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Dezidierte Knorpelbildgebung zur Detektion von Knorpelverletzungen und osteochondralen Läsionen

Advanced cartilage imaging for detection of cartilage injuries and osteochondral lesions

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Zusammenfassung

Hintergrund

Osteochondrale Läsionen stellen einen Hauptrisikofaktor für die Entwicklung einer Arthrose am Sprunggelenk dar.

Ziel

Es sollen ein Überblick über therapierelevante klinische Bildgebungsverfahren zur Knorpelbildgebung an Fuß und Sprunggelenk gegeben und typische osteochondrale Verletzungen demonstriert werden.

Material und Methoden

Eine intensive Literaturrecherche wurde durchgeführt und mit persönlicher Erfahrung unterstrichen.

Ergebnisse

Die Knorpelbildgebung zur Detektion osteochondraler Läsionen an Fuß und Sprunggelenk bleibt eine Herausforderung. Dennoch können dezidierte morphologische und quantitative magnetresonanztomographische (MR-)Bildgebungsmethoden klinisch wichtige Informationen zur Verfügung stellen, die hilfreich bei Therapieentscheidungen z. B. hinsichtlich einer knorpelchirurgischen Maßnahme sind. Die Sensitivität der MR-Arthrographie (MR-A) und computertomographischen Arthrographie (CT-A) ist der nativen Magnetresonanztomographie (MRT) bezüglich der Detektion osteochondraler Läsionen überlegen. Im Bereich der kleineren Gelenke des Fußes werden vor allem fortgeschrittene degenerative Veränderungen mittels konventioneller Röntgendiagnostik detektiert; nur in ausgewählten Fällen spielt die MR- und CT-Diagnostik dieser kleineren Gelenken eine Rolle.

Diskussion

Während die dezidierte Knorpelbildgebung mit CT und MRT im Bereich der kleinen Fußgelenke eine geringere Rolle spielt, wird sie im Bereich des Sprunggelenks aufgrund der verfügbaren therapeutischen Optionen wie verschiedenen knorpelchirurgischen Verfahren immer wichtiger für die klinische Diagnostik.

Abstract

Background

Osteochondral defects represent a main risk factor for osteoarthritis of the ankle.

Objectives

The aim of this article is to provide an overview of current optimal clinical cartilage imaging techniques of the foot and ankle and to show typical osteochondral injuries on imaging.

Materials and methods

A thorough literature search was performed and was supported by personal experience.

Results

Cartilage imaging of the foot and ankle remains challenging. However, advanced morphological and quantitative magnetic resonance (MR) imaging techniques may provide useful clinical information, for example, concerning cartilage repair surgery. Compared to MRI, MR arthrography (MR-A) and CT arthrography (CT-A) have higher sensitivity with respect to detection of osteochondral defects. Regarding smaller joints of the foot, mainly advanced osteoarthritic changes are detected on conventional radiography; only in rare cases, MR and CT imaging of these smaller joints is of relevance.

Conclusions

While at the smaller joints of the foot cartilage imaging only plays a minor role, at the ankle joint cross-sectional cartilage imaging using CT and MRI becomes more and more important for clinicians due to emerging therapeutic options, such as different osteochondral repair techniques.

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Authors and Affiliations

  1. Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland

    A. S. Gersing,  B. J. Schwaiger,  K. Wörtler &  P. M. Jungmann

  2. Klinik für Neuroradiologie, UniversitätsSpital Zürich, Universität Zürich, Frauenklinikstrasse 10, 8091, Zürich, Schweiz

    P. M. Jungmann

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  1. A. S. Gersing
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A.S. Gersing, B.J. Schwaiger, K. Wörtler und P.M. Jungmann geben an, dass kein Interessenkonflikt besteht.

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Gersing, A.S., Schwaiger, B.J., Wörtler, K. et al. Dezidierte Knorpelbildgebung zur Detektion von Knorpelverletzungen und osteochondralen Läsionen. Radiologe 58, 422–432 (2018). https://doi.org/10.1007/s00117-017-0348-2

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