Objective. To evaluate the diagnostic efficiency of the contrast-enhanced third-generation agent in the detection of angionephrosclerosis in patients with type 2 diabetes and non-alcoholic fatty liver disease background.Materials and methods. 26 patients (9 men and 17 women; mean age 61.5 ± 4.3 years) with a confirmed diagnosis of type 2 diabetes mellitus and NAFLD were examined. All patients underwent complex diagnostics, including: quantitative ultrasound steatometry of the liver in the framework of combined elastography with visual and quantitative assessment of the attenuation coefficient of the ultrasonic wave; ultrasound examination of the kidneys in B-mode with vascular diagnostics in the Doppler mapping mode. Also, all patients underwent contrast-enhanced ultrasound examination of the kidneys with the contrast agent for the diagnosis of angionephrosclerosis.Results. The method of CEUS of the kidneys with patients with type 2 diabetes and NAFLD has sensitivity of 92.7 %, and accuracy of 90.4 %. Color Doppler mode has sensitivity of 66.5–81.4 %, and accuracy of 58.4–73.6 %.Conclusion. The ultrasound contrast agent may be used in the early diagnosis of angionephrosclerosis in patients with type 2 diabetes and NAFLD as a non-alternative imaging method with no radiation exposure and no nephrotoxicity.
Aim of the research. Standardization of the quantitative assessment of the contrast-enhanced ultrasound examination of the kidneys in patients with type 2 diabetes.Materials and methods. On the basis of the Fundamental research laboratory “Diagnostic researches and minimally invasive technologies”, of the Federal State Budgetary Educational Institution of Higher Education “Smolensk State Medical University” of Smolensk State Medical University, the Ministry of Health of the Russian Federation, 12 patients with type 2 diabetes were examined in 2020. The age of the examined patients was 36–64 years old. Average age – 44 ± 1.8 years, of which 7 women (58.33%) and 5 men (41.67%). All patients were examined using a single diagnostic algorithm, which included 2 stages: 1 stage. Ultrasound examination of the kidneys (Aloka Hitachi Arietta 850 (Hitachi Medical Corporation, Japan) in B-mode; stage 2 – contrast-enhanced ultrasound examination (CEUS) of the kidneys. All patients were divided into 2 groups: the 1st group consisted of patients with type 2 diabetes type (n = 6), who underwent CEUS with subsequent assessment of the renal parenchyma in different areas of the cortex and medulla; group 2 consisted of patients with type 2 diabetes (n = 6) who underwent CEUS with subsequent standardized assessment in the indicated 5-th points of the arterial bed and 3 points of the venous bed.Results and discussions. Taking into account the current epidemiological situation in 2020, the number of performed radiation diagnostic methods, such as X-ray and computer examinations of the chest organs, significantly increased the overall background of radiation exposure on the bulk of patients. Taking into account the anxiety index of patients, ionizing research methods for the diagnosis of angionephrosclerosis are undesirable. The standardized method for quantitative parameters of CEUS showed good agreement (0.61–0.76). In turn, the assessment of the quantitative parameters of renal CEUS when using the routine technique showed low consistency (0.21–0.3). Cohen's kappa (CK) scores of 0 to 0.2 indicate a lack of agreement among clinicians; 0.21–0.4 – weak consistency; 0.41–0.6 – moderate agreement between doctors; 0.61–0.8 – good consistency; 0.81–1.0 – complete consistency.The circulatory system of the kidneys is characterized by the presence of a developed capillary network and, accordingly, low peripheral resistance, which confirms the importance of a standardized approach in conducting this study. In the context of the prevailing epidemiological circumstances, we understand that it is necessary to choose a reference research method that would allow us to accurately assess the characteristics of the experimental evaluation of this method. As a result of renal C EUS using a routine technique, hypoperfusion of the right kidney was revealed in 50% (n = 3) cases and the data were interpreted as normal in 50% (n = 3) cases. As a result of the renal CEUS using the proposed method, pronounced hypoperfusion of the right kidney was revealed in 100% (n = 6) cases. Dynamic nephroscintigraphy was used as a reference method to determine the functional work of the kidneys. According to the results of dynamic nephroscintigraphy of the kidneys, hypoperfusion of the right kidney was revealed in all cases in both groups of patients.Conclusion. 1. The standardized method for assessing the quantitative parameters of the kidney CEUS is more reproducible by the ultrasound doctors than the routine one. 2. Enhanced ultrasound can be used to assess the efficacy of hypoperfusion with the maximum efficacy of an equivalent dose per patient.
