{"id":4320,"date":"2023-05-30T08:07:04","date_gmt":"2023-05-30T06:07:04","guid":{"rendered":"https:\/\/www.slimnica.lv\/?post_type=jaunumi&p=4320"},"modified":"2023-07-31T07:46:09","modified_gmt":"2023-07-31T05:46:09","slug":"dr-anastasija-sumere-artritu-radiologiska-diagnostika","status":"publish","type":"jaunumi","link":"https:\/\/www.slimnica.lv\/ru\/jaunumi\/dr-anastasija-sumere-artritu-radiologiska-diagnostika\/","title":{"rendered":"Dr. Anastasija \u0160umere: artr\u012btu radiolo\u0123isk\u0101 diagnostika"},"parent":0,"menu_order":0,"template":"","jaunumu_atslegvardi":[71,66,86],"class_list":["post-4320","jaunumi","type-jaunumi","status-publish","hentry","jaunumu_atslegvardi-kaulu-un-locitavu-veseliba","jaunumu_atslegvardi-radiologija","jaunumu_atslegvardi-radiologs"],"acf":{"saturs":"

Artr\u012bti ir kop\u0113jais termins da\u017e\u0101du loc\u012btavu iekais\u012bgu saslim\u0161anu apz\u012bm\u0113\u0161anai, skaidro R\u012bgas 2. slimn\u012bcas radiolo\u0123e dr. Anastasija \u0160umere<\/a>. Artr\u012bts ir st\u0101voklis, kas izraisa iekaisumu loc\u012btav\u0101s, savuk\u0101rt tas rada s\u0101pes, st\u012bvumu un kust\u012bbu ierobe\u017eojumu. ASV Slim\u012bbu profilakses un kontroles centra dati liecina, ka vair\u0101k nek\u0101 30% no pacientiem ar artr\u012btiem, ir darbasp\u0113ju samazin\u0101\u0161an\u0101s un ap 25% pacientu cie\u0161 no stipr\u0101m s\u0101p\u0113m.<\/strong><\/p>\n

Da\u017e\u0101da veida artr\u012btiem rakstur\u012bga da\u017e\u0101da loc\u012btavu sinovi\u0101lo apvalku, kapsulas un skrim\u0161\u013cu, k\u0101 ar\u012b apk\u0101rt\u0113jo m\u012bksto audu iesaiste. Loc\u012btavas kapsula no vis\u0101m pus\u0113m ap\u0146em loc\u012btavas dobumu un nodro\u0161ina t\u0101 herm\u0113tiskumu.<\/p>\n

Sinovi\u0101lie apvalki izkl\u0101j loc\u012btavas kapsulu no iek\u0161puses un nodro\u0161ina loc\u012btavas baro\u0161anu caur t\u0101s asinsvadu t\u012bklojumu. Loc\u012btavas skrim\u0161\u013ci p\u0101rkl\u0101j kaulu kontaktvirsmas un atbild par loc\u012btavas amortiz\u0101ciju, br\u012bvu kust\u012bgumu.<\/p>\n

Artr\u012btu att\u012bst\u012bbas iemesls nereti ir autoim\u016bna saslim\u0161ana \u2013 tas ir, autoim\u016bn\u0101s sist\u0113mas funkcijas trauc\u0113jumi, kas s\u0101k uztvert pa\u0161a organisma audus par sve\u0161iem un tos boj\u0101.<\/strong> V\u0113l joproj\u0101m artr\u012btu etiolo\u0123ija nav l\u012bdz galam noskaidrota un izp\u0113t\u012bta. Past\u0101v vair\u0101k k\u0101 100 artr\u012btu tipu.<\/p>\n

Artr\u012btus var iedal\u012bt div\u0101s liel\u0101s grup\u0101s \u2013 iekais\u012bgie un de\u0123enerat\u012bvie.<\/p>\n

Visbie\u017e\u0101k sastopamie artr\u012btu tipi ir osteoartr\u012bts, reimato\u012bdais artr\u012bts, juven\u012blais idiop\u0101tiskais artr\u012bts, psori\u0101tiskais artr\u012bts, podagra. Loc\u012btavu, c\u012bpslu vai ent\u0113zes iekaisuma simptomi var b\u016bt \u012bslaic\u012bgi vai past\u0101v\u012bgi. Ja iekaisums turpin\u0101s, var rasties neatgriezeniski skeleta boj\u0101jumi, kas izraisa saslimst\u012bbu un invalidit\u0101ti.<\/p>\n

