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DOI: 10.1055/s-2003-45362
© Georg Thieme Verlag Stuttgart · New York
Der pulmonale Rundherd: Neue Konzepte bei einem alten Problem
Pulmonary Nodule: New Concepts of an Old ProblemPublication History
Publication Date:
15 December 2003 (online)
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Zusammenfassung
In der Vergangenheit wurde ein pulmonaler Rundherd bis zum (histologischen) Beweis des Gegenteils als maligne angesehen, sodass häufig eine invasive Diagnostik erfolgte. Der Rundherd wurde meist übersichtsradiographisch entdeckt und war in der Regel größer als 10 mm. Mit der modernen (Mehrzeilen-)Spiral-CT werden neuerdings zunehmend sehr kleine (≤ 10 mm) Rundherde gefunden; diese sind in über 95 % benigne. Daher erfordern diese Läsionen eine prinzipiell andere weiterführende Diagnostik zum Ausschluss von Malignität, die ganz überwiegend ohne invasive Maßnahmen auskommen sollte. In diesem Beitrag werden die aktuelle Datenlage sowie differenzialdiagnostische Methoden zur Dignitätsbestimmung von Rundherden vorgestellt und Konzepte zur weiterführenden Diagnostik bei kleinen Lungenrundherden vorgeschlagen.
Abstract
In the past, a pulmonary nodule was considered malignant until proven otherwise, usually histologically, which frequently required invasive diagnostic procedures. The nodule was mostly detected on conventional chest radiographs and usually larger than 10 mm. Recently, modern (multi-slice) helical CT detects an increasing number of very small (≤ 10 mm) nodules, which are benign in > 95 %. Consequently, the exclusion of malignancy demands different diagnostic procedures, which should be predominantly non-invasive. This article presents the current data as well as imaging techniques for the determination of the nature of pulmonary nodules and suggests concepts for the diagnostic approach to small pulmonary nodules.
Key words
Pulmonary nodule; - computed tomography; - contrast enhancement; - volumetry; - doubling time; - Follow-up
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Korrespondenzadresse
Priv. Doz. Dr. med. Stefan Diederich
Institut für Diagnostische und Interventionelle Radiologie sowie Nuklearmedizin Marien Hospital Düsseldorf
Rochusstrsaße 2
40479 Düsseldorf
Phone: +49 211 4400-2101
Fax: +49 211 4400-2102
Email: s.diederich@marien-hospital.de