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Kontrastverstärkter Ultraschall (CEUS) der Leber

Kritische Bewertung des Einsatzes in der Routinediagnostik

Contrast-enhanced ultrasound (CEUS) of the liver

Critical evaluation of use in clinical routine diagnostics

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Zusammenfassung

Klinisches/methodisches Problem

Fokale Leberläsionen sind ein häufiger Zufallsbefund in der Ultraschalldiagnostik des Abdomens.

Radiologische Standardverfahren

Allein anhand des B‑Bildes und des Farbdopplersignals kann eine fokale Leberläsion nicht immer abschließend beurteilt werden.

Methodische Innovationen

Durch den Einsatz des Kontrastmittelultraschalls („contrast-enhanced ultrasound“, CEUS) kann die Vaskularisation fokaler Leberläsionen in Echtzeit evaluiert werden. Dies ermöglicht die Charakterisierung benigner und maligner Leberläsionen. Vorteile gegenüber der kontrastverstärkten Schnittbildgebung sind hierbei eine fehlende Nephro-, Hepato- und Kardiotoxizität. Ferner kommt es zu keiner Beeinflussung der Schilddrüsenfunktion. Durch den Einsatz einer Fusionsbildgebung aus Schnittbilddiagnostik und CEUS können die Vorteile der verschiedenen bildgebenden Verfahren kombiniert werden.

Leistungsfähigkeit

Fokale Leberläsionen können mithilfe des CEUS mit einer diagnostischen Sicherheit von über 90 % charakterisiert werden.

Bewertung

Der CEUS hat daher in der Anwendung durch einen erfahrenen Arzt einen wichtigen Stellenwert in der Diagnostik fokaler Leberläsionen.

Empfehlung für die Praxis

Der CEUS bietet in unklaren Fällen eine wertvolle Ergänzung zur Schnittbildgebung und findet Einsatz bei der Therapieplanung, -durchführung und dem -monitoring maligner Leberläsionen.

Abstract

Clinical/methodical issue

Focal liver lesions are common incidental findings in abdominal ultrasound diagnostics.

Standard radiological methods

Characterization of focal liver lesions solely based on b‑mode and color duplex is not feasible in all cases.

Methodical innovations

Using contrast-enhanced ultrasound (CEUS) it is possible to dynamically visualize the vascularization of focal liver lesions, which enables the characterization of benign and malignant liver tumors. The advantages of CEUS are that ultrasound contrast media do not show renal, hepatic or cardiac toxicity and do not influence the thyroid gland. The approach by fusion of CEUS and contrast-enhanced cross-sectional imaging combines the advantages of both imaging modalities.

Performance

Using CEUS focal liver lesions can be characterized with a diagnostic accuracy greater than 90%.

Achievements

The use of CEUS has become an important imaging modality to evaluate unclear liver lesions.

Practical recommendations

The use of CEUS provides vital information as a supplement to cross-sectional imaging and it has become an important tool in therapy planning, control and monitoring of malignant liver lesions.

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Authors and Affiliations

  1. Institut für klinische Radiologie, Interdisziplinäres Ultraschall-Zentrum, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    K. Müller-Peltzer, J. Rübenthaler, M. Reiser & D.-A. Clevert

Authors
  1. K. Müller-Peltzer
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  2. J. Rübenthaler
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  3. M. Reiser
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  4. D.-A. Clevert
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Correspondence to K. Müller-Peltzer.

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Interessenkonflikt

K. Müller-Peltzer, J. Rübenthaler, M. Reiser 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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Müller-Peltzer, K., Rübenthaler, J., Reiser, M. et al. Kontrastverstärkter Ultraschall (CEUS) der Leber. Radiologe 57, 348–355 (2017). https://doi.org/10.1007/s00117-017-0225-z

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