Eine Leberraumforderung abklären – So gehen Sie vor

Christoph F Dietrich

doi:10.1055/s-0041-110913

Lege artis - Das Magazin zur ärztlichen Weiterbildung, Table of Contents

Lege artis - Das Magazin zur ärztlichen Weiterbildung 2016; 6(04): 250-254
DOI: 10.1055/s-0041-110913

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Eine Leberraumforderung abklären – So gehen Sie vor

Christoph F Dietrich

Abstract

Raumforderungen der Leber sind häufig ein sonografischer Zufallsbefund. Dann ist es wichtig, die Dignität sicher zuzuordnen. Die Kontrastmittelsonografie (CEUS) ermöglicht eine der CT und der MRT vergleichbare Detektionsrate von Lebermetastasen. Auch die Einschätzung der Dignität und der Artdiagnose von Lebertumoren (Hämangiom, FNH und hepatozelluläres Adenom) ist im gesunden Leberparenchym bei einem Großteil der Patienten möglich.

Schlüsselwörter:

Leberraumforderung - fokale Leberläsionen - CEUS - Lebermetastasen - Lebertumorcharakterisierung

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References

Literatur
1 Claudon M, Dietrich CF, Choi BI et al. Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver – update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol 2013; 39: 187-210
2 Claudon M, Dietrich CF, Choi BI et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver – update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med 2013; 34: 11-29
3 Dietrich CF, Sharma M, Gibson RN et al. Fortuitously discovered liver lesions. World J Gastroenterol 2013; 19: 3173-3188
4 Dietrich CF, Jenssen C. Der zufällig entdeckte Leberrundherd. Dtsch Med Wochenschr 2012; 137: 2099-2116
5 Barreiros AP, Braden B, Schieferstein-Knauer C et al. Characteristics of intestinal tuberculosis in ultrasonographic techniques. Scand J Gastroenterol 2008; 43: 1224-1231
6 Barreiros AP, Otto G, Ignee A et al. Sonographic signs of amyloidosis. Z Gastroenterol 2009; 47: 731-739
7 Barreiros AP, Chiorean L, Braden B et al. Ultrasound in rare diffuse liver disease. Z Gastroenterol 2014; 52: 1247-1256
8 Frohlich E, Jenssen C, Schuler A et al. Kontrastmittelsonografie zur Charakterisierung von Lebertumoren: Praktische Aspekte. Z Gastroenterol 2015; 53: 1099-1107
9 Ignee A, Weiper D, Schuessler G et al. Sonographic characterisation of hepatocellular carcinoma at time of diagnosis. Z Gastroenterol 2005; 43: 289-294
10 Barreiros AP, Piscaglia F, Dietrich CF. Contrast enhanced ultrasound for the diagnosis of hepatocellular carcinoma (HCC): comments on AASLD guidelines. J Hepatol 2012; 57: 930-932
11 Dietrich CF, Cui XW, Boozari B et al. Contrast-enhanced ultrasound (CEUS) in the diagnostic algorithm of hepatocellular and cholangiocellular carcinoma, comments on the AASLD guidelines. Ultraschall Med 2012; 33 (Suppl. 01)
12 Trojan J, Hammerstingl R, Engels K et al. Contrast-enhanced ultrasound in the diagnosis of malignant mesenchymal liver tumors. J Clin Ultrasound 2010; 38: 227-231
13 Cui XW, Ignee A, Woenckhaus M et al. Hämangioendotheliom, eine bildgebende Herausforderung. Endo heute 2014; 27: 34-36
14 Bernatik T, Seitz K, Blank W et al. Unclear focal liver lesions in contrast-enhanced ultrasonography – lessons to be learned from the DEGUM multicenter study for the characterization of liver tumors. Ultraschall Med 2010; 31: 577-581
15 Chiorean L, Cantisani V, Jenssen C et al. Focal masses in a non-cirrhotic liver: The additional benefit of CEUS over baseline imaging. Eur J Radiol 2015; 84: 1636-1643
16 Chiorean L, Caraiani C, Radzina M et al. Vascular phases in imaging and their role in focal liver lesions assessment. J ClinHemorheolMicrocirculation in press 2015;
17 Chiorean L, Cui XW, Tannapfel A et al. Benign liver tumors in pediatric patients - Review with emphasis on imaging features. World J Gastroenterol 2015; 21: 8541-8561
18 Dietrich CF, Ignee A, Trojan J et al. Improved characterisation of histologically proven liver tumours by contrast enhanced ultrasonography during the portal venous and specific late phase of SHU 508A. Gut 2004; 53: 401-405
