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CEUS – Diagnostik zystischer Nierenläsionen

CEUS—diagnostic workup of cystic renal lesions

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Zusammenfassung

Klinisches/methodisches Problem

Zystische Nierenläsionen sind ein häufiger Zufallsbefund in radiologischen Schnittbildgebungsverfahren und sollten sicher als gut- bzw. bösartig eingestuft werden können.

Radiologisches Standardverfahren

Anhand der nativen B‑Bild-Sonographie bzw. mit Hilfe der farbkodierten Duplexsonographie können zystische Nierenläsionen nicht immer sicher charakterisiert werden.

Methodische Innovationen

Mit Hilfe des kontrastmittelverstärkten Ultraschalls („contrast-enhanced ultrasound“, CEUS) ist es möglich, die Vaskularisation zystischer Nierenläsionen dynamisch zu evaluieren. Unter Einsatz der Bosniak-Klassifikation ist es dadurch möglich, den Grad einer potenziellen Malignität der zystischen Nierenläsion abzuschätzen und daraus weitere Empfehlungen für das weitere Vorgehen abzuleiten. Dabei kann der CEUS durch die fehlende Hepato- bzw. Nephrotoxizität auch dann zum Einsatz kommen, wenn andere radiologische bildgebende Verfahren kontraindiziert sind.

Leistungsfähigkeit

Zystische Nierenläsionen können mithilfe des CEUS mit einer diagnostischen Sicherheit von über 90 % zuverlässig charakterisiert werden.

Bewertung

Der CEUS ist geeignet, einen wichtigen Beitrag in der Diagnostik und Charakterisierung von zystischen Nierenläsionen zu leisten.

Empfehlung für die Praxis

Der CEUS bietet sich in unklaren Fällen als hervorragendes ergänzendes radiologisches Verfahren zur Diagnostik und Charakterisierung unklarer zystischer Nierenläsionen an.

Abstract

Clinical/methodical issue

Cystic renal lesions are common incidental findings in radiological imaging and they should be adequately examined to be able to characterize them as benign or malignant.

Standard radiological methods

It is not always possible to sufficiently characterize cystic renal lesion solely using native B‑mode sonography and color-Doppler sonography.

Methodical innovations

Using contrast-enhanced ultrasound (CEUS), it is possible to dynamically evaluate the perfusion of cystic renal lesions and to characterize the potential malignancy of these lesions using the Bosniak classification in order to give recommendations regarding further work-up. CEUS can also be used in patients with contraindications for other radiological imaging modalities as it uses a contrast agent with almost no side effects.

Performance

Using CEUS, cystic renal lesions can be reliably characterized with a diagnostic accuracy greater than 90%.

Achievements

CEUS is a useful method in diagnosing and characterizing unclear cystic renal lesions and should always be considered as a viable diagnostic tool.

Practical recommendations

CEUS should always be performed in initially unclear cases and is a useful additional tool for the diagnosis and characterization of unclear cystic renal lesions.

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Authors and Affiliations

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

    J. Rübenthaler, K. Mueller-Peltzer, G. Negrão de Figueiredo, E. Gresser & D. A. Clevert

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  1. J. Rübenthaler
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  2. K. Mueller-Peltzer
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  3. G. Negrão de Figueiredo
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  4. E. Gresser
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  5. D. A. Clevert
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Correspondence to J. Rübenthaler.

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Interessenkonflikt

J. Rübenthaler, K. Mueller-Peltzer, G. Negrão de Figueiredo, E. Gresser 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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Rübenthaler, J., Mueller-Peltzer, K., Negrão de Figueiredo, G. et al. CEUS – Diagnostik zystischer Nierenläsionen. Radiologe 58, 545–552 (2018). https://doi.org/10.1007/s00117-018-0394-4

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