The method of conducting ultrasound with a contrast agent. Features of ultrasound of the abdominal cavity with contrast: indications and advantages of the method

Radiography allows you to study the structure and structural features of internal organs. Urography - X-ray of the kidney - is considered one of the most effective ways of examining the urinary system, according to the results of which the doctor can make a final diagnosis and prescribe a therapeutic therapy.

What is X-ray?

X-ray irradiation is a procedure in which short electromagnetic waves pass through the body. "Transillumination" allows you to see any pathological abnormalities - displacements and fractures of bones, neoplasms in soft tissues. The result is displayed on a special film (X-ray) or on a screen (fluoroscopy).

Irradiation in high doses is dangerous for the body and can cause mutations and abnormal development. In medical practice, low energy rays are used, which are safe and do not cause side effects. The required dose for X-ray examination is calculated depending on the diagnosed part of the body (organ) and the apparatus used.

X-ray of the kidneys: indications for the examination

In order to make an X-ray of the kidneys, there are many indications, which include:

• Lumbar back pain.
• The presence of blood impurities in the urine.
• Infectious lesion of the urinary system.
• Renal colic.
• Trauma, contusion of the lower back.
• Disruption of the normal functioning of the kidneys.
• Deviations in urine test results.
• High blood pressure.
• Suspected urolithiasis.
• Control examination after surgery.

Prescribes an x-ray of the kidney and urinary tract the attending physician (therapist, urologist) to each patient strictly according to indications. The method is often used as a clarifying method after other types of examination, for example, ultrasound. Specialists in the field of radiation diagnostics determine the type of examination and the procedure.

X-ray (urography) of the kidneys: types of research

Depending on the indications, the patient is prescribed a certain type of radiography of the urinary system and kidneys. The simplest is a survey x-ray, during which you can assess the size, shape, localization of the kidneys. Large stones composed of calcium are translucent. This is the standard examination of the urinary tract during initial presentation for medical help.

The procedure for intravenous urography consists in the introduction of a contrast agent and monitoring of renal excretory function. Pictures of the organ are taken at the time when the kidneys begin to accumulate the substance, taking it from the blood, and at the time of excretion. Contrast renal X-rays produce a sharper image on film. If it is necessary to inject a large amount of a substance using a dropper, such a study is called infusion urography.

Computed tomography is the most modern examination method based on the use of X-ray irradiation. A special apparatus - a scanner - reads the information received and displays the result in the form of a three-dimensional image. This allows you to see the condition of the blood vessels and kidney tissue.

Contrast urography

X-ray of the kidneys using a contrast agent allows you to see pathological changes in the structure of the organ, tumors, soft tissue ruptures, various cysts and stones. This is one of the most reliable methods for detecting urinary tract pathologies. Intravenous urography is carried out with the introduction of iodine-containing substances into a vein ("Urografin", "Ultravist", "Omnipak"). In order to study the state of the organs, pictures are taken at regular intervals - at 6, 15 and 21 minutes. The specialist monitors the functioning of the kidneys, the rate of filtration of blood plasma and the ability to convert it into urine.

Contrast pyeloureterography involves the administration of sterile iodine-based drugs using a urinary catheter. Only a doctor can prescribe an X-ray of the kidneys with contrast after reviewing the patient's history. The method has some contraindications, therefore, before the procedure, the patient must pass laboratory tests. A few days before the urography with a contrast agent, you need to start preparing the body.

What will a kidney x-ray show?

Kidney X-ray is the first step in diagnosing various pathological conditions of the urinary system. The procedure helps to detect the following deviations from the norm:

• Congenital malformations - the absence of one kidney.
• An increase in the size of the kidneys - observed in hydronephrosis, polycystic, diabetes mellitus.
• Uneven contours of the organ - indicate polycystic disease, pyelonephritis.
• Descent of the kidney.
• A decrease in the size of the kidneys - speaks of chronic pyelonephritis, one kidney - of congenital hypoplasia.
• Rupture of soft tissues of the organ.
• Presence of kidney stones.
• Tumor.

For the diagnosis of various diseases of the urinary system, the most accurate method is precisely X-ray. Kidney stones of oxalate and phosphate type are clearly visible in the picture. You can find out their size, shape and exact location. Urography with contrast gives a complete picture of the state of the entire urinary system. Urate formations are practically invisible on conventional radiography, therefore they are diagnosed using ultrasound examination.

Kidney X-ray in children

Radiography can be used in pediatrics for strict indications. It is possible to conduct an examination using this method at any age, even in newborns. When prescribing an X-ray, the doctor tells about the need for this type of diagnosis and possible consequences in case of parental refusal. Indeed, not everyone is ready to expose a child to radiation, but modern medical X-ray machines can reduce the negative consequences of the procedure.

X-rays of the kidneys and genitourinary system with contrast are not performed in children in the first week of life, with developmental abnormalities and impaired renal function.

How is the procedure going?

Before prescribing an x-ray, the attending physician must make sure that the patient has no contraindications to its conduct. The patient agrees to the examination and administration of a contrast agent (if necessary).

Many are familiar with this type of diagnosis, but not everyone knows how to do an x-ray of the kidneys. First of all, before the procedure, it is necessary to remove all metal objects and jewelry. The patient may be offered sedatives or an injection of pain relief.

To begin with, a survey urography is performed, during which the condition of the entire urinary system is assessed. If no serious pathologies are found, the nurse makes a trial contrast injection. This is necessary in order to check the body's allergic reaction. In the absence of such a contrast agent is injected intravenously to the patient. If a contrast X-ray of the kidneys is done to a child, then before the procedure, the specialist must calculate the dose of the substance by age and weight.

At the 5-7th minute, the first picture is taken, in which the contrast is in the calyx-pelvis system. In the second picture (15-17 minutes), the substance passes through the ureter. When the contrast hits bladder, make the last X-ray (20-23 minutes). During the procedure, the patient can be in both vertical and horizontal position.

Decoding the results

X-ray of the kidneys with contrast agent allows you to get a clear picture of the urinary tract as well as the pelvic organs. The images obtained in the X-ray room must be taken to the attending physician, who must interpret them correctly and make a final diagnosis.

The shape, localization, contours of organs are taken into account. It is quite difficult to independently decipher the results of the survey without having the appropriate education.

How to prepare for a kidney x-ray

In order to get high-quality images, it is necessary to properly prepare for the X-ray of the kidneys. A few days before the procedure, the patient must adhere to diet food, which is aimed at reducing gassing. To cleanse the intestines, it is better to do an enema or take laxatives. Children also need preparation for kidney x-rays. Before the procedure, babies are given Espumisan.

Before doing an x-ray of the kidney, it is necessary to pass tests that will help to exclude renal failure. If accepted medicines, you need to warn your doctor about this. Food should not be eaten several hours before the procedure. Infants are allowed to drink. Areas of the body that are not examined are protected with a special screen, a lead apron.

Keep calm and not move while the X-ray machine is operating. One of the parents may be with a small child. If the result is blurry, indistinct images, the procedure will have to be repeated, and this is unnecessary radiation exposure and stress for the child.

Contraindications to renal radiography

The X-ray procedure is prohibited in the following cases:

• Breastfeeding period.
• Renal failure
• The grave condition of the patient (the need for intensive care, shock).
• Allergic reaction and intolerance to the components of contrast agents.
• Diabetes mellitus and pregnancy (X-rays are performed only on strict indications if the potential benefit of the diagnosis outweighs the harm done).

