Ultraschallgeräte für die abdominelle Diagnostik: neue Techniken und Applikationen – Was gibt es? Was ist möglich? Was ist sinnvoll?

Zusammenfassung

Die Ultraschalldiagnostik ist in vielen klinischen Situationen das Verfahren der ersten Wahl für die abdominelle Bildgebung. Neben dem Graustufenbild (B-Modus) und den klassischen Dopplerverfahren ermöglichen die kontrastmittelverstärkte Sonografie (CEUS), die Elastografie und die Fettquantifizierung eine multimodale Charakterisierung von Organen und Gewebestrukturen. Panorama- und 3D-Verfahren sowie Bildfusion haben die Befunddarstellung erweitert. Die Entwicklung tragbarer Kleingeräte führt zu einer Erweiterung der Einsatzmöglichkeiten der konventionellen Ultraschalldiagnostik.

In dieser Übersichtsarbeit werden moderne sonografisch relevante Verfahren diskutiert sowie Geräteklassen und Stufenkonzepte beschrieben und anhand der wissenschaftlichen Evidenz bewertet. Ferner werden Hinweise zu Qualitätsstandards für die abdominelle Ultraschalldiagnostik vermittelt.

Abstract

Abdominal ultrasound is the method of first choice in many clinical situations. Gray scale imaging (B-mode) and conventional Doppler techniques are nowadays complemented by contrast-enhanced ultrasound (CEUS), elastography, fat quantification and further technologies which allow multimodal characterization of organs and tissue structure using panoramic imaging, 3D-techniques and image fusion. The development of small portable devices augments the spectrum for sonographic diagnostics. In this review, we describe the current status of ultrasound technology based on published evidence. In addition, we provide guidance for quality assurance.

Schlüsselwörter

3D-Ultraschall - Abdomensonografie - Kontrastmittel-verstärkter Ultraschall - Elastografie - Bildfusion - Nadel-Tracking

Keywords

3-dimensional ultrasound - abdominal ultrasound - contrast-enhanced ultrasound - elastography - fusion imaging - needle tracking