M\u016bsdien\u0101s modernu \u0101rst\u0113\u0161anas l\u012bdzek\u013cu un strat\u0113\u0123iju ra\u0161an\u0101s prasa \u0101tru un prec\u012bzu artr\u012btu diagnostiku. Agr\u012bna \u0101rst\u0113\u0161ana ar m\u0113r\u0137tiec\u012bgu pieeju var main\u012bt ilgtermi\u0146a rezult\u0101tus, samazinot slim\u012bbas aktivit\u0101ti, nov\u0113r\u0161ot loc\u012btavu boj\u0101jumus un invalidit\u0101ti, uzlabojot pacientu dz\u012bves kvalit\u0101ti.<\/p>\n

Radiolo\u0123isk\u0101s izmekl\u0113\u0161anas metodes ir da\u013ca no artr\u012btu diagnostikas, ar to pal\u012bdz\u012bbu iesp\u0113jams konstat\u0113t specifiskas izmai\u0146as loc\u012btav\u0101s. J\u0101saprot, ka nereti radiolo\u0123sk\u0101s izmai\u0146as var b\u016bt nepietiekamas diagnozes noteik\u0161anai, t\u0101d\u0113\u013c svar\u012bgas ir ar\u012b kl\u012bnisk\u0101 un laborator\u0101 artr\u012btu diagnostikas metodes.<\/p>\n

Bie\u017e\u0101k pielietot\u0101s radiolo\u0123isk\u0101s metodes ir ultrasonogr\u0101fija (USG), rentgenogr\u0101fija (RTG), magn\u0113tisk\u0101 rezonanse (MR), ret\u0101k datortomogr\u0101fija (CT) un v\u0113l ret\u0101k scintigr\u0101fija.<\/strong><\/p>\n

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Rentgenogr\u0101fija<\/strong><\/h4>\n

Rentgenogr\u0101fija ir bie\u017ei izmantojama, labi pieejama, relat\u012bvi l\u0113ta metode, ar kuras pal\u012bdz\u012bbu iesp\u0113jams ieg\u016bt detaliz\u0113tus att\u0113lus un izv\u0113rt\u0113t kaulu, k\u0101 ar\u012b loc\u012btavu virsmu st\u0101vokli. Ar \u0161o metodi iesp\u0113jams ar\u012b monitor\u0113t slim\u012bbas gaitu. Izmekl\u0113jumu veic da\u017e\u0101d\u0101s, bie\u017e\u0101k standarta projekcij\u0101s. RTG att\u0113los izv\u0113rt\u0113 loc\u012btavu spraugu sa\u0161aurin\u0101jumu, osteof\u012btu, entezof\u012btu un eroziju veido\u0161anos. Atsevi\u0161\u0137os gad\u012bjumos veic RTG ar slodzi. Bie\u017ei vien osteoartr\u012bta diagnostik\u0101 \u0161\u012b ir vien\u012bg\u0101 metode, ar kuras pal\u012bdz\u012bbu \u0101rst\u0113jo\u0161ais \u0101rsts ieg\u016bst pietiekamu inform\u0101ciju par loc\u012btavas st\u0101vokli.<\/p>\n

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1. att\u0113ls. Rtg labai ce\u013ca loc\u012btavai AP, LL projekcij\u0101s. Pacientam tipisks ce\u013ca loc\u012btava osteoartr\u012bts ar loc\u012btavu spraugu sa\u0161aurin\u0101jumu, pagarin\u0101t\u0101m virsm\u0101m, sklerozi slodzes virsmu apvid\u016b.<\/p><\/div>\n

 <\/p>\n

De\u0123enerat\u012bvam osteoartr\u012btam izmanto da\u017e\u0101das klasifik\u0101cijas metodes, bet visbie\u017e\u0101k — \u00a0Kellgren\/Lawrence klasifik\u0101ciju, kur ir \u010detras osteoartr\u012bta pak\u0101pes, ko var konstat\u0113t un aprakst\u012bt rentgenogr\u0101fiski. Pak\u0101pes noteik\u0161anai izv\u0113rt\u0113 loc\u012btavas spraugas sa\u0161aurin\u0101jumu, osteof\u012btu (kaulu izaugumu) veido\u0161anos, slodzes da\u013cu kaulu sklerotiskas izmai\u0146as un loc\u012btavu virsmu deofrm\u0101ciju. (2., 3. att\u0113ls)<\/p>\n

