Reuter M, Biederer J, Both M, Schnabel A, Reinhold-Keller E, Gross W L, Heller M
Klinik für Diagnostische Radiologie, Universitätsklinikum Kiel.
Rofo. 2003 Sep;175(9):1184-92. doi: 10.1055/s-2003-41924.
Determination of disease extension and disease activity are in the foreground of diagnostic imaging in vasculitides. There are several radiologic modalities available each having specific indications. Magnetic resonance imaging (MRI) readily depicts granulomas and mucosal inflammations in the paranasal sinuses, nasal cavity and orbits. Computed tomography detects osseous lesions of the skull. Due to its superb sensitivity MRI is an established screening modality for CNS vasculitides, although there are limitations with regard to specificity. In spite of its limited accuracy in most institutions angiography is still required for radiological confirmation of CNS vasculitis. Perfusion and diffusion MR-imaging may combine the advantages of "conventional" MRI and angiography. By now the method is not fully validated for vasculitides, however. Vascular disease in Takayasu's arteritis and in giant cell arteritis involving predominantly large and medium sized vessels is readily diagnosed by non invasive magnetic resonance angiography. Percutaneous transluminal angioplasty has proven to be an effective and save therapeutic modality for the cure of vascular stenoses and occlusions. Plain film radiography in two planes is the established modality for pulmonary imaging. In pulmonary vasculitides a more thorough analysis of lung disease is provided by high resolution computed tomography. Diagnostic imaging does substantially assist in the interdisciplinary management of patients suffering from vasculitides.
确定疾病范围和疾病活动度是血管炎诊断成像的重点。有多种放射学检查方法可供选择,每种方法都有特定的适应证。磁共振成像(MRI)能够清晰显示鼻窦、鼻腔和眼眶内的肉芽肿及黏膜炎症。计算机断层扫描可检测颅骨的骨质病变。尽管在特异性方面存在局限性,但由于其极高的敏感性,MRI仍是中枢神经系统血管炎的一种既定筛查方法。尽管在大多数机构中其准确性有限,但血管造影术对于中枢神经系统血管炎的放射学确诊仍必不可少。灌注和弥散磁共振成像可能结合了“传统”MRI和血管造影的优点。不过,目前该方法在血管炎方面尚未完全得到验证。高安动脉炎和主要累及大中血管的巨细胞动脉炎中的血管病变,通过无创磁共振血管造影很容易诊断。经皮腔内血管成形术已被证明是治疗血管狭窄和闭塞的一种有效且安全的治疗方法。双平面X线平片是肺部成像的既定方法。在肺血管炎中,高分辨率计算机断层扫描能对肺部疾病进行更全面的分析。诊断成像对血管炎患者的多学科管理有很大帮助。
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