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Moderne Schnittbildgebung für urologische Erkrankungen

Modern tomography imaging techniques in urological diseases

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Zusammenfassung

Hintergrund

Radiologische Bildgebung spielt eine wichtige Rolle bei Detektion, Staging und Nachsorge von urologischen Tumoren. Grundlegende Therapieentscheidungen sowohl bei onkologischen (operative vs. systemische Therapie, z. B. bei Hodentumoren) als auch bei nichtonkologischen Pathologien (interventionelle vs. konservative Therapie z. B. bei Harnleitersteinen) hängen zum Großteil von der durchgeführten Schnittbildgebung ab. Die Computertomographie (CT) hat aufgrund ihrer fast ubiquitären Verfügbarkeit, Schnelligkeit und Kosteneffizienz nicht nur in der Abklärung von abdominellem Traumen und nicht-traumatischen Notfällen, sondern auch beim Staging und Follow-up onkologischer Patienten ihren Platz gefunden. Die Indikation zur CT sollte jedoch unter Berücksichtigung der Strahlenbelastung streng indiziert werden. Eine eingeschränkte Nierenfunktion und Allergien auf jodhaltige Kontrastmittel limitieren zudem den Einsatz der CT. Die Magnetresonanztomographie (MRT) stellt ohne den Einsatz ionisierender Strahlung mit funktionell spezifischen Protokollen und hohem Weichteilkontrast eine gute Alternative für viele Einsatzgebiete in der onkologischen und nichtonkologischen Bildgebung dar.

Ziel der Arbeit

Nachfolgend soll eine Übersicht über wesentliche Indikationen der CT-/MRT-Abdomen/-Becken in der Urologie gegeben und deren Limitationen aufgezeigt werden.

Schlussfolgerung

Die Anwendungsgebiete zwischen CT und MRT überschneiden sich zunehmend, da durch neuste Entwicklungen in der CT die Strahlenexposition stetig reduziert und gleichzeitig die Kontrastinformation erhöht werden kann, während sich parallel dazu in der MRT die Untersuchungsgeschwindigkeit und Robustheit bedeutend verbessern.

Abstract

Background

Radiologic imaging is important for the detection, staging and follow-up of urological tumors. Basic therapy decisions for both oncological (surgical vs. systemic therapy, e.g. in testicular cancer) and non-oncological pathologies (interventional vs. conservative therapy, e.g. for ureteral stones) depend largely on the tomographic imaging performed. Due to its almost ubiquitous availability, speed and cost-effectiveness, computed tomography (CT) plays an important role not only in the clarification of abdominal trauma and non-traumatic emergencies, but also in staging and follow-up of oncological patients. However, the level of radiation exposure, impaired renal function and allergies to iodinated contrast media limit the use of CT. Magnetic resonance imaging (MRI) can be a good alternative for many areas of application in oncological and non-oncological imaging due to its high soft tissue differentiation and functional-specific protocols but without the use of ionizing radiation.

Aim

In the following, the main indications of abdominal and pelvic CT and MRI in urology and their limitations are summarized.

Results

The areas of application between CT and MRI are increasingly overlapping, since the latest developments in CT continue to further reduce radiation exposure and increase contrast information, while the speed and robustness of MRI are significantly improving at the same time.

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Authors and Affiliations

  1. Urologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland

    Gita M. Schoenberg, Viktoria Schuetz & Joanne N. Nyarangi-Dix

  2. Klinik für Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Mannheim, Deutschland

    Steffen J. Diehl

  3. Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen, Deutschland

    Rafael Heiss & Boris Adamietz

  4. Radiologisches Zentrum für Diagnostik und Therapie München, München, Deutschland

    Boris Adamietz

Authors
  1. Gita M. Schoenberg
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  2. Viktoria Schuetz
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  3. Joanne N. Nyarangi-Dix
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  4. Steffen J. Diehl
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  5. Rafael Heiss
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  6. Boris Adamietz
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Correspondence to Gita M. Schoenberg.

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Interessenkonflikt

G.M. Schoenberg, V. Schuetz, J.N. Nyarangi-Dix, S.J. Diehl, R. Heiss und B. Adamietz geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Schoenberg, G.M., Schuetz, V., Nyarangi-Dix, J.N. et al. Moderne Schnittbildgebung für urologische Erkrankungen. Urologe 61, 374–383 (2022). https://doi.org/10.1007/s00120-022-01792-w

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