Der zufällig entdeckte Leberrundherd

Zusammenfassung

Der zufällig entdeckte Leberrundherd ist ein häufiges Problem, über dessen Abklärung nicht die Einigkeit besteht, die man eigentlich erwarten würde. Dies liegt auch daran, dass es mit Ausnahme von Patienten mit bekannter Leberzirrhose kein Vorsorgeprogramm zur frühzeitigen Detektion von Lebertumoren gibt.

Zur Abklärung (Detektion und Differenzialdiagnose) von Lebertumoren gehören theoretische Überlegungen, Anamnese, körperliche Untersuchung, laborchemische Untersuchungen, konventionelle Sonographie, dopplersonographische Techniken, kontrastverstärkte Sonographie (CEUS), Computertomographie (CT) und Magnetresonanztomographie (MRT) sowie die bildgebend gestützte Biopsie.

Als aussagekräftigste Methode haben sich kontrastverstärkte Ultraschalltechniken etabliert. Kontrastverstärkte Ultraschalltechniken wurden vor ca. 10 Jahren in die klinische Routine eingeführt und werden für vielfältige Indikationen im klinischen Alltag genutzt. Die kontrastverstärkte Sonographie ist in vielen Fällen die erste und auch entscheidende Technik zur Detektion und Charakterisierung von Lebertumoren. Diese Entwicklung wird durch vielfältige CEUS-Leitlinien reflektiert, beispielsweise durch die EFSUMB-Leitlinien 2004, 2008 und 2012 sowie die WFUMB-EFSUMB-Leitlinien 2012.

In dem CME-Artikel werden Überlegungen dargelegt, die eine geordnete Abklärung von inzidentellen Lebertumoren ermöglichen.

Abstract

The differential diagnosis of incidentally found Focal Liver Lesions (FLL) is complex. Screening procedures so far are only defined for patients with liver cirrhosis. Characterization of a FLL begins as soon as it is detected. Taking patients history and thorough clinical examination are essential. An imaging procedure that is used to detect liver masses should also allow the examiner to determine whether the lesion is benign or malignant. Conventional B-mode US and colour Doppler imaging are effective at detecting and characterizing typical liver cysts and calcifications. Laboratory data, computed tomography, magnetic resonance imaging and imaging guided liver biopsy are complementary methods.

Contrast Enhanced Ultrasound (CEUS) is a well established diagnostic imaging technique for a variety of indications and applications. One of the most important applications is in the liver where it is frequently a first-line technique for the detection and diagnosis (characterization) of focal liver lesions (FLL). In this setting the accurate differentiation of benign from malignant lesions is critical to ensure the patient undergoes the appropriate therapeutic option. This has been documented in recently published guidelines, in particular in terms of the enhancement patterns of the most common FLL hemangioma, focal nodular hyperplasia hepatocellular adenoma and their differentiation from malignant lesions. In this article the role of CEUS in the characterization of incidentally found FLL is described.

Schlüsselwörter

Echosignalverstärkte Sonographie - Leitlinien - Hämangiom - Fokal noduläre Hyperplasie - Lebermetastasen - Hepatozelluläres Karzinom - Computertomographie - Magnetresonanztomographie

Keywords

contrast enhanced ultrasonography - guidelines - hemangioma - focal nodular hyperplasia - liver metastases - hepatocellular carcinoma - computed tomography - magnetic resonance imaging

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