Zusammenfassung
Bildgebende Verfahren, insbesondere die Sonographie, haben ein Schlüsselrolle in der
Diagnostik und Therapie der zystischen Echinokokkose erlangt. Die unspezifische Symptomatik
der Erkrankung und die nach wie vor unbefriedigende Sensitivität und Spezifität serologischer
Methoden sind hierfür wichtige Gründe. Auch in Mittel- und Nordeuropa gewinnt diese
parasitäre Erkrankung aufgrund der Migration von Patienten aus Endemiegebieten an
klinischer Bedeutung und muss bei der Differenzialdiagnose zystischer Läsionen berücksichtigt
werden. Die differenzierte sonomorphologische Stadieneinteilung, die zuletzt durch
eine Expertenkommission der WHO im Jahr 2001 harmonisiert wurde, ermöglicht nicht
nur in vielen Fällen eine sichere Primärdiagnose, sondern unterstützt auch wesentlich
die Therapieentscheidung, Verlaufskontrolle und Rezidivdiagnostik. Der Ultraschall
hat sich daher bei abdomineller Erkrankungslokalisation als bildgebendes Verfahren
der Wahl etabliert. Indikationsbereiche für die Computertomographie und Magnetresonanztomographie
sind schlechte Ultraschallbedingungen, extraabdominelle Zystenlokalisation, komplizierter
Krankheitsverlauf und Planung einer chirurgischen oder interventionellen Therapie.
Neben der chirurgischen Therapie haben sich in den letzten Jahren drei weitere Behandlungsmöglichkeiten
etabliert: (1) die medikamentöse Therapie (Albendazol, Mebendazol), (2) die interventionelle
Therapie (PAIR) und (3) das abwartende Verhalten („watch and wait”).
Abstract
Imaging studies, ultrasonography, play a central role for the diagnosis and follow-up
of cystic echinococcosis (hydatid disease) due to the non-specific clinical symptoms
and still inadequate sensitivity and specificity of currently available serological
tests. Due to the increasing number of people immigrating to central Europe from countries
with a high incidence of cystic echinococcosis, cystic echinococcosis has become an
important differential diagnosis of cystic lesions. The imaging modality to localize
and stage the disease depends on the organs affected. Ultrasonography is the most
important imaging technique to screen for abdominal lesions (more than 75 % of the
cases). Therefore, an expert committee of the WHO Working Group on echinococcosis
has recently suggested a standardized ultrasonographic classification of hepatic cystic
echinococcosis. This classification proofs to be very useful for staging echinococcal
cysts with respect to parasite activity. Ultrasonography is not only an excellent
tool for the primary diagnosis and therapeutic decision but also for follow-up of
patients treated for cystic echinococcosis. Indications for computed tomography or
magnetic resonance tomography are restricted to extraabdominal disease, patients not
suited for ultrasonography because of obesity or meteorism, complicated cysts and
planning of surgery or interventional therapy. Apart from surgery three other treatment
options are well established: (1) chemotherapy with albendazole or mebendazole, (2)
percutaneous drainage and sterilization (PAIR) and (3) observation of inactive echinococcal
stages (“watch and wait” approach).
Key words
Cystic echinococcosis - hydatid disease - ultrasound - computed tomography, CT - MR-Imaging,
MRI
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Dr. Waldemar Hosch
Abteilung Radiodiagnostik, Universitätsklinik Heidelberg
Im Neuenheimer Feld 110
69120 Heidelberg
Phone: ++49/6221/566410
Fax: ++49/6221/565730
Email: waldemar_hosch@med.uni-heidelberg.de