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2. att\u0113ls. Kreis\u0101s g\u016b\u017eas loc\u012btavas Rtg izmekl\u0113jumi AP projekcij\u0101. 1.pak\u0101pes osteoartr\u012bts (kreisaj\u0101 pus\u0113) un 2.pak\u0101pes osteoartr\u012bts (labaj\u0101 pus\u0113) p\u0113c Kellgren\/Lawrence klasifik\u0101cijas.<\/p><\/div>\n

 <\/p>\n

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3. att\u0113ls. Lab\u0101s g\u016b\u017eas loc\u012btavas Rtg izmekl\u0113jums AP projekcij\u0101 3.pak\u0101pes osteoartr\u012bts (kreisaj\u0101 pus\u0113) un kreis\u0101s g\u016b\u017eas loc\u012btavas Rtg izmekl\u0113jums AP projekcij\u0101 4.pak\u0101pes osteoartr\u012bts (labaj\u0101 pus\u0113).<\/p><\/div>\n

 <\/p>\n

Svar\u012bgi saprast, ka ar RTG metodi iesp\u0113jams konstat\u0113t struktur\u0101las izmai\u0146as, bet ne iekaisumu, kur sensit\u012bv\u0101ka b\u016btu MR metode.<\/p>\n

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4. att\u0113ls. Rtg labai p\u0113dai AP projekcij\u0101. Multiplas metatars\u0101lo kaulu galvi\u0146u erozijas pacientam ar reimato\u012bdo artr\u012btu.<\/p><\/div>\n

\n

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5. att\u0113ls. Rtg kreisai p\u0113dai sl\u012bp\u0101 projekcij\u0101. Tipiska loc\u012btavu virsmu deform\u0101cija (\u201cpencil-in cup\u201d) eroziju un entez\u012btu rezult\u0101t\u0101 pacientam ar psori\u0101tisku artr\u012btu.<\/p><\/div>\n

 <\/p>\n

\n

Ultrasonogr\u0101fija<\/strong><\/h4>\n

Ultrasonogr\u0101fija ir neinvaz\u012bv\u0101 un nekait\u012bga metode, kur izmanto augstas frekvences ska\u0146as vi\u013c\u0146us.<\/p>\n

Ar\u012b ultrasonogr\u0101fija ir sal\u012bdzino\u0161i labi pieejama metode, ar kuras pal\u012bdz\u012bbu iesp\u0113jams izv\u0113rt\u0113t m\u012bkstos audus, strukt\u016bras loc\u012btav\u0101 un ap to \u2013 artr\u012btu gad\u012bjum\u0101 \u012bpa\u0161i svar\u012bgi izv\u0113rt\u0113t c\u012bpslas, saites, ent\u0113zes (kaula un c\u012bpslas vai saites savienojuma vieta), bursas (g\u013cotsomi\u0146as), sinovi\u0101los apvalkus, \u0161\u0137idrumu kolekcijas, kalcin\u0101tu izgulsn\u0113jumus. Ar USG metodi iesp\u0113jams ar\u012b diferenc\u0113t kaulu virsmu erozijas un osteof\u012btus. Turkl\u0101t p\u0113c US var spriest par iekaisuma aktivit\u0101ti, izv\u0113rt\u0113jot apvalku vaskulariz\u0101ciju ar jauda doplerogr\u0101fijas pal\u012bdz\u012bbu.<\/p>\n

 <\/p>\n

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6. att\u0113ls. US uzmekl\u0113jums p\u0113dai ar jauda doplerogr\u0101fijas re\u017e\u012bmu. P\u0113das pamatnes loc\u012btavas sinov\u012bts ar sabiez\u0113tiem sinovi\u0101liem apvalkiem un pastiprin\u0101tu to apasi\u0146o\u0161anu, k\u0101 ar\u012b vair\u0101kas kaulu erozijas pacientam ar reimato\u012bdo artr\u012btu.<\/p><\/div>\n

