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Die letzten Entwicklungen beim Ultraschall der Leber

Latest developments in ultrasound of the liver

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Zusammenfassung

Im Rahmen der Diagnostik fokaler Leberläsionen wird die Sonographie meist als erstes bildgebendes Verfahren eingesetzt. Neben der primären grundlegenden B-Bild-Optimierung wie „tissue harmonic imaging“ (THI), Spatial-compounding- und Speckle-reduction-Technik hat die Sonographie v. a. mit der Einführung von Ultraschallkontrastmitteln sowohl beim Nachweis als auch der Charakterisierung von Lebermetastasen zu den anderen Schnittbildverfahren aufgeschlossen. Zusätzlich können Volumendarstellungen und die sonographisch gestützte Bildfusion mittels CT oder MRT die Diagnostik und Therapiekontrolle nach Interventionen erleichtern.

In diesem Beitrag sollen die unterschiedlichen neuen Techniken mit ihren Einsatzmöglichkeiten dargestellt und anhand von Bildbeispielen erläutert werden.

Abstract

Abdominal ultrasound (US) is often the first-line imaging modality used to assess focal liver lesions. Due to various new gray-scaled US techniques, such as tissue harmonic imaging (THI), spatial compounding technique and speckle reduction technique, as well as contrast-enhanced techniques, abdominal ultrasound nowadays has great potential regarding detection and characterization of focal liver lesions. Furthermore, image fusion with computed tomography (CT), magnetic resonance imaging (MRI) and 3D ultrasound will most likely help to improve clinical management before and after interventional procedures.

This article illustrates the principles and clinical impact of recently developed techniques in the field of ultrasound.

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Literatur

  1. Bauer A, Solbiati L, Weissman N (2002) Ultrasound imaging with SonoVue: low mechanical index real-time imaging. Acad Radiol 9(Suppl 2):S282–284

    Article  PubMed  Google Scholar 

  2. Bleuzen A, Huang C, Olar M et al (2006) Diagnostic accuracy of contrast-enhanced ultrasound in focal lesions of the liver using cadence contrast pulse sequencing. Ultraschall Med 27(1):40–48

    Article  PubMed  CAS  Google Scholar 

  3. Brenner DJ, Hall EJ (2007) Computed tomography – an increasing source of radiation exposure. N Engl J Med 357(22):2277–2284

    Article  PubMed  CAS  Google Scholar 

  4. Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL Conference. European Association for the Study of the Liver. J Hepatol 35(3):421–430

    Article  PubMed  CAS  Google Scholar 

  5. Chiou SY, Forsberg F, Fox TB, Needleman L (2007) Comparing differential tissue harmonic imaging with tissue harmonic and fundamental gray scale imaging of the liver. J Ultrasound Med 26(11):1557–1563

    PubMed  Google Scholar 

  6. Choi BI (2004) The current status of imaging diagnosis of hepatocellular carcinoma. Liver Transpl 10(2 Suppl 1):S20–25

    Article  PubMed  Google Scholar 

  7. Claudon M, Cosgrove D, Albrecht T et al (2008) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) – update 2008. Ultraschall Med 29(1):28–44

    Article  PubMed  CAS  Google Scholar 

  8. Clevert D-A, Jung EM, Jungius KP et al (2007) Value of tissue harmonic imaging (THI) and contrast harmonic imaging (CHI) in detection and characterisation of breast tumours. Eur Radiol 17(1):1–10

    Article  PubMed  Google Scholar 

  9. Clevert D-A, Jung EM, Pfister K et al (2007) Modern ultrasound diagnostics of deep vein thrombosis in lung embolism of unknown origin. Radiologe 47(8):673–684

    Article  PubMed  Google Scholar 

  10. Clevert D-A, Jung EM, Stock KF et al (2009) Evaluation of malignant liver tumors: biphasic MS-CT versus quantitative contrast harmonic imaging ultrasound. Z Gastroenterol 47(12):1195–1202

