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CEUS – Diagnostik maligner Leberläsionen

CEUS—Diagnostic of malignant liver lesions

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Zusammenfassung

Klinisches/methodisches Problem

Radiologische bildgebende Verfahren bzw. der konventionelle Ultraschall sind nicht immer in der Lage, maligne Leberläsionen zu identifizieren und zu charakterisieren.

Radiologische Standardverfahren

Die Beurteilung maligner Leberläsionen im konventionellen Ultraschall erfolgte anhand morphologischer Kriterien wie Echostruktur, Begrenzung und Form, erforderte aber häufig den zusätzlichen Einsatz von kontrastmittelgestützter Computertomographie (CT), Magnetresonanztomographie (MRT) oder Biopsie.

Methodische Innovationen

Kontrastverstärkter Ultraschall („contrast-enhanced ultrasound“, CEUS) ist ein relativ sicheres Bildgebungsverfahren, das für die Detektion und Charakterisierung jeder Art von Leberläsionen Anwendung findet. Nach Kontrastmittelapplikation können deren Vaskularisation sowie die Leberperfusion in Echtzeit während der arteriellen, portalvenösen und Spätphase dargestellt werden.

Leistungsfähigkeit

Durch die unterschiedlichen Vaskularisationsmuster des Kontrastmittels ist es möglich, Leberläsionen mit hoher diagnostischer Genauigkeit (über 90 %) zu differenzieren.

Bewertung

CEUS ist eine hilfreiche, ergänzende Technik zur Schnittbildgebung in der Evaluation unklarer Leberläsionen und kann den Einsatz der Kontrastmittel-MRT oder -CT in vielen Fällen erübrigen.

Empfehlung für die Praxis

CEUS ermöglicht die Detektion und Charakterisierung von Leberläsionen in Echtzeit.

Abstract

Clinical/methodical issue

Cross-sectional modalities or conventional ultrasound are not always able to sufficiently identify and characterize malignant liver lesions.

Standard radiological methods

The evaluation of malignant liver lesions in conventional ultrasound relies on echostructure, shape and borders, but often warrants additional contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) studies.

Methodical innovations

Contrast-enhanced ultrasound (CEUS) is a relatively safe imaging technique used for the detection and characterization of malignant liver lesions. The use of a second-generation contrast agent in dynamic real-time imaging allows the visualization of vascularization in any kind of liver lesion as well as liver perfusion during the arterial, portal venous and late phase.

Performance

Due to the different enhancement patterns, it is possible to differentiate a liver lesion with high diagnostic accuracy (over 90%).

Achievements

CEUS is a helpful complementary technique to cross-sectional imaging for the evaluation of unclear liver lesions and may frequently obviate additional contrast-enhanced MRI or CT studies.

Practical recommendations

CEUS enables the detection and characterization of liver lesions in real time.

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Authors and Affiliations

  1. Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschall-Zentrum, Universitätsklinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland

    G. Negrão de Figueiredo, K. Müller-Peltzer, J. Rübenthaler & D. A. Clevert

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  1. G. Negrão de Figueiredo
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  2. K. Müller-Peltzer
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  3. J. Rübenthaler
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  4. D. A. Clevert
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Correspondence to G. Negrão de Figueiredo.

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Interessenkonflikt

G. Negrão de Figueiredo, K. Mueller-Peltzer, J. Rübenthaler und D.A. Clevert geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Negrão de Figueiredo, G., Müller-Peltzer, K., Rübenthaler, J. et al. CEUS – Diagnostik maligner Leberläsionen. Radiologe 58, 528–537 (2018). https://doi.org/10.1007/s00117-018-0386-4

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