 <\/p>\n

\"\"

7. att\u0113ls. US izmekl\u0113jums plaukstas loc\u012btavai ar jauda doplerogr\u0101fijas re\u017e\u012bmu. C\u012bpslas un t\u0101s apvlaku iekaisums (tendin\u012bts, tenosinov\u012bts) plaukstas loc\u012btavas l\u012bmen\u012b \u2013 redz sabiez\u0113tus sinovi\u0101los apvalkus, t\u016bskainu, neviendab\u012bgu c\u012bpslu, pastiprin\u0101tu apvalku un c\u012bpslas apasi\u0146o\u0161anu, pacientam ar reimato\u012bdo artr\u012btu.<\/p><\/div>\n

 <\/p>\n

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8. att\u0113ls. US uzmekl\u0113jums plaukstai. Mas\u012bvs ur\u0101tu krist\u0101lu sakopojums (tophus) pacientam ar podagru.<\/p><\/div>\n

L\u012bdz\u012bgi k\u0101 ar cit\u0101m metod\u0113m, ar\u012b ar ultasonogr\u0101fiju iesp\u0113jams diferenc\u0113t citus simptomu (piem\u0113ram, s\u0101pes, t\u016bskas) iemeslus, kas var kl\u012bniski simul\u0113t artr\u012btus.<\/p>\n

\u0160o metodi izmanto ar\u012b manipul\u0101ciju veik\u0161anai, piem\u0113ram, medikamentu injekciju vai kolekciju punkciju gad\u012bjum\u0101.<\/p>\n

\n

<\/h4>\n

Magn\u0113tisk\u0101 rezonanse<\/strong><\/h4>\n

Magn\u0113tisk\u0101s rezonanses metode ir neinvaz\u012bva att\u0113ldiagnostisk\u0101 metode, kur izmanto magn\u0113tisko lauku un radiovi\u013c\u0146us, lai rad\u012btu detaliz\u0113tus da\u017e\u0101du \u0137erme\u0146a da\u013cu att\u0113lus. Bie\u017ei izmanto ar m\u0113r\u0137i atkl\u0101t, diferenc\u0113t vai ar\u012b monitor\u0113t artr\u012btu gaitu.<\/p>\n

Ar \u0161o metodi iesp\u0113jams prec\u012bzi izv\u0113rt\u0113t loc\u012btavu un m\u012bksto audu boj\u0101juma pak\u0101pi, izv\u0113rt\u0113jot visas iepriek\u0161 min\u0113t\u0101s strukt\u016bras (skrimslis, loc\u012btavu apvalki un t\u0101 t\u0101l\u0101k).<\/p>\n

Viena no liel\u0101k\u0101m MR metodes priek\u0161roc\u012bb\u0101m ir iesp\u0113ja diferenc\u0113t kaula iekaisumu, kas iekais\u012bgu artr\u012btu gad\u012bjum\u0101 liecina par slim\u012bbas aktivit\u0101ti, bet infekcioz\u0101 artr\u012bta gad\u012bjum\u0101 par infekcijas izplat\u012bbas pla\u0161umu.<\/p>\n

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9. att\u0113ls. MR izmekl\u0113jums sakroili\u0101l\u0101m loc\u012btav\u0101m, STIR s\u0113rija. Pla\u0161a kaulu smadze\u0146u t\u016bska krusta un zarnu kaulos pacientam ar akt\u012bvu sakroil\u012btu.<\/p><\/div>\n

 <\/p>\n

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10. att\u0113ls. MR izmekl\u0113jums sakroili\u0101l\u0101m loc\u012btav\u0101m ar kontrastvielas ievadi v\u0113n\u0101, T1 FS s\u0113rija. Septisks lab\u0101s sakroili\u0101l\u0101s loc\u012btavas artr\u012bts, ar kaula un m\u012bksto audu infekciozu iekaisumu, strutainu saturu.<\/p><\/div>\n

Nereti prec\u012bz\u0101kai loc\u012btavu un audu st\u0101vok\u013ca izv\u0113rt\u0113\u0161anai artr\u012btu gad\u012bjum\u0101, v\u0113n\u0101 ievada kontrastvielu. Tas pal\u012bdz v\u0113l prec\u012bz\u0101k izv\u0113rt\u0113t iekaisuma aktivit\u0101ti, jo iekaisu\u0161ie audu intens\u012bvi kr\u0101j kontrastvielu.<\/p>\n

