Zusammenfassung
Im Hinblick auf die umschriebenen Leberveränderungen werden in diesem Beitrag zunächst die zur Verfügung stehenden bildgebenden Untersuchungsverfahren dargestellt. Die sich daran anschließende Charakterisierung der einzelnen Läsionen folgt einer Einteilung in drei Gruppen (Läsionen mit typischer Bildgebung, solche mit führender Klinik und solche mit schwieriger Diagnostik), bevor abschließend die diagnostische Strategie bei fokalen Leberläsionen noch einmal zusammenfassend dargestellt wird.
Abstract
This contribution first describes the imaging modalities available for focal hepatic changes. A subsequent characterization of the individual lesions is followed by a classification in three groups: lesions with typical imaging features, lesions in the presence of dominating clinical findings, and lesions posing a difficult diagnostic problem. Finally, the diagnostic strategy for focal liver lesions is summarized.
Key words
Liver - Liver CT - Liver MRI - Benign liver diseases - Liver neoplasms
Literatur
-
1
Baron R L.
Understanding and optimizing use of contrast material for CT of the liver.
AJR.
1994;
163
323-331
-
2
vanBeers B, Pringot J, Gigot J F, Dautrebande J, Mathurin P.
Nontumorous attenuation differences on CT portography.
Gastrointest Radiol.
1990;
15
107-111
-
3
Born M, Layer G, Kreft B, Schwarz N, Schild H.
MRT, CT und CTAP in der Diagnostik maligner Lebertumoren bei Leberzirrhose.
Röfo.
1998;
168
567-572
-
4
Bruneton J N, Kerboul P, Grimaldi C.
Hepatic intraarterial Lipiodol: technique, semiologic patterns and value for hepatic tumors.
Gastrointest Radiol.
1988;
13
45-51
-
5
Buetow P C, Buck J L, Ros P R, Goodman Z D.
Malignant vascular tumors of the liver: radiologic-pathologic correlation.
RadioGraphics.
1994;
14
153-166
-
6
Ferrell L, Wright T, Lake J, Raberts J, Ascher N.
Incidence and diagnostic features of macroregenerative nodules vs. small HCC in cirrhotic livers.
Hepatology.
1992;
16
1372-1381
-
7
Gorg C, Schwerk W B, Gorg K, Havemann K.
Focal involvement of malignant lymphoma in the liver.
Bildgebung.
1991;
58
67-70
-
8
Hamm , B , Thoeni R F, Gould R G, Bernardino M E, Lüning M, Saini S, Mahfouz A E, Taupitz M, Wolf K J.
Focal liver lesions: characterization with non-enhanced and dynamic contrast-enhanced MR imaging.
Radiology.
1994;
190
417-424
-
9
Högemann D, Flemming P, Kreipe H, Galanski M.
Correlation of MRI and CT findings with histopathology in hepatic angiomyolipoma.
Eur Radiol.
2001;
11
1389-1395
-
10
Hollett M D, Jeffrey R B, Nino-Murcia M, Jorgensen M J, Harris D P.
Dual-phase helical CT of the liver: value of arterial phase scans in the detection of small (≤ 1,5cm) malignant hepatic neoplasms.
AJR.
1995;
164
879-884
-
11
Hwang G J, Kim M J, Yoo H S, Lee J T.
Nodular HCC: Detection with arterial-, portal-, and delayed phase images at spiral CT.
Radiology.
1997;
202
383-388
-
12
Itai Y, Moss A A, Goldberg H I.
Transient hepatic attenuation difference of lobar and segmental distribution detected by dynamic CT.
Radiology.
1982;
144
835-839
-
13
Ito . et al .
Transient increased attenuation in the gallbladder bed in pts with gallbladder disease.
Radiology.
1997;
204
723-728
-
14
Lacomis J M, Baron R L, Oliver J H, Nalesnik M A, Federle M P.
Cholangiocarcinoma: delayed CT contrast enhancement patterns.
Radiology.
1997;
203
98-104
-
15
Mahfouz A E, Hamm B, Wolf K J.
Peripheral washout: a sign of malignancy on dynamic Gd-enhanced MR images of focal liver lesions.
Radiology.
1994;
197
317-319
-
16
Miller W J, Dodd G D, Federle M P, Baron R L.
1992 EH of the liver: imaging findings with pathologic correlation.
AJR.
