Radiologie up2date 2015; 15(02): 107-134
DOI: 10.1055/s-0034-1392231
Brustbildgebung/Mammografie
© Georg Thieme Verlag KG Stuttgart · New York

Mammasonografie Update

Breast ultrasound update
A. Mundinger
,
H. Madjar
Further Information

Publication History

Publication Date:
23 June 2015 (online)

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Zusammenfassung

Neue Entwicklungen der Sonografie umfassen die klinische Erprobung der automatisierten 3D-Ultraschallbildgebung, die technische Optimierung moderner Hochfrequenzschallköpfe, die multiparametrische Bildanalyse aus Elastizitäts-, Durchblutungs- und Architekturinformationen und die Integration der Sonografie in Hybridsysteme. Die automatisierte 3D-Ultraschallbildgebung liefert einen 3D-Bilddatensatz, der ähnlich wie CT- oder MR-Volumendatensätze an einer Workstation ausgelesen werden kann. Die Hochfrequenzsonografie ist erforderlich, um kleinste Details wie DCIS oder invasive multifokale Läsionen zu erfassen. Fortschrittliche Technologien wie Compounding, Harmonic Imaging oder die Verminderung von Speckles erhöhen das Signal-Kontrast-Verhältnis. Die vaskuläre Bildgebung und die Elastografie erlauben es, harte oder hypervaskularisierte BI-RADS-US-3-Herde auf BI-RADS-US 4a hochzustufen.

Abstract

New developments in ultrasound encompass 3-D automated US as an adjunct to screening mammography, handheld high frequency transducers in whole breast US, and hybrid systems. High-frequency ultrasound is relevant for assessing small mammographic masses and for preoperative staging to detect accompanying focal or ductal changes due to DCIS or invasive foci and metastatic axillary lymph nodes. Advanced modes as compounding, tissue harmonic imaging and speckle reduction increase the signal to contrast ratio. Doppler techniques and elastography are additional tools to re-categorize BI-RADS 3 vs. 4a lesions, suggesting to upgrade the former if the lesion is stiff or hyper-vascularised.

Kernaussagen

  • Schnelle Rechner und neue Schallköpfe erzeugen bessere Bilder mit schärferem Schichtdickenprofil. Spezielle Modi und die Hochfrequenztechnologie verbessern Detailauflösung und Kontrast. Dies führt zur besseren Detektion und Charakterisierung kleiner Brustläsionen und damit zur Verbesserung der Sensitivität. Die multimodale Sonografie mit hochauflösenden Modi, Doppler-Techniken, Elastografie und 3D-Imaging erhöht an der Schnittstelle zwischen wahrscheinlich benignen und suspekten Befunden die Spezifität.

  • Der aktuelle BI-RADS-Atlas der ACR bewertet die neuen Technologien einschließlich des automatisierten 3D-Volumen-Ultraschalls als Screening-Option positiv und schlägt einen verbesserten Standard für die Befundung vor. Einzelne Unterbegriffe tauschen die Stelle oder werden neu eingeführt. Die ehemalige Grenzzone (Halo) wird unter „unscharfem Rand“ subsumiert. Der frühere komplexe Herd wird zu „komplex zystisch und solide“. Intraduktale Kalzifikationen, einfache Zysten, Gefäßanomalitäten, postoperative Flüssigkeitsansammlung und Lipoidnekrose sind neu eingeführt worden.

  • Die Kombination aus Tastbefund, Mammografie, diagnostischen Zusatzaufnahmen, Sonografie und bildgebend gesteuerten Biopsien ist in der Abklärungsdiagnostik im Mammografie-Screening-Programm und in zertifizierten Brustzentren bei den meisten Fragestellungen ausreichend.

  • Automatisierte 3D-Volumen-Sonografie und digitale Tomosynthese sind die derzeit interessantesten Kandidaten als künftige Screening- und Hybridverfahren.

Keywords

Diagnostic ultrasound - diagnosis - breast neoplasm - benign breast disease - clinical issues - BI-RADS-ultrasound - state of the art equipment, imaging - Colour Doppler - 3-dimensional ultrasound - elastography - tissue harmonic imaging - automated volume ultrasound - mammography - MRI - histology minimal-invasive procedures - needle biopsy
 

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