Kontrastmittel-gestützte Ultraschalluntersuchung (CEUS) – Extrahepatische Anwendungen

Alle kontrastmittelgestützten Ultraschalluntersuchungen werden außerhalb der ausdrücklichen zugelassenen Anwendungen formal ”off-label“ durchgeführt. Erste Guidelines und Empfehlungen der EFSUMB (European Federation for Ultrasound in Medicine and Biology) ausschließlich zu extrahepatischen klinischen Anwendungen geben den aktuellen Stand der möglichen Diagnostik auf dem Boden des Expertenkonsens mit entsprechend Empfehlungs- und Evidenzgraden wider. Damit geben sie den Anwendern von CEUS eine gewisse Sicherheit auf der Grundlage der aktuellen Datenlage. Im Folgenden werden die wichtigsten und gesicherten extrahepatischen Indikationen und Einsatzbereiche für eine sinnvolle Diagnostik mit CEUS für Pankreas, Niere, Milz, GI-Trakt und Gefäße besprochen und anhand von Beispielen veranschaulicht.

Differentiated contrast medium supported diagnostic by ultrasound (CEUS) meanwhile has gained great significance even in extrahepatic regions. Main indications in the abdomen incl. emergency diagnostic are pancreas, kidney, spleen, gastrointestinal tract and vessels. Indications are manifold, in the meantime based on scientific results and the method is no longer dispensable in the day-to-day-practice of experienced ultrasound specialists. The current EFSUMB-Guidelines reflect the actual spectrum.

Key words

CEUS pancreas - CEUS kidney - CEUS spleen - CEUS gi-tract extrahepatic application - EFSUMB-guidelines

