Ultrasound parameters for evaluating local hemodynamics of internal carotid artery anomalies

Background: Despite the high prevalence of internal carotid artery (ICA) anomalies, there is still no consensus on which parameters should be used to evaluate their local hemodynamics and what significance each parameter holds.Objective: To determine the significance of various ultrasound parameters for evaluating the local hemodynamics of ICA anomalies.Materials and methods: In our cross-sectional observational study 427 outpatients underwent carotid ultrasound. To evaluate the significance of various ultrasound parameters for local hemodynamics assessment, we used a cluster analysis for the entire sample (n = 386), taking into account the deformation coefficient, angle of deformation, blood flow turbulence at the site of maximum deformation, and peak blood flow velocity at the site of maximum deformation. Based on the cluster analysis results, we did a discriminant function analysis.Results: During the clustering of patients from the total sample (n = 386), 3 clusters were formed. We did a discriminant function analysis to evaluate the indicators used. We found that all of them had a small Wilks’ Lambda indicating their greater discriminatory ability. The deformation coefficient was the most significant parameter as it had the smallest value (0.26). “Tolerance” analysis showed that the deformation coefficient is the most independent indicator (0.67).Conclusions: Our study showed that the most significant and independent parameter for evaluating the local hemodynamics of ICA anomalies is the deformation coefficient, with the blood flow turbulence being the least significant parameter

Echohysterosalpingography: pros and cons. A systematic review

Background. Infertility is becoming ever more pressing a problem by year in Russia and worldwide. Tubal-peritoneal infertility is most frequent, with the prevalence of 42.5-80.5% in various estimates. Echohysterosalpingography is considered the today’s “gold standard” in tubal-peritoneal infertility diagnosis in women. This method is known to possess a series of limitations and adverse consequences due to painful sensations during and after check-ups that psychologically afflict women.Objectives. An overview of current methods for inspecting fallopian tubes in reproductively impaired patients to inform promising diagnostic research.Methods. Publications were mined and analysed in the PubMed, eLibrary, Web of Science, Cochrane Library and Cyberleninka electronic databases. The query terms were: echohysterosalpingography [эхогистеросальпингография], echohysterography [эхогистерография], infertility [бесплодие], pregnancy planning [планирование беременности], fallopian patency [проходимость маточных труб], ultrasonic diagnosis [ультразвуковая диагностика], submucous myomatous node [субмукозный миоматозный узел], incompetent uterine scar [несостоятельный рубец на матке], niche [ниша]. The topic selected was female infertility, particularly, the use of echohysterosalpingography in fallopian diagnosis in reproductively impaired women.Results. The review covers 52 sources of the total 118 analysed. Current published evidence and its review identify a notable success of imaging techniques in the fallopian tube diagnosis in women with reproductive problems. The continually developing echohysterosalpingography technique is considered more promising for routine use. Techniques gain more value in analyses of implantation failures. The main challenges in current radiodiagnosis and monitoring of fallopian lesions at a background therapy are the inspection standardisation, disease classification, imaging diagnostic accuracy and prognostic value evaluation in patients with reproductive loss and infertility.Conclusion. The prospective routes of research comprise the definition of optimal check-up terms, echohysterography and echohysterosalpingography diagnostic criteria descriptiveness, improving prognosis in the carrying of pregnancy and treatment efficacy control. A timely and accurate diagnosis of uterus and fallopian tubes is of paramount importance to sustain the women’s reproductive health

Ультразвуковое исследование с контрастным усилением в дифференциальной диагностике опухолевых образований печени

