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Sonographie bei Leberzirrhose: von der TIPSS-Funktionsprüfung zur LI-RADS®-Klassifikation

Ultrasonography in hepatic cirrhosis: from the TIPSS function test to the LI-RADS® classification

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Zusammenfassung

Die Abdomensonographie hat in der Diagnostik und beim therapeutischen Management einer Leberzirrhose einen hohen Stellenwert. Wichtigste Kriterien für die sonographische Diagnose einer Leberzirrhose sind inhomogenes Parenchym, eine unregelmäßige Leberoberfläche und eine Rarefizierung der Lebervenen. Komplikationen, wie die portale Hypertension, Aszites und ein hepatozelluläres Karzinom (HCC), können erfasst werden. Nach Anlage eines transjugulären intrahepatischen portosystemischen Stentshunts (TIPSS) ist die Perfusion des TIPSS und der Pfortader sonographisch zu kontrollieren. Eine Abdomensonographie im Rahmen des HCC-Screenings wird bei Patienten mit Leberzirrhose alle 6 Monate empfohlen. Bei unklarer Leberraumforderung ist die Durchführung einer Kontrastmittelsonographie (CEUS) der nächste Schritt. Standardisierte CEUS-basierte Diagnosealgorithmen können die nichtinvasive Diagnose eines HCC erleichtern.

Abstract

Abdominal ultrasound helps in the diagnostic and therapeutic management of hepatic cirrhosis. Important sonographic criteria for the diagnosis of liver cirrhosis are inhomogeneous parenchyma, irregular liver surface, and rarefication of hepatic veins. Sonography detects complications such as portal hypertension, ascites, or hepatocellular carcinoma (HCC). After implantation of a transjugular intrahepatic portosystemic shunt (TIPSS), sonographic evaluation of perfusion of both TIPSS and portal vein is mandatory. A sonographic screening for HCC is recommended every 6 months in liver cirrhosis and patients at risk. In case of an unclear focal liver lesion, contrast-enhanced ultrasound (CEUS) should be performed. Standardized CEUS-based diagnostic algorithms may facilitate non-invasive diagnosis of HCC.

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Authors and Affiliations

  1. Medizinische Klinik 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland

    R. S. Görtz &  B. Schellhaas

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  1. R. S. Görtz
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  2. B. Schellhaas
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Correspondence to R. S. Görtz.

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R.S. Görtz und B. Schellhaas geben an, dass kein Interessenkonflikt besteht.

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

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M. Friedrich-Rust, Frankfurt

M. Gebel, Hannover

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Görtz, R.S., Schellhaas, B. Sonographie bei Leberzirrhose: von der TIPSS-Funktionsprüfung zur LI-RADS®-Klassifikation. Gastroenterologe 13, 292–297 (2018). https://doi.org/10.1007/s11377-018-0270-9

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