Grundlagen der kontrastverstärkten Sonografie (CEUS)

Zusammenfassung

Die kontrastverstärkte Sonografie (CEUS) wird für viele Fragestellungen und in zahlreichen Fachdisziplinen eingesetzt, wenn auch mit unterschiedlichen Indikationen und Schwerpunkten. Dabei spielt die Erfahrung des Untersuchers sowohl für die Befunderhebung als auch für die Befundbeurteilung eine wesentliche Rolle. Im Folgenden werden die Grundlagen und die wichtigsten Einsatzgebiete der CEUS dargestellt.

Abstract

In this article the basics of contrast-enhanced sonography (CEUS) as well as the most important indications are presented. Because CEUS relies on a well performed B-mode Sonography CEUS can not be regarded as a stand-alone technique. Therefor and because most oft the underlying physic of CEUS and B-mode Sonography are similar, a short excursion on the technique of B-mode Sonography is given as well.

Kernaussagen

• Die kontrastverstärkte Sonografie (CEUS) oder die sog. signalverstärkte Sonografie ist eine mittlerweile bei vielen Fragestellungen etablierte und wichtige Ergänzung zur B-Bild-Sonografie.

• Basis der CEUS sind neben einem entsprechend dazu geeigneten Sonografiegerät als Kontrastmittel gasgefüllte Kügelchen mit einer extrem dünnen Hülle aus Eiweißen und Lipiden.

• Bei einem Schalldruck zwischen 100 und 500 kPa (MI 0,1 – 0,5) ist die Dilatation der Mikrobläschen größer als die Kompression. Dies führt zu einer Asymmetrie des Echos und der Entstehung nicht linearer (harmonischer) Schwingungen.

• Kontrastspezifische Ultraschallverfahren basieren auf einer Auslöschung des vom Gewebe verursachten linearen Ultraschallsignals und der Verwendung der nicht linearen Antwort der Mikrobläschen.

• Wo Mikrobläschen im Ultraschall zu sehen sind, wird die entsprechende Struktur (normales Organ oder auch ein Tumor) durchblutet. Falls keine Mikrobläschen zu sehen sind, handelt es sich um eine Struktur ohne Gefäße, z. B. eine Zyste, ein frisches Hämatom, einen nekrotischen Tumor oder einen Infarkt.

• Ultraschallkontrastmittel dienen nicht der Verbesserung technisch unzureichender B-Bild-Untersuchungen, da hier wie dort die gleichen Einschränkungen gelten (z. B. Adipositas und Darmgasüberlagerung).

• Signalverstärkte Untersuchungen ermöglichen Zusatzinformationen (Durchblutung, Kontrastmittelkinetik), die ohne Kontrastmittel nicht verfügbar wären.

• Mittels CEUS gelingt es, frische Verletzungen parenchymatöser Organe darzustellen.

• Mittels CEUS gelingt die Differenzierung zwischen benignen und malignen Leberherden mit einer sehr hohen Genauigkeit, da sich in der Spätphase so gut wie alle malignen Läsionen echoarm darstellen, die Mehrzahl der soliden benignen Läsionen dagegen isoechogen oder echoreich. Ausnahmen dieser Regel bestehen insbesondere beim Leberzelladenom sowie beim atypischen HCC.

• Mittels kontrastverstärkter Sonografie können signifikant mehr Lebermetastasen erkannt werden als mittels konventioneller B-Bild-Sonografie.

Schlüsselwörter

kontrastverstärkte Sonografie - CEUS - signalverstärkte Sonografie - Ultraschalltechnik - harmonische Bildgebung

Key words

contrast enhanced ultrasound - harmonic imaging

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