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11. att\u0113ls. MR izmekl\u0113jums ab\u0101m p\u0113d\u0101m ar kontrastvielas ievadi v\u0113n\u0101, T1 FS s\u0113rija. Reimato\u012bdie m\u012bksto audu mezgli\u0146i pacientam ar reimato\u012bdo artr\u012btu.<\/p><\/div>\n

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M\u016bsdien\u0101s magn\u0113tisk\u0101s rezonanses izmekl\u0113jumus izmanto ar\u012b kl\u012bniskajos p\u0113t\u012bjumos, jo t\u0101d\u0113j\u0101di var prec\u012bz\u0101k izv\u0113rt\u0113t slim\u012bbas \u0101rst\u0113\u0161anas efektivit\u0101ti.<\/p>\n

\n

<\/h4>\n

Kaulu scintigr\u0101fija<\/strong><\/h4>\n

Kaulu scintigr\u0101fija ir nukle\u0101r\u0101s diagnostikas metode, kuras laik\u0101 izmanto nelielu radioakt\u012bv\u0101 materi\u0101la daudzumu. To var pielietot kaulu st\u0101vok\u013ca izv\u0113rt\u0113\u0161anai un patolo\u0123ijas atkl\u0101\u0161anai \u2013\u00a0 patolo\u0123iski veidojumi, iekaisumi, infekcija.<\/p>\n

\u0160o metodi izmanto daudz ret\u0101k, jo t\u0101 liel\u0101koties nepal\u012bdz artr\u012btu veidu diagnostikai, tom\u0113r atsevi\u0161\u0137os gad\u012bjumos var pielietot iekaisuma izplat\u012bbas noteik\u0161anai.<\/p>\n

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12. att\u0113ls. Kaulu scintigr\u0101fijas izmekl\u0113jums, pacientam ar aizdom\u0101m par poliartr\u012btu. Pastiprin\u0101ta prepar\u0101ta uzkr\u0101\u0161an\u0101s vair\u0101k\u0101s loc\u012btav\u0101s, izteikt\u0101k lab\u0101s plaukstas loc\u012btav\u0101. Att\u0113ls: Jekaterina \u0160teinberga.<\/p><\/div>\n

 <\/p>\n

\n

Datortomogr\u0101fija<\/strong><\/h4>\n

Datortomogr\u0101fijas metodi artr\u012btu diagnostik\u0101 izmanto ret\u0101k, jo ar t\u0101s pal\u012bdz\u012bbu liel\u0101koties iesp\u0113jams izv\u0113rt\u0113t kaulu st\u0101vokli, bet m\u012bksto audu izv\u0113rt\u0113\u0161ana ir izteikti ierobe\u017eota. Visbie\u017e\u0101k \u0161o metodi izmanto infekcijas gad\u012bjumos, jo izmekl\u0113juma laiks ir daudz \u0101tr\u0101ks, sal\u012bdzinot ar magn\u0113tisko rezonansi, metode ir pla\u0161\u0101k pieejama. Izmekl\u0113jumu var papildin\u0101t ar kontrastvielas ievadi, kas visbie\u017e\u0101k nepeicie\u0161ams abscesu (strutu kolekciju) noteik\u0161anai. Viena no apak\u0161metod\u0113m ir du\u0101l\u0101s ener\u0123ijas datortomogr\u0101fija (DECT). Ar \u0161\u012bs metodes pal\u012bdz\u012bbu reimato\u012bd\u0101 artr\u012bta gad\u012bjum\u0101 var konstat\u0113t iekaisumu loc\u012btavu apvalkos (sinov\u012btu), k\u0101 ar\u012b ir iesp\u0113jams vizualiz\u0113t ur\u0101tu krist\u0101lu izgulsn\u0113jumus podagriska artr\u012bta gad\u012bjum\u0101. Latvij\u0101 \u0161\u012b metode \u0161obr\u012bd nav pieejama.<\/p>\n

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Ierobe\u017eojumi<\/strong><\/h4>\n

