Zusammenfassung
Hintergrund
Das Harnsteinleiden stellt heutzutage eine Volkskrankheit dar. Bei Verdacht auf das Vorliegen einer Urolithiasis muss eine diagnostische Bildgebung durchgeführt werden. In Zeiten der modernen bildgebenden Verfahren gibt es hier eine Vielzahl von Optionen, um die akkurate Steinlokalisation und Steinlast zu evaluieren und darauf basierend das entsprechende Management für den individuellen Patienten festzulegen.
Ziel
In dieser Übersichtsarbeit werden neue Verfahren zusammen mit den etablierten Methoden der diagnostischen Bildgebung in Zusammenschau mit den aktuellen Leitlinien beleuchtet.
Ergebnisse
Die Ultraschalluntersuchung sollte immer die Bildgebung der ersten Wahl sein. Hiernach schließen sich dann bildgebende Verfahren mit ionisierenden Strahlen an. Neben den althergebrachten konventionellen Röntgenuntersuchungen wird heute zur Diagnostik in der akuten Kolik hauptsächlich die native Computertomographie (CT), vornehmlich unter Nutzung eines „Low-dose-Protokolls“ eingesetzt. Mit dem Dual-Energy-CT, dem Uro-Dyna-CT und der digitalen Tomosynthese stehen weitere Verfahren in der Erprobung, die im klinischen Alltag aktuell noch keinen großen Stellenwert haben. Die Magnetresonanztomographie kann Zeichen einer durch Harnleitersteine verursachten Obstruktion zeigen, spielt in der Routinediagnostik der Urolithiasis aber keine Rolle.
Abstract
Background
Urolithiasis is a widespread disease. Diagnostic imaging plays an important role in the evaluation and management of patients with suspected urolithiasis. Furthermore, modern imaging methods may provide information on stone location, size, fragility and composition aiding the urologist to determine the appropriate treatment modality.
Purpose
Based on the current literature and guidelines, this review reports on the various new and established diagnostic imaging modalities.
Results
Ultrasound should always be the initial imaging modality. Following ultrasound, noncontrast CT—principally using a low-dose protocol—is the imaging modality of choice in the evaluation of patients with acute flank pain and suspected urolithiasis. New imaging modalities like dual energy CT, Uro Dyna CT and digital tomosynthesis are currently under investigation but not yet part of daily clinical practice. Magnetic resonance imaging can be used to detect obstruction caused by urinary stones but is not a first-line imaging modality.
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A. Neisius, C. Thomas, F.C. Roos, W. Jäger, I. Tsaur, G. Bartsch, T. Knoll und A. Haferkamp geben an, dass kein Interessenkonflikt besteht.
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Neisius, A., Thomas, C., Roos, F.C. et al. Steindiagnostik 2016. Urologe 55, 1291–1296 (2016). https://doi.org/10.1007/s00120-016-0231-1
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DOI: https://doi.org/10.1007/s00120-016-0231-1