If X-ray is prohibited according to indications, the doctor selects alternative diagnostic methods. This can be magnetic resonance imaging (MRI) or ultrasound.

Possible side effects of X-ray with contrast

Most often, there is an allergic reaction to the injected contrast agent: swelling, redness, itching. In the event of such signs, the patient is administered antihistamines.

At the puncture site of the vein, suppuration, swelling may appear. Patients complain of fever and general malaise. With these symptoms, urgent medical attention is needed.

To exclude unwanted side effects before the x-ray, the patient must pass all tests to make sure there are no contraindications.

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Many people in the modern world are aware of the use of contrast media in many studies, such as computed tomography, magnetic resonance imaging, kidney urography, now in ultrasound diagnostics started to apply contrast agents.
For the first time in the Republic of Bashkortostan they used contrast agent... This project was implemented within the framework of " master class»October 19, 2015 at the Republican Clinical Hospital named after G.G. Kuvatov in the department of ultrasound diagnostics. This opportunity was provided to us by Philips and the manufacturer contrast media firm Bracco.
A large number of specialists in ultrasound and radiation diagnostics were invited to this event.
In advance, patients were selected with various focal formations of the liver, kidneys, as well as with diseases of the vascular system.
And so we will figure out why such a survey is needed and how contrast agent looks on the ultrasound picture.
Contrast agent, the trade name SONOVYU is a solution with gas microbubbles diameter 2.5 μm (active component sulfur hexafluoride).

trong\u003e Sulfur hexafluoride is an inert gas that is completely harmless to the human body, there is no nephrotoxicity, there is no radiation exposure, the gas is excreted within 15 minutes. Sonovyu is for diagnostic use only. The drug is used to increase the echogenicity of blood, for better visualization of organs, where the usual ultrasound diagnostics not entirely informative. The drug improves the quality of Doppler studies.
Method of application, a special bottle with Sonovu's drug is mixed with saline, vigorously shaken until a homogeneous white liquid is obtained, after which the drug is injected through a peripheral catheter into a vein, after which a special program for contrast agents is turned on on the ultrasound machine and the ultrasound picture is evaluated.
Application contrast media in ultrasound diagnostics this is a breakthrough, a new step in ultrasound, this examination with the use of contrast agents will be of great help in differential diagnosis complex diseases and will help to cure a huge number of patients.

WRITE YOUR NAME AND PHONE, AND WE WILL CALL YOU AND WRITE YOU TO USE!

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Basic indications

This study can be prescribed if:

1. systematic infectious lesions of the urinary system;
2. signs of renal colic;
3. blood in the urine;
4. signs urolithiasis;
5. and also in order to identify complications after surgery.

Information about research types

It is customary to distinguish between the following types of research:

• overview urography;
• excretory urography;
• infusion urography.

Under the general urography of the kidneys, it is necessary to understand an ordinary X-ray of the internal organs, which are located in the region of the kidneys.

Excretory urography is an X-ray examination using contrast agents. With this method, it is possible to study the structure of the kidneys in more detail.

It is important! As an X-ray contrast agent, concentrated 60-80% iodine-containing solutions can be used, for example, sergozin, urografin, urotrast, etc. These drugs are designed for slow intravenous jet) administration. The amount of contrast is calculated based on the patient's weight.

With the help of excretory urograms, it is possible to assess:

• Dimensions;
• Kidney contours;
• Position;
• Form;
• functional state of the kidneys;
• shape and contours of the bladder, ureters.

One of the types of excretory urography is infusion urography of the kidneys. Its essence lies in the fact that the patient is injected with a contrast agent using a dropper and in larger volumes, compared with conventional excretory urography. This allows you to get an even more detailed image of the structure of the kidneys and find out all the features.

Procedure

«\u003e Before conducting the study, the patient must give up those products that contribute to gas formation in 3 days. Immediately before urography, you need to abstain from food for 8 hours. It is forbidden to drink copious amounts of liquid.

It is important! Before starting the study, the treating specialist should take a test for allergy to contrast agents.

Immediately before the urography, the patient needs to remove all metal jewelry and objects from himself, and the bladder must first be emptied. In some cases, a specialist may prescribe sedatives or analgesics.

In most cases, it takes up to 45 minutes and directly depends on individual factors, for example, the presence of kidney stones, their location, size.

The main contraindications

If we talk about contraindications for urography, then these include:

• Hypersensitivity to iodine-containing contrast agents;
• The presence of acute glomerulonephritis;
• Renal failure (acute and chronic);
• Thyrotoxicosis
• The use of the drug glucophage in patients with diabetes mellitus;
• Reduced blood clotting;
• Pregnancy;
• Pheochromocytoma.

Complications after urography with contrast agent

Complications after this diagnostic measure, in most cases, depend on the number of performed x-ray examinations for a long period of time.

It is important! A special place is occupied by nephrotoxic effects and allergic reactions. A huge number of modern X-ray contrast agents contain iodine atoms, and intravenous urography is contraindicated in case of iodine allergy.

The risk group includes patients with bronchial asthma, allergic reactions to contrast agents and other severe allergic reactions.

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Indications for X-ray of the kidneys

If the patient has symptoms characteristic of kidney disease, an x-ray of this organ may be recommended.

Kidney X-rays are prescribed with or without contrast. Diagnostics is necessary in the following cases:

• deviations from the norm of indicators in the analysis of urine (change in specific gravity, the appearance of blood, leukocytes, salts and other impurities) and blood (creatinine, urea);
• signs of kidney disease (pain in the lumbar region, swelling);
• identification of structural changes in the kidneys, ureters and bladder by ultrasound;
• renal colic, diagnosis of urolithiasis, cysts, tumors;
• constantly recurrent infectious diseases of the urinary system;
• kidney injury;
• quality control of the performed surgical treatment.

Contraindications

X-ray of the kidneys, like most hardware diagnostic techniques, has contraindications:

• an allergic reaction to a contrast agent (almost all of them contain iodine isotopes);
• less than 3 days have passed since the examination of the gastrointestinal tract with contrast agents;
• pathology of the thyroid gland;
• severe renal or hepatic impairment;
• taking certain hypoglycemic drugs (prior consultation with an endocrinologist is required);
• pheochromocytoma (tumor of the adrenal gland);
• exacerbation of glomerulonephritis;
• existing active bleeding, serious condition of the patient.

Pregnancy, lactation and acute period infectious diseases - relative contraindications. This means that the procedure can be performed in case of emergency, while the patient must be explained all its possible consequences.

With severe obesity and ascites (accumulation of fluid in abdominal cavity), the doctor may doubt the advisability of a renal fluoroscopy, since these factors significantly impair the image quality and complicate the diagnosis. In such cases, computed tomography or magnetic resonance imaging may be recommended.

Plain radiography

To perform the procedure, the patient undresses, removes jewelry that may get on the picture (usually a navel piercing), and lies down on a special table. To protect the genitals from radiation for men, a special lead plate is applied to the groin area. Next, the patient must follow the instructions of the doctor.

A plain X-ray image obtained during a routine examination gives general concept about the state of the organ. With its help, you can see the location of the kidneys, an additional kidney, if any, evaluate their contours and sizes, see large formations, some types of stones. In addition, the image clearly shows the spine and pelvic bones, so that sometimes you can immediately differentiate the cause of pain in the lumbar region.

Plain radiography is far from the most informative method for examining the kidneys, but it provides general information about the state of the organ and helps to draw up a further plan for examining the patient.

