Das hepatozelluläre Karzinom. Rolle der Bildgebung zur Detektion, Therapieplanung und Therapiekontrolle

Zusammenfassung

Zielsetzung: Vorstellung der Methodik und klinischen Wertigkeit der bildgebenden Diagnostik zu Screening, Detektion, Interventionsplanung und Therapiekontrolle des hepatozellulären Karzinoms (HCC). Diagnostische Untersuchungstechniken werden diskutiert wie farbkodierte Duplexsonographie, Computertomographie (CT, MSCT) und kontrastmittelverstärkte Magnetresonanzverfahren (MRT, MRA und MRCP). Die Therapiekontrolle mittels Bildgebung erfolgt im Rahmen des Einsatzes chirurgischer Therapieverfahren wie Resektion und Lebertransplantation sowie der transarteriellen Chemoembolisation (TACE), Radiofrequenzablation und der laserinduzierten Thermotherapie (LITT). Die farbkodierte Duplexsonographie zeigt beim Screening des HCC bei vorliegender Leberzirrhose Sensitivitäten von 45 - 92 % bei einer Spezifität von 78 - 90 %. Die Ergebnisse der CT konnten durch Etablierung der mehrphasischen Mehrschicht-Spiral-CT verbessert werden. Die höchste diagnostische Treffsicherheit erzielt derzeit die kontrastverstärkte MRT mit einer Sensitivität von 82 - 96 %. Die TACE stellt derzeit ein palliatives Therapiekonzept dar, die MR-gesteuerte LITT und die Radiofrequenzablation werden als thermoablative Verfahren zur Lokaltherapie eingesetzt, und die Therapiekontrolle basiert auf obigen bildgebenden Verfahren. Zusammenfassend ist im Rahmen der Diagnostik und Therapiekontrolle des HCC ein individuell adaptierter Einsatz der bildgebenden Diagnostik erforderlich.

Abstract

Purpose: Demonstration of techniques and clinical value of imaging diagnostics for screening, detection, interventional follow-up and therapy control of hepatocellular carcinoma (HCC). Diagnostic techniques for screening, detection and differential diagnosis of HCC are presented using color-coded duplex sonography (US), computer tomography (CT) and contrast-enhanced magnetic resonance techniques like MRI, MR angiography and MR cholangiopancreaticography (MRCP). Therapy control with imaging was performed for surgical methods like resection and liver transplantation as for well as transarterial chemoembolization (TACE), radiofrequency ablation (RF) and laser-induced thermotherapy (LITT). In screening, HCC color-coded duplex sonography reveals a sensitivity from 45 to 92 % and a specificity from 78 to 90 % when liver cirrhosis is present. The diagnostic results of CT were further improved with the newly developed techniques of multislice CT. The highest diagnostic accuracy can currently be achieved using contrast-enhanced MRI with a sensitivity from 82 to 96 %. TACE presents a palliative therapy concept; MR-guided LITT and radiofrequency ablation are used as thermoablative methods for local therapy and the therapy control is based on the above imaging techniques. Contrast-enhanced MRI proves to be the superior imaging technique for the early diagnosis, differential diagnosis and follow-up of hepatocellular carcinoma.

Hepatozelluläres Karzinom (HCC) - radiologische Intervention - Transarterielle Chemoembolisation - TACE - laserinduzierte Thermotherapie - Radiofrequenzablation - Sonographie - CT - MRT

Hepatocellular carzinoma (HCC) - radiological intervention - transarterial chemoembolization - TACE - laser-induced thermotherapy - radiofrequency ablation - sonography - CT - MRI

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