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Kontrastmittelsonographie (CEUS) und Bildfusion zur Durchführung von Leberinterventionen

Contrast-enhanced ultrasound (CEUS) and image fusion for procedures of liver interventions

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Zusammenfassung

Klinisches/methodisches Problem

Der kontrastmittelverstärkte Ultraschall (CEUS) gewinnt zunehmend an Bedeutung für die Erkennung und Charakterisierung maligner Leberläsionen und ermöglicht durch die Bildgebung eine perkutane Behandlung, wenn eine Operation nicht möglich ist. Die zusätzliche Kombination der Bildfusion mit Computertomographie (CT) und Magnetresonanztomographie (MRT) eröffnet weitere Möglichkeiten zur gezielten Untersuchung oder einer modifizierten Tumorbehandlung.

Methodische Innovationen

Die Fusionsbildgebung bietet die Möglichkeit der Echtzeit-Bildgebung und kann mit anderen schnittbildgebenden Verfahren sowie mit CEUS kombiniert werden.

Leistungsfähigkeit

Die Sonographie hat mit der Einführung von Ultraschallkontrastmitteln und der Bildfusion sowohl beim Nachweis als auch bei der Charakterisierung von Leberläsionen zu den anderen Schnittbildverfahren aufgeschlossen. Zusätzlich kann dieses Verfahren auch zur Intervention genutzt werden. Die Erfolgsrate von fusionsgesteuerten Punktionen oder CEUS-unterstützten Tumorablationen liegt je nach Literatur zwischen 80–100 %.

Bewertung

Die sonographisch gestützte Bildfusion mittels CT oder MRT kann, in Kombination mit CEUS, die Diagnostik und Therapiekontrolle nach Interventionen der Leber erleichtern.

Empfehlung für die Praxis

Neben den primären Anwendungen der Bildfusion im Rahmen der Diagnostik und Therapie von Leberläsionen lassen sich noch weitere sinnvolle Indikationen in die tägliche Routine integrieren. Hierzu gehören z. B. intraoperative und vaskuläre Anwendungen sowie Einsatzmöglichkeiten bei anderen Organsystemen.

Abstract

Clinical/methodical issue

Contrast-enhanced ultrasound (CEUS) is becoming increasingly important for the detection and characterization of malignant liver lesions and allows percutaneous treatment when surgery is not possible. Contrast-enhanced ultrasound image fusion with computed tomography (CT) and magnetic resonance imaging (MRI) opens up further options for the targeted investigation of a modified tumor treatment.

Methodical innovations

Ultrasound image fusion offers the potential for real-time imaging and can be combined with other cross-sectional imaging techniques as well as CEUS.

Performance

With the implementation of ultrasound contrast agents and image fusion, ultrasound has been improved in the detection and characterization of liver lesions in comparison to other cross-sectional imaging techniques. In addition, this method can also be used for intervention procedures. The success rate of fusion-guided biopsies or CEUS-guided tumor ablation lies between 80 and 100% in the literature.

Achievements

Ultrasound-guided image fusion using CT or MRI data, in combination with CEUS, can facilitate diagnosis and therapy follow-up after liver interventions.

Practical recommendations

In addition to the primary applications of image fusion in the diagnosis and treatment of liver lesions, further useful indications can be integrated into daily work. These include, for example, intraoperative and vascular applications as well applications in other organ systems.

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Author information

Authors and Affiliations

  1. Interdisziplinäres Ultraschallzentrum und Institut für diagnostische Radiologie, Universitätsklinikum Regensburg, Franz-Josef Strauß Alle 11, 93042, Regensburg, Deutschland

    E. M. Jung

  2. Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschall-Zentrum, Universitätsklinikum der Ludwig-Maximilians-Universität München, München, Deutschland

    D. A. Clevert

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Correspondence to E. M. Jung.

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Interessenkonflikt

E.M. Jung 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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Jung, E.M., Clevert, D.A. Kontrastmittelsonographie (CEUS) und Bildfusion zur Durchführung von Leberinterventionen. Radiologe 58, 538–544 (2018). https://doi.org/10.1007/s00117-018-0411-7

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