Purpose: to evaluate the diagnostic value of contrastenhanced ultrasound (CEUS) with SonoVue in differential diagnosis of focal liver lesions (FLL) in a multidisciplinary clinic in Russian Federation.Materials and methods. Bolus intravenous administration of 1.2 ml of SonoVue (Bracco Swiss CA, Switzerland) followed with 5ml saline flush was used for liver CEUS. We utilized the scanners Mindray DC-8 (Mindrаy, China), Logiq S8 (GE, USA), Philips Epiq 7 (Philips, Holland), SonoScape S9 (SonoScape, China), Hitachi Ascendus (Hitachi, Japan) with 3.0–5.0 MHz convex probes in specialized “contrast” mode with low mechanic index (MI 0.08–0.1). The study conferred 73 patients in the age between 18 and 84 years (mean age 49 years) with FLL. CEUS was performed in 22 patients with previously verified diagnosis, while the rest of patients underwent CEUS before the final diagnosis. Contrast-enhanced liver CT was performed in all patients. In 49 (67.12%) of 73 cases, a pathology was performed after a targeted core-needle biopsy or autopsy. Qualitative features of US contrast enhancement of FLL were evaluated.Results. Qualitative aspects of CEUS for differentiation of FLL were defined. The principal sign for diagnosis between benign and malignant masses with CEUS was hypoenhancement of malignant lesions in comparison to surrounding normal parenchyma in portal and late venous phase (p ≤ 0.01). Alternatively, hyper- or isoenhancement throughout late venous phase was characteristic for benign FLL. Diffuse heterogeneous contrast enhancement was indicative of malignant FLL, and homogeneous – for benign. Additional diagnostic feature (p ≤ 0.05) was the type of contrast enhancement in the arterial phase. Heterogeneous diffuse contrast enhancement was observed in malignant FLL, while homogeneous – in benign FLL. Peripheral nodular contrast enhancement with centripetal filling was characteristic for liver hemangioma, centrifugal filling with “spoke-wheel” vascular pattern – for FNH, and peripheral rim-like hyperenhancement with rapid achievement of hypoenhancement at the beginning of the portal phase – for liver metastasis.Conclusion. Complex analysis of qualitative characteristics of CEUS with SonoVue is a promising option for differential diagnosis of FLL (sensitivity 92.85%, specificity 91.3%, diagnostic accuracy 92.15%) and can be utilized in daily practice.Цель исследования: оценить диагностические возможности применения ультразвукового исследования (УЗИ) с использованием контрастного препарата Соновью (Бракко Свисс СА, Швейцария) в дифференциальной диагностике опухолевых образований печени (ООП) в условиях многопрофильной клиники на территории Российской Федерации.Материал и методы. Контраст-усиленное УЗИ (КУУЗИ) печени выполнялось с внутривенным болюсным введением 1,2 мл контрастного препарата Соновью (Бракко Свисс СА, Швейцария) и последующим введением 5 мл 0,9% раствора NaCl. Исследования проводили на сканерах Mindray DC-8 (Mindrаy, Китай), Logiq S8 (GE, США), Philips EPIQ 7 (Philips, Нидерланды), SonoScape S9 (SonoScape, Китай), Hitachi Ascendus (Hitachi, Япония) с использованием конвексных датчиков 3–5 МГц в специализированном режиме “контраст” с низким меха ническим индексом (МИ 0,08–0,1). Исследование проведено 73 пациентам в возрасте 18–84 лет (средний возраст 49 лет) с опухолевыми образованиями печени. Из них 22 пациента до КУУЗИ имели установленный диагноз, у остальных КУУЗИ выполнено до установ ления окончательного диагноза. Во всех случаях пациентам проведена МСКТ печени с внутривенным контрастированием. В 49 (67,12%) из 73 случаев проведено морфологическое исследование после прицельной толсто игольной биопсии или аутопсии. Произведена оценка качественных характеристик контрастного усиления очаговых образований печени.Результаты. Выявлены качественные характеристики КУУЗИ, позволяющие проводить дифференциальную диагностику ООП. Основным дифференциально-диагностическим признаком доброкачественных и злокачественных ООП при КУУЗИ (p ≤ 0,01) является появление гипоусиления ООП в портальную и позднюю венозную фазу в случае злокачественных ООП, и изо- или гиперусиления в портальную и позднюю венозную фазы в случае доброкачественных ООП. Диффузное неоднородное контрастное усиление характерно для злокачественных ООП, а однородное контрастное усиление – для доброкачественных. Дополнительными диффе ренциально-диагностическими признаками (p ≤ 0,05) различных ООП являются тип и характер контрастного усиления в артериальную фазу: неоднородное диффузное контрастное усиление для злокачественных ООП и однородное – для доброкачественных ООП, перифе рическое узловое центростремительное контрастное усиление –достоверный признак гемангиом печени, центробежное усиление с сосудистым рисунком по типу “спиц колеса” – фокально-нодулярной гиперплазии и периферическое кольцевидное гипер-усиление, раннее появление гипоусиления в начале портальной фазы–метастазов печени.Выводы. Комплексная оценка качественных параметров КУУЗИ с ультразвуковым контрастным препаратом Соновью имеет большой диаг ностический потенциал для дифференциальной диаг ностики различных ООП (чувствительность 92,85%, специфичность 91,3%, общая точность 92,15%) и может использоваться в повседневной практике врача ультразвуковой диагностики