Contrast radiography

Excretory urography

To carry out urography, a contrast agent is injected into a vein, and as it spreads along the vascular bed, several x-rays of the kidneys and urinary tract are taken.

In this study, the doctor also receives an image of the kidneys using X-rays, but the information content of urography is several times higher than the usual plain radiography. The essence of the method is that before the examination, a contrast agent is injected intravenously to the patient, which rapidly accumulates in the urine. Then several pictures are taken at regular intervals (5-7, 12-15 and 20-25 minutes after the injection of the substance).

This study makes it possible to assess the excretory function of the kidneys, to identify abnormalities in the structure of the calyx-pelvic system, to detect stones, tumors, polyps, and not only in the kidneys, but also in the ureters and the bladder.

Before the study using a contrast agent, an allergic test must be performed, if it turns out to be positive, then the procedure becomes impossible. During the examination, the patient may experience slight nausea, dizziness, fever, and possibly a slight decrease in blood pressure. Symptoms like these are acceptable but should be monitored by a doctor. In case of severe deterioration of the patient's condition, the procedure is terminated.

Infusion urography

This procedure has the same principle as the excretory urography described above, only the contrast agent is injected intravenously, not by jet, but by drip. This method produces the best quality pictures.

Any urography must be performed under the supervision of a doctor who monitors the patient's condition and can provide assistance if deterioration occurs.

There are several other options for the administration of contrast agents: percutaneously or retrogradely through the urethra through a catheter.

Renal angiography

This is a type of X-ray examination of the vascular system of the kidneys, in which a contrast agent is injected into their vessels. Thanks to angiography, narrowing of the lumen of the renal vessels can be detected, for example, with their atherosclerosis and thrombosis. The procedure is performed under local or general anesthesia.

Preparing for a renal x-ray

Regardless of the type of examination, you need to prepare for it. The main reason for getting an insufficiently clear image is the accumulation of gas and feces in the intestines. That is why it is better to start preparing for the study 2-3 days in advance.

Products that cause increased gas formation should be excluded from the diet:

• dairy products, especially whole milk and cream;
• legumes;
• cabbage;
• cucumbers;
• grapes;
• cherries;
• fresh bread;
• sweets;
• kvass;
• carbonated drinks, etc.

If the patient has a tendency to constipation, then a few days before the study, laxatives are prescribed to him. In the evening on the eve of the procedure, dinner should be light, if possible, it is better to refuse it altogether. If there is any doubt that the intestines are sufficiently cleaned, a cleansing enema can be done.

In the morning, be sure to have breakfast, as gases are also formed in the empty intestines. You can eat a bowl of porridge boiled in water, a toasted white bread sandwich with cheese, and unsweetened tea. If necessary, drugs are taken that reduce gas formation in the intestine, and sorbents.

If the doctor wants to visualize the bladder on a plain X-ray (this organ usually also falls into the study area), he warns the patient that the bladder must be filled. To do this, 2 hours before the start of the examination, it is recommended to drink 1.5-2 liters of still water, unsweetened tea or compote and not urinate.

Of course, when it comes to emergency research, for example, with renal colic, we are not talking about any preliminary preparation.

Kidney X-ray is an inexpensive, available type of examination that can be performed in any hospital or clinic, unlike the expensive and not available everywhere CT and MRI. At the same time, the information obtained with its help, in most cases, is sufficient to make a diagnosis and choose a treatment tactics.

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A. Martegani, MD, L. Aiani, MD.

Diagnostic Imaging Unit, Valduce Hospital, Como, Italy.

Translation of the article: "Technological advancements improve the sensitivity of CEUS diagnostics".

Ultrasound procedure with contrast (CEUS) allows real-time display of the dynamics of vascularization of lesions, parenchyma and blood vessels.

Ultrasound characterization

Figure: one. Solid heterogeneous focal formation in the VII segment of the liver (A). On contrast-enhanced ultrasound, the lesion appears hypervascular in the arterial phase (B). In the late phase, there is a washout effect (C). Corresponding arterial phase on MSCT with contrast * (D).

Final diagnosis: "hepatocellular carcinoma".
* MSCT: multislice computed tomography.

The use of contrast enhances the diagnostic accuracy of ultrasound in the assessment of parenchymal and vascular diseases, not only in the abdominal organs, but also in the surface structures.

Introduction

Contrast-enhanced ultrasound (CEUS) is based on the interaction between an echo contrast agent (UCA) and an ultrasound system with special software. The contrast agent consists of microbubbles stabilized by a membrane that allows them to remain in the bloodstream for at least 4-5 minutes. Microbubbles amplify the ultrasound signal from the blood. Their size, approximately corresponding to the size of red blood cells, allows them to pass through the alveolar-capillary barrier and reach the circulatory system without penetrating the endothelial barrier, even when administered intravenously, therefore they can be considered as a contrast agent "blood depot".

According to the available data, echo contrast agents have a very good safety profile, as adverse events, mainly in the form of allergic reactions, are rare.

Echo contrast agents were originally developed to amplify signals in color modes and at the level of blood vessels that are too deep or where blood is moving too slowly.

However, the use of special algorithms at low acoustic pressure for visualization of contrast agents has made it possible to develop ultrasound techniques for the study of micro- and macrovascularization of parenchymal tissues and pathological formations, as well as large vessels.

Contrast-enhanced ultrasound as new method diagnostics, allows you to amplify the acoustic signal from microbubbles and filter out the signal coming from the tissues around immobile tissues, relying on the nonlinear properties of the contrast agent response. In this regard, this method allows you to determine only the bubbles distributed in the blood circulation of the studied organ in real time, and due to this, to display the microcirculation.

Recently developed technologies make it possible to use contrast-enhanced ultrasound to study deep parenchymal tissues, superficial tissues and vascular structures in real time. Below are the studies performed with convex and linear probes and special software supported by the system (Samsung Medison Co. Ltd., Seoul, Republic of Korea).

Contrast-enhanced ultrasound in studies of the abdominal cavity, superficial structures and vessels

A. Evaluation and monitoring of hepatocellular carcinoma with sTACE therapy

Contrast-enhanced ultrasound demonstrates high sensitivity in detecting hypervascularization phenomena (primarily in the microvasculature) in real time, therefore this method plays an important role in early and remote monitoring of therapy oncological diseasesparticularly percutaneous ablation or angiographic procedures.

Fig. 2. Solid and heterogeneous nodular formation with signs of intra- and perinodular blood flow in the mode, located in right lobe liver (A). Contrast-enhanced ultrasound demonstrates intense arterial enhancement (B) with gradual and delayed washout (C), which becomes more evident in the late phase (D).

MSCT with contrast in the axial plane in the arterial phase (E) and reconstruction in the MIP-3D mode (F) reveal diagnostic signs consistent with hepatocellular carcinoma.

In this particular case, contrast-enhanced ultrasound has revealed lesions that would otherwise be unlikely to have been detected on an ultrasound scan.

It helps in the management of patients after ablation procedures, in particular in the case of continued growth of neoplasms or relapses at the site of previously healed foci (Fig. 2,3).

Fig. 3. Angiographic demonstration of neoplasm vascularization (A). Follow-up study after selective embolization (B): maintaining the minimum size of the tumor, which receives nourishment from the blood supply from the right hepatic artery (red arrows). Below is a control ultrasound scan performed the next day: in B-mode (C), a hyperechoic nodule can be seen due to the presence of air areas.

