Objectives: The psoriatic arthritis magnetic resonance imaging scoring system (PsAMRIS-H) for the evaluation of inflammatory and destructive changes in PsA hands was validated on 0.6-T scanners. The applicability of the PsAMRIS-H on a low-field MRI system as a well-accepted, low-cost imaging modality was evaluated. Method: In 65 consecutive patients (31 males, median age 52 years), 73 scans on a 0.2-T dedicated extremity MRI system were obtained for evaluation of PsA. Images were scored for synovitis, tenosynovitis, periarticular enhancement, bone erosion, bone oedema, and proliferation, and the PsAMRIS-H score was calculated. The intraclass correlation coefficient (ICC) was calculated and the paired t-test conducted. Results: Intra-reader reliability for the total PsAMRIS-H score was good, with an ICC of 0.81 and 0.77 for readers 1 and 2, respectively, and inter-reader agreement was moderate (0.57 for each reader). However, the PsAMRIS-H score differed significantly between the two readers (22 vs. 31; p < 0.05). When individual components of the PsAMRIS were evaluated, intra- and inter-reader agreement was poor to moderate, especially for tenosynovitis and periarticular inflammation. Conclusions: Low-field 0.2-T MRI is capable of quantifying the PsAMRIS-H with good intra-reader reproducibility. However, low signal-to-noise ratio (SNR), low spatial resolution, and system artefacts limit the application of the PsAMRIS-H, leading to low inter- and intra-reader agreement for individual features.

Vasculitis of small and medium sized vessels mostly affects several organ systems and causes unspecific symptoms. The trunk, lungs, heart and the gastrointestinal and urogenital tracts are most frequently involved. Due to an unclear clinical picture imaging is part and parcel of diagnostics. The knowledge of typical and rare imaging patterns as well as knowledge of the correct imaging method is crucial for classification. Projection radiography is still the gold standard for imaging of the lungs. Using computed tomography discrete ground-glass pattern opacities, nodules and consolidations can be depicted. In the abdomen computed tomography and magnetic resonance imaging can depict swelling of the intestinal wall. Digital subtraction angiography may contribute to further differentiation and reveal microaneurysms in cases of polyarteriitis nodosa.

Vaskulitiden der kleinen und mittelgroßen Gefäße betreffen meist mehrere Organsysteme und führen zu einer unspezifischen Symptomatik. Am Körperstamm sind am häufigsten die Lunge, das Herz, der Gastrointestinal- und Urogenitaltrakt betroffen. Aufgrund des unklaren Krankheitsbildes stellt die Bildgebung einen wichtigen Bestandteil der Diagnostik dar. Zur differenzialdiagnostischen Einordnung ist die Kenntnis typischer und seltener Bildmorphologien, aber auch der geeigneten bildgebenden Verfahren entscheidend.

In der Diagnostik von initialen Veränderungen bei Rheumatoider Arthritis (RA) wird bisher neben der Projektionsradiographie (PR) im bilddiagnostischen Stufenkonzept die Magnetresonanztomographie (MRT) und die 3-Phasen-Skelettszintigraphie (3P-SZ) eingesetzt. Ziel dieser Studie war es, bei Patienten mit klinischem Verdacht auf eine RA die Wertigkeit der Handsonographie im Vergleich mit den etablierten Verfahren PR, MRT und 3P-SZ zu beurteilen.

PURPOSE:Besides the use of conventional x-rays in the diagnostic work-up of initial changes in patients suffering from rheumatoid arthritis (RA), 3-phase bone scintigraphy (3P-Sz) is as well established as magnetic resonance imaging (MRI). The aim of this study was to compare the diagnostic value of ultrasound of the hands with proven methods such as conventional x-rays, low-field MRI and 3P-Sz.METHODS:A total of 30 patients were studied using a 1 day protocol with ultrasound, 3P-Sz, MRI and x-ray of the hands. Images were visually assessed by two blinded nuclear medicine physicians and radiologists and classified as RA typical and non-RA typical changes. All methods were compared to the summarized findings interpreted by a rheumatologist after 2 years.RESULTS:Of the 30 patients, 19 presented with clinical symptoms of initial changes due to rheumatoid arthritis. Ultrasound revealed 14/19 patients with the correct diagnosis. Conventional x-rays indicated 11/19 patients, while 3P-Sz (100%) and low-field MRI (95%) showed high sensitivity. It was possible to differentiate between inflammation and inconspicuous findings.CONCLUSIONS:An experienced examiner can use ultrasound effectively for the initial diagnosis of RA. Based on its low cost, ultrasound is a valid alternative to conventional x-rays.

