Power-Dopplersonographie: Eine neue vielversprechende Methode zur Beurteilung der Organdurchblutung - erste Ergebnisse in Gynäkologie und Geburtshilfe

Zusammenfassung

Der Power-Doppler stellt ein neues Verfahren der farbcodierten Ultraschalldiagnostik dar. Durch eine Modifizierung der Auswertung der Dopplersignale ist es möglich, den größten Teil der Organdurchblutung darzustellen. Wesentlich ist hierbei, auch kleinste Blutgefäße darzustellen und die Organdurchblutung besser zu beurteilen als mit der herkömmlichen Farbdopplersonographie. In der Arteriosklerosediagnostik, der Transplantationschirurgie, der Diagnostik von hepatozellulären und Prostatakarzinomen sowie der männlichen Fertilitätsdiagnostik hat die Power-Dopplersonographie schon ihren Stellenwert. Die präzise Darstellung der Neovaskularisation bei Malignomen bringt einen vielversprechenden Ansatz in der Diagnostik und Früherkennung von Ovarialkarzinomen; gleiches gilt für die Dignitätseinschätzung von Mammakarzinomen und Tumoren der Zervix. Im Bereich der Geburtshilfe können mittels Power-Doppler intrakranielle Blutungen besser differenziert, die pulmonale Durchblutung exakter charakterisiert (z. B. Lungenhypoplasie, fetale Lungenreife) und blutgefäßassoziierte Fehlbildungen des Feten genauer diagnostiziert werden. Die Darstellung des Blutflusses bis hin zu kleinsten Blutgefäßen in Plazenta und fetalen Organen auf der Basis der Farbintensität ermöglicht neue Erkenntnisse in die Pathophysiologie der Plazentainsuffizienz und fetalen Wachstumsretardierung einschließlich der Überprüfung therapeutischer Konzepte (z. B. Hämodilution), Unterschiede zwischen einer unkomplizierten Schwangerschaft und Risikoschwangerschaft lassen sich mittels Power-Doppler aufzeigen. In der Sterilitätsdiagnostik kann die Beurteilung des Vaskularisationsgrades der Follikel mittels Power-Doppler wesentlich zur Abschätzung des Erfolges für eine Schwangerschaft beitragen. Eine Standardisierung der Methode, die Definition von „cut-off“-Werten, und der Vergleich mit herkömmlichen diagnostischen Verfahren sind notwendig, um die Power-Dopplersonographie vor allem in der Geburtshilfe für die klinische Praxis nutzbar zu machen.

Abstract

Power Doppler sonography is a new method to visualize small blood vessels by a modified analysis of color-coded Doppler signals. Assessment of small vessels and organ blood flow is improved compared with conventional color Doppler imaging. Power Doppler sonography is being used increasingly to study vascular disease, hepatocellular carcinoma, prostate cancer and male infertility, and in transplant surgery. In gynecology, Power Doppler sonography is being used to study neovascularization in benign and malignant tumors of the ovary, breast and cervix. In maternal-fetal medicine, the technology is being used to visualize intracranial hemorrhages, study lung perfusion and maturity in patients with pulmonary hypoplasia, diagnose malformations of blood vessels, and visualize blood flow in the small vessels of the placenta and in fetal organs. The focus is on pregnancies complicated by placental insufficiency and fetal growth restriction and studying therapeutic interventions (i.e., hemodilution). Power Doppler sonography may permit the early detection of high-risk pregnancies. In reproductive medicine, the technology is being used to study the degree of vascularization of the follicle. Before power Doppler sonography can be used in routine practice the method needs to be standardized and compared with other diagnostic modalities and cut-off values need to be defined.

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