DIAGNOSTIC ROLE OF COMPRESSION SONOELASTOGRAPHY IN MULTIPARAMETRIC ULTRASOUND INVESTIGATION IN THE DETECTION OF BENIGN OVARIAN FORMATION

Properly diagnosed benign ovarian tumors are a condition for optimal treatment tactics. Qualitative assessment of signs detected by multiparametric ultrasound, including compression elastography, is highly effective in the differential diagnosis of benign ovarian tumors. Our study became especially relevant for women in the reproductive period, because the correct diagnosis influenced the choice of surgical treatment in order to preserve the ovarian reserve. A comprehensive radiological study of 51 women with benign ovarian tumors was performed. The age of patients averaged 37.3 ± 8.7 years. In the structure of benign ovarian tumors, the frequency of serous cystadenoma was 31.38%, serous superficial papillomas - 25.49%, mucinous cystadenoma - 17.65%, mature teratomas - 15.68%, fibroma - 9.8%. Ultrasound was performed on a HITACHI ALOCA ARIETTA 70 using a cavitary multifrequency sensor with a frequency of 7.5-10 mHz and a sector sensor with a frequency of 2-5 mHz. The article analyzes the detailed sonographic picture of these formations in B-mode, Doppler mode and compression sonoelastography mode. Color and energy Doppler mapping techniques, as well as pulsed Doppler mode, which gave a quantitative characterization of blood flow, were used to study blood vessels. Vessel localization was determined using color Doppler mapping, and detailed qualitative assessment of blood flow loci was determined using energy Doppler. For all types of benign ovarian formations, a qualitative feature was determined - elastotype on the Ueno scale and stiffness index - Strain Ratio (coefficient of deformation) - a quantitative indicator. It was found that serous and mucinous cystadenomas belong to 0 and I elastotype on the Ueno scale, the papillary component of serous superficial papillomas was mapped with I and II elastotype, fibroids mainly belonged to II and III elastotype, and mature teratomas - to IV end V elastotype. Quantitative deformation rate for all benign ovarian tumors ranged from 0,63 to 24,9. Thus, the cardiac index of stiffness in serous cystadenomas was 0.92 ± 0.46, and in mature teratomas - 16.7 ± 8.4. The increased density of the latter in comparison with other representatives of benign formations can be explained by the presence in their structure of such elements as fibroblasts, bundles of spindle-shaped cells and bundles of collagen fibers (fibroids), bone and cartilage (mature teratoma). In addition to all the above research methods, the mobile application IOTA ADNEX 2014 was used, which helped to calculate the risk of malignancy. This is a simple calculator, which loads the data of the ultrasound examination, the patient's age, the level of CA-125. Our results showed that ultrasound examination of ovarian tumors is an accurate and highly informative method for stratification of risks according to the O-RADS classification. For stratification and the ultrasound risk management system, the O-RADS system was guided by consensus guidance from the American College of Radiology, which reduces or eliminates ambiguity in the interpretation of data in ultrasound protocols and provides a more accurate definition of ovarian malignancy. The O-RADS working group includes 5 categories: O-RADS 0 - incomplete examination score, O-RADS 1 - normal unchanged premenopausal ovary, O-RADS 2 - almost always benign (risk of malignancy - <1%), O-RADS 3 - the presence of education with a low level of malignancy - from 1 to 10%, O-RADS 4 - medium risk of malignancy - from 10 to 50% and O-RADS 5 - education with a high level of malignancy -> 50%.

Multiparametric Ultrasound Approach Using a Tree-Based Decision Classifier for Inconclusive Focal Liver Lesions Evaluated by Contrast Enhanced Ultrasound

Background: Multiparametric ultrasound (MPUS) is a concept whereby the examiner is encouraged to use the latest features of an ultrasound machine. The aim of this study was to reanalyze inconclusive focal liver lesions (FLLs) that had been analyzed via contrast enhanced ultrasound (CEUS) using the MPUS approach with the help of a tree-based decision classifier. Materials and methods: We retrospectively analyzed FLLs that were inconclusive upon CEUS examination in our department, focusing our attention on samples taken over a period of two years (2017−2018). MPUS reanalysis followed a three-step algorithm, taking into account the liver stiffness measurement (LSM), time–intensity curve analysis (TIC), and parametric imaging (PI). After processing all steps of the algorithm, a binary decision tree classifier (BDTC) was used to achieve a software-assisted decision. Results: Area was the only TIC-CEUS parameter that showed a significant difference between malign and benign lesions with a cutoff of >−19.3 dB for washout phenomena (AUROC = 0.58, Se = 74.0%, Sp = 45.7%). Using the binary decision tree classifier (BDTC) algorithm, we correctly classified 71 out of 91 lesions according to their malignant or benignant status, with an accuracy of 78.0% (sensitivity = 62%, specificity = 45%, and precision = 80%). Conclusions: By reevaluating inconclusive FLLs that had been analyzed via CEUS using MPUS, we managed to determine that 78% of the lesions were malignant and, in 28% of them, we established the lesion type.

