Advertisement

Der Urologe

, Volume 49, Issue 3, pp 421–432 | Cite as

Diagnostischer Algorithmus bei zystischen Nierenläsionen

  • D.-A. ClevertEmail author
  • A. Horng
  • M. Staehler
  • N. Haseke
  • C. Stief
  • M. Reiser
CME Weiterbildung · Zertifizierte Fortbildung

Zusammenfassung

Zystische Nierenläsionen können unterteilt werden in einfache oder komplizierte Zysten, die sowohl solitär als auch multifokal auftreten können. Die Bosniak-Klassifikation (I–IV) unterteilt die Nierenzysten anhand von sonographischen oder computertomographischen Kriterien. Aufgrund dieser Charaktersierung kann eine Entscheidung über das weitere therapeutische Vorgehen getroffen werden. Das Standardverfahren zur Diagnose von Nierenzysten ist die Sonographie. Neben der primären konventionellen B-Bild-Sonographie stellt der kontrastmittelverstärkte Ultraschall mit SonoVue® eine neue, vielversprechende Methode für die Einteilung der Zysten nach Bosniak dar. Dieser Review beschreibt zystische Nierenveränderungen mit dem Schwerpunkt auf Ätiologie und Bedeutung dieser Pathologien im Methodenvergleich zum konventionellen B-Bild, dem kontrastmittelverstärkten Ultraschall und der Computertomographie.

Schlüsselwörter

Nierenzysten Bosniak-Klassifikation B-Bild-Sonographie Kontrastmittelverstärkter Ultraschall Computertomographie 

Diagnostic algorithm in cystic renal masses

Abstract

Cystic renal lesions can be classified as either simple or complicated cysts, which might occur as solitary as well as multifocal lesions. The Bosniak classification (I-IV), which characterizes renal cysts on the basis of ultrasound or computer tomographic criteria, is very useful for further decision-making about the therapeutic approach. The method of choice for diagnosis of renal cysts is ultrasound. Besides the conventional B-mode ultrasound, contrast enhanced ultrasound with SonoVue® provides a promising new technique for distinguishing cysts according to the Bosniak classification. This review describes cystic renal lesions with emphasis on the etiology and significance of these pathologies in a methodological comparison of conventional B-mode, contrast enhanced ultrasound and computer tomography.

