Kraniofaziale Manifestationen von systemischen Erkrankungen: CT- und MRT-Befunde

In diesem Artikel werden die Bildgebungsbefunde verschiedener regionaler oder systemischer Krankheitsprozesse beschrieben, die sich auf die maxillofazialen Knochen auswirken können. Diese Bildgebungsbefunde erleichtern die Erkennung der zugrundeliegenden Erkrankung und die differenzialdiagnostische Abgrenzung und ermöglichen somit eine frühzeitige Veränderung des therapeutischen Vorgehens und eine Vermeidung schwerwiegender Komplikationen.

Abstract

Many systemic diseases or conditions can affect the maxillofacial bones; however, they are often overlooked or incidentally found at routine brain or head and neck imaging performed for other reasons. Early identification of some conditions may significantly affect patient care and alter outcomes. Early recognition of nonneoplastic hematologic disorders, such as thalassemia and sickle cell disease, may help initiate earlier treatment and prevent serious complications. The management of neoplastic diseases such as lymphoma, leukemia, or Langerhans cell histiocytosis may be different if diagnosed early, and metastases to the maxillofacial bones may be the first manifestation of an otherwise occult neoplasm. Endocrinologic and metabolic disorders also may manifest with maxillofacial conditions. Earlier recognition of osteoporosis may alter treatment and prevent complications such as insufficiency fractures, and identification of acromegaly may lead to surgical treatment if there is an underlying growth hormone-producing adenoma. Bone dysplasias sometimes are associated with skull base foraminal narrowing and subsequent involvement of the cranial nerves. Inflammatory processes such as rheumatoid arthritis and sarcoidosis may affect the maxillofacial bones, skull base, and temporomandibular joints. Radiologists should be familiar with the maxillofacial computed tomographic and magnetic resonance imaging findings of common systemic disorders because these may be the first manifestations of an otherwise unrevealed systemic process with potential for serious complications.

Kernaussagen

• Anomalien der maxillofazialen Strukturen können bei Patienten mit zahlreichen systemischen Erkrankungen beobachtet werden. Diese sind in manchen Fällen durch ein subtiles und unspezifisches klinisches Erscheinungsbild gekennzeichnet und dem primärversorgenden Arzt möglicherweise nicht bekannt.

• Das Vorliegen von multifokalen Läsionen oder einer diffusen Knochenbeteiligung deutet auf eine zugrundeliegende systemische Erkrankung hin. Eine fokale Knochenläsion kann ein Anhaltspunkt für das Vorliegen einer bis dato unerkannten systemischen Grunderkrankung sein, auch wenn sich die Abgrenzung von einer primären Knochenerkrankung häufig schwierig gestaltet.

• In der Bildgebung kann das multiple Myelom als intramedulläre Weichgewebemasse mit osteolytischen, wie ausgestanzt wirkenden Läsionen oder aber als Knochenmarkinfiltration imponieren. Für den Nachweis von Läsionen eignet sich die CT.

• Zu den CT-Befunden einer Osteoporose zählen eine verminderte Knochenmarkdichte, eine Weitung des trabekulären Knochengewebes sowie eine reduzierte Dicke der Kortikalis. Die MRT-Bildgebung ist bei der Osteoporosediagnostik nicht die Modalität der ersten Wahl.

• Bei der fibrösen Dysplasie wurden radiologisch 3 Varianten beschrieben: die pagetoide oder sklerotische, die zystische oder zystenartige sowie die gemischte. Das Erscheinungsbild der fibrösen Dysplasie in der CT hängt von der Quantität von Knochen und fibrösem Gewebe sowie vom Mineralisierungsgrad in den betroffenen Regionen ab. Die MRT-Befunde sind unterschiedlich.

• Die Bildgebungsbefunde bei Morbus Paget variieren je nach Stadium der Erkrankung von Osteoporosis circumscripta über das gleichzeitige Bestehen von osteolytischen und osteoblastischen Läsionen bis zum sog. Tam-oʼShanter-Schädel.

Keywords

Craniofacial Manifestations - systemic disorders - CT and MR imaging findings

Schlüsselwörter

Kraniofaziale Manifestation - systemische Erkrankungen - bildgebende Befunde

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