Zusammenfassung
Klinisches/methodisches Problem
Nierentumoren werden immer früher erkannt, häufig als Zufallsbefund bei Ultraschalluntersuchungen. Die Differenzialdiagnostik der verschiedenen Tumorentitäten ist schwierig.
Radiologische Standardverfahren
Alle Nierentumoren >1 cm sollten mittels CT/MRT untersucht werden, um bösartige Nierenläsionen auszuschließen. Zeigt der Nierentumor keinen Fettnachweis, werden die Patienten je nach Befund entweder weiterer Diagnostik oder einer tumorstadiengerechten urologischen Therapie zugeführt.
Methodische Innovationen
Durch kontrastverstärkten Ultraschall (CEUS) kann dabei im Rahmen einer multimodalen Ultraschalluntersuchung die Mikroperfusion von Nierentumoren exakt erfasst werden.
Leistungsfähigkeit
Bei papillären Nierenzellkarzinomen kann CEUS helfen, eingeblutete Zysten von Tumoren zu unterscheiden. Zudem kann mittels CEUS die Nierentumordetektion im Vergleich zu klassischen Ultraschallmodalitäten bei schwierigen anatomischen Verhältnissen verbessert werden. Pseudoläsionen, Parenchymzapfen im Nierenparenchym können mittels CEUS sicher diagnostiziert werden.
Bewertung
Eine sichere Trennung zwischen benignen und malignen Nierenläsionen >1 cm gelingt mittels CEUS nur in Ausnahmefällen. Das Verfahren jedoch geeignet, auch bei fokaler Pyelonephritis, Abzessen und Lymphomverdacht wichtige differenzialdiagnostische Informationen zu liefern und auch ultraschallgesteuerte Tumorbiopsien optimal zu planen.
Empfehlung für die Praxis
Entscheidend für die exakte Diagnostik bei Nierentumoren ist die Zusammenschau unterschiedlicher bildgebender Möglichkeiten in einem interdisziplinären Tumorboard zur individuellen Therapieentscheidung unter Berücksichtigung aller bildgebenden Informationen. Die CEUS von Nierenläsionen sollte als Videos präsentiert und kommentiert werden.
Abstract
Clinical issue
Renal lesions are detected earlier, often as a result of ultrasound examinations. However, the imaging-based differential diagnosis of different tumour entities remains challenging
Standard radiological methods
All renal tumours >1 cm should be evaluated for malignancy by computed tomography (CT) or magnetic resonance imaging (MRI). If an angiomyolipoma diagnosis cannot be established with imaging, further diagnostics are appropriate or if malignant progression is suspected, then multidisciplinary discussion for TNM-staging based uro-oncologic therapy is usual.
Methodical innovations
Contrast-enhanced ultrasound (CEUS) gives clear information about the microperfusion of renal tumours.
Performance
CEUS is helpful for the differentiation of renal cysts and especially papillary renal cell carcinomas. Moreover, CEUS advances renal tumour detection compared to B‑mode and Doppler ultrasound per se. Cortical pseudolesions may be confidently ruled out using CEUS.
Achievements
Clear differentiation of benign and malignant renal lesions >1 cm remains challenging, and only in rare cases is it possible with CEUS alone. Nevertheless CEUS is, in combination with other ultrasound techniques, eminently suitable for diagnosing focal pyelonephritis, renal abscesses and suspected renal lymphoma and supports the planning of ultrasound-assisted tumour biopsies.
Practical recommendations
Combining different imaging techniques is essential to accurately diagnose renal tumors. These imaging results (including the ultrasound/CEUS clips) should be viewed by the multidisciplinary cancer tumour board to facilitate individual treatment concepts for each patient.
Change history
25 January 2019
Erratum zu:
Radiologe 2018
https://doi.org/10.1007/s00117-018-0392-6
Im genannten Beitrag wurde leider die Abb. 8 fehlerhaft wiedergegeben. Wir bitten darum, die korrigierte Version des Algorithmus zu beachten (Abb. 8).
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K. Stock, H. Kübler, T. Maurer, J. Slotta-Huspenina und K. Holzapfel geben an, dass kein Interessenkonflikt besteht.
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Stock, K., Kübler, H., Maurer, T. et al. CEUS – Diagnostik solider Nierentumoren. Radiologe 58, 553–562 (2018). https://doi.org/10.1007/s00117-018-0392-6
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DOI: https://doi.org/10.1007/s00117-018-0392-6