19 Dietrich CF, Mertens JC, Braden B et al. Contrast-enhanced ultrasound of histologically proven liver hemangiomas. Hepatology 2007; 45: 1139-1145
20 Dietrich CF. Liver tumor characterization – comments and illustrations regarding guidelines. Ultraschall Med 2012; 33 (Suppl. 01)
21 Dietrich CF, Schuessler G, Trojan J et al. Differentiation of focal nodular hyperplasia and hepatocellular adenoma by contrast-enhanced ultrasound. Br J Radiol 2005; 78: 704-707
22 Ignee A, Piscaglia F, Ott M et al. A benign tumour of the liver mimicking malignant liver disease – cholangiocellular adenoma. Scand J Gastroenterol 2009; 44: 633-636
23 Schuessler G, Fellbaum C, Fauth F et al. Der inflammatorische Pseudotumor – eine schwierige Differenzialdiagnose. Ultraschall Med 2006; 27: 273-279
24 Dietrich CF, Kratzer W, Strobe D et al. Assessment of metastatic liver disease in patients with primary extrahepatic tumors by contrast-enhanced sonography versus CT and MRI. World J Gastroenterol 2006; 12: 1699-1705
25 Strobel D, Seitz K, Blank W et al. Contrast-enhanced ultrasound for the characterization of focal liver lesions –diagnostic accuracy in clinical practice (DEGUM multicenter trial). Ultraschall Med 2008; 29: 499-505
26 Claudon M, Cosgrove D, Albrecht T et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) – update 2008. Ultraschall Med 2008; 29: 28-44
27 Piscaglia F, Nolsoe C, Dietrich CF et al. The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med 2012; 33: 33-59
28 Dietrich CF, Averkiou MA, Correas JM et al. An EFSUMB introduction into Dynamic Contrast-Enhanced Ultrasound (DCE-US) for quantification of tumour perfusion. Ultraschall Med 2012; 33: 344-351
29 Dietrich CF, Cui XW, Schreiber-Dietrich DG et al. EFSUMB guidelines 2011: comments and illustrations. Ultraschall Med 2012; 33 (Suppl. 01)
30 Frohlich E, Muller R, Cui XW et al. Dynamic contrast-enhanced ultrasound for quantification of tissue perfusion. J Ultrasound Med 2015; 34: 179-196
31 Cui XW, Ignee A, Jedrzejczyk M et al. Dynamic Vascular Pattern (DVP), a quantification tool for contrast enhanced ultrasound. Z Gastroenterol 2013; 51: 427-431
32 Seitz K, Greis C, Schuler A et al. Frequency of tumor entities among liver tumors of unclear etiology initially detected by sonography in the noncirrhotic or cirrhotic livers of 1349 patients. Resultsofthe DEGUM multicenterstudy. Ultraschall Med 2011; 32: 598-603
33 Seitz K, Strobel D, Bernatik T et al. Contrast-Enhanced Ultrasound (CEUS) for the characterization of focal liver lesions – prospective comparison in clinical practice: CEUS vs. CT (DEGUM multicenter trial). Parts of this manuscript were presented at the Ultrasound Dreilandertreffen 2008, Davos. Ultraschall Med 2009; 30: 383-389
34 Strobel D, Seitz K, Blank W et al. Tumor-specific vascularization pattern of liver metastasis, hepatocellular carcinoma, hemangioma and focal nodular hyperplasia in the differential diagnosis of 1,349 liver lesions in contrast-enhanced ultrasound (CEUS). Ultraschall Med 2009; 30: 376-382
35 Strobel D, Bernatik T, Blank W et al. Diagnostic accuracy of CEUS in the differential diagnosis of small (</=20mm) and subcentimetric (</=10mm) focal liver lesions in comparison with histology. Resultsofthe DEGUM multicentertrial. Ultraschall Med 2011; 32: 593-597
36 Dietrich CF, Ignee A, Greis C et al. Artifacts and pitfalls in contrast-enhanced ultrasound of the liver. Ultraschall Med 2014; 35: 108-125
37 Dietrich CF, Ignee A, Hocke M et al. Pitfalls and artefacts using contrast enhanced ultrasound. Z Gastroenterol 2011; 49: 350-356
38 Cui XW, Ignee A, Hocke M et al. Prolonged Heterogeneous Liver Enhancement on Contrast-Enhanced Ultrasound. Ultraschall Med 2014; 35: 246-252
39 Bernatik T, Becker D, Neureiter D et al. Lebermetastasendetektion – Vergleich Kontrastmittel – Ultraschall mit Echosignalverstärkern der ersten versus zweiten Generation. Ultraschall Med 2003; 24: 175-179
