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Nierenzysten als Zufallsbefund in der Nachsorge der endovaskulären Aortenreparatur (EVAR) mittels kontrastverstärktem Ultraschall (CEUS)

Incidental diagnosis and characterization of renal cysts in the follow-up after endovascular aortic repair (EVAR) using contrast-enhanced ultrasound (CEUS)

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Zusammenfassung

Hintergrund

Durch die zwischenzeitlich standardmäßige Implementierung des kontrastverstärkten Ultraschalls in die Nachsorge nach endovaskulärer Aortenreparatur können zunehmend Zufallsbefunde detektiert werden, die nicht im direkten Zusammenhang mit der Stentversorgung stehen. Einen großen Anteil machen hierbei zystische Nierenläsionen aus, die insbesondere bei größerer Ausdehnung im Ultraschall mit eingesehen werden können und diagnostisch bewertet werden müssen.

Fragestellung

Wie kann der Untersucher zwischen gutartigen und bösartigen zystischen Nierenläsionen unterscheiden und eventuell weitere nötige Untersuchungen einleiten bzw. unnötige Zusatzuntersuchungen vermeiden?

Material und Methoden

Mit der Bosniak-Klassifikation von Nierenzysten stellen wir ein Modell vor, das es ermöglicht, die Wahrscheinlichkeit für eine maligne Genese zystischer Nierenläsionen abzuschätzen und somit das Risiko für den Patienten zu evaluieren.

Ergebnisse

Die Bosniak-Klassifikation von zystischen Nierenläsionen unterscheidet insgesamt 5 verschiedene Typen, die nach der steigenden Wahrscheinlichkeit für eine Malignität der Nierenläsion geordnet sind. Bosniak-Typ-I- und -II-Läsionen sind in nahezu 100 % der Fälle gutartige, zystische Läsionen. Dagegen weisen Bosniak-Typ-IIF-Zysten ein 6%iges Risiko für eine maligne Entartung auf und müssen verlaufskontrolliert werden. Bosniak-Typ-III- und -IV-Zysten besitzen ein Entartungsrisiko von 50 % bzw. von 100 % und müssen in jedem Fall weiter abgeklärt werden. Anhand verschiedener Beispiele zeigen wir die klassischen sonographischen Kriterien für die Einteilung in die verschiedenen Typen der Bosniak-Klassifikation.

Abstract

Background

Contrast-enhanced ultrasound has been implemented as the standard examination of choice for the follow-up after endovascular aortic repair. Coincidentally, there is a significant number of incidental findings associated with these follow-up examinations that have no direct causal correlation to the endovascular aortic repair. These findings mostly include cystic renal lesions that must be correctly identified and characterized.

Objective

What can help the examiner to distinguish between benign and malignant renal lesions in order to initiate or to avoid additional examinations.

Material and methods

The Bosniak classification for the evaluation of renal cysts allows a risk stratification of the potential malignancy of a cystic renal lesion and can be used to determine whether additional examinations are necessary.

Results

The Bosniak classification discriminates between five different types of cystic renal lesions that are arranged in an increasing likelihood for malignancy. Bosniak type I and II lesions are benign in almost 100% of the cases, whereas Bosniak type II F lesions show a potential malignancy rate of 6% and follow-up needs to be performed. Bosniak type III and IV lesions show a malignancy rate of 50% and 100%, respectively, and must be be clarified in all cases. We present several typical examples showing the classical sonographic criteria for the subdivision into the various types of the Bosniak classification.

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Authors and Affiliations

  1. Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschall-Zentrum, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland

    K. Mueller-Peltzer, J. Rübenthaler, M. Armbruster, M. Reiser & D.-A. Clevert

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  1. K. Mueller-Peltzer
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  2. J. Rübenthaler
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  3. M. Armbruster
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  4. M. Reiser
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  5. D.-A. Clevert
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Correspondence to K. Mueller-Peltzer.

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Interessenkonflikt

K. Mueller-Peltzer, J. Rübenthaler, M. Armbruster, M. Reiser und D.-A. Clevert geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Mueller-Peltzer, K., Rübenthaler, J., Armbruster, M. et al. Nierenzysten als Zufallsbefund in der Nachsorge der endovaskulären Aortenreparatur (EVAR) mittels kontrastverstärktem Ultraschall (CEUS). Gefässchirurgie 23, 37–43 (2018). https://doi.org/10.1007/s00772-017-0337-9

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