• Literatur

• 1 Jenssen C, Ewertsen C, Piscaglia F. et al. 50 Jahre EFSUMB: Wurzeln, Reifung und neue Triebe. Ultraschall Med 2022; 43: 227-231
• 2 Dietrich CF, Bolondi L, Duck F. et al. History of Ultrasound in Medicine from its birth to date (2022), on occasion of the 50 Years Anniversary of EFSUMB. A publication of the European Federation of Societies for Ultrasound In Medicine and Biology (EFSUMB), designed to record the historical development of medical ultrasound. Med Ultrason 2022;
• 3 Tovoli F, Cantisani V, Schiavone C. et al. Welche Zukunft hat Ultraschall in der Medizin. Ultraschall Med 2018; 39: 7-10
• 4 Merz E, Bätzel A. Quality assurance in ultrasound diagnostics--where are we at the end of 2009. Ultraschall Med 2009; 30: 525-527
• 5 Kassenärztliche Bundesvereinigung. Vereinbarung von Qualitätssicherungsmaßnahmen nach § 135 Abs. 2 SGB V zur Ultraschalldiagnostik. (Ultraschall-Vereinbarung) [updated Fassung vom 1 Oct 2021;. Accessed April 04, 2022 at: https://www.kbv.de/media/sp/Ultraschallvereinbarung.pdf
• 6 Dietrich CF, Bulla P, Dudwiesus H. et al. Entwicklungen, Herausforderung und Perspektiven des Handheld-Ultraschalls (HHUS). Z Gastroenterol 2022;
• 7 Heinitz S, Müller M, Blank V. et al. Applicability of high-performance ultrasound probes in subjects with obesity: a standardized prospective evaluation. Ultraschall Med 2022; S2-S3
• 8 Dietrich CF, Nolsøe CP, Barr RG. et al. Aktualisierte Leitlinien und Empfehlungen für die gute klinische Praxis für CEUS der Leber. Ultraschall Med 2020; 41: 562-585
• 9 Sidhu PS, Cantisani V, Dietrich CF. et al. Die EFSUMB-Leitlinien und Empfehlungen für den klinischen Einsatz des kontrastverstärkten Ultraschalls (CEUS) bei nicht-hepatischen Anwendungen: Update 2017 (Langversion). Ultraschall Med 2018; 39: e2-e44
• 10 Piscaglia F, Bolondi L. The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol 2006; 32: 1369-1375
• 11 Bitzer M, Voesch S, Albert J. et al. S3-Leitlinie – Diagnostik und Therapie biliärer Karzinome. Z Gastroenterol 2022; 60: e186-e227
• 12 Beyer LP, Wassermann F, Pregler B. et al. Charakterisierung von fokalen Leberläsionen mit CEUS und MRT mit leberspezifischem Kontrastmittel: Erfahrungen eines radiologischen Zentrums. Ultraschall Med 2017; 38: 619-625
• 13 Bernatik T, Schuler A, Kunze G. et al. Benefit of Contrast-Enhanced Ultrasound (CEUS) in the Follow-Up Care of Patients with Colon Cancer: A Prospective Multicenter Study. Ultraschall Med 2015; 36: 590-593
• 14 Kono Y, Lyshchik A, Cosgrove D. et al. Contrast Enhanced Ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS): the official version by the American College of Radiology (ACR). Ultraschall Med 2017; 38: 85-86
• 15 Schellhaas B, Wildner D, Pfeifer L. et al. LI-RADS-CEUS mit kontrastverstärktem Ultraschall – Vorschlag für eine standardisierte Klassifikation HCC-suspekter Leberraumforderungen bei Risikopatienten. Ultraschall Med 2016; 37: 627-634
• 16 Bansal S, Lu F, Frehlich L. A new proposal for secondary surveillance following potentially curative therapy of HCC: alternating MRI and CEUS. Abdom Radiol (NY) 2022; 47: 618-629
• 17 Wiesinger I, Wiggermann P, Zausig N. et al. Perkutane Therapie maligner Leberläsionen: Evaluation des Therapieerfolgs mittels CEUS und Perfusionssoftware. Ultraschall Med 2018; 39: 440-447
• 18 Dietrich CF, Averkiou MA, Correas JM. et al. An EFSUMB introduction into Dynamic Contrast-Enhanced Ultrasound (DCE-US) for quantification of tumour perfusion. Ultraschall Med 2012; 33: 344-351
• 19 Jung EM, Weber MA, Wiesinger I. Kontrastmittelverstärkter Ultraschall zur Perfusionsdiagnostik in Organen. Radiologe 2021; 61: 19-28
• 20 Lassau N, Koscielny S, Chami L. et al. Advanced hepatocellular carcinoma: early evaluation of response to bevacizumab therapy at dynamic contrast-enhanced US with quantification--preliminary results. Radiology 2011; 258: 291-300
• 21 Castera L, Friedrich-Rust M, Loomba R. Noninvasive Assessment of Liver Disease in Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology 2019; 156: 1264-1281.e4
• 22 EASL. Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update. J Hepatol 2021; 75: 659-689
• 23 Karlas T, Blank V, Böhlig A. Stellenwert der Sonografie bei Fettlebererkrankungen. Ultraschall Med 2021; 42: 128-153
• 24 Piscaglia F, Salvatore V, Mulazzani L. et al. Ultrasound Shear Wave Elastography for Liver Disease. A Critical Appraisal of the Many Actors on the Stage. Ultraschall Med 2016; 37: 1-5
