Additional ultrasound capabilities for local haemodynamically significant carotid deformity: a one-stage observational study

Background. Despite a wide range of studies, no consensus has been reached on the relative weight of ultrasound parameters for assessing local haemodynamically significant carotid deformations.Objectives. To estimate a diagnostic value for an additional multiparametric ultrasound parameter for local haemodynamically significant carotid deformations.Methods. In the first phase, 388 patients underwent an outpatient multiparametric ultrasound examination of the carotid arteries. The study involved patients of the age of 18 and older with a primary referral for carotid ultrasound by a resident physician, neurologist or cardiologist in order to rule out a carotid pathology. As a supplement to the main haemodynamic significance assessment parameters, we introduced an additional metric — the deformity coefficient – in order to diagnose carotid abnormalities. Based on the first phase results, two cohorts were selected. Cohort 1 (control) consisted of patients with no abnormalities in multiparametric carotid ultrasound. Cohort 2 consisted of patients with isolated unilateral internal carotid artery deformities at no haemodynamically significant stenosis of common and internal carotid arteries in multiparametric carotid ultrasound. In the second phase, the patients underwent transcranial duplex sonography of the middle cerebral arteries, in order to detect regional haemodynamically significant internal carotid artery deformities.Results. Mathematical modelling of abnormal arteries produced the empirical upper deformity coefficient thresholds to distinguish acute angulation. This value is >1.41 for C-shaped and >1.34 — for S-shaped curves.Subsequent statistical analysis revealed a clear positive correlation between angulation and the deformity coefficient at a p < 0.01 significance level. More acute angulation corresponds to higher coefficient values.The Spearman correlation between the deformity coefficient and blood flow asymmetry values for middle cerebral artery was 0.89. This defines a significant positive correlation (higher deformity coefficient corresponds to higher blood flow asymmetry) at a p < 0.01 significance level.Conclusion. The deformity coefficient is an additional ultrasound parameter for assessing local haemodynamically significant carotid abnormalities

Diagnostic value of multiparametric ultrasound and the EU-TIRADS system for differentiation of focal thyroid lesions

Background. Over the last 15 years, there have been many recommendations for the management of patients with thyroid nodules, based on the assessment of various ultrasound (US) criteria in B-mode. In 2020, the EU-TIRADS system (2017) was included in Russian Clinical Practice Guidelines. Shear wave elastography (SWE) increases the diagnostic efficacy of ultrasonic B-mode examination of thyroid nodules and can be recommended to be included in the current classification system. Objective. The study aims to assess the diagnostic efficacy of multiparametric US combining SWE and color flow mapping in differentiating between benign and malignant thyroid nodules to define their stage according to the EU-TIRADS system and decide on the need for fine-needle aspiration biopsy. Material and Methods. A total of 150 thyroid nodules from 116 patients were analyzed. Lesions were then classified according to the EU-TIRADS system, SWE with an assessment of the color map and tissue stiffness was performed (Emean). In all tumors, cytological and histological (in operated patients) verification was carried out. Results. After B-mode US with color flow mapping, differentiation of palpable thyroid abnormalities by the EU-TIRADS system was carried out. 78 nodules were classified as EU-TIRADS 2 (52%), 42 as EU-TIRADS 3 (28%), 26 as EU-TIRADS 4 (17.3%), 4 as EU-TIRADS 5 (2.7%). On cytological examination 42 tumor nodules were detected. Of these, 6 (14.3%) cases were reported as papillary thyroid carcinoma, 36 (85.7%) as follicular neoplasm, 22 (61%) among the last prove to be follicular carcinoma. Qualitative and quantitative evaluation of elastograms was performed. Benign nodules were colored primarily in blue, while suspicious for malignancy revealed red areas of different size. Elasticity index in benign nodules was 24.3 ± 5.63 kPa for colloid goiter, 27.8 ± 6.35 kPa for cellular goiter; in suspicious for malignancy this index was 80.9 ± 50.9 kPa for follicular neoplasm, 114 ± 56.8 kPa for papillary thyroid cancer. The stiffness cutoff value for malignancy indicated with ROC-analysis was estimated as 45.4 kPa. Mean elasticity index (kPa) was significantly higher in suspicious for malignancy nodules than in benign nodules (р < 0.05). Of 120 (80%) nodules, primarily assessed as benign and defined as EU-TIRADS 2 and 3, 18 (12%) nodules after SWE revealed areas of high stiffness exceeding the cutoff value. After that, these nodules were transferred to EU-TIRADS 4 and 5, and these stages require fine-needle aspiration. Of these, 11 (7.3%) cases were reported as follicular neoplasm, 6 (4%) among the last prove to be follicular thyroid carcinoma. Conclusion. Using multiparametric approach with SWE will give the opportunity to classify correctly the nodule according to the EU-TIRADS and to identify greater number of thyroid tumors for fine-needle aspiration. SWE made it possible to increase the specificity of US using the EU-TIRADS system. The characteristics of the SWE score were: sensitivity = 81%, specificity = 90.3%, positive predictive value = 88%, negative predictive value = 91%, and accuracy of comprehensive study = 88.4%

