Bildgebung bei kindlichem Tortikollis^[1]

Zusammenfassung

Ein Tortikollis ist eine angeborene oder erworbene Deformation, die durch eine Rotationsfehlstellung der Halswirbelsäule mit sekundärer Schiefstellung des Kopfes gekennzeichnet ist. Er ist ein Zeichen für einen zugrunde liegenden Krankheitsprozess, impliziert aber keine bestimmte Diagnose. Die Ursache sollte untersucht werden, wenn der Tortikollis persistiert oder mit weiteren Symptomen einhergeht. Ein angeborener Tortikollis bei Neugeborenen und Säuglingen ist üblicherweise durch Anomalien der kraniozervikalen Wirbel bedingt oder hat muskuläre Ursachen. Auch Anomalien der Augen, wie angeborener paralytischer Strabismus (Lähmungsschielen) und angeborener Nystagmus, kommen infrage. Ein erworbener Tortikollis bei älteren Kindern und Jugendlichen ist häufig die Folge von Trauma, Infektion oder Tumoren. Bildgebende Untersuchungen sollten erst nach vollständiger Anamnese und Interpretation der klinischen Befunde durchgeführt werden. Bei Neugeborenen oder Säuglingen mit angeborenem Tortikollis ist Ultraschall die Methode der Wahl. Bei erworbenem, posttraumatischem Tortikollis sollte eine Röntgenuntersuchung (laterale und anteroposteriore Ansichten) als erstes bildgebendes Verfahren eingesetzt werden. Bei einem erwobenen, nicht traumatischen Tortikollis ist als erstes bildgebendes Verfahren eine Computertomografie von Hals oder Halswirbelsäule angezeigt. Wenn die computertomografischen Befunde negativ sind, sollten magnetresonanztomografische Scans von Gehirn und Halswirbelsäule folgen. Bei der bildgebenden Untersuchung eines Tortikollis ist häufig der Einsatz mehrerer Techniken (Röntgen, Ultraschall, Computer- und Magnetresonanztomografie) erforderlich. Der Radiologe muss über die Bedeutung des jeweiligen bildgebenden Verfahrens bei Patienten in unterschiedlichen Altersgruppen informiert sein.

Abstract

Torticollis is a congenital or acquired deformity characterized by rotational deformity of the cervical spine with secondary tilting of the head. Although torticollis is a sign of an underlying disease process, its presence does not imply a specific diagnosis, and the cause should be sought if torticollis persists or is associated with other symptoms. Congenital torticollis, seen in neonates and infants, usually results from craniocervical vertebral anomalies or muscular causes, although ocular abnormalities such as congenital paralytic squint (strabismus) and congenital nystagmus should also be considered. Acquired torticollis, seen in older children and adolescents, is often secondary to trauma, infection, or tumors. Imaging should be used as a general screening tool only after a complete medical history and clinical findings have been obtained. In newborns or infants with congenital torticollis, ultrasonography is the modality of choice. In cases of acquired torticollis resulting from trauma, conventional radiography (lateral and anteroposterior views) should be the first-line imaging modality. In nontraumatic acquired torticollis, computed tomography of the neck or cervical spine is the initial imaging study. If computed tomography findings are negative, magnetic resonance imaging of the brain and cervical spine should be performed. The use of multiple imaging modalities (conventional radiography, ultrasonography, computed tomography, and magnetic resonance imaging) is common in the radiologic work-up of torticollis, and radiologists must understand the role of each imaging modality in patients of various ages.

¹ © 2012 The Radiological Society of North America. All rights reserved. Originally published in English in RadioGraphics 2012; 32: 557 – 571. Online published in 10.1148 /rg.322105143. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.

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