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Biochemische Knorpeldiagnostik – Update 2019

Biochemical cartilage imaging—update 2019

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Zusammenfassung

Hintergrund

Die Knorpeldiagnostik mittels Magnetresonanztomographie (MRT) ist tägliche Routine. Biochemische MR-Techniken zur Beurteilung von Knorpelschäden sind für eine optimale Therapieplanung alternativlos.

Ziel

Diese Übersichtsarbeit ist ein Update bezüglich moderner Knorpelbildgebung mittels biochemischer MR-Techniken. Es werden deren klinische Anwendungsmöglichkeiten sowie Vorteile gegenüber der morphologischen MR-Bildgebung aufgezeigt.

Material und Methoden

Es erfolgte eine Literaturrecherche zu den klinischen Anwendungsmöglichkeiten der verschiedenen biochemischen MR-Techniken in Ergänzung zur morphologischen MR-Bildgebung.

Ergebnisse

Während T2-Mapping eine einfache und auf jedem MR-Gerät installierbare Technik mit relativ kurzer Untersuchungszeit ist, stellt die T1rho-Methode eine technisch aufwändigere und nicht auf allen MR-Geräten verfügbare Anwendung dar. Die dGEMRIC-Technik kann auf allen Feldstärken eingesetzt werden, sie wurde aber in Europa durch die rezente Entscheidung der Europäischen Arzneimittebehörde (EMA), die linearen MR-Kontrastmittel vom Markt zu nehmen, einer Denkpause unterworfen. Die Natriumbildgebung ist die sensitivste Glykosaminoglykan(GAG)-spezifische Methode, ist aber auf 7 T limitiert. Knorpeldiagnostik mittels biochemischer MRT bedeutet den Sprung von der qualitativen, auf Kontrastbildern beruhenden hin zur quantitativen MRT. Neben der Früherkennung von Knorpeldegenerationen liefert die biochemische MRT auch prädiktive Marker.

Schlussfolgerung

Die biochemische MR-Knorpelbildgebung spielt sowohl in der Frühdiagnostik als auch in der Prädiktion eine zunehmend wichtige Rolle in der klinischen Diagnostik. In der Knorpelersatztherapie erlaubt sie eine Qualitätsbeurteilung des Erfolgs unterschiedlicher therapeutischer Konzepte des Knorpelersatzes.

Abstract

Background

Cartilage imaging using magnetic resonance imaging (MRI) is increasingly used for early detection of cartilage damage. Biochemical MR methods to assess cartilage damage are essential for optimal treatment planning.

Purpose

The aim of this review is to provide an update on advanced cartilage imaging based on biochemical MR techniques. The clinical applications and additional benefits compared to conventional MRI are presented.

Materials and methods

A literature search of PubMed regarding the clinical applications of various biochemical MR methods and morphological MR imaging was performed.

Results

While T2 mapping can be easily implemented on clinical routine MR scanners, the T1rho method is technically more demanding and is not available on all MR scanners. dGEMRIC, which can be performed with all field strengths, is now severely restricted due to the recent decision of the European Medical Agency (EMA) to withdraw linear gadolinium contrast agents from the market because of proven gadolinium deposition in the brain. Sodium imaging is the most sensitive MRI method for glycosaminoglycan (GAG), but is limited to 7 T. In addition to early diagnosis of cartilage degeneration before morphological changes are visible, biochemical MRI offers predictive markers, e.g., effect of lifestyle changes or assessing results of cartilage repair surgery.

Conclusion

Cartilage imaging based on biochemical MRI allows a shift from qualitative to quantitative MRI. Biochemical MRI plays an increasingly important role in the early diagnosis of cartilage degeneration for monitoring of disease-modifying drugs and as predictive imaging biomarker in clinical diagnostics. In cartilage repair, monitoring of the efficacy of different cartilage repair surgery techniques to develop hyaline-like cartilage can be performed with biochemical MRI.

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Authors and Affiliations

  1. Exzellenzzentrum für Hochfeld MR, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Lazarettgasse 14, 1090, Wien, Österreich

    S. Trattnig, M. Raudner & K. Bohndorf

  2. Universitätsklinik für Orthopädie und Unfallchirurgie, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090, Wien, Österreich

    M. Schreiner

  3. Radiologisches Institut, Universitätsklinikum Erlangen, Maximiliansplatz 3, 91054, Erlangen, Deutschland

    F. Roemer

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  1. S. Trattnig
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  2. M. Raudner
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  3. M. Schreiner
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  4. F. Roemer
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Correspondence to S. Trattnig.

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Interessenkonflikt

S. Trattnig, M. Raudner, M. Schreiner, F. Roemer und K. Bohndorf 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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Trattnig, S., Raudner, M., Schreiner, M. et al. Biochemische Knorpeldiagnostik – Update 2019. Radiologe 59, 742–749 (2019). https://doi.org/10.1007/s00117-019-0558-x

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