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DOI: 10.1055/s-2003-45274
Signalverstärkte Lebersonographie - Charakteristika einzelner Lebertumoren und Detektionsmöglichkeiten - eine Übersichtsarbeit
Improved Detection and Characterisation of Liver Tumors with Echo-Enhanced UltrasoundPublication History
Manuskript-Eingang: 5. März 2003
Annahme nach Revision: 7. August 2003
Publication Date:
08 December 2003 (online)
![](https://www.thieme-connect.de/media/zfg/200312/lookinside/thumbnails/10.1055-s-2003-45274-1.jpg)
Zusammenfassung
Die Sonographie mit Echosignalverstärkern und die damit verbundenen Ultraschalltechniken haben sich in den letzten Jahren ständig weiterentwickelt. In Form einer Übersichtsarbeit wird die echosignalverstärkte Sonographie der Leber anhand der Literatur und eigener Erfahrungen dargestellt.
Der Einsatz von Echosignalverstärkern, auch Ultraschallkontrastmittel genannt, hat die Ultraschalldiagnostik der Leber in den letzten Jahren verbessert. Die verbesserte Detektion und Charakterisierung von umschriebenen Leberraumforderungen mithilfe der Kontrastmittelkinetik stehen dabei im Vordergrund.
Die Echosignalverstärker bestehen aus Luft- oder Gasbläschen, die von verschiedenen Hüllsubstanzen umschlossen sind. Diese Mikrobläschen stellen einen starken Reflektor für den Ultraschall dar und erhöhen die Rückstreuung um bis zu 30 dB. Es lassen sich Blood-pool- und gewebespezifische Echosignalverstärker unterscheiden. Beide Substanzgruppen führen in der Leber zu einer von der Perfusionsphase (arterielle Phase, portalvenöse Phase, späte portalvenöse oder sinusoidale Phase) abhängigen Signalverstärkung des Leberparenchyms sowie der primären und sekundären Lebertumoren. Zusätzlich kann bei den lebergewebespezifischen Kontrastmitteln noch eine leberspezifische Spätphase abgegrenzt werden.
Die in der Bildgebung einzigartige Möglichkeit der Analyse von An- und Abflutung des Kontrastmittels (Echtzeitdarstellung, Real Time Imaging) verspricht eine Verbesserung der diagnostischen Möglichkeiten. Hypervaskularisierte Lebertumoren (z. B. fokal noduläre Hyperplasie, hepatozelluläres Karzinom, hypervaskularisierte Metastasen) können so besser erkannt und charakterisiert werden. Durch den Negativkontrast in der portalvenösen Durchblutungsphase oder in einer so genannten leberspezifischen Spätphase stellen sich die von uns untersuchten Tumoren (Metastasen und HCC) deutlicher dar und können von benignen Tumoren differenziert werden. Gelingt es, mit gleicher Zuverlässigkeit wie Spiral-CT und MRT die Detektion und Differenzierung von Lebertumoren mit kontrastmittelgestütztem US zu erzielen, könnten Mehrfachuntersuchungen eingespart werden.
Abstract
Contrast-enhanced ultrasound techniques represent the most challenging efforts in recent ultrasound developments. Contrast-enhanced imaging of the liver will be reviewed with respect to the literature and our own experience. Echo-enhancing agents, also known as ultrasound contrast media, have improved the accuracy of liver ultrasound within recent years. The characterisation of focal liver lesions which is possible by flow characteristics and the improved detection of liver tumors give special importance to the contrast agents. The agents consist of air or gas bubbles coated with different shell media. These micro-bubbles act as strong reflectors to the ultrasound beam enhancing the backscatter signal up to 30 dB. There are differences between blood pool agents and agents with a liver-specific late phase. The agents remain in the vessels during the vascular phase and lead to enhancement of different structures (arterial, capillary, portal venous, and sinusoidal perfusion). This is the first real-time imaging technique of liver lesions that allows a unique analysis of tumor perfusion. Liver tumors known to be hyperperfused in the arterial phase (e. g., focal nodular hyperplasia, hepatocellular carcinoma, and hyperperfused metastases) can be detected and characterised. Hypoperfused tumours (e. g., liver metastases of the gastrointestinal tract) can be recognised in the portal venous phase as less perfused „black spots”. Due to of the recently available improved ultrasound technology and affordable ultrasound systems, a reduction in the use of computed tomography (CT) and magnetic resonance imaging (MRI) may be possible, allowing these important technologies to be available for other indications (e. g., brain, thorax).
Schlüsselwörter
Lebertumoren - Ultraschall - Echokontrastmittel - Contrast-Harmonic Imaging
Key words
Liver tumors - ultrasound - echo-enhancing-contrast agents - contrast-harmonic imaging
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PD Dr. med. Christoph F. Dietrich
Innere Medizin 2 · Caritas-Krankenhaus Bad Mergentheim
Uhlandstr. 7
97980 Bad Mergentheim
Email: christoph.dietrich@ckbm.de