Качественный анализ ультразвукового исследования с применением контрастного препарата в дифференциальной диагностике узловых образований молочной железы

The objective. Revelation of informative markers of qualitative analysis CEUS in the differential diagnosis of breast lesions, determination of effectiveness CEUS in the breast cancer examination.Materials and methods. The work is based on the results of a retrospective comparison ultrasound data with the histological results conducted in 145 women with breast lesions at the age of 17-71 years (average age was 45.5 years) from December 2017 until November 2018 year.Results. Statistical analysis of markers of qualitative assessment CEUS showed that more important markers in the differential diagnosis were - indicators of definition of the boundaries of lesion during CEUS (Se 79,27 Sp 63,41); the velocity of accumulation of contrast agent (Se 78,05 Sp 80,95); wash-out velocity from lesion (Se 68,29 Sp 95,24).Conclusion. Qualitative data analysis of CEUS provides to detail of breast lesions and surround tissues vascular architecture, improves differential diagnosis of breast tumors, which allows to reduce the number of additional methods of examination and biopsies, predict the volume of surgical and complex treatment.Цель исследования: выявление информативных показателей качественного анализа ультразвукового исследования с контрастным усилением (КУУЗИ) для дифференциальной диагностики узловых образований молочной железы (МЖ), определение эффективности метода в диагностике рака молочной железы (РМЖ).Материал и методы. В основу работы положены результаты ретроспективного сопоставления данных ультразвуковых заключений с результатами гистологического исследования, проведенных у 145 женщин с узловыми образованиями МЖ в возрасте 17-71 года (средний возраст составил 45,5 года) в период с декабря 2017 г по ноябрь 2018 г.Результаты. Статистический анализ показателей качественной оценки КУУЗИ показал, что значимыми в дифференциальной диагностике являются следующие характеристики эхоконтрастирования: показатели четкости границ образования при КУУЗИ (Se 79,27, Sp 63,41); скорость накопления эхоконтрастного препарата (ЭКП) (Se 78,05, Sp 80,95); скорость вымывания ЭКП из узлового образования эКп (Se 68,29, Sp 95,24).Заключение. Анализ качественных данных при КУУЗИ позволяет детализировать сосудистую архитектонику узловых образований МЖ и прилегающих тканей, улучшает дифференциальную диагностику опухолей МЖ, что позволяет сократить количество дополнительных методов обследования и биопсий, прогнозировать объемы хирургического и комплексного лечения

Особенности вертеброневрологического статуса у больных с узловой трансформацией щитовидной железы

Pathological processes in the thyroid and the cervical spine through the structures of the autonomic nervous system may provide each other mutual influence. Detection of additional pathogenetic factors in uzloobrazovaniya help develop additional methods of treatment and prevention tireopaty.Патологические процессы в щитовидной железе и в шейном отделе позвоночника через структуры вегетативной нервной системы могут оказывать друг на друга обоюдное влияние. Обнаружение дополнительных патогенетических факторов в процессе узлообразования поможет разработать дополнительные методы лечения и профилактики тиреопатий