40 Bernatik T, Strobel D, Hahn EG et al. Detection of liver metastases: comparison of contrast-enhanced wide-band harmonic imaging with conventional ultrasonography. J Ultrasound Med 2001; 20: 509-515
41 Oldenburg A, Hohmann J, Foert E et al. Detection of hepatic metastases with low MI real time contrast enhanced sonography and SonoVue. Ultraschall Med 2005; 26: 277-284
42 Albrecht T, Blomley MJ, Burns PN et al. Improved detection of hepatic metastases with pulse-inversion US during the liver-specific phase of SHU 508A: multicenter study. Radiology 2003; 227: 361-370
43 Brenner DJ, Doll R, Goodhead DT et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. ProcNatlAcadSci U S A 2003; 100: 13761-13766
44 Hall EJ, Brenner DJ. Cancer risks from diagnostic radiology. Br J Radiol 2008; 81: 362-378
45 Brenner DJ, Hall EJ. Computed tomography – an increasing source of radiation exposure. N Engl J Med 2007; 357: 2277-2284
46 Hricak H, Brenner DJ, Adelstein SJ et al. Managing radiation use in medical imaging: a multifaceted challenge. Radiology 2011; 258: 889-905
47 Stacul F, van der Molen AJ, Reimer P et al. Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. EurRadiol 2011; 21: 2527-2541
48 Morcos SK, Thomsen HS, Exley CM. Contrast media: interactions with other drugs and clinical tests. EurRadiol 2005; 15: 1463-1468
49 van der Molen AJ, Thomsen HS, Morcos SK. Effect of iodinated contrast media on thyroid function in adults. EurRadiol 2004; 14: 902-907
50 Thomsen HS, Morcos SK. ESUR guidelines on contrast media. Abdom Imaging 2006; 31: 131-140
51 Bellin MF, Stacul F, Webb JA et al. Late adverse reactions to intravascular iodine based contrast media: an update. EurRadiol 2011; 21: 2305-2310
52 Morcos SK, Bellin MF, Thomsen HS et al. Reducing the risk of iodine-based and MRI contrast media administration: recommendation for a questionnaire at the time of booking. Eur J Radiol 2008; 66: 225-229
53 Bellin MF, Webb JA, van der Molen AJ et al. Safety of MR liver specific contrast media. EurRadiol 2005; 15: 1607-1614
54 Jakobsen JA, Oyen R, Thomsen HS et al. Safety of ultrasound contrast agents. EurRadiol 2005; 15: 941-945
55 Thomsen HS, Morcos SK, Almen T et al. Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines. EurRadiol 2013; 23: 307-318
56 Piscaglia F, Bolondi L. The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol 2006; 32: 1369-1375
57 Westwood M, Joore M, Grutters J et al. Contrast-enhanced ultrasound using SonoVue® (sulphur hexafluoride microbubbles) compared with contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging for the characterisation of focal liver lesions and detection of liver metastases: a systematic review and cost-effectiveness analysis. HealthTechnolAssess 2013; 17: 1-243
58 von Herbay A, Vogt C, Haussinger D. Late-phase pulse-inversion sonography using the contrast agent levovist: differentiation between benign and malignant focal lesions of the liver. AJR Am J Roentgenol 2002; 179: 1273-1279
59 Piscaglia F, Cucchetti A, Dietrich CF et al. Towards new tools for refined management of patients with advanced hepatocellular carcinoma under systemic therapy: some enthusiasm with a word of caution. J Hepatol 2013; 59: 924-925
60 Boozari B, Soudah B, Rifai K et al. Grading of hypervascular hepatocellular carcinoma using late phase of contrast enhanced sonography – a prospective study. DigLiver Dis 2011; 43: 484-490
61 Bridgewater J, Galle PR, Khan SA et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol 2014; 60: 1268-1289
62 Greten TF, Malek NP, Schmidt S et al. Diagnostik und Therapie des hepatozellulären Karzinoms. Z Gastroenterol 2013; 51: 1269-1326
63 Mork H, Ignee A, Schuessler G et al. Analysis of neuroendocrine tumour metastases in the liver using contrast enhanced ultrasonography. Scand J Gastroenterol 2007; 42: 652-662
64 Morita Y, Shirado H, Shinohara M et al. Arterial-portal shunt in cavernous hemangioma of the liver. RinshoHoshasen 1983; 28: 1507-1510