An overview of TI-RADS systems from a point of view of follicular tumors diagnosis

The existing systems for describing thyroid nodules are highly informative and can be applied in routine practice, but suspicious criteria of thyroid nodules are based on the echographic pattern of papillary neoplasia, due to its predominance in the population. Follicular tumors are difficult to be differentiated between adenomas and follicular cancer, both echographically and morphologically. Despite the lower prevalence, this type of tumor has a high risk of aggressive course and relapse of 30–55% and this determines its early detection importance. The analysis of publications from 2009 to 2020 of existing TI‑RADS systems and national guidelines for the diagnosis of thyroid tumors, with an emphasis on the assessment of follicular tumors, was carried out. In Russia, at the beginning of 2021, the national guidelines require the use of EU‑TIRADS 2017, and the introduction of the national RU‑TIRADS is underway. Difficulties remain in the differential diagnosis of follicular tumors of different malignancy potential. It is possible that a combined risk assessment of echography, elastography, cytology, and molecular genetic studies will allow a more reliable stratification of the risks of thyroid nodules at the preoperative stage

Doppler assessment of throphoblastic blood flow to predict adverse pregnancy outcome

Objective. To evaluate the diagnostic utility of trophoblastic blood flow Doppler parameters in predicting an adverse pregnancy outcome.Material and Methods. This was a retrospective study of 218 pregnancies of women between 8 and 11 weeks’ gestation. Depending on the pregnancy outcome, patients were divided into 4 clinical groups. All women underwent an ultrasound examination using Voluson S8, Voluson E8 with high-quality grey scale, color flow mapping and pulsed-wave Doppler modes. We used a program for obstetric research with the following instrument settings: 100 MHz Doppler frequency, thermal index (TI) was <1, mechanical index (MI) was 1. The examination time did not exceed 20 minutes. There was no radiation exposure. Transvaginal and transabdominal sonographies were performed.Results. To form a risk group for an adverse fetal outcome due to fetoplacental insufficiency, it is necessary to identify ultrasound markers of inadequate placental perfusion by means of a Doppler study of fetoplacental blood flow. For this purpose, we examined 218 pregnancies of women between 8 and 11 weeks’ gestation to determine the diagnostic utility of various parameters: resistivity index, pulsatility index, systolic/diastolic ratio and chorionic vascularization index (k, %). We received results proving high sensitivity (76.9%) and specificity (89.7%) of the chorionic vascularization index (k, %), as well as low specificity (54.7%) and high sensitivity (81.5%) of trophoblastic blood flow resistivity index.Conclusion. Thus, the chorionic vascularization index (k, %) is of high diagnostic utility for predicting an adverse fetal outcome

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

Complex of ultrasound techniques in diagnosis of nodular thyroid pathology

The objectives of this study is evaluation of the role of elastography of shear wave in addition to color Doppler ultrasound in differential diagnosis of the focal thyroid pathology. For this purpose 134 patients with different nodal pathology of thyroid gland were examined before surgery. The acquired elastography datasets were comparable to the morphologycal analysis at the thyroid gland biopsy. We've concluded that the elastography of shear wave with color Doppler ultrasound provide a more reliable and valid assessment of the thyroid nodule, than both 2D ultrasound imaging and Color Doppler. This technique can aid in the diagnosis of thyroid cancer more early

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

Foeto-foetal transfusion syndrome in dichorionic diamniotic twins: a clinical case

Background. Management of multiple gestation complicated by the foeto-foetal transfusion syndrome is among most intricate modern obstetric issues. The syndrome develops in 10–20% of monochorionic diamniotic twins leading to 80–100% mortality in one or both twins if left uncorrected, especially in early syndrome cases. Although foeto-foetal transfusion usually develops with monochorionic placentae, there are notable exceptions of vascular placental anastomoses reported with dichorionic monozygotic twins. The disease supposedly entails from an imbalanced blood interflow between dichorionic twins due to placental vascular anastomoses.Clinical Case Description. Patient S., 32 yo, visited perinatal diagnostics at the Territorial Perinatal Centre of the Children’s Territorial Clinical Hospital with a preliminary diagnosis: 22 weeks and 5 days’ pregnancy. Dichorionic diamniotic twins. Threat of extremely preterm birth. Two caesarean uterine scars. Gestational diabetes mellitus.Medical files: patient history, pregnancy calendar. Pregnancy was regularly monitored with main ultrasound foetometry, foeto-foetal transfusion dynamics control and Doppler velocimetry.Ultrasonographic signs of abnormal haemodynamics underlying the foeto-foetal transfusion syndrome were detected at the first scan at 11–13 weeks 6 days’ term as collar space thickening in one foetus. Hydramnios in one foetus and oligohydramnios in the other were diagnosed at 28 weeks’ gestation conclusively indicating the foeto-foetal transfusion syndrome. This evidence suggested the formation of placental anastomoses, which was confirmed morphologically in placenta examination.Conclusion. A timely diagnosis and correction of emerging complications allowed prolongation of pregnancy in hospital conditions to 33–34 weeks. Both boys were live-born with Apgar score 7–8