On the echogram with contrast (D), in comparison with the B-mode, the formation looks mostly avascular, which confirms the angiographic data on the preservation of active tumor tissue at the periphery (F, G). Confirmation - on images obtained by MSCT with contrast in the arterial (H) and venous (I) phases. Diagnostic signs correspond to the state after subtotal therapy for hepatocellular carcinoma.

B. Evaluation of hematogenous dissemination of metastases in the peritoneum

Modern technologies allow the use of contrast-enhanced ultrasound in the study of surface structures using high-frequency linear sensors.

Contrast-enhanced ultrasound showed a higher sensitivity than when determining changes in the macro- and microcirculatory bed. This opens up the possibility of determining the solid and vascularized nature of the masses, indicating the direction for further diagnosis (Fig. 4).

Fig. 4. Color Doppler ultrasound (A) confirms the presence of nodules on the parietal peritoneum (white arrows) and parietal pleura (yellow arrows). Concomitant ascites and single small vascular areas only in the nodular formations on the pleura.

Selective study of the nodule on the peritoneum, performed with echo contrast using a high-frequency linear transducer: compared to the original image (B), one can notice an intense signal amplification in the nodule in the early arterial phase (C) and an increase in the signal from the nodule and adjacent liver parenchyma in late phase (D).

Compared to the initial CT image (E), the contrasting image demonstrates an increase (F) of the nodular formation on the peritoneum (before contrasting - 49 Hounsfield units, after contrasting - 105 Hounsfield units).

Final diagnosis: "carcinomatosis of the peritoneum".

C. Study of the internal carotid artery: occlusion or pseudo-obstruction?

Contrast-enhanced ultrasound can also be used in large blood vessels because it is more sensitive to slow blood flow and is less susceptible to artifacts.

As reported in many recent publications, contrast-enhanced ultrasound allows for a more accurate measurement of the thickness of the intima-media complex, which is currently considered an important indicator in determining the risk of cardiovascular diseases, moreover, a contrast agent can help distinguish pronounced carotid artery stenosis and pseudo-occlusion from complete occlusion, since it has a higher sensitivity to slow blood flow than Doppler mode (Fig. 5).

Fig. five. In B-mode ultrasound (A), a hyperechoic heterogeneous heterogeneous echostructure is visualized in the postbulbar part of the internal carotid artery. Presence of a small calcified plaque (white arrow) adjacent to the bulbar wall of the internal carotid artery.

With color Doppler mapping (B), a weak signal from the vessel is observed throughout the lumen of the carotid artery. In transcranial color Doppler imaging (TCD), the Doppler spectrum of the opposite middle cerebral artery (C) is characterized by a low peak systolic velocity and low systolic-diastolic modulation, especially compared to the artery on the opposite side (D).

Contrast-enhanced ultrasound (E-F-G) performed with a high-frequency linear transducer shows a uniform lumen of the carotid artery within the bulb. The absence of contrast agent was confirmed in the postbulbar part of the internal carotid artery.

Final diagnosis: complete occlusion of the postbulbar part of the internal carotid artery.

Another option for the use of contrast-enhanced ultrasound for the carotid arteries is the study of plaques in the carotid arteries not only at the morphological level, but also at the functional level, since the contrast agent can detect the presence of vasa vasorum in plaques in real time. In a number of studies, the presence of vasa vasorum in atheromatous plaques correlates with their increased instability. Thus, contrast-enhanced ultrasound has the potential to be an important indicator of an increased risk of cardiovascular disease in the near future.

Discussion

In our daily practice, we often use contrast-enhanced ultrasound to diagnose a variety of clinical cases and study various anatomical areas. The signal-enhancing effect that this technique provides is an important factor in planning an appropriate approach to diagnosis and treatment, as well as a comprehensive assessment of pathological signs, potentially providing a comprehensive set of diagnostic tools capable of covering a wide range of anatomical structures.

Conclusion

When used correctly, contrast-enhanced ultrasound is highly sensitive and can even produce results comparable to CT and MRI. Low invasiveness and low cost of the method are also advantages over other imaging methods. Taking into account recent technological developments and the possibility of using contrast-enhanced ultrasound for superficial structures, this method may open prospects even in the diagnosis of neoplasms of the mammary glands and prostate gland.

Supported systems: , .

Literature

1. EFSUMB Study: Group The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatlc applications. Ultraschall Med. 2012; 33 (1): 33-59.
2. Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver - update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, A | UM, ASUM, FLAUS and ICUS. Ultrasound Med Biol. 2013; 39 (2): 187-210.
3. Meloni MF, Livraghi T, Fitce Cr Lazzaroni S, Caliada F, Perretti L: Radiofrequency ablation of liver tumors: the role of microbubble ultrasound contrast agents. Ultrasound Q. 2006; 22 (1): 41-17.
4. Bolondi L The appropriate alocation of CEUS in the diagnostic algorithm of liver lesions: a debated issue. Ultrasound Med. Biol. 2013; 39 (2): 183-5.
5. Piscaglia F, Bolondi L. The safety of Sonovues in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med. Biol. 2006; 32 (9): 1369-75.
6. Martegani A, Aiani C Borghi C: "The use of contrast-ehnancend ultrasound in large vessels". Eur. Radiol. 2004; 14 Suppl 8: 73-86.

Ultrasound is used in the diagnosis of a huge list of diseases (including in urology and gynecology), as well as in the management of pregnancy.

Unlike the X-ray method, ultrasound examination can be performed quite often, and this allows you to monitor the patient's condition in dynamics. This eliminates the risk of errors in diagnosis and treatment.

Ultrasound examination is completely painless, maximally comfortable for the patient, in 90% of cases it does not require preliminary preparation.

Contrast-enhanced ultrasound

Contrast-enhanced ultrasound studies have appeared only in the last decade, but have already become an integral part of diagnostics. The use of a contrast agent allows you to get an accurate image of complex formations, violations in the structure of organs, vessels, cavities, etc.

Contrast ultrasound is used mainly in:

• obstetrics;
• angiology;
• hepatology;
• cardiology;
• oncology;
• orthopedics;
• uronephrology.

But the high accuracy of the method suggests that in the near future, contrast-enhanced ultrasound will be used in all areas of medicine.

Ultrasound during pregnancy

Ultrasound examinations are necessary both at the planning stage and during the course of pregnancy.

Ultrasound can detect abnormalities that can interfere with conception and bearing a child. In the early stages of pregnancy - to exclude an ectopic pregnancy, improper attachment of a fertilized egg.

In the course of further diagnostics, using ultrasound examinations, not only the sex of the unborn child is determined, but its development is monitored.

Timely detection of developmental pathologies, intrauterine diseases, disorders in the urinary and reproductive systems of the mother herself allow avoiding many risks associated with carrying a pregnancy, childbirth and the health of the unborn baby.

Modern myths

Many mothers, due to prejudices or too strong pressure from the older generation, are afraid to undergo this procedure, as they believe that it can harm the child. However, many years of research have shown that ultrasound is absolutely harmless to the fetus.

The gel used during the procedure does not cause allergic reactions. It is sterile, does not penetrate into the deep subcutaneous layers and does not cause complications in inflammation of internal organs, including the uterus, ovaries and rectum.

During a transvaginal examination during pregnancy, the gel does not in any way affect the nature of the formation of the fetus, the amount of amniotic fluid and other factors. Just as the frequency at which the ultrasound machine works does not affect the formation of the child and in no case does it harm the formation of internal organs, the brain, etc.