OBJECTIVE:To report on radiological and epidemiological characteristics of pulmonary disease in patients with HIV infection in times of highly active antiretroviral therapy (HAART).METHODS:Clinical data of 130 HIV infected adults with acute pulmonary symptoms were compared with findings in chest radiography (n = 130) and computed tomography (CT, n = 42). Presence and distribution of consolidation, interstitial changes, pleural effusion, and adenopathy were evaluated. Results were compared to findings from sputum, bronchoalveolar lavage, transbronchial biopsy, or empirical therapy results.RESULTS:48% of patients presented pathologic findings. Overall sensitivity for the detection of pulmonary involvement was 0.87 (chest radiography) vs. 0.97 (CT). Disease specific sensitivity was 0.33 compared to 0.70. Bacterial pneumonia (BP, n = 26, 20%) was the most frequent diagnosis, followed by pneumocystis jiroveci pneumonia (PJP, n = 17, 13%), mycobacterium avium complex (MAC, 6%), Kaposi's sarcoma and lymphoma (KS and NHL, each 4%), fungal pneumonia (2%), and tuberculosis (TBC, 1%). Focal pulmonary infiltration was predominantly present in BP (50%, n = 13). Reticular (35%; n = 6) and micronodular (35%; n = 6) infiltration were predominantly found in PJP.CONCLUSIONS:Despite HAART, lung involvement is still common. Only contrast-enhanced computed tomography shows an acceptable disease-specific sensitivity. In unclear cases, CT should be performed.

Analyse weichgeweblicher magnetresonanztomographischer (MRT-)Befundmuster früher Stadien rheumatischer Erkrankungen durch retrospektive Auswertung von MRT-Untersuchungen der Hand.

Purpose. The aim of this study was to evaluate typical magnetic resonance imaging (MRI) findings in early rheumatic diseases manifesting at the soft tissues of the hand using a retrospective analysis. Material and methods. A total of 186 MRI examinations of patients with clinical suspicion of a rheumatic disease were evaluated in a consensus reading by two experienced radiologists. All imaging patterns were assessed with respect to their type and localization. Under blinded and non-blinded conditions diagnoses were correlated with final clinical diagnosis. Results. The most frequent diagnoses were rheumatoid arthritis (RA, 45.7%) and psoriatic arthritis (PsA, 15.6%). The mean correlation between clinical and MRI diagnosis (r) was 0.75 in blinded and 0.853 in non-blinded reading (p < 0.001). The following extra-articular imaging patterns were found: synovitis (59.1%), tendovaginitis (91.4%), dactylitis (14.5%), and bone marrow edema (18.3%). Only dactylitis was specific for a particular rheumatic disease (PsA; r=0.934; sensitivity 84.9%, specificity 82.4%). Conclusion. Inflammatory conditions of the hand can be reliably detected with MRI. In many cases the definite diagnosis can only be made when taking clinical, serological, and radiographic results into account (+13.7% increase of significance).

PURPOSE:The aim of this review is to evaluate the role of inflammatory spine disease in patients with chronic back pain. The contribution of imaging modalities for the diagnostic evaluation of back pain is discussed.MATERIAL AND METHODS:A systematic literature search based on the classification of seronegative spondyloarthropathies and rheumatoid arthritis was performed. The results of this search and the experiences in a large collective of rheumatological patients are analyzed.RESULTS:The prevalence of rheumatoid arthritis (1-2%) is comparable to that of spondyloarthropathies (1.9%). The etiology of these entities is not fully elucidated. Magnetic resonance imaging is increasingly used for early detection and surveillance of therapy with TNF-alpha antagonists.DISCUSSION:Bone marrow edema, which is only detectable with MRI, represents an early sign of inflammation. Therapy with TNF-alpha antagonists is based on clinical and laboratory criteria, and signs of inflammation in MRI. MRI is useful for assessment of the effectiveness of anti-inflammatory therapy.

