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Der Radiologe

, Volume 59, Issue 4, pp 328–337 | Cite as

Differenzialdiagnose von Befunden an der Gallenblase

Ultraschall, Computertomographie und Magnetresonanztomographie
  • H. Kopf
  • W. Schima
  • S. MengEmail author
Leitthema
  • 220 Downloads

Zusammenfassung

Klinisches Problem

Mit der Fragestellung der Cholezystitis und der Cholezystolithiasis gehört die Gallenblase zu den am häufigsten bildgebend untersuchten Organen.

Radiologische Standardverfahren

Bei nahezu allen Fragestellungen zur Gallenblase ist der Ultraschall aufgrund der guten Verfügbarkeit, Schnelligkeit und der überlegenen räumlichen Auflösung die primäre bildgebende Modalität. Bei unklaren Befunden oder möglichen Komplikationen werden die Computertomographie (CT) und die Magnetresonanztomographie (MRT) eingesetzt.

Methodische Innovationen

Für spezifische Fragestellung können diese Modalitäten um spezielle Techniken wie die Kontrastmittelsonographie, Dual-Energy-CT-Technik und spezifische MR-Sequenzen erweitert werden.

Leistungsfähigkeit

Sonderformen der Cholezystitis wie die Adenomyomatose und die xanthogranulomatöse Cholezystitis stellen eine diagnostische Herausforderung dar, da sie anderen Erkrankungen ähneln können. Komplikationen der Cholezystolithiasis wie das Mirizzi-Syndrom und der Gallensteinileus können die Abklärung erschweren, da es dabei zu einer Änderung der Lokalisation der Ätiologie und der Symptome kommen kann. Neoplasien wie das Gallenblasenkarzinom und andere Malignome müssen mit Hilfe einer größeren Bandbreite von Modalitäten untersucht werden.

Bewertung

Obwohl die Gallenblase einfach mittels Ultraschall untersucht werden kann, ist in manchen Fällen nur eine umfangreichere Ultraschalluntersuchung und in anderen Fällen nur eine Kombination aus mehreren Modalitäten diagnostisch zielführend. Weitere Entwicklungen in der Technik und im Untersuchungsablauf sind zu erwarten.

Empfehlung für die Praxis

Der Ultraschall die beste primäre Untersuchungsmodalität. Bei nicht eindeutigen Befunden und Komplikationen ist eine CT oder MRT empfohlen.

Schlüsselwörter

Gallengangsystem Cholezystitis Cholezystolithiasis Tumoren Polypen 

Differential diagnosis of gallbladder abnormalities

Ultrasound, computed tomography, and magnetic resonance imaging

Abstract

Clinical issue

Due to the high prevalence of clinically suspected cholecystitis or cholecystolithiasis the gallbladder is one of the organs examined the most by imaging.

Standard radiological methods

In most clinical settings ultrasound is the primary imaging method because of its wide availability, speed and superior spatial resolution. In cases of ambiguous findings or potential complications computed tomography (CT) and magnetic resonance imaging (MRI) are used.

Methodical innovations

When specific problems arise these imaging modalities may be enhanced by special techniques, e. g. contrast-enhanced ultrasound or dual-energy CT, and specific MRI sequences.

Performance

Special variants of cholecystitis, such as xanthogranulomatous cholecystitis and adenomyomatosis, may pose a particularly difficult diagnostic problem as they may resemble other diseases. Sequelae of cholecystolithiasis, such as the Mirizzi syndrome and acute bowel obstruction, may complicate the imaging algorithm as the location and the symptoms shift. Cases of neoplastic diseases of gallbladder cancer and other malignancies require a broad spectrum of imaging modalities.

Achievements

Although the gallbladder can easily be examined with ultrasound, some cases require a more thorough ultrasound examination. In some cases only a combination of multiple imaging modalities yield the diagnosis. Further developments regarding technical issues and the diagnostic algorithm can be expected.

Practical recommendations

Ultrasound is the best first imaging modality. In cases of ambiguous findings or clinical complications CT or MRI are recommended.

Keywords

Bile tract diseases Cholecystitis Cholecystolithiasis Neoplasms Polyps 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

H. Kopf, W. Schima und S. Meng geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Abteilung für Diagnostische und Interventionelle Radiologie, Göttlicher Heiland KrankenhausVinzenzgruppeWienÖsterreich
  2. 2.RadiologieKFJ SpitalWienÖsterreich
  3. 3.Zentrum für Anatomie und ZellbiologieMedizinische Universität WienWienÖsterreich

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