Keywords

Renal cysts Bosniak classification B-mode ultrasound Contrast enhanced ultrasound Computer tomography 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Ascenti G, Mazziotti S, Zimbaro G et al (2007) Complex cystic renal masses: characterization with contrast-enhanced US. Radiology 243(1):158–165CrossRefPubMedGoogle Scholar
  2. 2.
    Balci NC, Semelka RC, Patt RH et al (1999) Complex renal cysts: Findings on MR imaging. Am J Roentgenol 172:1495–1500Google Scholar
  3. 3.
    Bosniak MA (1986) The current radiological approach to renal cysts. Radiology 158:1–10PubMedGoogle Scholar
  4. 4.
    Bosniak MA (1997) Diagnosis and management of patients with complicated cystic lesions of the kidney. AJR Am J Roentgenol 169:819–821PubMedGoogle Scholar
  5. 5.
    Bosniak MA (1997) The use of the Bosniak classification system for renal cysts and cystic tumors. J Urol 157:1852–1853CrossRefPubMedGoogle Scholar
  6. 6.
    Clevert DA, Bensler S, Stickel M et al (2007) Contrast enhanced ultrasound eases interpretation of an unclear renal tumor in addition to CT, MRI and histological findings – a case report in a young patient. Clin Hemorheol Microcirc 36(4):313–318PubMedGoogle Scholar
  7. 7.
    Clevert DA, Minaifar N, Weckbach S et al (2008) Multislice computed tomography versus contrast-enhanced ultrasound in evaluation of complex cystic renal masses using the Bosniak classification system Clin Hemorheol Microcirc 39(1–4):171–178Google Scholar
  8. 8.
    Clevert DA, Stock K, Klein B et al (2009) Evaluation of Acoustic Radiation Force Impulse (ARFI) Imaging and contrast enhanced ultrasound in renal tumors of unknown etiology in comparison to histological findings. Clin Hemorheol Microcirc 43(1):129–139PubMedGoogle Scholar
  9. 9.
    Clevert DA, Weckbach S, Minaifar N et al (2008) Contrast-enhanced ultrasound versus MS-CT in blunt abdominal trauma. Clin Hemorheol Microcirc 39(1–4):155–169Google Scholar
  10. 10.
    Curry NS, Cochran ST, Bissada NK (2000) Cystic renal masses: accurate Bosniak classification requires adequate renal CT. AJR Am J Roentgenol 175:339–342PubMedGoogle Scholar
  11. 11.
    Graser A, Zech CJ, Stief CG et al (2009) Imaging renal cell carcinoma Urologe A 48(4):427–436Google Scholar
  12. 12.
    Greis C (2009) Ultrasound contrast agents as markers of vascularity and microcirculation. Clin Hemorheol Microcirc 43(1):1–9PubMedGoogle Scholar
  13. 13.
    Hartman DS, Choyke PL, Hartman MS (2004) A practical approach to the cystic renal mass. Radiographics 24(Suppl 1):S101–S115CrossRefPubMedGoogle Scholar
  14. 14.
    Hartman DS, Weatherby E, Laskin WB et al (1992) Cystic renal cell carcinoma: CT findings simulating benign hyperdense cyst. AJR Am J Roentgenol 159:1235–1237PubMedGoogle Scholar
  15. 15.
    Heckmann M, Heinrich M, Humke U et al (2008) Differentialdiagnosis of focal lesions of the kidney in CT and MRT. Röntgenpraxis 56:219–240CrossRefPubMedGoogle Scholar
  16. 16.
    Horng A, Reiser M, Clevert DA (2009) Aktuelle Entwicklungen in der vaskulären Sonographie. Radiologe 49(11):998–1004CrossRefPubMedGoogle Scholar
  17. 17.
    Israel GM, Bosniak MA (2003) Calcification in cystic renal masses: is it important in diagnosis? Radiology 226:47–52CrossRefPubMedGoogle Scholar
  18. 18.
    Israel GM, Bosniak MA (2003) Follow-up CT of moderately complex cystic lesions of the kidney (Bosniak category IIF). AJR Am J Roentgenol 181:627–633PubMedGoogle Scholar
  19. 19.
    Israel GM, Bosniak MA (2005) How I do it: evaluating renal masses. Radiology 236(2):441–450CrossRefPubMedGoogle Scholar
  20. 20.
    Israel GM, Hindmann N, Bosniak A (2004) Evaluation of cystic renal masses: Comparison of CT and MR Imaging by Using the Bosniak Classification System. Radiology 231:365–371CrossRefPubMedGoogle Scholar
  21. 21.
    Israel GM, Bosniak MA (2005) An update of the Bosniak renal cyst classification system. Urology 66(3):484–488CrossRefPubMedGoogle Scholar
  22. 22.
    Ko K, Kim B, Park B (2004) The use of contrast enhanced ultrasonography in the evaluation of cystic renal masses: comparison with CT [abstr]. In: Radiological Society of North America Scientific Assembly and Annual Meeting Program. Oak Brook, Ill: Radiological Society of North America; 152Google Scholar
  23. 23.
    Kreft B, Schild HH (2003) Cystic renal lesions Rofo 175(7):892–903Google Scholar
  24. 24.
    Kreft B, Flacke S, Conrad R et al (1999) Pathologisch/MR-tomographische Korrelation und Differentialdiagnose von Nierentumoren. Fortschr Röntgenstr 171:106–112Google Scholar
  25. 25.
    Onishi T, Oishi Y, Goto H et al (2001) Cyst-associated renal cell carcinoma: clinicopathological characteristics and evaluation of prognosis in 27 cases. Int J Urol 8:268–274CrossRefPubMedGoogle Scholar
  26. 26.
    Parienty RA, Pradel J, Parienty I (1985) Cystic renal cancers: CT characteristics. Radiology 157:741–744PubMedGoogle Scholar
  27. 27.
    Prantl L, Pfister K, Kubale R et al (2007) Value of high resolution ultrasound and contrast enhanced US pulse inversion imaging for the evaluation of the vascular integrity of free-flap grafts. Clin Hemorheol Microcirc 36(3):203–216PubMedGoogle Scholar
  28. 28.
    Radermacher J (2003) Ultrasonography of kidney and renal vessels. Part II: focal lesions and color Doppler ultrasonography. Internist (Berl) 44:1413–1431Google Scholar
  29. 29.
    Ravine D, Gibson RN, Donlan J et al (1993) An ultrasound renal cyst prevalence survey: specificity data for inherited renal cystic diseases. Am J Kidney Dis 22:803–807PubMedGoogle Scholar
  30. 30.
    Siegel CL, McFarland EG, Brink JA et al (1997) CT of cystic renal masses: analysis of diagnostic performance and interobserver variation. AJR Am J Roentgenol 169:813–818PubMedGoogle Scholar
  31. 31.
    Stock K (2009) Ultrasound of the kidneys and the urinary tract. Nephrologe 4:273–285CrossRefGoogle Scholar
  32. 32.
    Yamashita Y, Watanabe O, Miyazaki T et al (1994) Cystic renal carcinoma: imaging findings and pathologic correlation. Acta Radiol 35:19–24PubMedGoogle Scholar
  33. 33.
    Warren KS, McFarlane J (2005) The Bosniak classification of renal cystic masses. BJU Int 95(7):939–942CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2010

Authors and Affiliations

  • D.-A. Clevert
    • 1
    Email author
  • A. Horng
    • 1
  • M. Staehler
    • 2
  • N. Haseke
    • 2
  • C. Stief
    • 2
  • M. Reiser
    • 1
  1. 1.Institut für Klinische RadiologieUniversitätsklinikum der Universität LMU München – Campus GroßhadernMünchenDeutschland
  2. 2.Urologische Klinik und PoliklinikKlinikum der Universität München – GroßhadernMünchenDeutschland

Personalised recommendations