    Article  PubMed  Google Scholar 

  11. Downey DB, Fenster A, Williams JC (2000) Clinical utility of three-dimensional US. Radiographics 20(2):559–571

    PubMed  CAS  Google Scholar 

  12. Elliott ST (2008) Volume ultrasound: the next big thing? Br J Radiol 81(961):8–9

    Article  PubMed  CAS  Google Scholar 

  13. Ewertsen C, Henriksen BM, Torp-Pedersen S et al (2011) Characterization by biopsy or CEUS of liver lesions guided by image fusion between ultrasonography and CT, PET/CT or MRI. Ultraschall Med 32(2):191–197

    Article  PubMed  CAS  Google Scholar 

  14. Greis C (2004) Technology overview: SonoVue (Bracco, Milan). Eur Radiol 14(Suppl 8):P11–15

    Article  PubMed  Google Scholar 

  15. Greis C (2009) Ultrasound contrast agents as markers of vascularity and microcirculation. Clin Hemorheol Microcirc 43(1):1–9

    PubMed  Google Scholar 

  16. Greis C (2011) Summary of technical principles of contrast sonography and future perspectives. Radiologe 51:456–461

    Article  PubMed  CAS  Google Scholar 

  17. Harvey CJ, Blomley MJ, Eckersley RJ, Cosgrove DO (2001) Developments in ultrasound contrast media. Eur Radiol 11(4):675–689

    Article  PubMed  CAS  Google Scholar 

  18. Horng A, Reiser M, Clevert D-A (2009) Current developments in vascular ultrasound. Radiologe 49(11):998–1004

    Article  PubMed  CAS  Google Scholar 

  19. Jung EM, Clevert D-A, Lutz R et al (2002) Preoperative wire localisation of breast lesions by tissue harmonic imaging (THI) sonography. Rofo 174(9):1121–1125

    PubMed  CAS  Google Scholar 

  20. Jung EM SA, Schacherer D, Menzel C et al (2009) New real-time image fusion technique for characterization of tumor vascularisation and tumor perfusion of liver tumors with contrast-enhanced ultrasound, spiral CT or MRI: first results. Clin Hemorheol Microcirc (43):57–69

    Google Scholar 

  21. Jung EM, Uller W, Stroszczynski C, Clevert D-A (2011) Contrast-enhanced sonography: therapy control of radiofrequency ablation and transarterial chemoembolization of hepatocellular carcinoma. Radiologe 51:462–468

    Article  PubMed  CAS  Google Scholar 

  22. Kalmantis K, Papageorgiou T, Rodolakis A et al (2007) The role of three-dimensional (3D) sonography and 3D power Doppler in the preoperative assessment of borderline ovarian tumors. Eur J Gynaecol Oncol 28(5):381–385

    PubMed  CAS  Google Scholar 

  23. Lin DC, Nazarian LN, O’Kane PL et al (2002) Advantages of real-time spatial compound sonography of the musculoskeletal system versus conventional sonography. AJR Am J Roentgenol 179(6):1629–1631

    PubMed  Google Scholar 

  24. Mahnken AH, Krombach GA, Hohl C et al (2004) Imaging of the abdominal wall: combination of tissue-harmonic-imaging and extended field-of-view sonography. Rofo 176(12):1837–1842

    PubMed  CAS  Google Scholar 

  25. Michaely HJ, Thomsen HS, Reiser MF, Schoenberg SO (2007) Nephrogenic systemic fibrosis (NSF) – implications for radiology. Radiologe 47(9):785–793

    Article  PubMed  CAS  Google Scholar 

  26. Oldenburg A, Hohmann J, Foert E et al (2005) Detection of hepatic metastases with low MI real time contrast enhanced sonography and SonoVue. Ultraschall Med 26(4):277–284

    Article  PubMed  CAS  Google Scholar 

  27. Polakow J, Janica J, Serwatka W et al (2003) Value of three-dimensional sonography in biopsy of focal liver lesions. J Hepatobiliary Pancreat Surg 10(1):87–89

    PubMed  Google Scholar 

  28. Regge D, Campanella D, Anselmetti GC et al (2006) Diagnostic accuracy of portal-phase CT and MRI with mangafodipir trisodium in detecting liver metastases from colorectal carcinoma. Clin Radiol 61(4):338–347

    Article  PubMed  CAS  Google Scholar 

  29. Ross CJ, Rennert J, Schacherer D et al (2010) Image fusion with volume navigation of contrast enhanced ultrasound (CEUS) with computed tomography (CT) or magnetic resonance imaging (MRI) for post-interventional follow-up after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinomas (HCC): preliminary results. Clin Hemorheol Microcirc 46(2–3):101–115

