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Arthrose am Kniegelenk

Welche neuen Erkenntnisse hat die MRT gebracht?
  • F. Roemer
Leitthema
  • 10 Downloads

Zusammenfassung

Hintergrund

Die Arthrose ist die häufigste Gelenkerkrankung, und die demographische Altersentwicklung prognostiziert einen weiteren deutlichen Anstieg der Inzidenz für die nächsten Jahrzehnte. Nach wie vor stellt die konventionelle projektionsradiographische Röntgenbildanalyse die einfachste und günstigste radiologische Modalität dar. Diese hat aber deutliche Defizite, insbesondere in der Verlaufsbeurteilung. Die Magnetresonanztomographie (MRT) hat in den letzten Jahren das Verständnis von Krankheitsinzidenz und -progression grundlegend gewandelt.

Fragestellung

Ein Überblick über neuere Entwicklungen in der Arthroseforschung der letzten Jahre anhand von MRT-basierten Studienergebnissen wird gegeben.

Material und Methode

Eine Literaturrecherche und Extraktion relevanter Studien wurden durchgeführt.

Ergebnisse

Mehrere MRT-basierte Verfahren zur Beurteilung der Kniegelenkarthrose sind verfügbar, einschließlich semiquantitativer, quantitativer und kompositioneller Techniken. Die MRT hat in den letzten Jahren maßgeblich dazu beigetragen, das Verständnis der Erkrankung vom Konzept des Knorpelverschleißes hin zu einem Multigewebsprozess zu wandeln. Insbesondere hat man die enge Verknüpfung von Gelenkknorpel und subchondralem Knochen erkannt. Ferner wurden multiple Risikofaktoren isoliert, die eine progrediente Gelenkschädigung prognostizieren. Hierzu zählen Achsfehlstellungen, intrinsische Gewebsveränderungen wie Meniskuspathologien, fokale Knorpeldefekte, Bandinstabilitäten oder subchondrale Knochenmarködem-ähnliche Veränderungen.

Schlussfolgerung

Während die Arthrose über Jahrzehnte als eine Erkrankung des hyalinen Knorpels betrachtet wurde, hat sich diese Bewertung deutlich geändert. Nur die MRT ist in der Lage, alle Gelenkstrukturen mit hoher Auflösung ohne Überlagerungseffekte darzustellen.

Schlüsselwörter

Knie Osteophyten Bildgebung Radiographie Literaturrecherche 

Osteoarthritis of the knee joint

What new knowledge has been gained from MRI?

Abstract

Background

Osteoarthritis (OA) is the most prevalent joint disorder and due to ageing of the society a further increase in the OA incidence is expected in the next decades. Conventional radiographic X‑ray analysis is still the simplest and most favorable radiological modality; however, shortcomings are observed particularly in monitoring the course of the disease. In recent years magnetic resonance imaging (MRI) has markedly deepened our understanding of the incidence and progression of the disease.

Objective

This article gives an overview of new developments in MRI-based study results on OA research in recent years.

Material and methods

A comprehensive literature search and extraction of relevant studies were carried out.

Results

Several MRI-based procedures for assessment of OA of the knee joint are available, including semiquantitative, quantitative and compositional techniques. The use of MRI in recent years has essentially contributed to the understanding of the disease to change from the concept of cartilage wear and tear to a multi-tissue process. In particular, the close linkage between joint cartilage and subchondral bone has been recognized. Furthermore, multiple risk factors have been isolated, which are prognostic for progressive joint damage. These include malalignment, intrinsic tissue alterations, such as pathologies of the meniscus, focal chondral defects, ligament instability and subchondral bone marrow alterations.

Conclusion

Whereas for many years OA was considered a disease of the hyaline cartilage, this has considerably changed. Only MRI is able to visualize all joint structures with high resolution and without artifacts due to superimposition.

Keywords

Knee Osteophytes Imaging Radiography Literature search 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

F. Roemer ist Chief Medical Officer und Teilhaber von Boston Imaging Core Lab (BICL), einer Firma, die radiologische Serviceleistungen für akademische Institutionen und die Pharmaindustrie anbietet, sowie Teilhaber von MSK Wissen-Gesellschaft zur Förderung des Wissenstransfers in der muskuloskelettalen Radiologie.

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

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Radiologisches InstitutUniversitätsklinikum ErlangenErlangenDeutschland

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