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Moderne Bildgebung von Nierentumoren

Modern imaging of kidney tumors

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Zusammenfassung

Die bildgebenden Verfahren stellen bei Patienten mit Verdacht auf Nierenraumforderungen die Hauptsäule der klinischen Diagnostik dar. In den letzten Jahren haben sich enorme Fortschritte erzielen lassen, die eine genaue artdiagnostische Einordnung von Nierenpathologien in der Mehrzahl der Fälle zweifelsfrei erlauben. Nach wie vor ist die Methode der ersten Wahl die Ultraschalluntersuchung, wobei für die Beurteilung von Nierenraumforderungen KM gegeben werden sollte. Die hier vorliegende Arbeit zeigt das Potential dieser Modalität ebenso auf wie neuste Entwicklungen auf dem Gebiet der Mehrzeilencomputertomographie, bei der besonders die sog. „Dual energy-Bildgebung“ hervorzuheben ist – diese hat das Potential zu signifikanter Dosisreduktion und Verbesserung der Charakterisierung von Nierentumoren. Weiterhin kommt die Magnetresonanztomographie bei unklaren Befunden der beiden zuvor genannten Verfahren sowie bei jungen Patienten und bekannter Allergie gegen jodhaltiges KM zum Einsatz. Sie erlaubt mittels hoher Feldstärken, schneller Gradientenmagneten und stark verbesserter Ortsauflösung eine sehr detailgenaue Abbildung von Nierenraumforderungen.

Die Lektüre der hier vorliegenden Arbeit soll unseren urologischen Kollegen den Stellenwert der oben genannten Verfahren sowie ihre Indikationen und Kontraindikationen nahebringen; zudem wird eine Übersicht über die wichtigsten Nierenraumforderungen und ihre radiologische Darstellung gegeben.

Abstract

If a renal mass is suspected on clinical examination or ultrasound the finding has to be confirmed by cross-sectional imaging. Methods that are used include multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). Also contrast-enhanced ultrasound has been successfully implemented in renal imaging and now plays a major role in the differentiation of benign from malignant renal masses. In expert hands it can be used to show very faint vascularization and subtle enhancement. The MDCT technique benefits from the recently introduced dual energy technology that allows superior characterization of renal masses in a single-phase examination, thereby greatly reducing radiation exposure. For young patients and persons allergic to iodine MRI should be used and it provides excellent soft tissue contrast and visualizes contrast enhancement kinetics in multiphase examinations.

This article aims at giving a comprehensive overview of these different imaging modalities, their clinical indications and contraindications, as well as a description of imaging findings of various renal masses.

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Correspondence to PD Dr. A. Graser.

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Clevert, D., Sterzik, A., Braunagel, M. et al. Moderne Bildgebung von Nierentumoren. Urologe 52, 515–526 (2013). https://doi.org/10.1007/s00120-012-3098-9

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Schlüsselwörter

  • Nierentumor
  • Ultraschall
  • Kontrastmittel
  • Computertomographie
  • Magnetresonanztomographie

Keywords

  • Renal mass
  • Ultrasound
  • Contrast agent
  • Computed tomography
  • Magnetic resonance imaging