Fortschritte im Staging des Nierenzellkarzinoms mittels hochauflösender Bildgebung

Zusammenfassung

Die modernen schnittbildgebenden Verfahren Computertomografie und MRT erlauben die zeitlich und räumlich hochaufgelöste Darstellung des gesamten Abdomens. Die therapeutischen Möglichkeiten des Nierenzellkarzinoms haben sich in den letzten Jahren deutlich erweitert. Neben der offenen und laparoskopischen Tumornephrektomie und der organerhaltenden Operation werden zunehmende lokale tumorablative Verfahren wie die Kryotherapie und die Radiofrequenzablation angewandt. Zeitgleich werden auch ausgedehnte Tumore mittels verbesserter anästhesiologischer Methoden und neuer operativer Verfahren einer kurativen Operation zugeführt. Die Anforderung an die präoperative Diagnostik geht entsprechend über die Frage des Tumornachweises und des Stagings hinaus. Tumorbedingte intrarenale Infiltrationen des Nierenbeckens oder großer hilusnaher Gefäße müssen bei der Planung einer organerhaltenden Operation ausgeschlossen werden. Bei ausgedehnten Tumoren mit Infiltration der Vena cava inferior muss die genaue craniale Ausdehnung des Tumorzapfens dargestellt werden. Der Radiologe sollte die Möglichkeiten und Grenzen der unterschiedlichen bildgebenden Methoden kennen und somit den Urologen bei der Planung des operativen Eingriffes unterstützen.

Abstract

Modern imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) allow high-resolution imaging of the abdomen. Modern scanners made high temporal as well as high spatial resolution available. Therapeutic approaches to the treatment of renal cell carcinoma have been improved over the recent years. Besides conventional and open laparoscopic tumor nephrectomy and nephron sparing, surgical approaches such as local tumor cryotherapy and radiofrequency ablation (RF) are ablative modalities and are used increasingly. Improved anesthesiological methods and new surgical approaches also allow curative treatment in extended tumors. Prerequisites for preoperative imaging modalities include visualization of the kidney tumor as well as its staging. Tumor-related infiltration of the renal pelvis or invasion of the perinephric fat and the renal hilus has to be excluded prior to nephron sparing surgery. In cases with extended tumors with infiltration of the inferior vena cava, it is necessary to visualize the exact extension of the tumor growth towards the right atrium in the vena cava. The radiologist should be informed about the diagnostic possibilities and limitations of the imaging modalities of CT and MRI in order to support the urologist in the planning and performance of surgical therapeutical approaches.

Key words

renal cell carcinoma - staging - imaging modalities - CT high resolution - MR imaging - therapy planning

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