ИНФОРМАЦИОННАЯ ЗНАЧИМОСТЬ ПАРАМЕТРОВ УЛЬТРАЗВУКОВОГО ИССЛЕДОВАНИЯ ПЛОДА И ЭКСТРАЭМБРИОНАЛЬНЫХ СТРУКТУР С 8-Й ПО 11-Ю НЕДЕЛЮ БЕРЕМЕННОСТИ

The  purpose  of this  research  was  to  define  the  importance   of ultrasound   parameters of fetus  pathology  and extra-embryo  structure in the first trimester  of pregnancy.  We have studied 369 pregnancies with 8 to 11 weeks of gestation. We used original metod to define index of correlation between embryonic crown — rump length (CRL) and the length of heart (the distance  between the chin and crown). The normal index values are in a range 1,6–2,6. We used factory mathematic analysis and received results.  The most informative parameters are: aplasia of yolk sack, wrong differential structure of anatomical embryo, wrong correlation between the length of head to body of fetus, discordance between CRL to period of gestation. Least informative ultrasound  parameters are: tonus miometrium, poor vascularisation  of corpus luteum.  These results allow to segregate the group of high pathology of fetus.Целью исследования было выявление информативных ультразвуковых критериев патологии плода и экстраэмбриональных структур в первом триместре  беременности.  Обследованы  369  беременных  в сроках гестации с 8-й по 11-ю неделю. По оригинальной методике осуществлялся расчет церебро-корпорального коэффициента (ЦКК).  Данный показатель  отражает  отношение копчико-теменного  размера  эмбриона  (КТР)  к расстоянию от наивысшей точки темени к подбородочному выступу. Нормальные значения находятся в диапазоне 1,6–2,6. С использованием метода факторного анализа определены наиболее значимые ультразвуковые критерии неблагоприятного исхода беременности для плода. Наибольший информационный вес имеют следующие критерии: отсутствие желточного мешка, нарушение дифференцировки анатомических структур эмбриона, церебро-корпоральный   коэффициент,   несоответствие   копчико-теменного  размера   эмбриона  его  гестационному сроку. Наименьший информационный вес имеют: тонус миометрия, неадекватная васкуляризация желтого тела яичника. Подобный подход позволил сформировать группу высокого риска по перинатальной патологии

Multiparametric ultrasound in the diagnosis of ovarian focal lesions

Objective Development of an ultrasound diagnostic matrix for predicting the severity of proliferative changes in the ovarian focal lesion.Material and Methods The research was conducted on the basis of the Clinical Oncology Center, Regional Clinical Hospital no. 2. Echography (B-mode), color Doppler mapping, energy Doppler mapping (pulsation index, resistance index) on GE Voluson E8 and Aloka SSD 3500 devices were used as research methods. Retrospectively, 81 patients of reproductive age from 18 to 45 years were examined. Depending on the histological structure of ovarian lesion, the results of surgical treatment, dynamic observation and the outcome of the disease, were divided into 4 clinical groups: I (n = 12; 14,8%) – controls with no changes in the structure of the ovaries; II (n = 20; 24,7%) – patients with retention ovarian lesions; III (n = 20; 24,7%) – with benign tumors; IV (n = 29; 35,8%) – with malignant tumors.Results A large number of diagnostic parameters does not always allow to formulate an instrumental diagnosis correctly because they have different diagnostic significance. That is why we made an attempt to create a diagnostic matrix. For each of the 18 parameters, three answers were offered. When analyzing the results of the study, there was an increase in the number of pathological parameters from II to IV clinical groups. Thus, in group III, the combination of 2 pathological signs was found in 65% of cases, and 3 signs – in 25% of the examined women. In group IV, the combination of 2 signs was determined in 82% of the subjects, and 3 signs in 65%.Conclusion Thus, we found out that in-depth ultrasound examination (color Doppler imaging, pulsed Doppler) allowed to identify the severity of the proliferative changes and to give the prognosis of the disease