Objective: to determine the possibilities of contrast-enhanced ultrasound (CEUS) in identifying and evaluating the efficiency of chemotherapy in patients with colorectal liver metastases (CLM).Material and methods. The investigation enrolled 28 patients with CLM. The patients were divided into two groups: Group 1 – 15 pretreatment patients; Group 2 – 13 posttreatment patients with process stabilization. All the patients underwent standard B-mode ultrasound of the liver and that using the contrast agent SonoVue ® (Bracco, Italy), by recording and estimating the parameters of the intensity-time curve (CIV). Liver CEUS assesses the nature of contrasting metastases in three phases (arterial, venous, and delay ones).Results. The investigators identified three types of contrast agent accumulation in CLM in the arterial phase: along the periphery of the lesions (in 60% of the patients of Group 1, in 76.9% in Group 2), homogeneously over the entire volume (in 26.7% in Group 1 and in 0.08% in Group 2), in parallel with intact liver parenchyma (13.3% in Group 1 and 23.02% in Group 2). In the delay phase, more metastases were detected in 4 cases (14.3%). Estimation of CIV parameters showed a difference at the beginning of contrast enhancement stages between the patients in both groups. Group 1 exhibited the early contrasting of liver metastases (19.3 sec); Group 2 displayed the late washout of a contrast agent (65.9 sec).Conclusion. CEUS versus B-mode ultrasound improves the imaging of liver metastases. The change in the vascular architectonics and hemodynamics in CLM after chemotherapy is reflected in the alteration of the rate of contrast accumulation and washout from the metastases, which allows CEUS to be used in the evaluation of the efficiency of this treatment.
In this article, based on two clinical examples, the possibilities of multiparametric ultrasound in the differential diagnosis of metastatic and lymphoproliferative changes in lymph nodes in primary-multiple malignant tumors, including breast cancer and lym - phoma, are evaluated. Multiparameteric ultrasound includes B-mode, color and energy Doppler imaging, strain elastography, shear wave elastography and contrast-enhanced ultrasound (CEUS). Standardization and reproducibility of these ultrasound techniques will allow to objectify the study, obtaining specific indicators of shear wave velocity in the zones of interest and specific signs of contrast enhancement, which can be used as impor tant differential diagnostic tool in oncology.
The objective: to evaluate the possibilities of ARFI technology (Acoustic Radiation Force Impulse), including Virtual Touch™ Tissue Imaging (VTI) and Virtual Touch™ Tissue Quantification (VTQ) for differentiation of lymphomatous and metastatic superficial lymphadenopathy.Materials and methods. The prospective study included 138 patients with enlarged superficial lymph nodes (LN). Based on a previous histological examination, patients were divided into two groups: 1st group (n = 108) – patients with non-Hodgkin’s lymphomas and Hodgkin’s lymphoma; 2nd group (n = 30) – patients with metastasis of solid tumors in superficial LN. All patients underwent ultrasound elastography of the enlarged LN using ARFI technology. In VTI study the Area Ratio parameter was evaluated, and the minimum and average values of the shear wave velocity were estimated in VTQ study.Results. According to the results of VTI study the Area Ratio parameter for enlarged LN in lymphoma (1st group) and for metastatic lymphadenopathy (2 nd group) were 1.031 ± 0.197 and 0.851 ± 0.15, respectively (p = 0.000009). The cut off value of the Area Ratio parameter was 0.901 with sensitivity, specificity and accuracy 80.6, 70.0 and 78.8 %, respectively. Minimum values of shear wave velocities for 1st and 2 nd groups were 1.980 ± 0.557 and 2.214 ± 0.367 m/s, respectively (p = 0.032). The cut off values of the average shear wave velocity in the differentiating of lymphomatous and metastatic lymphadenopathy are determined at the level of 2.00 m/s, with sensitivity of 70.0 %, specificity of 59.3 %, and accuracy of 61.6 %.Conclusion. Ultrasound elastography with ARFI technology demonstrated statistically significant differences in the Area Ratio parameter and in the minimum shear wave velocity in the enlarged superficial LN in lymphoma and with metastasis that can be used as a preliminary non-invasive differential diagnosis of enlarged superficial LN in these conditions. Moreover, the Area Ratio parameter has a statistically more significant effect on differentiating of lymphomatous and metastatic lymphadenopathy.
