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28.02.2018 | Knochentumoren | Leitthema

Tumoren des Fußes und der Sprunggelenkregion

Teil II: Maligne Knochentumoren und Weichteiltumoren des Fußes mit differenzialdiagnostischen Hinweisen

verfasst von: Dr. T. Grieser

Erschienen in: Die Radiologie | Ausgabe 5/2018

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Zusammenfassung

Klinisches Problem

Am Fuß treten sowohl benigne als auch maligne Tumoren auf. Wegen ihrer Seltenheit lösen sie diagnostische Unsicherheiten aus. Bei der Differenzierung versagen die gängigen Kriterien wie Größe, Invasivität oder auch Schmerz.

Radiologische Standardverfahren

Bei Knochentumoren spielen die Projektionsradiographie und die CT zunächst die entscheidende Rolle. Bei den Weichteiltumoren sollte die Sonographie Ganglien sicher erkennen. Die weitere Diagnostik erfolgt dann mittels MRT. Nuklearmedizinische Methoden dienen zum Nachweis von Multifokalität, einer systemischen Ausbreitung oder zur Biopsieplanung.

Methodische Innovationen

Auf den Stellenwert der Dual-Energy-CT wurde bereits in Teil I verwiesen. Inwieweit sich dieses Verfahren auch zur Knochenödemdiagnostik sicher einsetzen lässt, ist momentan noch sehr umstritten.

Besonderheiten der Fußtumoren

Primäre Knochentumoren des Fußes sind vorwiegend in der Sprunggelenkregion und am Rückfuß anzutreffen, vorzugsweise maligne Vertreter wie das Chondrosarkom. Die Weichteiltumoren hingegen finden sich häufiger an der Mittel- und Vorfußregion.

Bewertung

Während die radiologischen Diagnostika bei den primären Knochentumoren am Fuß recht zuverlässig funktionieren, ist bei pedalen Weichteiltumoren größere Vorsicht geboten. Hier gibt es differenzialdiagnostisch eine Reihe von Verwechslungsmöglichkeiten.

Empfehlungen für die Praxis

Suffiziente Röntgendarstellung des Fußes in (mindestens) 2 Ebenen, ggf. Spezialaufnahmen bei knöcherner Pathologie. Alles, was sonographisch keine Zyste ist, muss weiter abgeklärt werden. Die MRT bleibt wichtigste Modalität, aber bitte nie allein! CAVE: Die Größe und Randbegrenzung pedaler Weichteiltumoren ist kein Dignitätskriterium!

Nur mit Berechtigung zugänglich

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Titel: Tumoren des Fußes und der Sprunggelenkregion
Teil II: Maligne Knochentumoren und Weichteiltumoren des Fußes mit differenzialdiagnostischen Hinweisen
verfasst von: Dr. T. Grieser
Publikationsdatum: 28.02.2018
Verlag: Springer Medizin
Schlagwörter: Knochentumoren
Weichteiltumoren
Osteosarkom
Chondrosarkom
Ewing-Sarkom
Sarkome
Weichteilsarkome
Osteosarkom
Ewing-Sarkom
Erschienen in: Die Radiologie / Ausgabe 5/2018
Print ISSN: 2731-7048
Elektronische ISSN: 2731-7056
DOI: https://doi.org/10.1007/s00117-018-0361-0

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