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Der Radiologe

, Volume 58, Issue 6, pp 553–562 | Cite as

CEUS – Diagnostik solider Nierentumoren

  • K. Stock
  • H. Kübler
  • T. Maurer
  • J. Slotta-Huspenina
  • K. Holzapfel
Leitthema

Zusammenfassung

Klinisches/methodisches Problem

Nierentumoren werden immer früher erkannt, häufig als Zufallsbefund bei Ultraschalluntersuchungen. Die Differenzialdiagnostik der verschiedenen Tumorentitäten ist schwierig.

Radiologische Standardverfahren

Alle Nierentumoren >1 cm sollten mittels CT/MRT untersucht werden, um bösartige Nierenläsionen auszuschließen. Zeigt der Nierentumor keinen Fettnachweis, werden die Patienten je nach Befund entweder weiterer Diagnostik oder einer tumorstadiengerechten urologischen Therapie zugeführt.

Methodische Innovationen

Durch kontrastverstärkten Ultraschall (CEUS) kann dabei im Rahmen einer multimodalen Ultraschalluntersuchung die Mikroperfusion von Nierentumoren exakt erfasst werden.

Leistungsfähigkeit

Bei papillären Nierenzellkarzinomen kann CEUS helfen, eingeblutete Zysten von Tumoren zu unterscheiden. Zudem kann mittels CEUS die Nierentumordetektion im Vergleich zu klassischen Ultraschallmodalitäten bei schwierigen anatomischen Verhältnissen verbessert werden. Pseudoläsionen, Parenchymzapfen im Nierenparenchym können mittels CEUS sicher diagnostiziert werden.

Bewertung

Eine sichere Trennung zwischen benignen und malignen Nierenläsionen >1 cm gelingt mittels CEUS nur in Ausnahmefällen. Das Verfahren jedoch geeignet, auch bei fokaler Pyelonephritis, Abzessen und Lymphomverdacht wichtige differenzialdiagnostische Informationen zu liefern und auch ultraschallgesteuerte Tumorbiopsien optimal zu planen.

Empfehlung für die Praxis

Entscheidend für die exakte Diagnostik bei Nierentumoren ist die Zusammenschau unterschiedlicher bildgebender Möglichkeiten in einem interdisziplinären Tumorboard zur individuellen Therapieentscheidung unter Berücksichtigung aller bildgebenden Informationen. Die CEUS von Nierenläsionen sollte als Videos präsentiert und kommentiert werden.

Schlüsselwörter

Nierenläsionen Angiomyolipom Nierenzellkarzinom Differenzialdiagnose Nierenzyste Sonographie 

CEUS—diagnosis of solid renal tumors

Abstract

Clinical issue

Renal lesions are detected earlier, often as a result of ultrasound examinations. However, the imaging-based differential diagnosis of different tumour entities remains challenging

Standard radiological methods

All renal tumours >1 cm should be evaluated for malignancy by computed tomography (CT) or magnetic resonance imaging (MRI). If an angiomyolipoma diagnosis cannot be established with imaging, further diagnostics are appropriate or if malignant progression is suspected, then multidisciplinary discussion for TNM-staging based uro-oncologic therapy is usual.

Methodical innovations

Contrast-enhanced ultrasound (CEUS) gives clear information about the microperfusion of renal tumours.

Performance

CEUS is helpful for the differentiation of renal cysts and especially papillary renal cell carcinomas. Moreover, CEUS advances renal tumour detection compared to B‑mode and Doppler ultrasound per se. Cortical pseudolesions may be confidently ruled out using CEUS.

Achievements

Clear differentiation of benign and malignant renal lesions >1 cm remains challenging, and only in rare cases is it possible with CEUS alone. Nevertheless CEUS is, in combination with other ultrasound techniques, eminently suitable for diagnosing focal pyelonephritis, renal abscesses and suspected renal lymphoma and supports the planning of ultrasound-assisted tumour biopsies.

Practical recommendations

Combining different imaging techniques is essential to accurately diagnose renal tumors. These imaging results (including the ultrasound/CEUS clips) should be viewed by the multidisciplinary cancer tumour board to facilitate individual treatment concepts for each patient.

Keywords

Kidney neoplasms Angiomyolipoma Renal cell carcinoma Differential diagnosis Renal cysts Ultrasonography 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

K. Stock, H. Kübler, T. Maurer, J. Slotta-Huspenina und K. Holzapfel 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 2018

Authors and Affiliations

  • K. Stock
    • 1
  • H. Kübler
    • 2
  • T. Maurer
    • 3
  • J. Slotta-Huspenina
    • 4
  • K. Holzapfel
    • 5
  1. 1.Nephrologischer Ultraschall, Abteilung für Nephrologie, Klinikum rechts der IsarTU MünchenMünchenDeutschland
  2. 2.Klinik und Poliklinik für Urologie und KinderurologieUniversitätsklinikum WürzburgWürzburgDeutschland
  3. 3.Klinik und Poliklinik für Urologie, Klinikum rechts der IsarTU MünchenMünchenDeutschland
  4. 4.Institut für Pathologie und pathologische AnatomieTU MünchenMünchenDeutschland
  5. 5.Institut für RadiologieKrankenhaus Landshut-AchdorfLandshutDeutschland

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