Objective: to evaluate the possibilities of ultrasound elastography for differentiation of reactive and lymphomatous superficial lymph nodes (LN).Materials and methods. The prospective study included 138 patients with enlarged superficial LN. Based on a previous histological examination, patients were divided into two groups: 1st group (n = 108) – patients with non-Hodgkin’s lymphomas and Hodgkin’s lymphoma; 2nd (n = 30) – patients with reactive (inflammatory) changes in superficial LN. All patients underwent ultrasound elastography of the enlarged LN using ARFI technology.Results. According to the results of ultrasound elastography, the average, minimum, and maximum shear wave velocities for enlarged LN in lymphoma (1st group) were 2.616 ± 0.684; 1.980 ± 0.557 and 3.351 ± 0.987 m / s, respectively; for LN with reactive changes (2nd group) – 1.704 ± 0.223; 1.414 ± 0.209 and 2.027 ± 0.261 m / s, respectively. Thus, the average, minimum, and maximum values of shear wave velocities significantly different between the groups (p ˂0.001). The cut off values of the average shear wave velocity in the differential diagnosis of lymphoma and hyperplasia are determined at the level of 2.05 m / s, with a sensitivity of 88.5 %, specificity of 100 %, and AUC of 0.942 (p ˂0.001).Conclusion. Ultrasound elastography demonstrated statistically significant differences in shear wave velocity in the enlarged superficial LN in lymphoma and in inflammatory processes that can be used as a preliminary non-invasive differential diagnosis of enlarged superficial LN in these conditions.
The study objective is to assess the capabilities of ultrasonography in the diagnosis of oropharyngeal squamous cell carcinomas and in the evaluation of treatment efficacy (changes in tumor volume).Materials and methods. This study included 98 patients (27 (27.5 %) females and 71 (72.5 %) males aged between 20 and 78 years with oropharyngeal tumors; of them, 12 (12.2 %) patients had recurrent tumors. Sixty-seven (68.4 %) participants had their tumors located in the tonsils; 31 (31.6 %) patients had tumors of the root of the tongue; 47 (48.0 %) patients presented with tumors invading adjacent tissues; 57 (58.2 %) patients had their lymph nodes involved. Thirty-two patients were operated at the first stage of treatment, whereas 66 (67.3 %) individuals received induction chemotherapy followed by sequential chemoradiotherapy. Treatment efficacy was evaluated 2 weeks following the completion of the second course of induction chemotherapy. We assessed tumor volume, its structure, type and intensity of vascularization, and the number and size of lymph nodes affected by metastasis. Ultrasonography findings were compared with the results of fibroscopy, X-ray computed tomography (CT) and magnetic resonance imaging (MRI) performed 2 weeks following the completion of the second course of induction chemotherapy (no later than 7–10 days).Results. The disagreement between histology and ultrasonography findings reflecting tumor volume (of either newly diagnosed or recurrent tumor) was statistically insignificant. The results of X-ray CT were more likely to be in agreement with histology than the ultrasonography results (85.0 % vs 70.0 %); however, this difference was not statistically significant. Data of X-ray CT and ultrasonography on the tumor volume demonstrated no significant difference between them. MRI and ultrasonography findings on the tumor volume were consistent in 50 % of cases. We identified the most common changes in the structure of the oropharyngeal tumors typical of positive and negative dynamics after 2 courses of induction chemotherapy. Patients with positive dynamics demonstrated a significant decrease in tumor volume detected by all diagnostic methods used (ultrasonography, X-ray CT, and MRI). There was a significant negative correlation between the efficacy of treatment assessed by ultrasonography and the grade of therapeutic pathomorphosis assessed by histology (r = –0.69; р = 0.0014).Conclusion. The accuracy of ultrasonography for the estimation of oropharyngeal tumor volume and its spread is comparable with that of X-ray CT and MRI. The disagreement between these methods was statistically insignificant. Ultrasonography is a more sensitive method for the evaluation of patient response to treatment than clinical data.
