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Moderne CT- und PET/CT-Bildgebung der Leber

Modern CT and PET/CT imaging of the liver

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Zusammmenfassung

Die Computertomographie (CT) ist heute breit verfügbar und stellt eine wichtige und schnelle Methode zur Diagnostik akuter Lebererkrankungen, der Artdiagnostik fokaler Leberläsionen und der Planung interventioneller Therapiemaßnahmen sowie der postinterventionellen Kontrolle dar. In den letzten Jahren hat die CT trotz des zunehmenden Stellenwerts der Magnetresonanztomographie (MRT) nicht an Bedeutung verloren. Durch den Einsatz unterschiedlicher Kontrastmittelphasen kann meist eine gute Charakterisierung von Raumforderungen erfolgen. Bei der Diagnostik des hepatozellulären Karzinoms (HCC) sollte beispielsweise immer ein triphasisches Untersuchungsprotokoll angewendet werden. Mit Einführung der Dual-energy-CT hat die Sensitivität in der Darstellung hyper- und hypovaskularisierter Leberläsionen zugenommen. Ebenfalls ist es durch virtuelle native Bilder möglich geworden, auf eine zusätzliche native Bildgebung zu verzichten, wodurch die Strahlenexposition des Patienten vermindert werden kann. Die PET/CT hat in der onkologischen Bildgebung den Vorteil, dass nahezu der gesamte Körper des Patienten abgebildet wird. Hier ist auch die Hauptindikation der PET/CT zu sehen (Ganzkörperstaging). Bei rein hepatischer Fragestellung hat die FDG-PET/CT unter Verwendung diagnostischer CT-Daten zwar eine höhere Genauigkeit als die CT alleine, ist der MRT jedoch unterlegen.

Abstract

Computed tomography (CT) is now widely available and represents an important and rapid method for the diagnostics of acute liver disease, characterization of focal liver lesions, planning of interventional therapy measures and postintervention control. In recent years CT has not become less important despite the increasing value of magnetic resonance imaging (MRI). By the use of different contrast medium phases good characterization of space-occupying lesions can be achieved. For the diagnostics of hepatocellular carcinoma (HCC) a triphasic examination protocol should always be implemented. The introduction of dual energy CT increased the sensitivity of imaging of hypervascularized and hypovascularized liver lesions and by the use of virtual native imaging it has become possible to avoid additional native imaging which reduces the x-ray exposition of patients. Positron emission tomography (PET) has an advantage for imaging in oncology because nearly the complete body of the patient can be screened and this is the main indication for PET/CT (whole-body staging). For purely hepatic problems 18F-fluorodeoxyglucose (FDG)-PET/CT using diagnostic CT data has a higher precision than CT alone but is inferior to MRI.

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Authors and Affiliations

  1. Institut für Diagnostische und Interventionelle Radiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    J. Klasen, T.A. Heusner, C. Riegger, D. Reichelt, J. Kuhlemann, G. Antoch  & D. Blondin

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  1. J. Klasen
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  2. T.A. Heusner
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  3. C. Riegger
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  4. D. Reichelt
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  5. J. Kuhlemann
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  6. G. Antoch
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  7. D. Blondin
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Correspondence to J. Klasen.

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Klasen, J., Heusner, T., Riegger, C. et al. Moderne CT- und PET/CT-Bildgebung der Leber. Radiologe 51, 671–679 (2011). https://doi.org/10.1007/s00117-010-2125-3

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