Zu den Kollagenosen, die zu einer Beteiligung des Lungenparenchyms führen können, gehören rheumatoide Arthritis, systemischer Lupus erythematodes, Sklerodermie, Dermatomyositis und Polymyositis, M. Bechterew, Sjögren-Syndrom und die Mischkollagenosen. Die Charakteristika der pulmonalen Beteiligungen dieser einzelnen Krankheitsbilder werden herausgearbeitet. Dabei ist es von besonderer Bedeutung, die Frühformen des Lungenbefalls richtig zu deuten und mit der zugrunde liegenden Kollagenose in Zusammenhang zu bringen. Häufig entsteht aus einer unerkannten Lungenbeteiligung eine Fibrose mit irreversibler Einschränkung der Lungenfunktion.

ZusammenfassungIn der Initialdiagnostik bei rheumatoider Arthritis (RA) wer-den neben der Projektionsradiographie (PR) auch die Mag-netresonanztomographie (MRT) und die 3-Phasen-Skelettszintigraphie (3P-SZ) eingesetzt. Ziel dieser Studie war es, bei Patienten mit Verdacht auf RA die Wertigkeit der PR, der 3P-SZ und der MRT anhand von Verlaufsbeobachtun-gen über 2 Jahre zu beurteilen. Patienten, Methoden: Bei 42 Patienten wurden am selben Tag je eine 3P-SZ, Niederfeld-MRT und PR der Hände im dorsovolaren Strahlengang durchgeführt. Verlaufskontrollen erfolgten im jährlichen Abstand. Alle Bilder wurden von jeweils zwei erfahrenen Radiologen/ Nuklearmedizinern befundet und in rheumatypisch und nicht rheumatypisch unterteilt. Als Goldstandard diente die abschließende klinische Diagnose des Rheumatologen unter Berücksichtigung des Ritchie-articular-Index. Ergebnisse: Bei 24/42 Patienten wurde die Diagnose einer initialen RA gestellt. In der PR konnte bei 20/ 24Patienten imzeitlichen Verlauf die richtigeDiagnose gestellt werden. Demgegenüber wurde sowohl in der 3P-SZ als auch in der MRT bei allen 24 Patienten eine beginnende RA erkannt. Lediglich im Detektionszeitpunkt gab es Variationen mit insgesamt tendenziell späterer Diagnosestel-lung in der PR. Schlussfolgerung: In der bildgebenden Initialdiagnostik der RA ist die PR weiterhin als Verfahren der ersten Wahl anzusehen. In der weiterführenden Diagnostik von unklaren Befunden stellt die Niederfeld-MRT ein der 3P-SZ annähernd vergleichbar sensitives Verfahren dar. Trotzdem sollten – wenn möglich – aufgrund des geringen Field-of-view neben der 3P-SZ zur weiteren Abklärung unklarer Befunde Hochfeldtomographen bevorzugt werden.