It has been proven that ultrasound is not only safe, but is strictly indicated in the management of pregnancy.

Contraindications

Ultrasound examination should not be performed when:

• infectious skin diseases;
• suppurations on the surface of the epidermis and mucous membranes;
• rashes of unknown etiology;
• mental disorders.

You should also postpone the prescribed study if the patient has an exacerbation of inflammatory processes of the kidneys, ureters, liver. At the peak of the disease, even slight pressure from the tip can cause severe pain.

All other contraindications are associated not with health hazards, but with low information content for the diagnosis of a specific disorder or the need to conduct research only in a certain period. For example, some gynecological or monologic examinations are performed only on the days of the cycle indicated by the doctor.

Patients undergoing routine ultrasound (ultrasound) are sometimes referred for additional examination using Sonovyu's echo-contrast agent. Of course, many questions immediately arise, for example, whether the contrast agent will harm the body or why another study is carried out on an ultrasound machine, if it has already been performed recently.
We invite you to familiarize yourself with the answers to all your questions.

What is Sonovyu?
Sonovyu is a diagnostic product belonging to the group of echo-contrasts, the use of which in world practice has been carried out since the early 90s.
Sonovyu's echo-contrast agent is a suspension of microbubbles, the size of which is comparable to the size of an erythrocyte, surrounded by an elastic phospholipid membrane. The bubbles are filled with inert gas.

How does Sonovyu's drug work?
The drug is administered intravenously through a PVC catheter installed before the examination. Bubbles of the drug enter the venous bed and begin to circulate in the blood vessels, reaching the zone of interest (pathological formations of various localization).
Despite their small size, gas microbubbles significantly increase the reflection of the ultrasonic wave, which leads to the formation of a significantly clearer image than with conventional ultrasound. This is especially important for assessing the structure of pathological education and blood flow in it. The latter is the most important indicator in determining the nature of the studied formation (benign, malignant).

How is the drug excreted from the body?
Under the action of an ultrasonic wave, Sonovyu's microbubbles are destroyed. The average period of "life span" of bubbles in the patient's bloodstream is 12 minutes. The released inert gas leaves the body along with the exhaled air. The phospholipid membrane is utilized by the liver.

What are the advantages of Sonovya over other contrast studies performed in radiology (computed tomography, magnetic resonance imaging)?
When using Sonovyu, high safety for the patient is noted:

• almost complete absence of allergic reactions;
• lack of toxic effects on the kidneys (nephrotoxicity);
• when conducting an ultrasound scan with Sonovya, there is no radiation effect on the body;
• there are no contraindications associated with the presence of metal structures in the body, pacemakers and other devices;
• no restriction for use in claustrophobic patients.

The procedure for conducting an ultrasound scan using an echo-contrast agent Sonovyu.

Before an ultrasound scan, a nurse in a sterile manipulation room installs a special catheter into a vein. Sonovyu's working solution is being prepared.

After clarifying the localization of the pathological focus under ultrasound, the drug Sonovyu is injected with an assessment of its diffusion into the pathological focus. The study lasts no more than 5-8 minutes.

Upon completion of the study, the catheter is removed from the vein, a pressure bandage is applied to the elbow fold, which can be removed independently after 20 minutes. After that, the patient can be free.

The answer is formed after a specialist examines the ultrasound record with a second-by-second image analysis. The study protocol together with the record (on CD-carrier) can be collected by the patient the next day after the study at the registry of the ultrasound department. If the patient still has questions, he can ask the doctor who conducted the study.

The material on patients' issues was formed by the head of the head of the department of radiation diagnostics, doctor of medical sciences, professor of the North-Western State Medical University, head of the Center for High Technologies of Ultrasound -.

) before an abdominal ultrasound?

Can I smoke before an abdominal ultrasound, take alcohol?

What does preparing children for an abdominal ultrasound include?

Ultrasound of healthy organs of the abdominal cavity. Abdominal hernia on ultrasound

Liver ultrasound is normal. Ultrasound diagnostics of liver diseases

Study of the pancreas by ultrasound of the abdominal cavity

Ultrasound of the gastrointestinal tract ( Gastrointestinal tract). Diseases of the stomach, intestines on ultrasound. Ultrasound diagnosis of appendicitis - ( video)

Ultrasound of the lymph nodes and vessels of the abdominal cavity ( aorta, inferior vena cava)

The site provides background information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

What is abdominal ultrasound? Abdominal ultrasound in comparison with other research methods

Ultrasound procedure ( Ultrasound) is a type of radiation diagnostics in which ultrasound is used to obtain a diagnostic image. Obtaining a diagnostic image is considered an important auxiliary method for clinical examination in the treatment of various diseases of internal organs.

Ultrasound examination is also called echography. This name is due to the fact that ultrasonic waves, passing through human tissue, are reflected back in the form of an echo. The echo recorded by the sensor serves as the basis for the formation of an image on the screen of the ultrasound machine. Structures of different densities reflect ultrasonic waves in different ways, which creates a contrasting image.

Ultrasound examination has entered tightly medical practice since the 1960s. Since then, medical technology has stepped forward, ultrasound equipment has become more advanced. With the help of ultrasound, it is now possible to create a three-dimensional model of the organs under study. Abdominal ultrasound is the most common procedure for examining internal organs due to its simplicity and availability. An abdominal ultrasound is performed for people of any age in almost every medical institution.

What is the principle of ultrasound examination? How does an ultrasound machine work?

Ultrasound is a mechanical vibration of elastic media with a frequency of over 20 kHz. This value is the threshold for the human hearing organ. The name "ultrasound" is explained by the fact that waves of this frequency are beyond the perception of ordinary sound. In medicine, ultrasound with a frequency of 1-10 MHz is used.

Ultrasonic waves are created using a piezoelectric effect. It consists in creating ultrasonic vibrations under the influence of an electric current. Only a few substances, such as quartz, have this ability. Piezoelectric elements are made from such substances, which create ultrasonic waves. Modern ultrasonic sensors contain from 500 to 1000 piezoelectric elements.

There is also a reverse piezoelectric effect. It consists in the fact that under the action of ultrasound, the piezoelectric element generates an electric current. Due to the reverse piezoelectric effect, the ultrasonic sensor works simultaneously as a receiver of reflected ultrasonic waves.

Ultrasonic waves travel in different media at different speeds. In air, their speed is 330 meters per second, in soft tissues and organs of the abdominal cavity - 1500 m / s, in bones - 3500 m / s. At the border of two media with different speeds of ultrasound propagation in it ( acoustic density), ultrasonic waves are reflected. The greatest reflection of waves is observed from the surfaces of media with a large difference in density ( for example between bones and soft tissues ). The stronger the reflection of ultrasonic waves, the brighter the color of the structures on the screen of the ultrasound machine.

In the correct assessment of an ultrasound image, its resolution plays an important role. The resolution is determined by the distance at which two adjacent points are distinguishable on the screen of the ultrasound machine. To obtain a high-quality ultrasound image, the parameters of the sensor are very important. In the arsenal of the doctor, there are several options for sensors that have different parameters. If the transducer creates ultrasonic waves of higher frequency, then they give very good resolution, but they penetrate to a shallow depth. Using ultrasound at a lower frequency can increase the depth of penetration of the ultrasonic waves, but the image resolution deteriorates.

What organs are examined when performing an abdominal ultrasound?