• Literatur

• 1 Piscaglia F, Nolsoe C, Dietrich CF et al. The EFSUMB Guidelines and Recommendations on the clinical practice of contrast enhanced ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall in Med e-pub 2011;
• 2 Dietrich CF, Braden B, Hocke M et al. Improved characterisation of solitary solid pancreatic tumours using contrast enhanced transabdominal ultrasound. J Cancer Res Clin Oncol 2008; 134: 635-643
• 3 D'Onofrio M, Megibow AJ, Faccioli N et al. Comparison of contrast-enhanced sonography and MRI in displaying anatomic features of cystic pancreatic masses. Am J Roentgenol 2007; 189: 1435-1442
• 4 Kitano M, Kudo M, Maekawa K et al. Dynamic imaging of pancreatic diseases by contrast enhanced coded phase inversion harmonic ultrasonography. Gut 2004; 53: 854-859
• 5 D'Onofrio M, Malago R, Zamboni G et al. Contrast-enhanced ultrasonography better identifies pancreatic tumor vascularization than helical CT. Pancreatology 2005; 5: 398-402
• 6 D'Onofrio M, Barbi E, Dietrich CF. Pancreatic multicenter ultrasound study (PAMUS). Eur J Radiol e-pub 2011; 1001-1053
• 7 Ripolles T, Martinez MJ, Lopez E et al. Contrast-enhanced ultrasound in the staging of acute pancreatitis. Eur Radiol 2010; 20: 2518-2523
• 8 Rickes S, Wermke W. Differentiation of cystic pancreatic neoplasms and pseudocysts by conventional and echo-enhanced ultrasound. J Gastroenterol Hepatol 2004; 19: 761-766
• 9 D'Onofrio M, Gallotti A, Pozzi Mucelli R. Imaging techniques in pancreatic tumors. Expert Rev Med Devices 2010; 7: 257-273
• 10 Itoh T, Hirooka Y, Itoh A et al. Usefulness of contrast-enhanced transabdominal ultrasonography in the diagnosis of intraductal papillary mucinous tumors of the pancreas. Am J Gastroenterol 2005; 100: 144-152
• 11 Quaia E, Bertolotto M, Cioffi V et al. Comparison of contrast-enhanced sonography with unenhanced sonography and contrast-enhanced CT in the diagnosis of malignancy in complex cystic renal masses. Am J Roentgenol 2008; 191: 1239-1249
• 12 A. Schuler, H. Heynemann. Fokale Nierenveränderungen. In: Klinische Sonographie und sonographische Differenzialdiagnostik. Seitz K, Schuler A, Rettenmaier G. Auflage. Stuttgart: Thieme Verlag; 2008. 2.
• 13 Tamai H, Takiguchi Y, Oka M et al. Contrast-enhanced ultrasonography in the diagnosis of solid renal tumors. J Ultrasound Med 2005; 24: 1635-1640
• 14 Bertolotto M, Martegani A, Aiani L et al. Value of contrast-enhanced ultrasonography for detecting renal infarcts proven by contrast enhanced CT. A feasibility study. Eur Radiol 2008; 18: 376-383
• 15 Goerg C, Bert T. Contrast enhanced sonography of focal splenic lesion with a second-generation contrast agent. Ultraschall in Med 2005; 26: 470-477
• 16 Goerg C, Graef C, Bert T. Contrast-enhanced sonography for differential diagnosis of an inhomogeneous spleen of unknown cause in patients with pain in the left upper quadrant. J Ultrasound Med 2006; 25: 729-734
• 17 Goerg C, Faoro C, Bert T et al. Contrast enhanced ultrasound of splenic lymphoma involvement. Eur J Radiol epub 2009;
• 18 von Herbay A, Barreiros AP, Ignee A et al. Contrast-enhanced ultrasonography with SonoVue: differentiation between benign and malignant lesions of the spleen. J Ultrasound Med 2009; 28: 421-434
• 19 Chiavaroli R, Grima P, Tundo P. Characterization of nontraumatic focal splenic lesions using contrast-enhanced sonography. J Clin Ultrasound 2011; 39: 310-315
• 20 Goerg C, Bert T. Second-generation sonographic contrast agent for differential diagnosis of perisplenic lesions. Am J Roentgenol 2006; 186: 621-626
• 21 Plikat K, Klebl F, Buchner C et al. Evaluation of intestinal hyperaemia in inflamed bowel by high resolution Contrast Harmonic Imaging (CHI). Ultraschall in Med 2004; 25: 257-262
• 22 Girlich C, Jung EM, Huber E, Ott C, Iesalnieks I, Schreyer A, Schacherer D. Comparison between Preoperative Quantitative Assessment of Bowel Wall Vascularization by Contrast-Enhanced Ultrasound and Operative Macroscopic Findings and Results of Histopathological Scoring in Crohn's Disease. Ultraschall in Med 2011; 32: 154-159
• 23 Schlottmann K, Kratzer W, Schoelmerich J. Doppler ultrasound and intravenous contrast agents in gastrointestinal tract disorders: current role and future implications. Eur J Gastroenterol Hepatol 2005; 17: 263-275
• 24 Pauls S, Gabelmann A, Schmidt SA et al. Evaluating bowel wall vascularity in Crohn's disease: a comparison of dynamic MRI and wideband harmonic imaging contrast-enhanced low MI ultrasound. Eur Radiol 2006; 16: 2410-2417
• 25 Ripolles T, Martinez MJ, Paredes JM et al. Crohn disease: correlation of findings at contrast-enhanced US with severity at endoscopy. Radiology 2009; 253: 241-248
• 26 Schuler A, Beuscher-Willems B, Strohm WD. Sonographisches Monitoring der Infliximab-Therapie komplizierter Fisteln bei M. Crohn. Ultraschall in Med 2001; 22: 126-126
• 27 Clevert DA, Horng A, Jung EM et al. Contrast-enhanced ultrasound versus conventional ultrasound and MS-CT in the diagnosis of abdominal aortic dissection. Clin Hemorheol Microcirc 2009; 43: 129-139
• 28 Clevert DA, Sommer WH, Zengel P et al. Imaging of carotid arterial diseases with contrast-enhanced ultrasound (CEUS). Eur J Radiol epub 2011;
• 29 Coli S, Magnoni M, Sangiorgi G et al. Contrast-enhanced ultrasound imaging of intraplaque neovascularization in carotid arteries: correlation with histology and plaque echogenicity. J Am Coll Cardiol 2008; 52: 223-230
• 30 Giannoni MF, Vicenzini E, Citone M et al. Contrast carotid ultrasound for the detection of unstable plaques with neoangiogenesis: a pilot study. Eur J Vasc Endovasc Surg 2009; 37: 722-727