Ziele: Ziel der Studie war es, über radiologische, epidemiologische und mikrobiologosche Aspekte pulmonaler Erkrankungen bei Patienten mit gesicherter HIV-Infektion in der HAART-Ära zu berichten. Methode: Von 2000–2004 wurden die klinischen Daten von 130 HIV-Patienten mit akuten pulmonalen Symptomen analysiert und radiologische Untersuchungen ausgewertet; diese wurden von zwei erfahrenen Radiologen im Konsensus ausgewertet. Alle Patienten bekamen eine Röntgenthorax-Aufnahme, 42 hatten zusätzlich eine CT des Thorax. Die Bildgebung wurde nach der Verteilung von Infiltrationen, Lungengerüstveränderungen, pleuraler- und Lymphknoten-Beteiligung analysiert und nach typischen Mustern klassifiziert. Die pulmonale Enddiagnose erfolgte durch Therapieergebnisse, bronchoalveolärer Lavage oder transbronchialer Biopsie. Ergebnis: Bei 46% der Patienten war eine Lungenerkrankung die Erstmanifestation von HIV. Bakterielle Pneumonien (18%) waren am häufigsten, neben der Pneumozystis carinii Pneumonie (PCP) (13%), M.avium-Infektionen (MAI) (6%), Kaposi-Sarkom und Lymphom (4%). Typische Infiltrationsmuster waren „kleinnodulär“ bei Kaposi-Sarkom, „großnodulär“ bei Lymphom und „flächig-alveolär“ bei bakterieller Pneumonie. Die häufigsten Lokalisationen waren basal und perihilär/symmetrisch bei PCP, basal und perihilär/asymmetrisch bei Kaposi-Sarkom und basal/asymmetrisch bei bakterieller Pneumonie. Eine Lymphadenopathie wurde am häufigsten bei MAI (60%) und Lymphom (50%)beobachtet, Pleuraergüsse bei Kaposi-Sarkom (80%). Die allgemeine Sensitivität für Röntgen-Thoraxaufnahmen lag bei 0.87 und für CT-Thorax bei 0.97. Die artspezifische Sensitivität lag bei 0.33 (konventionell) bzw. 0.70 (CT) (p<0.001) Schlussfolgerung: In der HAART-Ära treten pulmonale Manifestationen, einschließlich der PCP, bei HIV weiterhin häufig auf. Für bestimmte Krankheiten werden typische radiologische Befallsmuster beobachtet. In der radiologischen Primärdiagnostik hat nur die CT eine gute algemeine- und artspezifischen Sensitivität.

Collagen based vascular diseases with pulmonary involvement comprise rheumatoid arthritis, systemic lupus erythematosus, progressive systemic sclerosis, dermatomyositis and polymyositis, ankylosing spondylitis, Sjögren's syndrome, and mixed connective tissue diseases. The different characteristics of pulmonary involvement are described. In such circumstances, early recognition of lung involvement is of considerable significance and the relationship to the corresponding disease has to be made. Frequently unrecognised pulmonary involvement ends up as fibrosis with irreversible deficits in respiratory function.

Collagen based vascular diseases with pulmonary involvement comprise rheumatoid arthritis, systemic lupus erythematosus, progressive systemic sclerosis, dermatomyositis and polymyositis, ankylosing spondylitis, Sjogrens syndrome, and mixed connective tissue diseases. The different characteristics of pulmonary involvement are described. In such circumstances, early recognition of lung involvement is of considerable significance and the relationship to the corresponding disease has to be made. Frequently unrecognised pulmonary involvement ends up as fibrosis with irreversible deficits in respiratory function.

Besides conventional x-ray, in the diagnostic work up of initial changes in patients suffering from rheumatoid arthritis (RA), 3-phase bone scintigraphy (3P-Sz) is as well established as magnetic resonance imaging (MRI). The aim of this study was to compare the diagnostic value of a newly developed low field MRI with proven methods such as conventional x-ray and 3P-Sz. Patients, Methods: 42 patients were studied using a one day*s protocol with 3P-Sz, MRI, and x-ray of the hands with yearly follow up examinations. Images were visually assessed by two blinded nuclear medicine physicians and radiologists and classified as RA-typical and non-RA-typical changes. All methods were compared to the summarised findings interpreted by a rheumatologist in consideration of the Ritchie articular index as gold-standard. Results: 24/42 patients presented with clinical symptoms of initial changes by rheumatoid arthritis. Conventional x-ray revealed in 20/24 patients within the correct diagnosis in the study period. On the other hand 3P-Sz and low field MRI concordantly showed all 24 patients with initial changes due to RA. Time of detection showed variations with a tendency to later findings by conventional x-ray. Conclusions: In the diagnostic work up of initial changes conventional x-ray should be the first choice in imaging. Our findings suggest that MRI represents an equally sensitive method for the diagnosis of initial changes due to RA in the region of the bonds as compared to the 3P-Sz. The limitation of the low field MRI is the small field of view, so we prefer 3P-Sz or high field MRI in the diagnosis of patients with suspected RA.