The abdominal cavity includes a large number of vital anatomical structures. There is no better way to visualize these structures than ultrasound. On x-rays, abdominal organs are displayed much worse than on ultrasound, due to the low contrast of soft tissues.

Abdominal ultrasound includes examination of the following structures:

• gallbladder and bile ducts;
• spleen;
• vessels of the abdominal cavity.

The liver, pancreas and spleen are parenchymal organs. This means that they have a dense structure and do not have cavities. They are made up of unique cells that are no longer found in the body. On ultrasound, parenchymal organs look like more or less homogeneous formations. The stomach, intestines and gallbladder are hollow organs, so ultrasound searches for signs of damage to their walls. For the study of blood vessels, a special type of study is used - duplex ultrasound, which allows you to assess the blood flow velocity and some additional parameters of blood flow.

Ultrasound of the abdominal cavity with functional tests

Despite the fact that a comprehensive ultrasound of the abdominal cavity includes many organs, sometimes ultrasound is performed on a purposeful basis to study certain structures. This is done in cases where the underlying disease is already known. Depending on the organ being examined, special ultrasound techniques can sometimes be used. They are aimed at studying the functional state of the organ. Ultrasound of the abdominal cavity with functional tests takes much longer than conventional ultrasound ( about 1 hour), therefore it is carried out not so often and only for certain indications.

Functional studies include ultrasound of the biliary tract with food load. In response to food intake, the gallbladder contracts and bile is secreted from it. With the help of ultrasound, you can assess the degree of contraction of the gallbladder. This technique allows you to assess the motor ( contractile) the function of the biliary tract.

Another study that allows to evaluate the function is ultrasound of the stomach and intestines with a water-siphon test. After filling the gastrointestinal tract, not only does its visibility on ultrasound improve, but it is also possible to trace the speed of fluid movement through the digestive organs. Using a water-siphon test, peristalsis is assessed ( muscle contractions of the walls of the stomach and intestines) and the rate of absorption of fluid in the intestine.

Abdominal ultrasound with color Doppler mapping ( CDK)

Ultrasound examination of blood vessels is complicated by the fact that blood is a liquid and almost completely absorbs ultrasonic waves. Therefore, an additional method based on the Doppler effect is used to study blood vessels. It consists in changing the frequency of ultrasonic waves when reflected from an object in motion. The moving elements from which the reflection occurs are blood cells. When cells move towards the sensor, the frequency of ultrasonic waves increases, and when they move away, it decreases.

Color Doppler mapping provides color coding of the recorded frequencies on the monitor screen. Red indicates the approach of blood flow, and blue indicates its distance from the sensor. With the help of this, a branched tree of blood vessels can be obtained on the screen, colored in different colors depending on the direction of blood flow.

Ultrasound of the abdominal cavity with dopplerometry can also be called duplex ( double) research. This name is explained by the fact that at first a routine scan of all organs is carried out, and then the Doppler technique is used separately. Duplex exploration is used when examining abdominal aorta, portal blood flow of the liver, in the presence of tumors and neoplasms.

Abdominal ultrasound with contrast

Contrast agents in radiation diagnostics are widely used in X-ray examination. They serve to improve the visualization of certain structures. Recently, a method of using contrast agents has also appeared in ultrasound examination. Ultrasound contrast media consist of a small amount of liquid in which tiny gas bubbles are dissolved. Such compositions are called echo contrast.

Contrast ultrasound is performed for the following purposes:

• identifying the differences between benign and malignant tumors;
• assessment of the blood supply to various organs during their inflammation ( e.g. liver);
• study of blood flow parameters in some vessels.

An echo contrast agent is injected intravenously in a small amount. Within 10 - 15 minutes, it reaches the abdominal cavity and creates a contrast zone at the place where the vessels pass. Air bubbles of the echocontrast substance at the border with blood have high degree reflection of ultrasonic waves, due to which the contents of the vessels become visible on ultrasound. For the patient, such a study is absolutely harmless. With the use of contrasting, ultrasound examination approaches computed tomography ( CT scan) and magnetic resonance imaging ( MRI) in the possibilities of diagnosing tumors.

CT scan ( CT scan) and ultrasound of the abdominal cavity

Computed tomography is a modern X-ray method for examining any organs and systems. CT is also successfully used for examining the abdominal organs. With the help of CT, numerous sections of the abdominal cavity are created in all planes at a short distance from each other. This allows you to find the smallest formations in the stomach, liver, gallbladder and other organs.

Abdominal CT is very often done with contrast. Through computed tomography almost all diseases can be diagnosed, including inflammatory ones. Ultrasound is not as accurate as computed tomography, but it is more affordable and faster. In addition, ultrasound does not expose the patient to radiation and therefore has no contraindications.

Computed tomography is most often prescribed before surgical interventions on the abdominal cavity. Surgeons need to know in advance the location in the abdominal cavity of the formations for which the operation is being performed. Ultrasound cannot provide accurate data, while it is clearly visible on a CT scan. Thus, for a routine examination of the abdominal organs, an ultrasound scan is sufficient, but with serious illnessesin which ultrasound is not informative enough, CT is recommended.

Magnetic resonance imaging ( MRI) and ultrasound of the abdominal cavity

Magnetic resonance imaging is the most powerful diagnostic tool in medicine at the moment. Compared to computed tomography, MRI has a better display of soft tissues. The use of MRI is absolutely safe, since the tomograph is not a source of X-ray radiation. Its action is based on the use of magnetic field energy.

MRI of the abdominal cavity is informative and is successfully used for the following groups of abdominal diseases:

• inflammatory diseases;
• congenital anomalies in the structure of organs;
• benign tumors;
• malignant tumors;
• vascular diseases and others.

Only with the help of MRI it is possible to accurately assess the size and stage of malignant tumors. As with computed tomography, the image is built in the form of slices in several planes, so that a three-dimensional structure of the organ under study can be obtained. Unfortunately, the equipment for performing magnetic resonance imaging is in short supply and is available only in large cities. Therefore, MRI of the abdominal organs is performed less frequently than ultrasound, but at the same time it provides information that is unique in terms of accuracy.

Ultrasound of the abdominal cavity and EGD ( fibrogastroduodenoscopy)

EGD is an endoscopic examination of the hollow organs of the gastrointestinal tract. The compound name of the research abbreviation includes all organs that can be examined with this instrument - the esophagus, stomach, duodenum. EGD is a visual examination of the walls of the stomach and intestines using a special optical system located inside a long tube. To penetrate the tube into the stomach, the patient must make a series of swallowing movements. The tube diameter is approximately one centimeter.

In the study of hollow organs, ultrasound is not as informative as in the study of parenchymal organs, such as the liver, pancreas. The wall of the hollow organs has a small thickness, and the resolution of the ultrasound machine may not allow viewing all its details. Therefore, for the diagnosis of certain diseases ( ulcer, gastritis) it is necessary to conduct a visual endoscopic examination of the wall of the stomach and intestines. Naturally, this procedure is less convenient for the patient, but it gives a reliable result. With the help of FGDS, it is also possible to take tissue and biological fluids from the stomach cavity.

Unfortunately, FGDS is not performed for children due to unpleasant sensations that can cause psychological trauma to the child. Modern ultrasound equipment has made a step forward and in some cases allows diagnosing defects in the mucous membrane of the gastrointestinal tract. However, despite this, in diseases of the stomach and intestines, EGD is a priority study.