The study objectiveis to evaluate the capacity of contrast-enhanced ultrasound in the diagnosis of head and neck squamous cell carcinoma.Materials and methods. We examined 34 patients with head and neck tumors (or suspected of having a tumor) using contrast-enhanced ultrasound imaging with sulfur hexafluoride.Results. Contrast enhancement of primary and recurrent tumors (developed within 3 months since the end of treatment) was characterized by rapid wash-in (including peak enhancement) and wash-out of contrast agent. However, recurrent tumors (developed within 3 months after treatment) demonstrated slightly slower wash-in than primary tumors. In patients with suspected relapse, which was not confirmed by histological examination, contrast agent accumulated only in the surrounding tissues and did not penetrate into the fibrous infiltrate; there were no wash-in and wash-out phases (although this did not exclude the presence of small tumors in the infiltrate). By contrast, tumors demonstrated rapid achievement of peak enhancement and fast wash-out. Laryngeal and laryngopharyngeal tumors accumulate and release contrast agent like any other oropharyngeal squamous cell carcinomas. Laryngeal cartilages have high echogenicity and don’t accumulate contrast agent. Tumor-altered vocal cords accumulate contrast agent, which significantly improves the visualization. Intact vocal cords appear as hyperechogenic symmetric structures on B-scans. Contrast-enhanced ultrasound imaging allows better visualization of the vocal cords. Contrast-enhancement can significantly improve the diagnostic value of ultrasound examination of the larynx, especially when B-scanning is hindered by some anatomical features (such as large Adam’s apple) or ossification of laryngeal cartilages.Conclusion. Contrast-enhanced ultrasound imaging of the head and neck is a highly promising diagnostic tool, although it requires further evaluation. Improved visualization with contrast-enhancement increases the diagnostic value of the method for the differentiation between various tumors and fibrotic changes and detection of tumor spread to the laryngeal cartilages, which is important for surgical treatment and planning anticancer therapy.
The article presents the literature review of modern approaches in the diagnosis and treatment of squamous cell cancer of the oropharyngeal region and larynx. Various views on the treatment of patients with oropharyngeal tumors are presented. Special attention is paid to the ultrasound examination of patients with laryngeal tumors and to the possibilities of ultrasound in assessing the integrity of the laryngeal cartilage. Various ultrasound techniques for assessing the thickness and depth of invasion of oral tumors are highlighted. The features of regional anatomy that affect the informative value of visualization techniques are discussed. In the article presents criteria for assessing the prevalence of the tumor process in the adjacent organs and tissues, metastasis in regional lymph nodes.
Background. The parasternal lymphatic collector is an important pathway of the lymph drainage from the breast in breast cancer patients. Evaluation of parasternal lymph nodes is not available during physical examination. To date, no algorithm for diagnostic imaging of the parasternal lymphatic pathway has been developed. The presence of metastases in parasternal lymph nodes upstages the breast cancer patient to a minimum of clinical stage III disease.Case description. We present the case of breast cancer progression in a 40-year-old woman. The patient received treatment for triple-negative stage IIA breast cancer (Т2N0M0) in 2018. In August, 2019, 18-FDG PET /CT images revealed a solitary metastasis in the parasternal lymph node. Ultrasound images also showed the same lymph node assessed by PET -CT and the additional parasternal lymph node metastasis. A fine-needle aspiration biopsy of both lymph nodes confirmed the specific involvement of the parasternal lymph nodes.Conclusion. Ultrasound scans are used to assess the axillary, subclavian and supraclavicular lymphatic collectors, but there is little evidence in the literature on the use of ultrasound in the assessment of parasternal lymph nodes. Our clinical case shows the feasibility of using ultrasound in assessing the status of the parasternal of lymph nodes, as well as the feasibility of performing fine-needle aspiration biopsy by ultrasound navigation.
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