Normwerte in der Abdomensonografie – Leber und Lebergefäße

Zusammenfassung

Ziel: Normwerte in der B-Bild-Sonografie des Abdomens werden kontrovers diskutiert aufgrund der begrenzten Datenlage in der Literatur. Es erfolgt eine systematische Zusammenstellung bislang publizierter Daten bezüglich der Leber und Lebergefäße. Methoden: Literatur-Recherche bezüglich Normwerten im Abdomen von 1970 – 2010 an gesunden über 18-jährigen Probanden. In Anlehnung an die Bestimmung von Referenzintervallen für Laborwerte werden Normwerte in der Regel mithilfe von 95 %-Referenzintervallen und den zugehörigen 90 %-Konfidenzintervallen bestimmt. Evaluierte Parameter waren die Lebergröße, das Lebervolumen, Pfortaderdurchmesser und -querschnitt sowie die Diameter der Lebervenen. Ergebnisse: Die Lebergröße wird meist anhand ihres Diameters in der Medioklavikularlinie gemessen. Als Normwert, der allerdings nicht ausreichend evaluiert ist, kann < 16 cm verwendet werden. Für die Bestimmung des Lebervolumens wurden zahlreiche Methoden beschrieben, die nicht vergleichbar sind. Für den Durchmesser der Pfortader konnten Referenzintervalle aus 6 Studien abgeleitet werden. Die Daten aus 4 Studien über die Lebervenen unterscheiden sich je nach Lokalisation, an der gemessen wurde. Diskussion: Normwerte sind hilfreich für die Abgrenzung zahlreicher pathologischer Prozesse in den jeweiligen Organen. Leider ist die Datenlage spärlich und die Untersuchungstechnik häufig nicht ausreichend standardisiert. Eine multizentrische Normwertestudie ist erforderlich, um die Untersuchungstechnik zu vereinheitlichen und eine bessere Ergebnisqualität zu erreichen.

Abstract

Objective: Reference values for B-mode abdominal ultrasound are being controversially discussed due to the limited data in the literature. A systematic survey of data published so far is presented for liver and hepatic vessels. Methods: A literature search for reference values in the abdomen from 1970 to 2010 in healthy subjects 18 years of age and older was carried out. In accord with the determination of reference intervals for laboratory values, reference values are generally determined with the aid of 95 % reference intervals and the associated 90 % confidence intervals. Evaluated parameters were the size and volume of the liver, the portal vein diameter and cross-section and the diameters of the hepatic veins. Results: Liver size is usually determined by its longitudinal diameter in the midclavicular line. Although not sufficiently evaluated, < 16 cm can be used as a reference value. Numerous methods, which are not comparable, have been described for the determination of liver volume. For the portal vein diameter, refererence intervals could be deduced from 6 studies. Data from 4 studies on the liver veins differ depending on the exact localisation of measurement. Discussion: Normal values are helpful in delineating numerous pathological changes in the respective organs. Unfortunately, data are scarce and the examination technique, so far, has not been standardised sufficiently to compare data. A multicentre trial is required to standardise examination techniques and improve the quality of the results.

Schlüsselwörter

Normwerte - Referenzwerte - Organgrößen - Ultraschall - Lebergröße - Lebervolumen - Pfortader - Lebervenen

Key words

Reference values - reference standards - organ size - ultrasonography - liver size - liver volume - portal vein - hepatic veins

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