Zusammenfassung
Fokale Leberläsionen können maligne Erkrankungen und gutartige Veränderungen darstellen. Bei den malignen Läsionen sind neben dem hepatozellulären Karzinom v. a. Lebermetastasen zu nennen. Dagegen sind gutartige Läsionen wie die fokal noduläre Hyperplasie und hepatozelluläre Adenome seltener anzutreffen. Verschiedene radiologische Verfahren werden zur (Diffenzial)diagnose eingesetzt. Die transabdominelle Ultraschalluntersuchung wird durch Farbdopplerverfahren, den kontrastverstärkten bzw. intraoperativen Ultraschall ergänzt. Die Computertomographie sollte sowohl nativ als auch nach Applikation moderner nichtionischer jodhaltiger wasserlöslicher Kontrastmittel durchgeführt werden, Standard ist heute die Multidetektor-Spiral-CT. Bei vergleichbarer optimaler Technik vor Ort ist jedoch dem (kontrastverstärkten) MRT der Vorzug zu geben. Durch die Schnittbildverfahren hat die intraarterielle selektive Angiographie ihre Bedeutung in Nachweis und Charakterisierung von herdförmigen Leberveränderungen vollständig verloren. Die Frage, ob eine sonographie- oder CT-gestützte Leberbiopsie zur weiterführenden Diagnostik notwendig, ein abwartendes Verhalten gerechtfertigt oder eine Operation zur Abklärung der Diagnose nötig ist, ist stets individuell zu beantworten.
Abstract
Besides malignant disease, focal liver lesions can also represent benign changes. Among the malignant lesions, in addition to hepatocellular carcinoma, liver metastases should be mentioned. In contrast, benign lesions such as focal nodular hyperplasia and hepatocellular adenoma are rarely encountered. Various radiological procedures are employed for the (differential) diagnosis. The transabdominal ultrasound examination is supplemented by color Doppler procedures, contrast-enhanced or intraoperative ultrasound. Computed tomography (CT) should be performed with native images as well as after using modern nonionic, iodine-containing water-soluble contrast agents; multidetector spiral CT is today’s standard. If comparable optimal technology is available on-site, (contrast-enhanced) MRI is preferable. Intra-arterial selective angiography has become less important for detecting and characterizing focal liver changes with the advent of tomographic procedures. The question of whether sonography- or CT-guided biopsy of the liver is needed for further diagnostic work-up, whether a wait-and-see approach is justified, or whether surgery is required to clarify the diagnosis should always be answered on a case-by-case basis.
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Danksagung
Die Abb. 9a–c wurden freundlicherweise durch das Institut für Röntgendiagnostik des Klinikums rechts der Isar der Technischen Universität München (Direktor: Prof. Dr. E.J. Rummeny) überlassen.
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Der korrespondierende Autor weist auf folgende Beziehung/en hin: Referentenhonorare für Fa. Altana.
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Layer, G., Bohrer, M. Radiologische Diagnostik von Lebertumoren. Radiologe 47, 819–832 (2007). https://doi.org/10.1007/s00117-007-1553-1
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DOI: https://doi.org/10.1007/s00117-007-1553-1
Schlüsselwörter
- Lebertumoren
- Hepatozelluläres Karzinom
- Kontrastverstärkte Sonographie
- Multidetektor-Spiralcomputertomographie