Innovativer Ultraschall: Kontrastverstärkter Ultraschall der Nieren

Zusammenfassung

Die Ultraschalluntersuchung der Nieren im B-Bild-Ultraschall und mittels farbkodierter Dopplersonografie stellt die Basis der Nierenbildgebung dar. Mit der kontrastverstärkten Ultraschalluntersuchung steht nun seit einigen Jahren eine nichtinvasive, nierenschonende und jodfreie Echtzeitbildgebung zur Verfügung, die nach der intravenösen Gabe von Gasbläschen (Schwefelhexafluorid) die Nierengefäße bis hin zur Nierenmikroperfusion abbildet. Haupteinsatzgebiete der neuen Bildgebung sind zystische Nierenläsionen und die Analyse tumorverdächtiger Nierenherde, aber auch die Darstellung von Entzündungen sowie die Nierenperfusion nach Traumata und Infarkten.

Abstract

Ultrasound examination of the kidneys with grey-scale imaging and colour Doppler ultrasound is the most common renal imaging modality. A few years ago, contrast-enhanced ultrasound (CEUS) emerged as a non-invasive perfusion imaging modality to evaluate the renal vessels and microvascularisation. These contrast media contain intravenous microbubbles (sulfur hexafluoride), which have no deleterious effect on renal function. Being free of iodine, they also pose no risk for the thyroid gland. CEUS of the kidneys is mainly used for the evaluation of renal cysts and the analysis of renal lesions suspicious for malignancy. Also this method is used to visualise inflammation as well as renal perfusion after trauma or infarction.

Schlüsselwörter

Diagnostik - Ultraschall - Niere - kontrastverstärkter Ultraschall - Perfusion - Bildgebung

Keywords

diagnostics - ultrasonography - kidney - perfusion imaging - contrast-enhanced ultrasound - CEUS - contrast media

• Literatur

• 1 Stock K. Ultrasound of the kidneys and the urinary tract. Nephrologe 2009; 4: 273-285
• 2 Stock K. Ultrasound diagnostics of renal blood vessels and transplant kidney. Radiologe 2009; 49: 1040-1047
• 3 Stock KF, Klein B, Steubl D. et al. Comparison of a pocket-size ultrasound device with a premium ultrasound machine: diagnostic value and time required in bedside ultrasound examination. Abdom Imaging 2015; 40: 2861-2866
• 4 Andersen GN, Graven T, Skjetne K. et al. Diagnostic influence of routine point-of-care pocket-size ultrasound examinations performed by medical residents. J Ultrasound Med 2015; 34: 627-636
• 5 Krumme B. Renal Doppler sonography–update in clinical nephrology. Nephron Clin Pract 2006; 103: c24-c28
• 6 Krumme B, Blum U, Schwertfeger E. et al. Diagnosis of renovascular disease by intra- and extrarenal Doppler scanning. Kidney Int 1996; 50: 1288-1292
• 7 Radermacher J. Ultrasound of the kidney and renal vessels. I: Normal findings, congenital diseases, diseases of the kidney parenchyma. Internist (Berl) 2003; 44: 1283-1297 quiz 1298–1299
• 8 Radermacher J. Sonografie der Nieren und Nierengefäße. Urologe 2005; 44: 1351-1365
• 9 Tenant SC, Gutteridge CM. The clinical use of contrast-enhanced ultrasound in the kidney. Ultrasound 2016; 24: 94-103
• 10 McArthur C, Baxter GM. Current and potential renal applications of contrast-enhanced ultrasound. Clin Radiol 2012; 67: 909-922
• 11 Solivetti FM, Elia F, Musicco F. et al. Anaphylactic shock induced by sulphur hexafluoride in an individual with no history of heart disease: case report and literature review. Ultraschall Med 2012; 33: 597-598
• 12 Piscaglia F, Bolondi L. The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol 2006; 32: 1369-1375
• 13 Jaspers N, Pfister R, Kinkel H. et al. Contrast-enhanced ultrasound. Dtsch Med Wochenschr 2012; 137: 2336-2339
• 14 Claudon M, Cosgrove D, Albrecht T. et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) - update 2008. Ultraschall Med 2008; 29: 28-44
• 15 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 Med 2012; 33: 33-59
• 16 Ascenti G, Mazziotti S, Zimbaro G. et al. Complex cystic renal masses: characterization with contrast-enhanced US. Radiology 2007; 243: 158-165
• 17 Clevert DA, Minaifar N, Weckbach S. et al. Multislice computed tomography versus contrast-enhanced ultrasound in evaluation of complex cystic renal masses using the Bosniak classification system. Clin Hemorheol Microcirc 2008; 39: 171-178
• 18 Rubenthaler J, Bogner F, Reiser M. et al. Contrast-Enhanced Ultrasound (CEUS) of the kidneys by using the Bosniak classification. Ultraschall Med 2016; 37: 234-251
• 19 Weibl P, Klatte T, Waldert M. et al. Complex renal cystic masses: current standards and controversies. Int Urol Nephrol 2012; 44: 13-18
• 20 Clevert DA, Weckbach S, Minaifar N. et al. Contrast-enhanced ultrasound versus MS-CT in blunt abdominal trauma. Clin Hemorheol Microcirc 2008; 39: 155-169
• 21 Fontanilla T, Minaya J, Cortes C. et al. Acute complicated pyelonephritis: contrast-enhanced ultrasound. Abdom Imaging 2012; 37: 639-646