Diagnostik der atraumatischen Femurkopfnekrose des Erwachsenen

 

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Zusammenfassung

Eine frühe Diagnose der atraumatischen Femurkopfnekrose ermöglicht einen frühzeitigen Therapiebeginn und damit verbunden eine bessere Prognose. Die radiologische Abklärung bei Verdacht auf eine atraumatische Femurkopfnekrose ist dabei essenziell. Die bildgebende Diagnostik sollte mit konventionellen Röntgenbildern beider Hüftgelenke beginnen, um Differenzialdiagnosen auszuschließen. Die Magnetresonanztomografie (MRT) ist heute das bildgebende Verfahren der Wahl, mit der höchsten Sensitivität und Spezifität. Mit Hilfe der multiplanaren Computertomografie (CT) kann das Vorliegen einer subchondralen Fraktur am sichersten erfasst werden. Für diese Fragestellung ist die CT der MRT derzeit noch überlegen. Die Skelettszintigrafie sollte nur noch in Ausnahmefällen eingesetzt werden, in denen Kontraindikationen für eine MRT bestehen. Die bildgebende Diagnostik mittels Röntgen, MRT und CT erlaubt eine genaue Stadieneinteilung nach der ARCO-Klassifikation und ermöglicht es, den Patienten frühzeitig einer stadiengerechten Therapie zuzuführen.

Summary

Early diagnosis of atraumatic femoral head necrosis enables an early therapy and therefore a better prognosis. Radiological classification is essential if a femoral head necrosis is assumed. The diagnostic should start with conventional radiographs of the hip to exclude other differential diagnosis. Today, magnetic resonance imaging (MRI) is the most sensitive and specific diagnostic tool. The use of computed tomography (CT) with multiplanary reconstruction is the most sensitive method to detect subchondral fractures. In this case, CT is more sensitive compared to MRI. Bone scintigraphy should only be used in cases where MRI cannot be performed due to contraindications. Radiological diagnostics using radiography, MRI and CT allows an accurate staging according to the ARCO-classification and enables an early stage-dependent therapy for the patient.

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