, pp 5–43 | Cite as

Moderne radiologische Diagnostik in der Wirbelsäulenchirurgie

  • Uwe H.W. SchützEmail author
Leitthema

Zusammenfassung

Hintergrund

Die radiologische Bildgebung ist wichtig bei der präoperativen Diagnostik vieler Formen der Wirbelsäulenpathologie und spielt eine fundamentale Rolle bei der Beurteilung von p.o. Effekten, die in Abhängigkeit von der verwendeten Bildgebungsmethode sowohl an der Wirbelsäule als auch an deren umgebenden Weichteilgeweben verifizierbar sind.

Ziel

Der Artikel gibt einen Überblick über den aktuellen Stand und die Möglichkeiten der Methoden der radiologischen Diagnostik zur Verifizierung eventuell zu empfehlender operativer Maßnahmen an der Wirbelsäule im Kontext degenerativer, entzündlich-infektiöser, posttraumatischer oder p.o. Pathologien und Veränderungen an der Wirbelsäule: Röntgen, Computertomographie (CT), Magnetresonanztomographie (MRT). Die bei speziellen Fragestellungen eventuell erforderlichen ergänzenden nuklearmedizinische Verfahren (Szintigraphie, PET[-CT], SPECT usw.) werden nicht diskutiert.

Material und Methoden

Die Vorzüge und Grenzen der Verfahren im Rahmen der Abklärung fortgeschrittener degenerativer Wirbelsäulenpathologien und posttraumatischer Zustände werden diskutiert, wobei die Multidetektor-CT bei der Clearence der Wirbelsäule hinsichtlich traumatischer Verletzungen im Vordergrund steht. In den meisten Fällen einer Wirbelsäuleninfektion zeigen die Bilder in der MRT – als zentrales Diagnosewerkzeug – typische Befunde, wie Zerstörung der angrenzenden Endplatten, Anomalien des Knochenmark- und Bandscheibensignals und paravertebrale oder epidurale Abszesse. Es ist jedoch nicht immer leicht, eine Rückeninfektion zu diagnostizieren, insbesondere wenn atypische MRT-Muster einer infektiösen Spondylitis vorliegen. Deren Kenntnis hilft, Fehldiagnosen und unsachgemäße Behandlung zu vermeiden.

Ergebnisse

Es wird aufgezeigt, dass qualitativ hochwertige moderne radiologische Untersuchungen essenziell für die Diagnose und das p.o. Management sind, da diese Antworten auf die wichtigsten Fragen bei der Behandlung liefern: Ist die Veränderung/Verletzung stabil oder instabil, akut oder alt, gutartig oder maligne, besteht eine Myelopathie oder eine p.o. Komplikation?

Diskussion

Die Hauptindikationen für die verschiedenen p.o. Bilddiagnostiken, Schwierigkeiten wie Metallartefaktbildung und mögliche Fallstricke werden analysiert. Entitätsspezifische radiologische Bildmuster, Bildgebungsalgorithmen und differenzialdiagnostische Besonderheiten werden, orientiert an der aktuellen Literatur und ausgewählten Fallbeispielen, aufgezeigt und diskutiert.

Schlüsselwörter

Röntgen Computertomographie Magnetresonanztomographie Infektion Trauma 

Abkürzungen

BS

Bandscheibe

BSP

Bandscheibenprotrusion

BSV

Bandscheibenvorfall

BWS

Brustwirbelsäule

CE

„Contrast enhanced“

CISS

„Constructive interference steady state“

CT

Computertomographie

DL

Durchleuchtung

DTI

„Diffusion tensor imaging“

DWI

„Diffusion weighted imaging“

FCG

Facettengelenk

FDG

18F-Fluor-2-desoxy-D-glucose

FIESTA

„Fast imaging employing steady-state acquisition“

fMRT

Funktionelle MRT

fs

Fettsättigung

FWE

Funktionelle Wirbelsäuleneinheit

GE

Gradientenecho

HLB

Hinteres Längsband

HWS

Halswirbelsäule

IDEAL

Iterative Dekomposition von Wasser und Fett

IMAR

Iterative Metallartefaktreduktion

IVR

Intervertebralraum

KM

Kontrastmittel

LWS

Lendenwirbelsäule

MAR

Metallartefaktreduktion

MDCT

Multidetektor-CT

MPR

Multiplanare Rekonstruktion

MRT

Magnetresonanztomographie

NF

Neuroforamen

p.o.

Postoperativ

p.t.

Posttraumatisch

PE

Polyethylen

PET

Positronenemissionstomographie

RM

Rückenmark

Röntgenbildgebung

SCIWORA

„Spinal cord injury without radiological abnormality“

SE

Spinecho

SEMAC

„Slice encoding for metal artefact correction“

SI

Signalintensität

SK

Spinalkanal

SPECT

Einzelphotonen-Emissionscomputertomographie

SRV

Signal-Rausch-Verhältnis

STIR

„Short tau inversion recovery“

T1w, T2w

T1-/T2-gewichtete Bilder

TIRM

„Turbo inversion recovery magnitude“

TSE

Turbo-SE-Sequenz

V. a.

Verdacht auf

VLB

Vorderes Längsband

VMS

virtuell monochromatisch spektral

WK

Wirbelkörper

WS

Wirbelsäule

Z.n.

Zustand nach

Modern radiological diagnostics in spine surgery

Abstract

Background

Radiological imaging is important in the preoperative diagnosis of many forms of spinal pathology and plays a fundamental role in the assessment of p.o. effects, which can be verified on the spinal column as well as on the surrounding soft tissues, depending on the imaging method used.

Aim

The article provides an overview of the current status and possibilities of radiological diagnostic methods for the verification of possibly recommended spine surgery in the context of degenerative, inflammatory-infectious, post-traumatic or p.o. pathologies and changes in the spine: X‑rays, computed tomography (CT), magnetic resonance imaging (MRI). The supplementary nuclear medicine procedures (scintigraphy, PET[-CT], SPECT, etc.) which may be required for special questions are not discussed.

Material and methods

The merits and limitations of the techniques used in the investigation of advanced degenerative spinal pathologies and post-traumatic conditions are discussed, with multidetector CT being the focus of attention in spinal clearance for traumatic injuries. In most cases of spinal infection, MRI images, as a central diagnostic tool, show typical findings such as destruction of adjacent endplates, bone marrow and intervertebral disc abnormalities, and paravertebral or epidural abscesses. However, it is not always easy to diagnose a spinal infection, especially if atypical MR patterns of infectious spondylitis are present. Knowledge of them means misdiagnosis and improper treatment can be avoided.

Results

It is shown that high-quality modern radiological examinations are essential for diagnosis and p.o. management, as these provide answers to the main questions in the treatment: Is the entity/injury stable or unstable, acute or old, benign or malign; is there a myelopathy or p.o. complication?

Discussion

The main indications for p.o. diagnostic imaging, difficulties such as metal artefact formation, and potential pitfalls are analyzed. Entity-specific radiological image patterns, imaging algorithms and differential diagnostic peculiarities are presented and discussed based on current literature and selected case studies.

Keywords

X-ray Computed tomography Magnetic resonance imaging Infection Trauma 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

U. Schütz gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Supplementary material

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik für Diagnostische und Interventionelle RadiologieUniversitätsklinikum UlmUlmDeutschland
  2. 2.Orthopädie und Schmerzmedizin am Grünen TurmRavensburgDeutschland

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