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Ist Rheuma scanbar?

Ein Überblick über die aktuelle Studienlage zur fluoreszenzoptischen Bildgebung

Can rheuma be scanned?

Review of the current study situation on fluorescence optical imaging

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Zusammenfassung

Hintergrund

Die Technologie der Indocyaningrün(ICG)-basierten fluoreszenzoptischen Bildgebung (FOI) mittels Xiralite®-System (Xiralite GmbH, Berlin, Deutschland) („Rheumascan“) ist weltweit seit Zulassung für den klinischen Gebrauch in der europäischen Union (2009), in den USA (2014) als auch in Asien Gegenstand vieler verschiedener Studien. FOI stellt die durch Entzündung hervorgerufene gestörte Mikrozirkulation in den Gelenken beider Hände dar.

Ziel der Arbeit

Die Arbeit soll einen Überblick über die derzeitige Studienlage zur ICG-basierten FOI in den verschiedenen rheumatologischen Indikationen geben.

Methoden

Es wird eine umfassende Literaturanalyse der seit 2010 publizierten Arbeiten zur ICG-basierten FOI in der Diagnostik verschiedener entzündlich-rheumatischer Gelenkerkrankungen vorgestellt, ihr Einsatz im Therapiemonitoring erläutert als auch die Wertigkeit bei anderen Indikationen dargelegt.

Ergebnisse

Zusammenfassend haben die Studien die Genauigkeit der FOI in der Entzündungsdiagnostik ausgiebig gezeigt. Daraus kann abgeleitet werden, dass die FOI eine gute Ergänzung zu den bisherigen Bildgebungsverfahren ist. Aufgrund charakteristischer Muster sowohl der Haut als auch der Nägel ist die FOI vor allem bei der Psoriasisarthritis ein indiziertes Verfahren und kann hier sehr hilfreich im diagnostischen Prozess bei früher undifferenzierter Arthritis sein. Die FOI hat ihren Nutzen bei Kindern (juvenile idiopathische Arthritis), zur Therapieverlaufskontrolle und beim Einsatz von Patienten mit systemischer Sklerose gezeigt.

Schlussfolgerung

Die vorliegenden Daten implizieren, dass die FOI als wertvolle ergänzende Bildgebung im diagnostischen Algorithmus in der täglichen rheumatologischen Praxis anzusehen ist – sowohl bei der Diagnosestellung als auch zum Verlaufsmonitoring. Insbesondere zukünftig durchführbare automatisierte Analysen lassen sowohl auf objektive Messungen der Entzündungsaktivität als auch zum Monitoren des Therapieansprechens hoffen.

Abstract

Background

The novel technique of indocyanine green (ICG)-based fluorescence optical imaging (FOI) using the Xiralite® system (Rheumascan) has been the subject of many different studies worldwide since approval for clinical use in the European Union (2009), USA (2014) and Asia. The FOI depicts the disturbed microcirculation in the joints of both hands caused by inflammation.

Objective

The aim of this article is to provide an overview of the current state of studies on ICG-based FOI in different rheumatologic indications.

Methods

A narrative literature review of publications on ICG-based FOI in the diagnosis of various inflammatory rheumatic joint diseases since 2010 is presented, its use in treatment monitoring is explained, and its value in systemic sclerosis is outlined.

Results

In summary, studies have extensively demonstrated the accuracy of FOI in inflammation detection. Therefore, it can be concluded that FOI is a good supplement to existing imaging modalities. Due to characteristic patterns of both skin and nails, FOI is an indicated procedure especially in psoriatic arthritis and can be very helpful in the diagnostic process in early undifferentiated arthritis. The FOI has shown its usefulness in children (juvenile idiopathic arthritis), for monitoring the course of treatment, and for demonstrating disturbed microcirculation in patients with systemic sclerosis.

Conclusion

The presented data imply that FOI should be considered as a valuable complementary imaging tool in the diagnostic algorithm of daily rheumatologic practice, both for diagnosis and for follow-up monitoring. In particular, the automated analyses should be able in the future to objectify measurements of inflammatory activity as well as monitoring the response to treatment.

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Authors and Affiliations

  1. RHIO (Rheumatologie, Immunologie, Osteologie) Düsseldorf und RHIO-Forschungsinstitut, Düsseldorf, Deutschland

    Stephanie Gabriele Werner

  2. Abteilung für Rheumatologie und Klinische Immunologie, Parkklinik Weißensee, Berlin, Deutschland

    Marina Backhaus

  3. Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    Sarah Ohrndorf

Authors
  1. Stephanie Gabriele Werner
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  2. Marina Backhaus
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Correspondence to Sarah Ohrndorf.

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Interessenkonflikt

S.G. Werner, M. Backhaus und S. Ohrndorf geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autorinnen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Paula Hoff, Berlin

Sarah Ohrndorf, Berlin

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Werner, S.G., Backhaus, M. & Ohrndorf, S. Ist Rheuma scanbar?. Z Rheumatol 82, 627–637 (2023). https://doi.org/10.1007/s00393-023-01404-8

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