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Kontrastverstärkte Sonographie in der Lymphknotendiagnostik

Contrast-enhanced ultrasound in the diagnostic workup of lymph nodes

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Zusammenfassung

Klinisches/methodisches Problem

Zu den täglichen Aufgaben der sonographischen Diagnostik gehören Detektion und Charakterisierung peripherer und abdomineller Lymphknoten.

Radiologische Standardverfahren

Neben den B‑Mode-Verfahren hat die farbkodierte Dopplersonographie (FKDS) einen festen Stellenwert in der Diagnostik von Lymphknoten (LK).

Methodische Innovationen

Die kontrastverstärkte Sonographie (CEUS) ist in der Gefäß- und Organdiagnostik ein Standardverfahren geworden. Die Gewebeperfusion kann in Echtzeit visuell wie auch retrospektiv mittels zeitabhängiger Intensitätsanalyse erfasst werden. Die Kontrastmitteldosierung richtet sich v. a. nach der Lokalisation der Lymphknoten und des Schallkopftyps sowie der -frequenz. Gefäß- und Tumorzelldichte, intranodaler Druck durch erhöhte Gefäßpermeabilität sowie Erhalt oder Destruktion der Kapsel müssen bei der Interpretation der Befunde bedacht werden.

Leistungsfähigkeit

Die Indikation zur CEUS ergibt sich aus dem B‑Mode- und FKDS-Befund und spielt v. a. beim Vitalitätsnachweis vor und nach Therapie eine wichtige Rolle. Ungleichmäßig oder scheinbar nichtperfundierte Areale ermöglichen eine gezielte Punktion von vitalem Tumorgewebe.

Bewertung

Insbesondere bei abdominellen Lymphknoten weist die CEUS eine hohe diagnostische Zuverlässigkeit auf. Differenzialdiagnostisch können entzündliche und durch Lymphominfiltration veränderte Lymphknoten nicht immer voneinander differenziert werden.

Empfehlung für die Praxis

CEUS hilft durch Darstellung der Mikro- und Makrovaskularisation, Lymphkoten in ihrer Dignität besser einzuschätzen. Nach frustraner Punktion können vitale Bezirke gezielt biopsiert werden. Die CEUS ist v. a. bei der Einschätzung des Therapieerfolgs von großem Wert.

Abstract

Clinical/methodical issue

Daily tasks in sonographic diagnostics include detection and characterization of peripheral and abdominal lymph nodes.

Standard radiological methods

In addition to the B‑mode methods, color-coded Doppler sonography (CCDS) plays an important role in the evaluation of lymph nodes.

Methodical innovations

Contrast-enhanced ultrasound (CEUS) has become a standard procedure in vascular and organ diagnostics. Tissue perfusion can be recorded visually and retrospectively in real time using time-dependent intensity analysis. The contrast agent dosage depends primarily on the location of the lymph nodes and the type and frequency of the transducer. Vascular and tumor cell density, intranodal pressure due to increased vascular permeability and preservation or destruction of the capsule must be taken into account when interpreting the findings.

Performance

The indication for CEUS results from the B‑mode and CCDS findings and plays an important role especially in the verification of vitality before and after therapy. Uneven or apparently non-perfused areas allow a targeted puncture of vital tumor tissue.

Achievements

Especially in abdominal lymph nodes, CEUS has a high diagnostic reliability. It is not always possible to differentiate between inflamed lymph nodes and lymph nodes altered by lymphoma filtration.

Practical recommendations

CEUS helps to better assess the dignity of lymph nodes by visualizing their micro- and macrovascularization. After frustrated puncture, vital areas can be specifically biopsied. CEUS is particularly valuable in assessing the success of therapy.

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Authors and Affiliations

  1. Ultraschall Ambulanz, Klinikum Siloah-Oststadt-Heidehaus, Klinikum Region Hannover, Stadionbrücke 4, 30459, Hannover, Deutschland

    H.‑P. Weskott

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

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Weskott, H. Kontrastverstärkte Sonographie in der Lymphknotendiagnostik. Radiologe 58, 563–571 (2018). https://doi.org/10.1007/s00117-018-0389-1

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