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MR- und CT-Arthrographie zur Knorpeldiagnostik

Indikationen und Durchführung

MR and CT arthrography in cartilage imaging

Indications and implementation

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Zusammenfassung

Hintergrund

Die Diagnostik von Knorpelveränderungen ist ein zentraler Bestandteil in der Abklärung akuter und chronischer Gelenkbeschwerden. Die CT- und MR-Arthrographie gehören neben der nativen MRT zu den etablierten Techniken für die dezidierte Beurteilung des Gelenkknorpels. Für die Anwendung in der klinischen Diagnostik sollten Radiologen deren Anwendungsmöglichkeiten kennen und sichere Techniken zur Kontrastmittelinjektion beherrschen.

Ziel

Dieser Übersichtsartikel erläutert die Techniken der Schnittbild-Arthrographie an verschiedenen Gelenken, gibt einen Überblick über die allgemeine und gelenkspezifische Durchführung sowie über übliche Indikationen in der Knorpeldiagnostik.

Material und Methoden

Es erfolgte eine selektive PubMed-Literaturrecherche zu den Stichworten „arthrography“, „CT arthrography“, „MR arthrography“, „arthrography cartilage“, „arthrography wrist“, „arthrography elbow“, „arthrography shoulder“, „arthrography hip“, „arthrography knee“, „arthrography ankle“, „arthrography complications“, „arthrography imaging guidance“ „osteochondral lesion“, „cartilage imaging“, „cartilage lesion“.

Ergebnisse und Schlussfolgerung

Die CT- und MR-Arthrographie sind nützliche und sichere Verfahren in der Knorpeldiagnostik. Sie haben ihren Stellenwert in der Verifizierung und Spezifizierung chondraler Pathologien, in der Regel nach bereits erfolgter nativer MRT, und spielen insbesondere bei der Stabilitätsbeurteilung und Therapieentscheidung osteochondraler Läsionen eine wichtige Rolle. Die CT-Arthrographie ist nicht nur Ersatzverfahren bei MRT-Kontraindikationen, sondern aufgrund ihrer höheren Auflösung für die Knorpelbeurteilung an kleinen Gelenken (Handgelenk, Ellenbogen, Sprunggelenk) der MR-Arthrographie tendenziell überlegen und kann in diesen Fällen auch als primäre Technik eingesetzt werden. Für die bildgesteuerte Gelenkpunktion ist die Fluoroskopie aktuell noch am Weitesten verbreitet, die ultraschallgesteuerte Punktion gewinnt aber zunehmend an Bedeutung. Die Gelenkuntersuchung unter Traktion bietet einen vielversprechenden Ansatz zur Verbesserung der Knorpeldarstellung, gehört jedoch noch nicht zur klinischen Routine.

Abstract

Background

The imaging of chondral pathologies is an essential part in the work-up of acute and chronic joint diseases. Besides conventional MR imaging, CT and MR arthrography are well-established methods in evaluating articular cartilage. The application of these techniques requires knowledge of indications and safe injection procedures by the performing radiologist.

Purpose

Our goal is to describe the techniques of cross-sectional arthrographies of different joints, give an overview of general and joint-specific considerations for practical application as well as provide typical indications for cartilage imaging.

Materials and methods

A selective PubMed literature search concerning “arthrography”, “CT arthrography”, “MR arthrography”, “arthrography cartilage”, “arthrography wrist”, “arthrography elbow”, “arthrography shoulder”, “arthrography hip”, “arthrography knee”, “arthrography ankle”, “arthrography complications”, “arthrography imaging guidance” “osteochondral lesion”, “cartilage imaging” and “cartilage lesion” was performed.

Results and conclusion

CT and MR arthrography are valuable and safe tools in cartilage imaging. They are useful to verify and specify chondral pathologies, usually after conventional MR imaging, and have an important role in evaluating the stability and therefore in therapeutic decision making of osteochondral lesions. CT arthrography is not only a substitute technique in case of MR contraindications, it can be advantageous in small joints (wrist, elbow, ankle) compared to MR arthrography due to its higher image resolution. Fluoroscopic guided joint puncture is still the most commonly used image guidance method, but the role of ultrasound is steadily increasing. Joint traction in MR arthrography is a promising technique to improve cartilage visualization, though it is not yet used in clinical routine imaging.

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Authors and Affiliations

  1. Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Deutschland

    B. Klaan & M.-A. Weber

  2. Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    F. Wuennemann & L. Kintzelé

  3. Institut für Diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland

    A. S. Gersing

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  1. B. Klaan
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B. Klaan, F. Wuennemann, L. Kintzelé, A.S. Gersing und M.-A. Weber 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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Klaan, B., Wuennemann, F., Kintzelé, L. et al. MR- und CT-Arthrographie zur Knorpeldiagnostik. Radiologe 59, 710–721 (2019). https://doi.org/10.1007/s00117-019-0564-z

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