Indications and contraindications for ultrasound of the abdominal cavity

Abdominal ultrasound is a study that is often performed in modern medicine... This is due to the high prevalence of diseases of the gastrointestinal tract and organs involved in digestion. At the modern pace of life, people have to break their diet, which provokes various diseases. At the same time, ultrasound examination allows you to quickly and fairly accurately examine all organs of the abdominal cavity and establish the nature of the pathology.

The purpose of the ultrasound of the abdominal cavity

An abdominal ultrasound has several goals. The main purpose of abdominal ultrasound is to help establish the correct diagnosis in the presence of symptoms and complaints from the patient. However, the disease is much easier to prevent than to cure, so an abdominal ultrasound can and should be done as a preventive measure. In addition, ultrasound is performed to monitor the state of internal organs in dynamics.

The objectives of the abdominal ultrasound are:

• Preventive examination of internal organs. It is recommended to perform a preventive examination every three years, starting at the age of 21.
• Exclusion or confirmation of diseases of the abdominal organs. In this case, an ultrasound scan is performed to establish a diagnosis and select treatment tactics.
• Monitoring chronic processes. For some diseases, they adhere to expectant tactics, since their treatment poses a great risk. In this case, an examination of organs is carried out approximately every six months.
• Assistance in performing diagnostic and therapeutic procedures. Puncture of cysts, abscesses, collection of a piece of tissue ( biopsy) are performed under the control of an ultrasonic sensor.
• Postoperative observation. The success of abdominal surgeries is assessed by live examination as well as by ultrasound.

Thus, abdominal ultrasound is performed for different purposes. Considering its safety, ultrasound examination can be performed an unlimited number of times. Ultrasound can also be performed on your own initiative in order to make sure that the internal organs are in good condition.

Indications for ultrasound of the abdominal cavity. What symptoms should you see a doctor and have an abdominal ultrasound scan?

The main purpose of ultrasound is to diagnose various diseases of internal organs. People seek medical attention when they experience certain symptoms. Unfortunately, symptoms usually appear as the disease progresses. There are a large number of organs in the abdominal cavity, so the symptoms of their diseases are very diverse. Understand the exact reason feeling unwell only a medical specialist can.

An abdominal ultrasound should be performed with the following symptoms:

• digestive disorders ( constipation, flatulence);
• the acquisition of a yellow tint by the skin ( jaundice);
• feeling of heaviness after eating;
• a sharp change in weight.

These symptoms can indicate diseases of the liver, pancreas, stomach, intestines and other reasons. Sometimes changes are observed in several organs at once, since all the digestive organs are interconnected in one way or another. To establish the exact cause, an ultrasound examination must be performed.

Abdominal ultrasound for abdominal pain

Abdominal pain is the most common symptom that accompanies diseases of the internal organs. It can be both sharp and strong, and dull, but long. In any case, the appearance of pain is a reason to see a doctor. Acute pain, as a rule, speaks of urgent, urgent conditions. If doctors have an ultrasound machine at their disposal, then acute pain ultrasound is always performed.

Acute abdominal pain can occur for the following reasons:

• Hepatic colic. Pain occurs in the right hypochondrium. Ultrasound of the abdominal cavity reveals stones in the gallbladder and its inflammation.
• Acute pancreatitis. Pain appears in the middle or upper abdomen and radiates to the lower back ( girdle pain). An ultrasound scan detects enlargement, swelling, and inflammation of the pancreas.
• Exacerbation of peptic ulcer disease. With ulcers, pain is associated with food intake and appears in the upper abdomen along the midline. Ultrasound is not very informative in the diagnosis of ulcers; EGD is preferred.
• Bowel inflammation ( enteritis, colitis). Pain appears in the middle and lower abdomen, accompanied by constipation or diarrhea ( diarrhea). An ultrasound scan cannot detect intestinal inflammation, so indigestion is the main sign of intestinal damage.
• Appendicitis. Pain in appendicitis initially appears in the lower right abdomen, but quickly spreads to the entire surface of the abdomen. With appendicitis, it is necessary to provide surgical care... Ultrasound is also effective in detecting appendicitis.
• Stones in the kidneys. Pain with kidney stones appears in the back, but it seems to the patient that they are given to the abdomen and extend to the groin area. With the help of ultrasound, they are detected in almost all cases.
• Tumor disease. Tumors rarely cause acute pain. This usually refers to malignant tumors or mechanical complications tumors. Pain occurs when the tumor compresses the lumen of the bile ducts or ureters. Ultrasound can determine these abnormalities, but the priority research for diagnosing tumors is MRI or CT.
• Spine and muscle disease. If all of the above causes have been excluded, then it is suspected that the pain is caused by inflammation of the vertebral nerves or muscles.

As you can see, abdominal pain can appear for a variety of reasons. In some conditions, ultrasound is informative, and in some conditions it cannot provide the necessary information. Therefore, in determining the indications for ultrasound examination, the decisive opinion remains with the attending physician, who can exclude certain diseases, based on a live examination of the patient.

Indications for ultrasound of the abdominal organs for pregnant women

During pregnancy, a woman's body is subject to overload. Because of this, various problems with internal organs can arise or worsen. They can, to a certain extent, affect the course of pregnancy and the health of the unborn child. To diagnose diseases of internal organs, pregnant women are recommended to undergo an ultrasound examination.

Abdominal ultrasound for pregnant women is indicated in the following cases:

• the presence of pain in the upper abdomen;
• symptoms of intoxication ( nausea, vomiting, weakness) after the third month of pregnancy;
• yellowness or pallor of the skin;
• changes in the blood test;

Toxicosis of pregnant women ( vomiting, nausea) usually goes away after the first trimester of pregnancy. The entire period of pregnancy, a woman should be under the supervision of doctors. Thanks to this, various complications can be avoided. Ultrasound of the abdominal cavity is absolutely harmless for both the mother and the unborn child.

Is it harmful to carry out an abdominal ultrasound? How often can an abdominal ultrasound be done?

Ultrasound examination does not create ionizing X-ray radiation, so its use is absolutely safe. Ultrasonic waves do not harm a person at any age. This opinion was put forward in the 1980s by American doctors and is now generally accepted in the medical community. Ultrasound is successfully used in various fields of medicine, in cosmetology and dentistry.

Abdominal ultrasound can be performed an unlimited number of times due to its safety. For prophylactic purposes, an ultrasound of the abdominal cavity is recommended once every 3 years, and with chronic diseases abdominal organs, ultrasound is performed more often ( about once every six months) to monitor changes in organs. During the treatment of acute diseases, ultrasound can be performed several times per course to observe the dynamics of recovery.

Contraindications to ultrasound of the abdominal cavity

Abdominal ultrasound has no contraindications. There are only some limitations that reduce the diagnostic capabilities of this method. An abdominal ultrasound requires some preparation on the part of the patient ( three day diet). If the diet is not followed, it is advisable to postpone the ultrasound scan at a later date, if possible. Conducting EGD on the same day with ultrasound is a relative contraindication, since during endoscopic examination air enters the gastrointestinal tract, which interferes with the propagation of ultrasonic waves.

Difficulties for ultrasound examination arise in the presence of excess weight and thick subcutaneous adipose tissue. In this case, it is necessary to use special sensors with an increased depth of investigation. If there are wounds or abrasions on the skin, this place is isolated using medical latex. It can then be carefully examined using an ultrasonic probe. Thus, abdominal ultrasound can be successfully performed in various situations due to the simplicity and convenience of this procedure.

Can an abdominal ultrasound be done during menstruation?