Aim of the research. Тo evaluate the diagnostic efficacy of the contrast-enhanced ultrasound examination of kidneys in patients with type 2 diabetes mellitus with a dose of 0.5 ml of contrast agent administered.Materials and methods. We examined 12 patients with a verified diagnosis of type 2 diabetes. The age of the examined patients was 31–59 years, the mean age was 49 ± 1.3 years. All patients underwent complex diagnostics, including ultrasound examination of the kidneys in B-mode with further renal vessels color Doppler imaging to assess vessels hemodynamics. A contrast-enhanced ultrasound examination of the kidneys was carried out using Sonovue contrast agent at the doses of 2.5 ml (according to the European Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound) and 0.5 ml (an improved technique of contrast agent intravenous bolus administration).Results. The improved technique (0.5 ml of contrast agent intravenous bolus administration) in comparison with the European Recommendations technique (2.5 ml of contrast agent intravenous bolus administration) used in patients with type 2 diabetes showed no or minor differences in the qualitative and quantitative indicators of contrast-enhanced ultrasound examination which did not affect the interpretation of the results.Conclusion. The improved contrast-enhanced ultrasound examination technique using 0.5 ml of a contrast agent showed its possibilities in diagnosing diabetic nephropathy in patients with type 2 diabetes, and also revealed the potential of an economically beneficial distribution of a contrast agent without losing the quality and information content of the study.
Objective. To demonstrate the capabilities of a comprehensive instrumental multimodal differential diagnosis of viral pneumonia in the context of the COVID-19 pandemic.Material and methods. A clinical case of a patient with complicated viral pneumonia and a detailed description of the clinical picture, laboratory information, instrumental research data using minimally invasive interventions, followed by cytological and bacteriological examination, is presented.Results. While the patient was in the hospital, a comprehensive study was performed with a targeted assessment of the state of the chest organs and using minimally invasive diagnostic methods. The signs of bilateral pneumonia (probably of viral etiology, possibly corresponding to COVID-19 infection) revealed by ultrasound and MDCT of the chest organs were the basis for patient’s hospitalization.Conclusion. The multimodal instrumental approach allows to obtain a more complete picture of the pathological process in patients with viral pneumonia in a short time and minimizing radiation and determine the further tactical position in the treatment of this category of patients.
Purpose: To demonstrate the capabilities of a complex of multiparametric ultrasound and MRI with intravenous contrast in the detection and characterization of atypical hepatocellular carcinoma with the example of a clinical case of a middle-aged patient without liver cirrhosis.Material and methods: Comprehensive study of medical history, outpatient records, results of clinical, laboratory, instrumental and morphological methods with independent retrospective analysis of the histological preparation of focal liver lesion.Results: Diagnostic search data are presented in a 48-year-old patient with hepatocellular carcinoma without signs of liver cirrhosis. The diagnosis required 1.5 months of examination in gastroenterological department, repeated review of the histological preparation by morphologists. The disease debuted with weakness after physical exertion, which was noted during a planned multiparameter abdomen ultrasound examination. During the study, multiple focal formations with uneven fuzzy contours, an inhomogeneous structure were visualized. Stiffness of the parenchyma in focal liver lesion is 108.29 kPa due to 2D-SWE. Further tactics consisted of hospitalization with further laboratory examination and abdomen MRI with intravenous contrast enhancement. Considering the results of instrumental examination, the patient was prescribed a puncture aspiration biopsy of focal liver lesion under ultrasound control followed by morphological verification.Conclusion: The presented clinical observation demonstrates the need of use an integrated approach in instrumental imaging methods in the diagnosis of atypical hepatocellular carcinoma.
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