65 Morita M, Sakakiyama Y, Shiono H et al. An autopsy case of a cavernous hemangioma with solitary fibromatous fibrosis within the cavernous space in the liver of an adult. Sapporo IgakuZasshi 1970; 38: 1-7
66 Girard C, Graham JH, Johnson WC. Arteriovenous hemangioma (arteriovenous shunt). A clinicopathological and histochemical study. J CutanPathol 1974; 1: 73-87
67 Mostbeck A, Grunert V, Valencak E. Angioscintigraphy and shunt volume determination in a.-v. hemangiomas. Wien Med Wochenschr 1970; 120: 872-875
68 Bioulac-Sage P, Rebouissou S, Thomas C et al. Hepatocellular adenoma subtype classification using molecular markers and immunohistochemistry. Hepatology 2007; 46: 740-748
69 Balabaud C, Al Rabih WR, Chen PJ et al. Focal nodular hyperplasia and hepatocellular adenoma around the world viewed through the scope of the immunopathological classification. Int J Hepatol 2013; 2013: 268625-268625
70 Laumonier H, Cailliez H, Balabaud C et al. Role of contrast-enhanced sonography in differentiation of subtypes of hepatocellular adenoma: correlation with MRI findings. AJR Am J Roentgenol 2012; 199: 341-348
71 Manichon AF, Bancel B, Durieux-Millon M et al. Hepatocellular adenoma: evaluation with contrast-enhanced ultrasound and MRI and correlation with pathologic and phenotypic classification in 26 lesions. HPB Surg 2012; 2012: 418745-418745
72 Dietrich CF, Schuessler G, Trojan J et al. Differentiation of focal nodular hyperplasia and hepatocellular adenoma by contrast-enhanced ultrasound. Br J Radiol 2005; 78: 704-707
73 Wilson SR, Burns PN. An algorithm for the diagnosis of focal liver masses using microbubble contrast-enhanced pulse-inversion sonography. AJR Am J Roentgenol 2006; 186: 1401-1412
74 Piscaglia F, Venturi A, Mancini M et al. Diagnostic features of real-time contrast-enhanced ultrasound in focal nodular hyperplasia of the liver. Ultraschall Med 2010; 31: 276-282
75 Dietrich CF, Schuessler G, Trojan J et al. Differentiation of focal nodular hyperplasia and hepatocellular adenoma by contrast-enhanced ultrasound. Br J Radiol 2005; 78: 704-707
76 Hirche TO, Ignee A, Hirche H et al. Evaluation of hepatic steatosis by ultrasound in patients with chronic hepatitis C virus infection. LiverInt 2007; 27: 748-757
77 Schuessler G, Ignee A, Hirche T et al. Signalverstärkte Lebersonographie - Charakteristika einzelner Lebertumoren und Detektionsmöglichkeiten – eine Übersichtsarbeit. Z Gastroenterol 2003; 41: 1167-1176
78 Rickes S, Wermke T, Ocran K, Seitz G, Wermke W. Das Kontrastverhalten des Leberangiomyolipoms in der echosignalverstärkten Power-Dopplersonographie. Ultraschall Med 2002; 23: 338-340
79 Rickes S, Ocran K, Schulze S et al. Evaluierung dopplersonographischer Kriterien zur Differenzialdiagnostik von hepatozellulären Karzinomen und Regeneratknoten bei Leberzirrhose. Ultraschall Med 2002; 23: 83-90
80 Rickes S, Ocran KW, Gerstenhauer G, Neye H, Wermke W. Evaluation of diagnostic criteria for liver metastases of adenocarcinomas and neuroendocrine tumours at conventional ultrasound, unenhanced power Doppler sonography and echo-enhanced ultrasound. Dig Dis 2004; 22: 81-86
81 Bauditz J, Rudolph B, Wermke W. Osteoclast-like giant cell tumors of the pancreas and liver. World J Gastroenterol 2006; 12: 7878-7883
82 Goertz RS, Janka R, Nagel A et al. Eosinophilic infiltration of the liver and pancreas mimicking metastatic disease. Z Gastroenterol 2010; 48: 1138-1140
83 Bernatik T, Schuler A, Kunze G et al. Benefit of Contrast-Enhanced Ultrasound (CEUS) in the follow-up care of patients with colon cancer: A prospective multicenter study. Ultraschall Med 2015;
84 Dietrich CF, Cui XW, Chiorean L et al. Local ablative procedures of the liver. Z Gastroenterol 2015; 53: 579-590
85 Dietrich CF, Rudd L. The EFSUMB website, a guide for better understanding. Med Ultrason 2013; 15: 215-223

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