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Radiologische Abklärung pulmonaler Rundherde

Radiological evaluation of pulmonary nodules

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Der Pneumologe Aims and scope

Zusammenfassung

Solitäre pulmonale Rundherde (SPR) sind ein häufiges pneumologisches Problem. Bei der Abklärung von SPR müssen insbesondere maligne Rundherde zuverlässig von benignen Rundherden unterschieden werden. Das diagnostische Vorgehen richtet sich vor allem nach der Raucher- und Malignomanamnese, der Größe, der Begrenzung und der Computertomographie- (CT-)Morphologie der Herde. Ein benignes Verkalkungsmuster oder ein fehlendes Wachstum über 2 Jahre sind zuverlässige Zeichen benigner SPR. Bei kleinen SPR (≤8 mm) werden Verlaufskontrollen empfohlen, deren Intervall sich nach dem Risiko und der Größe der Herde richtet. Bei größeren SPR werden je nach Vortestwahrscheinlichkeit Verlaufskontrollen, eine dynamische CT oder Magnetresonanztomographie (MRT), eine 18-Fluordeoxyglukose-Positronenemissionstomographie (FDG-PET), die feingewebliche Abklärung oder eine operative Entfernung empfohlen.

Abstract

Solitary pulmonary nodules (SPN) are a frequent problem in the clinical routine of pneumologists. In the evaluation of SPN, malignant nodules need to be differentiated from benign SPN with a high level of confidence. The management of SPN is based on the pre-test probability of malignancy (smoking history, other known malignancy) and on morphologic criteria seen on radiographs and especially CT. The presence of benign calcifications and a SPN that is stable on imaging tests for at least 2 years are highly suggestive of a benign lesion. For the indeterminate SPN ≤ 8 mm CT follow-up is recommended, with intervals depending on the size and pre-test-probability of malignancy. For the indeterminate SPN >8 mm, management should again be based on the pre-test probability of malignancy, with CT follow-up, dynamic CT and MRT, FDG-PET, histological analysis and possibly surgical removal representing the diagnostic options.

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  1. Institut für Radiodiagnostik, Otto-Wagner-Spital, Sanatoriumsstraße 2, 1140, Wien, Österreich

    H. Prosch & G. Mostbeck

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  1. H. Prosch
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  2. G. Mostbeck
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Correspondence to H. Prosch.

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Prosch, H., Mostbeck, G. Radiologische Abklärung pulmonaler Rundherde. Pneumologe 6, 415–426 (2009). https://doi.org/10.1007/s10405-009-0354-9

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