1992;
159
53-57
-
17
Miller W J, Baron R L, Dodd G D, Federle M P.
Malignancies in patients with cirrhosis: CT sensitivity and specificity in 200 consecutive transplant patients.
Radiology.
1994;
193
645-650
-
18
Ngan H.
Lipiodol computerized tomography: how sensitive and specific is the technique in the diagnosis of HCC?.
Brit J Radiol.
1990;
63
771-775
-
19
Oliver J H, Baron R L, Federle M P, Rockette H E.
Detecting hepatocellular carcinoma: value of unenhanced or arterial phase CT or both used in conjunction with conventional portal venous phase contrast enhanced CT imaging.
AJR.
1996;
167
71-77
-
20
Oliver J H, Baron R L, Federle M P, Jones B C, Sheng R.
Hypervascular liver metastases: Do unenhanced and hepatic arterial phase CT images affect tumor detection?.
Radiology.
1997;
205
709-715
-
21
Patten R M, Byun J Y, Freeny P C.
CT of hypervascular hepatic tumors: are unenhanced scans necessary for diagnosis?.
AJR.
1993;
161
979-981
-
22
Pauleit D, Textor J, Bachmann R, Conrad R, Flacke S, Layer G, Kreft B, Schild H.
HCC: Detection with Gd- FeO-enhanced MR imaging of the liver.
Radiology.
2002;
222
73-80
-
23
Penkrot R J, van Thiel D.
CT of cavernous hemangiomas of the liver: how sure are we?.
J Comput Tomogr.
1986;
10
309-312
-
24
Quiroga S, Sebastia C, Pallisa E, Castella E, Perez-Lafuente M, Alvarez-Castells A.
Improved diagnosis of hepatic perfusion disorders: value of hepatic arterial phase imaging during helical CT.
Radiographics.
2001;
21
65-81
-
25
Shamsi K, de Schepper A, Degryse H, Deckers F.
FNH of the liver: radiologic findings.
Abdom Imaging.
1993;
18
32-38
-
26
Soyer P, Bluemke D A, Reichle R, Calhoun P S, Bliss D F, Scherrer A, Fishman E K.
Imaging of intrahepatic cholangiocarcinoma. I peripheral cholangiocarcinoma.
AJR.
1995;
165
1427-1431
-
27
Takayasu K, Furukawa H, Wakao F, Muramatsu Y, Abe H, Terauchi T, Winter T C, Sakamoto M, Hirohashi S.
CT diagnosis of early HCC: Sensitivity, findings and Cytopathologic correlation.
AJR.
1995;
164
885-890
-
28
Taournel P G, Pageaux G P, Coste V, Fabre J M, Pradel J A, Ramos J, Larrey D, Domergue J, Michel H, Bruel J M.
Small HCC in patients undergoing liver transplantation: detection with CT after injection of iodized oil.
Radiology.
1995;
197
377-380
-
29
Theise N D, Schwartz M, Miller C, Thung S N.
Macroregenerative nodules and HCC in 44 sequential adult liver explants with cirrhosis.
Hepatology.
1992;
16
949-955
-
30
Utsunomiya T, Matsumata T, Adachi E, Honda H, Sugimachi K.
Limitations of current preoperative liver imaging techniques for intrahepatic metastatic nodules of HCC.
Hepatology.
1992;
16
694-701
-
31
Vilgrain V, Boulos L, Vullierme M P, Denys A, Terris B, Menu Y.
Imaging of atypical hemangiomas of the liver with pathological correlation.
Radiographics.
2000;
20
379-397
-
32
Ward J, Guthrie J A, Scott D J. et al .
HCC in the cirrhotic liver: double-contrast MR imaging for diagnosis.
Radiology.
2000;
216
154-162
-
33
White P G, Adams H, Smith P M.
The CT appearance of angiosarcoma of the liver.
Clin Radiol.
1993;
48
321-325
-
34
Yu J S, Kim K W, Sung K B. et al .
Small arterial-portal venous shunts: a cause of pseudolesions at hepatic imaging.
Radiology.
1997;
203
737-742
PD Dr. Dagmar Högemann Savellano
Diagnostische Radiologie · Medizinische Hochschule Hannover
Carl-Neuberg-Straße 1 · 30625 Hannover
Phone: +49(0)511 532 3128
Fax: +49(0)511 532
Email: hoegemann.dagmar@mh-hannover.de