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Computertomographie und/oder Magnetresonanztomographie der Leber

Wie(so), weshalb, warum?

Computed tomography and/or magnetic resonance imaging of the liver

How, why, what for?

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Zusammenfassung

Klinisches Problem

Kolorektale Metastasen (KRLM) sind die häufigsten malignen Leberläsionen. Die Leberbildgebung bei Patienten mit kolorektalem Karzinom erfolgt im Rahmen der Erstdiagnose der Tumorerkrankung, der Verlaufsbildgebung unter Therapie sowie der Nachsorge zum Ausschluss bzw. dem Nachweis einer metachronen Metastasierung.

Radiologische Standardverfahren

Hier spielen sowohl im Hinblick auf das therapeutische Management als auch die prognostische Beurteilung insbesondere die radiologischen Schnittbildverfahren in Form der Mehrschicht-Computertomographie (CT) und Magnetresonanztomographie (MRT) eine zentrale Rolle.

Leistungsfähigkeit, Bewertung

Die Stärken der kontrastmittelunterstützten CT liegen vor allem in der sehr guten Verfügbarkeit, schnellen Bildakquisition und der Möglichkeit zum umfassenden Tumorstaging. Die MRT hingegen hat, vor allem unter Verwendung diffusionsgewichteter Sequenzen und dem Einsatz leberspezifischer Kontrastmittel, aufgrund des exzellenten Weichteilkontrastes die höchste Sensitivität für den Nachweis insbesondere von Metastasen <1 cm.

Empfehlung für die Praxis

Die Wahl des bildgebenden Verfahrens im klinischen Alltag ist in der Regel von der Verfügbarkeit und dem klinischen Kontext abhängig, wobei nicht selten beispielsweise zur Klärung der Operabilität (Ausmaß der Metastasierung, Lagebeziehung der Herde zu kritischen Strukturen) auch beide Verfahren kombiniert zum Einsatz kommen können.

Abstract

Clinical problem

Colorectal metastases are the most common malignant liver lesions. Imaging of the liver in patients with colorectal carcinoma is performed for early detection of liver metastases (CRLM) at the time of initial tumor diagnosis, for monitoring and follow-up in order to exclude or diagnose metachronous metastases.

Standard radiological methods

Radiological imaging includes primarily multislice computed tomography (CT) and magnetic resonance imaging (MRI), which play an important role regarding therapeutic management and assessment of prognosis.

Performance, achievements

Contrast-enhanced CT is broadly available and allows for rapid image acquisition including the possibility for complete tumor staging. MRI, on the other hand, is characterized by very good soft tissue contrast and has—especially with the use of diffusion-weighted imaging and administration of liver-specific contrast agents—the highest sensitivity for detection of metastases smaller than 1 cm.

Practical recommendations

The choice of imaging in daily routine is often dependent on availability and clinical question. Frequently, e.g. for assessment of resectability (extent of metastases, anatomic relation of lesions to critical structures), both modalities may be implemented in combination.

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Authors and Affiliations

  1. Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    G. H. Pöhler &  K. I. Ringe

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Correspondence to K. I. Ringe.

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Interessenkonflikt

G.H. Pöhler und K.I. Ringe geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Pöhler, G.H., Ringe, K.I. Computertomographie und/oder Magnetresonanztomographie der Leber. Radiologe 59, 804–811 (2019). https://doi.org/10.1007/s00117-019-00583-3

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