Diagnostik fokaler Leberläsionen mittels Mehrschicht-Computertomografie und MRT

Zusammenfassung

Nachweis und Charakterisierung von primären und sekundären Leberläsionen sind von fundamentaler Bedeutung im Rahmen des Tumorstagings. Die Mehrschicht-Computertomografie (MSCT) und die kontrastverstärkte MRT zeigen die Vielzahl benigner und maligner Läsionen mit unterschiedlicher Bildmorphologie. Angesichts nicht selten gleichzeitig auftretender benigner und maligner Läsionen der Leber muss eine differenzialdiagnostische Befundklärung vor Planung multimodaler Therapiekonzepte angestrebt werden. Die Entwicklung der MSCT eröffnete die Möglichkeit zur hochauflösenden Volumenbildgebung in kurzer Messzeit. Die isotrope Voxelgeometrie mit Kantenlängen unter einem Millimeter ist eine Grundlage zur Weiterverarbeitung des Datensatzes mittels 2D- und 3D-Algorithmen. Es resultieren Rekonstruktionen der versorgenden und dränierenden Gefäße (CT-Angiografie), präzise Lebervolumetrien und eine Visualisierung komplexer Segmentanatomie mittels dedizierter Workstations. Unspezifische Kontrastmittel finden Einsatz in der Computertomografie (Jod) und MRT (Gadolinium-Chelate) seit mehr als zwei Jahrzehnten. Diese KM adressieren im Wesentlichen den Extrazellularraum der untersuchten Gewebe. In den letzten 10 Jahren entstanden neue Präparationen für die MRT mit einer verbesserter Gewebespezifität. Dieser Artikel diskutiert die diagnostischen Möglichkeiten moderner MSCT und MRT unter Verwendung verschiedener Kontrastmittel zur optimierten Detektion, Differenzialdiagnostik und Visualisierung von Lebertumoren.

Abstract

Since both malignant and benign lesions may occur concomitantly in the same patient, it is of decisive importance not only to detect but to characterize a lesion. This is particularly mandatory if a surgical procedure or multimodal therapy concepts are planned. An abundance of benign and malignant lesions with various appearances in Multi-Slice computed tomography (MSCT) and MR imaging can be found. The advent of Multi-Slice CT has offered the opportunity of multiphasic volume imaging rather than slice imaging. Submillimeter isotropic voxel geometry served as the reference data set to provide useful information in terms of vascular reconstruction, volumetry and 3D-segmental anatomy. Non-specific contrast agents have been used in abdominal CT (iodine) and MR imaging (gadolinium-chelates) for more than two decades. This category of contrast agents mainly addresses the extracellular space. Various efforts have been made over the last decade to develop contrast agents that combine the excellent contrast resolution of MRI with improved tissue specificity. This article discusses the capabilities of modern MSCT and MRI with various contrast media in the detection and differential diagnosis of hepatic neoplasm with regard to visualisation techniques to improve therapy planning.

Schlüsselwörter

Computertomografie - Magnetresonanztomografie - Kontrastmittel - hepatozelluläres Karzinom - Lebermetastasen

Key words

computed tomography - magnetic resonance imaging - contrast media - hepatocellular carcinoma - liver metastasis

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