Schwierige endosonografische Differenzialdiagnosen am Pankreas – zystische Läsionen

Zusammenfassung

Zystische Läsionen des Pankreas sind häufig und werden zunehmend als Zufallsbefunde bildgebender Diagnostik entdeckt. Im Gegensatz zu anderen parenchymatösen Organen sind dysontogenetische Pankreaszysten sehr selten. Unter den Zufallsbefunden dominieren zystische Neoplasien unterschiedlichen Malignitätsrisikos, bei symptomatischen zystischen Pankreasläsionen handelt es sich dagegen überwiegend um akute oder chronische Pseudozysten. Die Endosonografie spielt neben anamnestisch-klinischen Kriterien in der differenzialdiagnostischen und prognostischen Charakterisierung eine herausragende Rolle. In einer Sitzung sind morphologische Beurteilung, Darstellung der Vaskularisation und Feinnadelaspiration von Zysteninhalt, Zystenwandung und soliden Anteilen möglich. Dennoch können Differenzialdiagnose und Entscheidungsfindung über das weitere Vorgehen im Einzelfall erhebliche Probleme aufwerfen, die in dieser Übersicht diskutiert werden. Es wird ein evidenzbasierter diagnostischer Algorithmus für zystische Pankreasläsionen vorgestellt. 

Abstract

Pancreatic cystic lesions are common. They are increasingly detected as a finding of radiological imaging. In contrast to other parenchymal organs in the pancreas dysontogenetic cysts are extremely rare. The majority of incidental cystic lesions are neoplasms which own different risks of malignancy. In symptomatic patients the most frequent cystic pancreatic lesions are acute and chronic pseudocysts. In addition to clinical criteria endoscopic ultrasound has an outstanding role in the differential diagnosis and prognostic characterization of pancreatic cystic lesions. In one examination it is possible to perform morphological description, perfusion imaging, and fine-needle aspiration of cyst content, cyst wall and solid components. Nevertheless, in several cases differential diagnosis and management decisions may prove difficult. This review will discuss problems in and approaches to endosonographic diagnosis of cystic pancreatic lesions. An evidence-based algorithm for diagnosis of pancreatic cystic lesions is introduced. 

Schlüsselwörter

Endosonografie - abdominelle Sonografie - kontrastverstärkte Sonografie - EUS - EUS-FNA - zystische Pankreasläsion - seröse zystische Neoplasie - Zystadenom - muzinöse zystische Neoplasie - intraduktale papillär-muzinöse Neoplasie

Key words

endoscopic ultrasound - transabdominal ultrasound - contrast-enhanced ultrasound - EUS - EUS-FNA - cystic pancreatic lesion - serous cystic neoplasm - mucinous cystic neoplasm - intraductal papillary mucinous neoplasm

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