Zusammenfassung
Die konventionelle Abdominalsonographie hat bei der Diagnostik von
Erkrankungen des Magen-Darm-Traktes eine zunehmende Bedeutung erlangt. Ihr Wert
bei der Diagnostik von Tumoren ist jedoch limitiert.
Die sonographische Darstellbarkeit des Kolons lässt sich durch
die retrograde Instillation von Flüssigkeit in das Kolon deutlich
verbessern. Durch diese Methode, die Hydrokolonsonographie genannt wird, ist es
möglich, das Kolon kontinuierlich vom Beginn des rektosigmoidalen
Übergangs bis zum Zökum in seiner gesamten Kontinuität
sonographisch darzustellen. Durch die Beurteilung des echofreien
Dickdarmlumens, der 5 Darmwandschichten und des den Dickdarm umgebenden
Bindegewebes, ist eine genauere sonographische Diagnose unterschiedlicher
Dickdarmerkrankungen möglich. Kolonkarzinome und Polypen stellen sich als
echoreiche wandständige Strukturen dar. Kolonpolypen ab einer
Größe von 7 mm und Karzinome können mit großer
Sensitivität diagnostiziert werden. Durch die detaillierte Analyse der
Darmwandveränderungen ist ein genaueres Staging der Tumoren möglich.
Bei Patienten mit einem Morbus Crohn oder einer Colitis ulcerosa lassen sich
typische Wandveränderungen nachweisen. Die Hydrokolonsonographie hat sich
weiterhin als ein effektives Verfahren zur hydrostatischen Reposition der
Invagination bei Kindern erwiesen. Die virtuelle Koloskopie ist eine anderes
neueres bildgebendes Verfahren für die Diagnose von Dickdarmerkrankungen.
Der Unterschied zwischen der Hydrokolonsonographie und der virtuellen
Koloskopie und ihr möglicher Einsatz als Screeningverfahren für die
Diagnose des Kolonkarzinoms wird diskutiert.
Hydrocolonic sonography - potentials and limitations of
ultrasonographic diagnosis of colon diseases
Ultrasonic examination has become increasingly important in the
diagnosis of diseases of the gastrointestinal tract. In neoplastic diseases of
the large intestine, however, the diagnostic value of conventional
transabdominal sonography is limited.
The sonographic evaluation of the colon could be improved by the
retrograde instillation of water into the colon in a procedure called
hydrocolonic sonography. This technique allows the visualization of the colon
sonographically from the rectosigmoid transition to the cecum. Hydrocolonic
sonography enables a detailed sonographic examination of the hypoechoic colonic
lumen, the five individual layers of the colon wall and the surrounding
connective tissue, thus providing additional information and allowing a more
precise diagnosis of many diseases of the colon.
Colonic polyps and carcinomas appear sonographically as echogenic
structures projecting from the intestinal wall into the lumen. Colonic polyps
larger than 7 mm in diameter and carcinomas of the colon can be detected
with great sensitivity. In addition, detailed evaluation of the structure of
the bowel wall permits more precise staging of tumors of the colon. Aside from
such localized changes, hydrocolonic sonography can also demonstrate changes in
the wall structure in chronic inflammatory large bowel diseases such as
Crohn’s disease and ulcerative colitis. In addition hydrocolonic
sonography has been proven to be of great value for the
ultrasonographically-guided hydrostatic reduction of intussusception in
children.
On the other hand virtual colonoscopy is another promising new
imaging method for the diagnosis of colon diseases. The differences between
hydrcolonic sonography and virtual colonoscopy and their potential for
screening purposes of colon cancer will be discussed.
Schlüsselwörter
Ultraschall - Hydrokolonsonographie - Colitis
ulcerosa - Morbus
Crohn - Kolonkarzinom - Kolontumor - Virtuelle
Koloskopie - Screening - Invagination - Dickdarmerkrankungen
Key words
Ultrasonography - Hydrocolonic
Sonography - Ulcerative Colitis - Crohn’s
Disease - Colon Cancer - Colonic Neoplasms - Virtual
Colonoscopy - Screening - Intussusception - Colon
Diseases
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Anschrift des Verfassers
Prof. Dr. med. Bernd Limberg
Medizinische Klinik
Städtisches Krankenhaus Wolfenbüttel
Akademisches Lehrkrankenhaus der Universität
Göttingen
Alter Weg 80
38302 Wolfenbüttel
Fax: 0 53 31/9 34-32 02
