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Bildgebende radiologische Diagnostik und Verlaufsbeurteilung beim HCC

  • C. J. Zech
  • A. Potthoff
  • J. Ricke
Leitthema
  • 10 Downloads

Zusammenfassung

Hintergrund

Die bildgebende radiologische Diagnostik ist heute aus den Untersuchungen beim hepatozellulären Karzinom (HCC) nicht mehr wegzudenken. Die Multidetektor-Computertomographie (CT) und Magnetresonanztomographie (MRT) spielen hierbei eine entscheidende Rolle. Die Kontrastmittelsonographie (CE-US, „contrast enhanced ultrasound“) stellt zudem für die Charakterisierung des HCC bei einer in der B‑Bild-Sonographie zufällig entdeckten Leberläsion bei Hochrisikopatienten eine Alternative dar.

Methode

Es wurden eine Recherche und Analyse aktueller Literatur durchgeführt.

Ergebnisse

Die CT ist als schnell und universell verfügbare Bildgebungsmodalität eine wichtige Methode zur Diagnostik des HCC. Sie profitiert von den technischen Weiterentwicklungen der letzten Jahrzehnte, die sich neben reduzierter Strahlendosis v. a. in schnellerer Akquisition niederschlagen. Mit der MRT können noch weitere Diagnosekriterien für die Evaluation und Differenzialdiagnose von fokalen Leberläsionen in der zirrhotischen Leber herangezogen werden. Sie ist heute ausreichend robust, um bei den allermeisten Patienten adäquate Bilder zu generieren. Die CE-US ist in der aktuellen nationalen S3-Leitlinie zur Diagnostik und Therapie des HCC als alternatives bildgebendes Verfahren zur CT und MRT für die Charakterisierung des HCC empfohlen, wenn ein unklarer Leberrundherd unabhängig von seiner Größe in einer Hochrisikogruppe in der B‑Bild-Sonographie detektiert wird. Die Vorteile liegen in den geringen Kosten, der raschen Verfügbarkeit, der fehlenden Strahlenbelastung und der fehlenden Nephrotoxizität. Im klinischen Alltag hat sich die Responsebeurteilung mit den mRECIST-Kriterien beim HCC weitestgehend durchgesetzt.

Schlüsselwörter

Leber Computertomographie Magnetresonanztomographie Kontrastmittelsonographie mRECIST-Kriterien 

Radiological imaging and response assessment in HCC

Abstract

Background

Radiological imaging is nowadays an integral part of making the diagnosis in hepatocellular carcinoma (HCC). Multidetector computed tomography (CT) and magnetic resonance imaging (MRI) play a decisive role in this. Contrast-enhanced ultrasound (CE-US) represents an alternative to these for the characterization of incidentally discovered hepatic lesions in B‑image ultrasound in high-risk patients.

Method

A search and analysis of the currently available literature were carried out.

Results

The CT is a rapid and universally available imaging modality which is an important method in the diagnostics of HCC. It has profited from the technical developments over the last decade, which is particularly reflected in the more rapid acquisition in addition to reduced radiation doses. With MRI more diagnostic criteria for the evaluation and differential diagnosis of focal hepatic lesions in a cirrhotic liver can be acquired. Nowadays, it is sufficiently robust to generate adequate images from most patients. In the current national S3 guidelines on the diagnostics and treatment of HCC, CE-US is recommended as an alternative imaging procedure to CT and MRI for characterization of HCC in a high-risk group, when an unclear focal liver nodule is detected in B‑image ultrasound, independent of its size. The advantage lies in the lower costs, rapid availability, lack of radiation exposure and lack of nephrotoxicity. In the clinical routine the response assessment with the mRECIST criteria for HCC has become widely established.

Keywords

Liver Computed tomography Magnetic resonance imaging Contrast-enhanced ultrasound mRECIST criteria 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

C.J. Zech und J. Ricke weisen auf folgende Interessenkonflikte hin: C.J. Zech – Advisory Board und Vortragshonorare von Bayer Healthcare; J. Ricke Research grant und Advisory board Bayer healthcare. A. Potthoff gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Radiologie und NuklearmedizinUniversitätsspital BaselBaselSchweiz
  2. 2.Klinik für Gastroenterologie, Hepatologie und EndokrinologieMedizinische Hochschule HannoverHannoverDeutschland
  3. 3.Klinik und Poliklinik für RadiologieLudwig-Maximilians-Universität MünchenMünchenDeutschland

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