Ultrasonic Elastography in the Differential Diagnosis of Thyroid Nodular Patholog

Aim. In this study, we set out to determine the informative value of multi-parametric ultrasound examination using ultrasound elastography in the differential diagnosis of thyroid nodular neoplasms.Materials and methods. We analysed 229 multi-parametric ultrasound examinations of patients in the preoperative period in order to assess the effectiveness of strain elastography (SE) and shear wave elastography (SWE) drawing on the example of ARFI and Strain Ratio. Two patient groups were formed. The fi rst group (N1=93) included patients with thyroid cancer, whereas the second one (N2=136) was composed of patients with benign thyroid nodules (thyroid adenoma and follicular or colloid goitre). The control group consisted of 174 patients with unchanged thyroid parenchyma. SE visualised tissue elasticity as a colour map. Shear wave elastography (SWE) — ARFI and Strain Ratio techniques — was performed using the following ultrasonic apparatuses: Acuson S-2000 (Siemens, Germany), Ultrasonix SP (Sonix, Canada) and Mindray DC-8 (Mindray, China).Results. According to the obtained data (SE technique), the parenchyma of the unchanged thyroid gland exhibited heterogeneous, uneven fi ne / moderately granular, symmetrical staining (96.6%). Thyroid cancer was characterised by a shear wave velocity (ARFI) of greater than 3.57 m/s, as well as a density ratio (elasticity modulus and Strain Ratio) of more than 1.56.Conclusion. The study revealed that the application of ultrasound elastography is highly informative in the comprehensive diagnosis of thyroid nodular neoplasms and should be used when thyroid cancer is suspected to ascertain the size of nodules, as well as the tumour invasion into surrounding tissues

RESTATEMENT OF INDICATIONS FOR THYROID NODULES BIOPSY

The ultrasonic signs of focal formations have a defining value for indication of fine-needle aspiration biopsy of thyroid nodules. The size and dynamics of growth aren’t so important. The evaluation of indications for performing a thyroid nodules biopsy was made in 6403 patients. It was proved that the size of thyroid nodules hadn’t any value for the indications and technique of aspiration biopsy. It was stated that a subjectivity assessment, many errors and parameters variety took place in clinical and ultrasound examination in the case of thyroid nodules changes. Indications for biopsy based on the size of nodules hadn’t any theoretical or practical value. The indications according to TIRADS system are reasonable. Their application considerably improved obtaining an informative material and increased the probability of thyroid tumor detection

Microbubbles Stabilized by Protein Shell: From Pioneering Ultrasound Contrast Agents to Advanced Theranostic Systems

Ultrasound is a widely-used imaging modality in clinics as a low-cost, non-invasive, non-radiative procedure allowing therapists faster decision-making. Microbubbles have been used as ultrasound contrast agents for decades, while recent attention has been attracted to consider them as stimuli-responsive drug delivery systems. Pioneering microbubbles were Albunex with a protein shell composed of human serum albumin, which entered clinical practice in 1993. However, current research expanded the set of proteins for a microbubble shell beyond albumin and applications of protein microbubbles beyond ultrasound imaging. Hence, this review summarizes all-known protein microbubbles over decades with a critical evaluation of formulations and applications to optimize the safety (low toxicity and high biocompatibility) as well as imaging efficiency. We provide a comprehensive overview of (1) proteins involved in microbubble formulation, (2) peculiarities of preparation of protein stabilized microbubbles with consideration of large-scale production, (3) key chemical factors of stabilization and functionalization of protein-shelled microbubbles, and (4) biomedical applications beyond ultrasound imaging (multimodal imaging, drug/gene delivery with attention to anticancer treatment, antibacterial activity, biosensing). Presented critical evaluation of the current state-of-the-art for protein microbubbles should focus the field on relevant strategies in microbubble formulation and application for short-term clinical translation. Thus, a protein bubble-based platform is very perspective for theranostic application in clinics