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Der Urologe

, Volume 58, Issue 1, pp 5–13 | Cite as

Wertigkeit der Bildgebung bei Tumoren des oberen Harntraktes

  • G. B. SchulzEmail author
  • E. K. Gresser
  • J. Casuscelli
  • F. Strittmatter
  • S. Tritschler
  • A. Karl
  • C. G. Stief
  • D. Nörenberg
Leitthema
  • 26 Downloads

Zusammenfassung

Hintergrund

Staging und Nachsorge von Harnblasentumoren, Hämaturie und die Diagnostik von Raumforderungen des oberen Harntraktes (OHT) sind häufige Indikationen für eine Abklärung von Nieren, Nierenbeckenkelchsystem und Ureteren. Die direkte visuelle Beurteilung des OHT ist im Vergleich zur Diagnostik der Harnblase deutlich invasiver. Hieraus ergibt sich die Frage nach der optimalen Bildgebung und deren Effektivität. Sowohl in der CT-Bildgebung (Computertomographie), aber auch in der Magnetresonanztomographie (MRT) kam es in den letzten Jahren zu deutlichen technischen Verbesserungen.

Fragestellung

Die verschiedenen Bildgebungsmodalitäten und deren Limitationen bei der Detektion von Tumoren des OHT werden verglichen.

Material und Methoden

Es wird eine systematische Literaturrecherche und ein Vergleich der deutschen, europäischen und amerikanischen Leitlinien zum Blasenkarzinom, Urothelkarzinom des OHT und der Hämaturie durchgeführt.

Ergebnisse

Die CT-Urographie hat das Ausscheidungsurogramm (AUG) abgelöst und ist der derzeitige Goldstandard in der Bildgebung des OHT. Bei Kontraindikationen zur CT ist die MRT eine alternative bildgebende Methode. In jedem Fall sollte das Untersuchungsprotokoll eine Urographiephase beinhalten.

Diskussion

Die radiologische Bildgebung sollte sinnvoll in eine Sequenz bestehend aus endourologischen und zytologischen Verfahren intergiert werden. Neue bildgebende Verfahren wie die optische Kohärenztomographie, konfokale Laserendomikroskopie oder wissenschaftliche Neuerungen aus dem Themengebiet „Radiomics“ könnten die Abklärung und Differentialdiagnose von Läsionen des OHT in Zukunft verbessern.

Schlüsselwörter

Urothelkarzinom Urographie Nierenbecken Harnleiter Ausscheidungsurographie 

Value of imaging in upper urinary tract tumors

Abstract

Background

Staging of bladder cancer, hematuria as well as the evaluation of unclear findings of the kidneys and ureters are the most frequent indications for imaging of the upper urinary tract (UUT). Endourological assessment of the UUT is much more invasive compared to imaging of the bladder, raising the question of the optimal imaging technique. Several technical improvements regarding computed tomography (CT) as well as magnetic resonance imaging (MRI) were implemented in recent years.

Objectives

To compare the efficacy and limitations of the most important imaging techniques regarding the UUT.

Materials and methods

Systematic review of the literature and current German, European, and American guidelines regarding bladder cancer, urothelial carcinoma of the UUT and hematuria.

Results

The CT-based urography has superseded excretory urography and is the first choice for imaging of the UUT. In case of contraindications, MRI is a feasible alternative. In all cases, a urography phase is indispensable.

Conclusions

Imaging of the UUT has to be used in a reasonable combination together with endourological methods and cytology. Optical coherence tomography, confocal laser endomicroscopy and scientific innovations such as radiomics might improve UUT imaging and differential diagnosis of UUT lesions in the future.

Keywords

Urothelial carcinoma Urography Renal pelvis Ureter Excretory urography 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

G. B. Schulz, E. K. Gresser, J. Casuscelli, F. Strittmatter, S. Tritschler, A. Karl, C. G. Stief und D. Nörenberg 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

  • G. B. Schulz
    • 1
    Email author
  • E. K. Gresser
    • 2
  • J. Casuscelli
    • 1
  • F. Strittmatter
    • 1
  • S. Tritschler
    • 1
  • A. Karl
    • 1
  • C. G. Stief
    • 1
  • D. Nörenberg
    • 2
  1. 1.Urologische Klinik und PoliklinikKlinikum der Universität München, Campus GroßhadernMünchenDeutschland
  2. 2.Klinik und Poliklinik für RadiologieKlinikum der Universität München, Campus GroßhadernMünchenDeutschland

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