INFORMATIVE VALUE OF SONOELASTOGRAPHY IN THE DIFFERENTIAL DIAGNOSIS OF FOLLICULAR THYROID CANCER

In recent years, the opportunities of radiation diagnostic methods have stepped far ahead and today they play a leading role at the stage of preoperative diagnosis of thyroid diseases. The most promising of them is multiparametric ultrasound examination, as well as sonoelastography associated with it. Strain elastography and shear wave elastography make it possible to determine the boundaries of pathological formation and quantitative characteristics of nodular stiffness, which is important when determining the boundaries of invasive tumor growth, primarily thyroid cancer, when planning an upcoming surgical intervention. The article describes a clinical case of radiation diagnosis made for follicular thyroid cancer; it shows the importance of multiparametric ultrasound, including sonoelastography, in the early detection of thyroid cancer. A timely diagnosis and a correct chosen tactics for treating follicular thyroid cancer resulted in a favorable disease outcome.

EVALUATION OF PREDICTIVE CAPABILITIES OF TIRADS, EU-TIRADS, TLA_RU SYSTEMS IN THE ULTRASOUND DIAGNOSIS OF THYROID NODULAR PATHOLOGY

The aim of the study was to evaluate the prognostic capabilities of EU-TIRADS, TIRADS, TLA_RU systems in ultrasound diagnostics of thyroid nodular masses. A retrospective independent continuous blind study of ultrasound examination protocols was conducted in 665 patients, 241 patients had benign non-cancerous thyroid diseases, 86 patients had benign tumors (adenomas), 338 patients had thyroid cancer. During the preoperative examination, all patients underwent a multiparametric ultrasound examination of the neck organs according to the standard procedure, with the registration of identified thyroid nodes, with examining the prognostic capabilities of stratification systems – TIRADS, EU-TIRADS, TLA_RU. It was found that the TIRADS system has a sensitivity of 91.04%, specificity – 91.41%. Focusing on the scale of AUC values reflecting the quality of the diagnostic test, it can be stated that TIRADS is a test with excellent quality (AUC =0.972). Basing on the results of the analyzing the data obtained by the EU-TIRADS system, it was revealed that it is a high-quality test (AUC=0.826), but its predictive capabilities are worse than those of TIRADS. The original TLA_RU model has 87.5% sensitivity and 95.7% specificity. During the ROC analysis, it was found that the AUC is equal to 0.954±0.00894, which suggests that the TLA_RU model is an excellent quality test in the differential diagnosis of thyroid nodular masses. Multivariate statistical comparative analysis of thyroid imaging assessment systems (TIRADS, EU-TIRADS and TLA_RU) from the standpoint of evidence-based medicine has shown that thyroid cancer risk stratification systems based on the assessment of multiparametric ultrasound signs have great diagnostic capabilities.

Multiparametric ultrasound and micro-ultrasound in prostate cancer: a comprehensive review

Prostate cancer (PCa) is the most common non-cutaneous cancer diagnosed in males. Traditional tools for screening and diagnosis, such as prostate-specific antigen, digital rectal examination and conventional transrectal ultrasound (TRUS), present low accuracy for PCa detection. Multiparametric MRI has become a game changer in the PCa diagnosis pathway and MRI-targeted biopsies are currently recommended for males at risk of clinically significant PCa, even in biopsy-naïve patients. Recent advances in ultrasound have also emerged with the goal to provide a readily accessible and cost-effective tool for detection of PCa. These newer techniques include elastography and contrast-enhanced ultrasound, as well as improved B-mode and Doppler techniques. These modalities can be combined to define a novel ultrasound approach, multiparametric ultrasound. High frequency Micro-ultrasound has emerged as a promising imaging technology for PCa diagnosis. Initial results have shown high sensitivity of Micro-ultrasound in detecting PCa in addition to its potential in improving the accuracy of targeted biopsies, based on targeting under real-time visualization, rather than relying on cognitive/fusion software MRI-transrectal ultrasound-guided biopsy.