M\u016bsdien\u0101s ierobe\u017eojumu izmekl\u0113jumu veik\u0161anai ir relat\u012bvi maz. Magn\u0113tis\u0101s rezonanses izmekl\u0113jumiem pirm\u0101 un svar\u012bg\u0101k\u0101 kontrindik\u0101cija ir kardiostimulators. Tom\u0113r izmekl\u0113jumu da\u017eos gad\u012bjumos iesp\u0113jams veikt, pielietojot stimulatora \u201cMR dro\u0161u\u201d programmu. Ir v\u0113l da\u017ei st\u0101vok\u013ci, kas var ierobe\u017eot izmekl\u0113juma veik\u0161anu, piem\u0113ram, kalustrofobija. Izteiktas klaustrofobijas gad\u012bjum\u0101 izmekl\u0113jumu iesp\u0113jams veikt ar anest\u0113ziju.<\/p>\n

\u0145emot v\u0113r\u0101 to, ka MR izmekl\u0113juma laik\u0101 pacientam j\u0101gu\u013c mier\u012bgi, nekustoties, ar\u012b s\u0101pes var rad\u012bt zin\u0101mas probl\u0113mas. Pacientam pa\u0161am ieteicams izv\u0113rt\u0113t s\u0101pju l\u012bmeni un prets\u0101pju medikamentu lieto\u0161anas nepiecie\u0161am\u012bbu \u012bsi pirms izmekl\u0113juma.<\/p>\n

J\u0101atceras, ka met\u0101la implanti un sve\u0161\u0137erme\u0146i rada magn\u0113tisk\u0101 lauka krop\u013cojumu un ja \u00a0tie ir izmekl\u0113juma zon\u0101, att\u0113los ir artefakti, kas ierobe\u017eo izv\u0113rt\u0113\u0161anu, z\u016bd att\u0113lu kvalit\u0101te, tom\u0113r tas nenoz\u012bm\u0113, ka MR izmekl\u0113jumu nav iesp\u0113jams veikt. Par implanta esam\u012bbu MR kabineta person\u0101lu nepiecie\u0161ams br\u012bdin\u0101t pirms izmekl\u0113juma. Tos veicot, b\u016btiska noz\u012bme ir pacienta svaram. Adipozit\u0101tes gad\u012bjum\u0101 ir apgr\u016btin\u0101ti veikt gan US, gan MR izmekl\u0113jumu. Magn\u0113tisk\u0101s rezonanses iek\u0101rtas galdam ir noteikts svara limits, kas liel\u0101koties ir ap 120 l\u012bdz 130 kilogrami, bet vari\u0113 atkar\u012bb\u0101 no iek\u0101rtas. Turkl\u0101t ir svar\u012bgi, vai gentrija diametrs \u013caus pacientam gul\u0113t taj\u0101 komfortabli. Ultrasonogr\u0101fij\u0101 zem\u0101das tauku sl\u0101\u0146a biezumam ir liela loma \u2013 jo biez\u0101ks taukaudu sl\u0101nis, jo gr\u016bt\u0101k prec\u012bzi izv\u0113rt\u0113t m\u012bksto audu strukt\u016bras.<\/p>\n

Rentgenogr\u0101fij\u0101 izmekl\u0113juma kvalit\u0101ti var ierobe\u017eot s\u0101pes un\/vai loc\u012btavu st\u012bvums, kas ne\u013cauj veikt prec\u012bzas projekcijas.<\/p>\n

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Kopsavilkums<\/strong><\/h4>\n

Artr\u012btu radiolo\u0123isk\u0101 diagnostika visbie\u017e\u0101k nav vien\u012bg\u0101 metode diagnozes noteik\u0161ana, bet tai ir liela noz\u012bme. Da\u017e\u0101das radiolo\u0123isk\u0101s metodes pal\u012bdz ar\u012b izv\u0113rt\u0113t slim\u012bbas gaitu un terapijas efektivit\u0101ti. M\u016bsdien\u0101s ir vair\u0101kas att\u0113ldiagnostisk\u0101s metodes, b\u016btiska ir pareizas izmekl\u0113juma metodes izv\u0113le, t\u0101d\u0113\u013c to liel\u0101koties veic speci\u0101lists \u2013 \u0101rst\u0113jo\u0161ais \u0101rsts.<\/strong><\/p>\n

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