• 25 Tacke F, Canbay A, Bantel H. et al. Updated S2k Clinical Practice Guideline on Non-alcoholic Fatty Liver Disease (NAFLD) issued by the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS). AWMF Registration No.: 021 – 025. . https://www.dgvs.de/wp-content/uploads/2022/04/LL-NAFLD_englisch_final_28.04.22.pdf
• 26 Dietrich CF, Bamber J, Berzigotti A. et al. EFSUMB-Leitlinien und Empfehlungen zur klinischen Anwendung der Leberelastographie, Update 2017 (Langversion). Ultraschall Med 2017; 38: e16-e47
• 27 Papatheodoridi M, Hiriart JB, Lupsor-Platon M. et al. Refining the Baveno VI elastography criteria for the definition of compensated advanced chronic liver disease. J Hepatol 2021; 74: 1109-1116
• 28 Berzigotti A. Non-invasive evaluation of portal hypertension using ultrasound elastography. J Hepatol 2017; 67: 399-411
• 29 Karlas T, Petroff D, Sasso M. et al. Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis. J Hepatol 2017; 66: 1022-1030
• 30 Petroff D, Blank V, Newsome PN. et al. Assessment of hepatic steatosis by controlled attenuation parameter using the M and XL probes: an individual patient data meta-analysis. Lancet Gastroenterol Hepatol 2021; 6: 185-198
• 31 Blank V, Petroff D, Wiegand J. M probe comes first: Impact of initial probe choice on diagnostic performance of vibration controlled transient elastography. Dig Liver Dis 2022; 54: 358-364
• 32 Semmler G, Wöran K, Scheiner B. et al. Novel reliability criteria for controlled attenuation parameter assessments for non-invasive evaluation of hepatic steatosis. United European Gastroenterol J 2020; 8: 321-331
• 33 Wong VWS, Petta S, Hiriart JB. et al. Validity criteria for the diagnosis of fatty liver by M probe-based controlled attenuation parameter. J Hepatol 2017; 67: 577-584
• 34 Wong VWS. Predicting NASH response with liver fat: Are we back to square one. J Hepatol 2020; 72: 386-388
• 35 Ferraioli G, Maiocchi L, Raciti MV. et al. Detection of Liver Steatosis With a Novel Ultrasound-Based Technique: A Pilot Study Using MRI-Derived Proton Density Fat Fraction as the Gold Standard. Clin Transl Gastroenterol 2019; 10: e00081
• 36 Ferraioli G, Maiocchi L, Savietto G. et al. Performance of the Attenuation Imaging Technology in the Detection of Liver Steatosis. J Ultrasound Med 2021; 40: 1325-1332
• 37 Ferraioli G, Soares Monteiro LB. Ultrasound-based techniques for the diagnosis of liver steatosis. World J Gastroenterol 2019; 25: 6053-6062
• 38 Ferraioli G, Berzigotti A, Barr RG. et al. Quantification of Liver Fat Content with Ultrasound: A WFUMB Position Paper. Ultrasound Med Biol 2021; 47: 2803-2820
• 39 Dietrich CF, Shi L, Löwe A. et al. Konventioneller Ultraschall in der Fettleber-Diagnostik ist besser als sein Ruf. Z Gastroenterol 2022; 60: 1235-1248
• 40 Bedossa P, Carrat F. Liver biopsy: the best, not the gold standard. J Hepatol 2009; 50: 1-3
• 41 Sugimoto K, Moriyasu F, Oshiro H. et al. Viscoelasticity Measurement in Rat Livers Using Shear-Wave US Elastography. Ultrasound Med Biol 2018; 44: 2018-2024
• 42 Sugimoto K, Moriyasu F, Oshiro H. et al. The Role of Multiparametric US of the Liver for the Evaluation of Nonalcoholic Steatohepatitis. Radiology 2020; 296: 532-540
• 43 Tapper EB, Loomba R. Noninvasive imaging biomarker assessment of liver fibrosis by elastography in NAFLD. Nat Rev Gastroenterol Hepatol 2018; 15: 274-282
• 44 Dietrich CF, Caspary WF. SieScape-Panoramabildverfahren. Klinischer Wert. Internist (Berl) 2000; 41: 24-28
• 45 Massalha K, Kröger K, Rudofsky G. „Panoramabilder“ per Ultraschall. Ein Rechenprogramm setzt Einzelbilder zu einer kontinuierlichen Aufnahme zusammen. MMW Fortschr Med 2000; 142: 38-40
• 46 Fu Z, Zhang J, Lu Y. et al. Clinical Applications of Superb Microvascular Imaging in the Superficial Tissues and Organs: A Systematic Review. Acad Radiol 2021; 28: 694-703
• 47 Jeon SK, Lee JY, Han JK. Superb microvascular imaging technology of ultrasound examinations for the evaluation of tumor vascularity in hepatic hemangiomas. Ultrasonography 2021; 40: 538-545
• 48 Umemura A, Yamada K. B-mode flow imaging of the carotid artery. Stroke 2001; 32: 2055-2057
• 49 Morgan TA, Jha P, Poder L. Advanced ultrasound applications in the assessment of renal transplants: contrast-enhanced ultrasound, elastography, and B-flow. Abdom Radiol (NY) 2018; 43: 2604-2614
• 50 Blank V, Engel K, Keim V. Cinematic Rendering: fotorealistische Darstellung komplexer Ultraschallbefunde der Leber. Ultraschall Med 2019; S3-S4
• 51 Blank V, Wiegand J, Keim V. Evaluation of a novel tomographic ultrasound device for abdominal examinations. PLoS One 2019; 14: e0218754
• 52 Minami Y, Kudo M. Image Guidance in Ablation for Hepatocellular Carcinoma: Contrast-Enhanced Ultrasound and Fusion Imaging. Front Oncol 2021; 11: 593636