The Use of Compression Sonoelastography in Multiparametric Ultrasound Examination in Cases of Benign Ovarian Formations

Properly diagnosed benign ovarian formations are a condition for appropriate treatment choice. Qualitative assessment of signs detected by multiparametric ultrasound, including compression elastography, is highly effective in the differential diagnosis of benign ovarian formations. Our study became especially relevant for women in the reproductive period since the correct diagnosis influenced the choice of surgical treatment in order to preserve the ovarian reserve. The detailed sonographic aspect of these formations in B-mode, Doppler mode and compression sonoelastography mode is analyzed in the article. Color Flow Mapping, power Doppler and pulsed wave Doppler were used to study blood vessels. Pulsed wave Doppler characterized blood flow quantitatively. Color Flow Mapping was used to determine vessels localization, and power Doppler was used to provide a detailed qualitative assessment of blood flow loci. Elastotype according to the Ueno scale as a qualitative feature and Strain Ratio (coefficient of deformation) as a quantitative indicator were determined for all types of benign ovarian formations. Serous and mucinous cystadenomas were found to belong to elastotypes 0 and I according to the Ueno scale, the papillary component of serous superficial papillomas was mapped as elastotype I and II, fibroids predominantly belonged to elastotype II and III, mature teratoma appertained to elastotypes IV and V. Quantitative coefficient of deformation for all benign ovarian formations ranged from 0.63 to 24.9. According to our results, ultrasound examination of ovarian formations is an accurate and highly informative method for stratification of risks in accordance with the O-RADS classification.

Comparative assessment of the effectiveness of multiparametric ultrasound techniques in the differential diagnosis of solid kidney formations

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Efficacy of logistic regression model based on multiparametric ultrasound in assessment of cervical lymphadenopathy - a retrospective study

Objectives: To investigate whether a multiparametric ultrasound (MPUS) diagnostic model improves differential diagnosis of benign and malignant cervical lymph nodes. Methods: MPUS evaluation was performed on 87 lesions in 86 patients, and related characteristics and parameters of the patients and lesions were studied and logistic regression models based on the MPUS characteristics of cervical lymph nodes were built. A receiver operating characteristic curve and area under the curve (AUC) were built for the evaluation of diagnostic performances. Results: Of the 87 lesions in 86 patients, there were 31 benign and 56 malignant lesions. Regression models for Duplex ultrasound and MPUS were established. The Duplex ultrasound regression model showed a sensitivity, specificity, positive predictive value and negative predictive value of 94.4, 61.3, 86.3 and 80.9%, respectively. The predictive accuracy was 82.4%, and the AUC was 0.861. The MPUS regression model showed a sensitivity, specificity, positive predictive value and negative predictive value of 98.1, 61.3, 81.5 and 95.0%, respectively. The predictive accuracy was 84.7%, and the AUC was 0.894. The differences in AUCs between the Duplex ultrasound model and MPUS model, ultrasound model and ultrasonic elastography (UE), and Duplex ultrasound and UE were not significant (all p > 0.05); the differences in AUCs between the MPUS model and Duplex ultrasound, Duplex ultrasound model and Duplex ultrasound, and MPUS model and UE were significant (all p < 0.05). Conclusions: The Duplex ultrasound and MPUS models achieve significantly higher diagnostic performance for differentiating between benign and malignant cervical lymph nodes.

Мультипараметрическая ультразвуковая диагностика рака предстательной железы

В обзоре литературы рассматривается применение различных модальностей трансректального ультразвукового исследования в диагностике рака предстательной железы. Представлена диагностическая эффективность В-режима (включая микроультразвуковое исследование, использующее сверхвысокие частоты), различных методов оценки кровотока (включая микродопплеровское картирование), гистосканирования, эластографии (качественный и количественный анализ), контрастного усиления (качественный и количественный анализ). Показана роль магнитно-резонансного и ультразвукового совмещения (фьюжен) при биопсии предстательной железы. Обсуждаются перспективы объединения различных ультразвуковых методов в мультипараметрическое трансректальное ультразвуковое исследование, возможности создания стандартизированных шкал для описания выявленных изменений. Имеющиеся данные подтверждают, что использование современных технологий трансректального ультразвукового исследования значительно повышает его диагностическую точность, в том числе в выявлении клинически значимого рака предстательной железы. Ключевые слова: трансректальное ультразвуковое исследование (ТРУЗИ), допплеровское исследование, ультразвуковое исследование с контрастным усилением, ультразвуковая эластография, микродопплеровское картирование, микроультразвуковое исследование, мультипараметрическое ультразвуковое исследование, магнитно-резонансное и ультразвуковое совмещение (фьюжен), рак предстательной железы; transrectal ultrasound (TRUS), Doppler ultrasound, contrast-enhanced ultrasound (CEUS), ultrasound elastography, micro-Doppler, micro-ultrasound, multiparametric ultrasound, magnetic resonance/transrectal ultrasound fusion (MRI/TRUS fusion), prostate cancer.