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Radiologische Abklärung inzidenteller pulmonaler Rundherde

Radiological evaluation of incidental pulmonary nodules

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Zusammenfassung

Der Nachweis pulmonaler Rundherde hat sich in den letzten Jahren vervielfacht. Die hohe Prävalenz von Rundherden, von denen die große Mehrheit benigne ist, stellt ein häufiges Problem in der klinischen Routine dar. Ziel der bildgebenden Diagnostik ist es, bei der Abklärung von pulmonalen Rundherden maligne Prozesse mit hoher diagnostischer Sicherheit von benignen Veränderungen zu differenzieren. Das diagnostische Vorgehen richtet sich dabei nach der Vortestwahrscheinlichkeit, dass der Rundherd maligne ist. Kleine Rundherde (<8 mm) werden durch Verlaufsuntersuchungen weiter beobachtet, wobei sich die Intervalle nach der klinischen Vortestwahrscheinlichkeit und der Größe richten. Größerer Rundherde (>8 mm) werden entweder durch Verlaufsuntersuchungen oder eine PET/CT weiter nicht-invasiv abgeklärt oder biopsiert. Bei sehr hoher Vortestwahrscheinlichkeit für das Vorliegen einer Malignität wird eine Resektion des Rundherds empfohlen.

Abstract

Since the widespread use of computed tomography (CT), the detection of pulmonary nodules has considerably increased and has become part of the daily clinical routine. In the evaluation of pulmonary nodules, malignant nodules have to be differentiated from benign pulmonary nodules with a high level of confidence. The diagnostic approach for pulmonary nodules depends on the pretest probability for malignancy. For indeterminate pulmonary nodules <8 mm, non-contrast CT observational follow-up is recommended and depending on the size and pretest probability for malignancy, follow-up CT intervals range from 3 to 12 months. For indeterminate pulmonary nodules >8 mm, management is based on patient surgical risk and pretest probability for malignancy. Either CT follow-up alone, 18-fluorodeoxyglucose-positron emission tomography (FDG-PET) or non-surgical biopsy for tissue diagnosis are utilized to evaluate the lesions. For pulmonary nodules with a high pretest probability for malignancy, surgical resection is recommended unless specifically contraindicated.

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Authors and Affiliations

  1. Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Allgemeines Krankenhaus Wien, Währingergürtel 18–22, A-1090, Wien, Österreich

    H. Prosch

  2. Radiologie, Meander Medical Center, Ameersfoort und Radboud Universitaet, Nijmegen, Niederlande

    C. Schaefer-Prokop

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Correspondence to H. Prosch.

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Prosch, H., Schaefer-Prokop, C. Radiologische Abklärung inzidenteller pulmonaler Rundherde. Radiologe 53, 623–638 (2013). https://doi.org/10.1007/s00117-013-2530-5

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