    Google Scholar 

  30. Sodhi KS, Sidhu R, Gulati M et al (2005) Role of tissue harmonic imaging in focal hepatic lesions: comparison with conventional sonography. J Gastroenterol Hepatol 20(10):1488–1493

    Article  PubMed  Google Scholar 

  31. Stenberg B, Elliott S (2010) Diagnosis of gallbladder problems using three-dimensional ultrasound. Eur Radiol 20(4):908–914

    Article  PubMed  Google Scholar 

  32. Stiskal M, Steinbach R, Obholzer G et al (2000) Tissue harmonic imaging sonography. Is the image quality in routine abdominal ulstrasound improved? Rofo 172(12):1006–1010

    PubMed  CAS  Google Scholar 

  33. Strobel DBT (2006) Diagnostik bei fokalen Leberläsionen. Dtsch Arztebl Int 103(12):789–793

    Google Scholar 

  34. Strobel D, Seitz K, Blank W et al (2008) Contrast-enhanced ultrasound for the characterization of focal liver lesions – diagnostic accuracy in clinical practice (DEGUM Multicenter Trial). Ultraschall Med 29(5):499–505

    Article  PubMed  CAS  Google Scholar 

  35. Von Herbay A, Haeussinger D, Gregor M, Vogt C (2007) Characterization and detection of hepatocellular carcinoma (HCC): comparison of the ultrasound contrast agents SonoVue (BR 1) and levovist (SH U 508A) – comparison of SonoVue and levovist in HCC. Ultraschall Med 28(2):168–175

    Article  Google Scholar 

  36. Watermann DO, Foldi M, Hanjalic-Beck A et al (2005) Three-dimensional ultrasound for the assessment of breast lesions. Ultrasound Obstet Gynecol 25(6):592–598

    Article  PubMed  CAS  Google Scholar 

  37. Wein W, Brunke S, Khamene A et al (2008) Automatic CT-ultrasound registration for diagnostic imaging and image-guided intervention. Med Image Anal 12(5):577–585

    Article  PubMed  Google Scholar 

  38. Wein W, Khamene A, Clevert D-A et al (2007) Simulation and fully automatic multimodal registration of medical ultrasound. Med Image Comput Comput Assist Interv 10(Pt 1):136–143

    PubMed  Google Scholar 

  39. Weskott (2011) Nachweis und Charakterisierung von Lebermetastasen. Radiologe [Epub ahead of print] German

  40. Willinek WA, Falkenhausen M von, Strunk H, Schild HH (2000) Tissue harmonic imaging in comparison with conventional sonography: effect on image quality and observer variability in the measurement of the intima-media thickness in the common carotid artery. Rofo 172(7):641–645

    PubMed  CAS  Google Scholar 

  41. Wilson SR, Gupta C, Eliasziw M, Andrew A (2009) Volume imaging in the abdomen with ultrasound: how we do it. AJR Am J Roentgenol 193(1):79–85

    Article  PubMed  Google Scholar 

  42. Wohrle NK, Hellerhoff K, Reiser MF, Clevert D-A (2010) Modern gray-scale sonography of the breast. Radiologe 50(11):964, 966–972

    Article  PubMed  CAS  Google Scholar 

  43. Zikic D, Wein W, Khamene A et al (2006) Fast deformable registration of 3D-ultrasound data using a variational approach. Med Image Comput Comput Assist Interv 9(Pt 1):915–923

    PubMed  Google Scholar 

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Referent für die Firmen Siemens, Philips, GE, Falk, Bracco.

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Authors and Affiliations

  1. Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland

    D.-A. Clevert, A. Helck, P.M. Paprottka, F. Schwarz & M.F. Reiser

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  1. D.-A. Clevert
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  2. A. Helck
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  3. P.M. Paprottka
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  4. F. Schwarz
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  5. M.F. Reiser
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Correspondence to D.-A. Clevert.

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Clevert, DA., Helck, A., Paprottka, P. et al. Die letzten Entwicklungen beim Ultraschall der Leber. Radiologe 51, 661–670 (2011). https://doi.org/10.1007/s00117-010-2124-4

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