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Bildgebung bei Spondylitis ankylosans

Imaging in ankylosing spondylitis

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Zusammenfassung

Neben den konventionellen Röntgenverfahren hat vor allem die Magnetresonanztomographie (MRT) Bedeutung für Diagnostik und Management der Spondylitis ankylosans (AS). Während die Röntgentechnik vorwiegend für die Diagnostik chronischer struktureller Veränderungen geeignet ist, ermöglicht die MRT-Technik zusätzlich den Nachweis von aktiven entzündlichen Veränderungen.

Über die klinischen Symptome der Patienten hinaus bleiben das Röntgenbild der Sakroiliakalgelenke und z. T. der Wirbelsäule die Basis für die Diagnosestellung der AS. Für die Diagnostik einer Sakroiliitis oder Spondylitis in sehr frühen Krankheitsstadien ist vor allem die MRT geeignet, hierbei müssen Kontrastmittel bzw. Fettsättigungstechniken wie z. B. STIR (TIRM) verwendet werden. Die Röntgenuntersuchung der Wirbelsäule ist Grundlage für den Nachweis von AS-spezifischen knöchernen Veränderungen der Wirbelsäule wie z. B. so genannten glänzenden Ecken bei Spondylitis sowie Syndesmophyten bzw. Ankylosen. Der modifizierte „Stoke AS Spine Score“ (mSASSS) ist die zur Zeit beste Scoring-Methode für solche Röntgenveränderungen, wobei nur die HWS und die LWS beurteilt werden. Auch die MRT-Veränderungen an der Wirbelsäule können quantifiziert werden. Neue Scoring-Methoden zeigten sich sensitiv gegenüber MRT-Veränderungen in einem Zeitraum von nur 3 Monaten nach Beginn einer Anti-TNF-α-Therapie.

Abstract

In addition to the typical clinical symptoms, conventional x-rays and magnetic resonance imaging (MRI) are important for the diagnosis and management of ankylosing spondylitis (AS). While radiography is mainly useful for detecting chronic structural changes, MRI is, in addition, able to detect active inflammation.

The detection of structural changes in the sacroiliac joints and, in part, the spine, remains the gold standard for the diagnosis of AS. The detection of active sacroiliitis or spondylitis in early disease stages is only possible using MR techniques such as STIR and T1 post-gadolinium sequences. Lateral radiographs of the spine are useful for detecting shiny corners and the characteristic syndesmophytes and ankylosis. The modified Stoke Anklyosing Spondylitis Spine Score (SASSS) is the best scoring method for quantifying such changes, allthough only the cervical and the lumber spine are evaluated with this method. MRI changes can also be quantified. New scoring methods are sensitive to change only 3 months after initiation of therapy with anti-TNF agents.

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Authors and Affiliations

  1. Rheumazentrum Ruhrgebiet, Landgrafenstraße 15, 44652, Herne, Deutschland

    J. Braun

  2. Abt. Rheumatologie, Universitätsmedizin Charité, Campus Benjamin Franklin, Berlin, Deutschland

    M. Rudwaleit

  3. Abt. Radiologie, Universitätsmedizin Charité, Campus Mitte, Berlin, Deutschland

    K. G. Hermann

  4. Rheumaklinik, Evangelisches Fachkrankenhaus, Ratingen, Deutschland

    R. Rau

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  1. J. Braun
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Correspondence to J. Braun.

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Braun, J., Rudwaleit, M., Hermann, K.G. et al. Bildgebung bei Spondylitis ankylosans. Z. Rheumatol. 66, 167–178 (2007). https://doi.org/10.1007/s00393-006-0108-6

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