• 53 Minami Y, Minami T, Takita M. et al. Radiofrequency ablation for hepatocellular carcinoma: Clinical value of ultrasound-ultrasound overlay fusion for optimal ablation and local controllability. Hepatol Res 2020; 50: 67-74
• 54 Dietrich CF, Lorentzen T, Appelbaum L. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III – Abdominal Treatment Procedures (Short Version). Ultraschall Med 2016; 37: 27-45
• 55 Ignee A, Randak M, Schüßler G. Die neutrale Fusionssonografie ist nützlich bei der Charakterisierung von in der Schnittbildgebung unklar gebliebenen abdominellen Läsionen. Ultraschall Med 2019; S4
• 56 Jung EM, Dinkel J, Verloh N. et al. Wireless point-of-care ultrasound: First experiences with a new generation handheld device. Clin Hemorheol Microcirc 2021; 79: 463-474
• 57 Lo H, Frauendorf V, Wischke S. et al. Handheld-Ultraschall im Point-of-Care-Einsatz (HH-POCUS) in der ambulanten Versorgung in ländlichen Regionen Brandenburgs – eine Pilotstudie. Ultraschall Med 2021;
• 58 Vilanova-Rotllan S, Kostov B, Giner Martos MJ. et al. Estudio de viabilidad de la ecografía abdominal con dispositivos portátiles en atención domiciliaria. Med Clin (Barc) 2021;
• 59 Nielsen MB, Cantisani V, Sidhu PS. et al. Die Anwendung handgeführter Ultraschallgeräte – Ein EFSUMB Positionspapier. Ultraschall Med 2019; 40: e1
• 60 Aldaas OM, Igata S, Raisinghani A. et al. Accuracy of left ventricular ejection fraction determined by automated analysis of handheld echocardiograms: A comparison of experienced and novice examiners. Echocardiography 2019; 36: 2145-2151
• 61 Stewart JE, Goudie A, Mukherjee A. et al. Artificial intelligence-enhanced echocardiography in the emergency department. Emerg Med Australas 2021; 33: 1117-1120
• 62 Kaneko T, Kagiyama N, Nakamura Y. et al. Effectiveness of real-time tele-ultrasound for echocardiography in resource-limited medical teams. J Echocardiogr 2022; 20: 16-23
• 63 Uschnig C, Recker F, Blaivas M. et al. Tele-ultrasound in the Era of COVID-19: A Practical Guide. Ultrasound Med Biol 2022; 48: 965-974
• 64 Malik AN, Rowland J, Haber BD. et al. The Use of Handheld Ultrasound Devices in Emergency Medicine. Curr Emerg Hosp Med Rep 2021; 9: 73-81
• 65 Barreiros AP, Cui XW, Ignee A. et al. EchoScopy in scanning abdominal diseases: initial clinical experience. Z Gastroenterol 2014; 52: 269-275
• 66 Barreiros AP, Dong Y, Ignee A. et al. EchoScopy in scanning abdominal diseases; a prospective single center study. Med Ultrason 2019; 21: 8-15
• 67 Dietrich CF, Goudie A, Chiorean L. et al. Point of Care Ultrasound: A WFUMB Position Paper. Ultrasound Med Biol 2017; 43: 49-58
• 68 Baribeau Y, Sharkey A, Chaudhary O. et al. Handheld Point-of-Care Ultrasound Probes: The New Generation of POCUS. J Cardiothorac Vasc Anesth 2020; 34: 3139-3145
• 69 Austin DR, Chang MG, Bittner EA. Use of Handheld Point-of-Care Ultrasound in Emergency Airway Management. Chest 2021; 159: 1155-1165
• 70 Galusko V, Khanji MY, Bodger O. Hand-held Ultrasound Scanners in Medical Education: A Systematic Review. J Cardiovasc Ultrasound 2017; 25: 75-83
• 71 Haji-Hassan M, Lenghel LM, Bolboacă SD. Hand-Held Ultrasound of the Lung: A Systematic Review. Diagnostics (Basel) 2021; 11
• 72 Benbassat J, Gilon D. Teaching the physical examination by context and by integrating hand-held ultrasound devices. Med Teach 2020; 42: 993-999
• 73 Varsou O. The Use of Ultrasound in Educational Settings: What Should We Consider When Implementing this Technique for Visualisation of Anatomical Structures. Adv Exp Med Biol 2019; 1156: 1-11
• 74 Dietrich CF, Hoffmann B, Abramowicz J. et al. Medical Student Ultrasound Education: A WFUMB Position Paper, Part I. Ultrasound Med Biol 2019; 45: 271-281
• 75 Hoffmann B, Blaivas M, Abramowicz J. et al. Medical Student Ultrasound Education, a WFUMB Position Paper, Part II. A consensus statement of ultrasound societies. Med Ultrason 2020; 22: 220-229
• 76 Rajendram R, Hussain A, Mahmood N. et al. Feasibility of using a handheld ultrasound device to detect and characterize shunt and deep vein thrombosis in patients with COVID-19: an observational study. Ultrasound J 2020; 12: 49
• 77 Bennett D, Vita de E, Mezzasalma F. et al. Portable Pocket-Sized Ultrasound Scanner for the Evaluation of Lung Involvement in Coronavirus Disease 2019 Patients. Ultrasound Med Biol 2021; 47: 19-24
• 78 Rykkje A, Carlsen JF, Nielsen MB. Hand-Held Ultrasound Devices Compared with High-End Ultrasound Systems: A Systematic Review. Diagnostics (Basel) 2019; 9