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Radiologische Diagnostik zerebraler Metastasen

Radiological diagnosis of cerebral metastases

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Die radiologische Bildgebung spielt beim Nachweis von Hirnmetastasen (HM) eine Schlüsselrolle.

Ziel

In dieser Übersichtsarbeit soll der Stellenwert der Magnetresonanztomographie (MRT) und Computertomographie (CT) beim Nachweis von HM dargestellt werden. Neben typischen CT- und MRT-Bildbefunden werden technische Aspekte zur verbesserten Darstellung beschrieben und Differenzialdiagnosen erläutert.

Material und Methoden

Diese Übersichtsarbeit basiert auf eigenen Erfahrungen sowie relevanten Publikationen der letzten Jahre.

Ergebnisse

Bildgebende Methode der Wahl in der Diagnostik von HM ist die kontrastmittelverstärkte MRT. Dabei können eine Erhöhung der Kontrastmitteldosis sowie verschiedene MR-Techniken die Abgrenzbarkeit verbessern und die Nachweisrate erhöhen. Der Einsatz neuer funktionell-dynamischer MR-Verfahren wie Diffusions-MR, Perfusions-MR und MR-Spektroskopie erleichtert die Differenzialdiagnose und verbessert die Verlaufskontrolle. Falls die CT zur Diagnostik von HM eingesetzt wird, sollte diese mit erhöhter Kontrastmitteldosis, kombiniert mit einer Scanverzögerung, erfolgen.

Schlussfolgerungen

Die MRT hat insbesondere als multimodale MRT die höchste Sensitivität beim Nachweis von HM und sollte der CT vorgezogen werden.

Abstract

Background

Imaging plays a key role in the diagnosis of central nervous system (CNS) metastases.

Objective

In this review the role of magnetic resonance imaging (MRI) and computed tomography (CT) in the work-up of cerebral metastases is presented. In addition to characteristic imaging findings technical aspects for improved detection of CNS metastases and differential diagnoses are shown.

Material and methods

This review is based on own experience and relevant recent publications.

Results

In the diagnosis of CNS metastases contrast-enhanced MRI is the radiological method of choice. The sensitivity can be further increased by increasing contrast medium dose as well as the use of various magnetization transfer techniques. Functional MRI techniques, such as magnetic resonance spectroscopy, perfusion and diffusion-weighted imaging, diffusion tensor imaging and dynamic contrast-enhanced imaging can further improve the differential diagnosis and detection of recurrent disease. If CT is used for diagnostics of cerebral metastases it should be performed with increased contrast combined with a scan delay.

Conclusions

Contrast-enhanced MRI ideally using a multimodal protocol is the most sensitive method for the detection of CNS metastases and should therefore be preferred to CT.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. T. Engelhorn und A. Dörfler geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Abteilung für Neuroradiologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Deutschland

    T. Engelhorn & A. Dörfler

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  1. T. Engelhorn
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  2. A. Dörfler
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Correspondence to T. Engelhorn.

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Engelhorn, T., Dörfler, A. Radiologische Diagnostik zerebraler Metastasen. Onkologe 20, 20–30 (2014). https://doi.org/10.1007/s00761-013-2557-2

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  • DOI: https://doi.org/10.1007/s00761-013-2557-2

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