An abdominal ultrasound can be done at any time during the menstrual cycle. If necessary, if you feel unwell, the study can be postponed for several days. There are some situations when ultrasound is recommended to be performed in accordance with menstrual cycle... With a joint study of the abdominal and pelvic organs, the doctor prescribes a study for a specific day of the cycle. This is due to the physiological characteristics of the reproductive organs.

How long is the abdominal ultrasound result valid?

The ultrasound result is valid for as long as its description corresponds to the state of the internal organs. If the ultrasound does not reveal any changes, then it is considered that it is valid until the next preventive examination, that is, about three years. However, in the presence of acute or chronic diseases of internal organs, various changes can occur in a short time. Therefore, in this case, the expiration date of the ultrasound examination does not have clearly established dates. If you suspect a worsening of the condition, it is better to re-conduct an ultrasound scan than to build on the results of a previous study, especially since this study is harmless and does not take much time.

Abdominal ultrasound technique

Abdominal ultrasound is a standard procedure for various diseases of the internal organs. Due to extensive testimony, many have conducted this study... First-time examiners sometimes feel anxious about an abdominal ultrasound. It should be noted that it has no basis whatsoever. Ultrasound is a painless and harmless procedure.

The abdominal ultrasound technique may vary depending on the organs in which pathological changes are suspected. The scanning plane depends on this. Detection of abnormalities on ultrasound may necessitate a more thorough and prolonged examination. However, in the largest case, an ultrasound of the abdominal organs without additional techniques takes 30 minutes.

How to get a referral for an abdominal ultrasound?

Referrals for abdominal ultrasound can be obtained from different doctors. The easiest way to get it is from your family doctor, who accepts it at the local polyclinic. Specialized treatment of diseases of the gastrointestinal tract is carried out gastroenterologists ( sign up) ... These doctors usually deal with the treatment of patients in hospitals. When treating with a gastroenterologist, a referral for an ultrasound of the abdominal cavity is mandatory.

A referral to an abdominal ultrasound can also give surgeon ( sign up) ... Ultrasound examination is required for surgeons in the treatment of hernias, tumors, appendicitis and other diseases. Surgery may be needed if you experience acute abdominal pain. In this case, an abdominal ultrasound is performed on an emergency basis in the emergency department.

Which doctor performs an abdominal ultrasound?

An abdominal ultrasound is performed by a doctor who has received special education in the field of functional diagnostics using ultrasound. These specialists are also called sonologists ( from the alternative name of ultrasound - sonography). The sonologist fully conducts ultrasound diagnostics, issues a conclusion, but does not make a final diagnosis and does not prescribe treatment. The latter is the responsibility of the attending physician, since he has at his disposal the data of all patient studies, and not just ultrasound.

If necessary and the presence of equipment, ultrasound examination can be performed by the attending physician himself. For example, it is sometimes better for surgeons to perform an abdominal ultrasound on their own prior to surgery to clarify some of the anatomical features of a given patient. It helps surgeons navigate during abdominal surgery.

Equipment for an ultrasound diagnostic room

The ultrasound room should be large enough to accommodate the ultrasound machine, couch, desk and chair. According to the norms, its area should be at least 20 square meters. Its dimensions and the entrance door should, if necessary, allow the gurney with the patient to be brought in and transferred to the couch.

The ultrasound diagnostics room contains:

• ultrasound machine;
• couch;
• doctor's workplace ( desk, armchair);
• hanger;
• sink;
• first aid kit.

The couch in the ultrasound room should be flat, soft, with a raised head end. Patient confidentiality is respected during the examination, so usually the office contains only 1 ultrasound machine. Thanks to this, the research is not interrupted by outsiders. The ultrasound machine does not generate X-rays, so there is no anti-radiation protection in the ultrasound room.

There should be good lighting in the ultrasound diagnostic room. Light should come from windows, but it should not be too bright, as this interferes with viewing the image on the monitor. The office should have a coat rack or wardrobe so that the patient can undress comfortably before the examination. There must be a source in the office drinking water and a sink where the patient can clean himself up after the examination.

Ultrasound diagnostic apparatus

An ultrasound examination cannot be performed without an ultrasound machine. Today they are high-tech expensive devices. The ultrasound machine is universal, that is, it allows you to explore various parts of the body. Ultrasound machines offer a variety of imaging options. Many modern devices allow three-dimensional modeling of organs after scanning. The main components of the ultrasound machine are common to devices of all generations.

The components of the ultrasound diagnostic apparatus are:

• Power Supply. Serves to convert the current of a standard electrical network into the current necessary for the correct operation of the device.
• Ultrasonic sensor. The sensor is both a source and a receiver of ultrasonic waves. These two processes alternate very often, about 1000 times per second.
• Ultrasonic pulse transducer. Serves to represent the ultrasonic pulse from the transducer as an electrical signal.
• CPU. Processes all signals coming from the sensor. Allows you to correct the image, eliminate defects, measure linear parameters, adjust the scan.
• Monitor. Serves to display and present the scan results in a form convenient for the doctor's perception.
• Data input devices ( keyboard). Input devices are used when storing a patient record in the memory of the device.
• Storage disk. Stores data on all studies performed.
• A printer. After the examination, the ultrasound examiner often prints out the most representative static image obtained during the examination.

It should be borne in mind that the quality of the device and the duration of its operation are of great importance. Research on new devices is more accurate and can, to a certain extent, reduce the degree of influence of the human factor in assessing research results. To conduct a high-quality examination, it is necessary to inquire in advance about the quality of the ultrasound equipment used.

Ultrasound scan modes

There are several scanning modes for ultrasound examination. At the moment, some of them are more promising and are used more often. The choice of the scanning mode is made by the settings of the ultrasound machine itself. The scanning mode is independent of the sensors used.

Currently, the following ultrasound scanning modes are used in medicine:

• A-mode. The reflected signals are displayed as peaks, between which the distance can be determined. With this method of scanning, the examined organ itself is not displayed, therefore, this technique is gradually abandoned.
• M-mode. This method is used to examine moving organs such as heart valves or the aorta. A wavy line is created on the screen to represent the movement of the anatomical structures.
• B-mode. It is most often used because this method creates a two-dimensional image of the structures under study. It is built in a fan-shaped manner, corresponds to the real scale of depth in the human body.
• Doppler scan. With this method, blood flow is displayed on the screen in the form of a color pattern. The colors correspond to the speed and direction of blood movement relative to the stationary sensor.

With the development of equipment and medical technology, new scanning techniques appear. For example, today, when scanning a fetus, it is possible to obtain its three-dimensional reconstruction using means of computer processing of an ultrasound image. However, scanning cannot be performed without a transducer, which is both a generator and a receiver of ultrasonic waves. There is a certain variety of sensors as they are designed for different applications.

Types of sensors used in abdominal ultrasound

The transducer is the most important part of the ultrasound machine. With its help, an ultrasound image of the internal structures of the body is built on the monitor screen. The sensor is selected depending on the depth at which the organs under investigation are located. For each organ, there are specific recommendations for the frequency of the sensor used.

The higher the sensor frequency, the better the image quality, but at the same time the possible depth of investigation decreases. For example, a sensor operating at a frequency of 7.5 MHz has a resolution of 0.5 mm, but its possible depth of application is only 5 cm. A sensor operating at a frequency of 3.5 MHz allows one to study structures at a depth of 16 cm, but its resolution is half the size.

There are the following types of sensors:

• Linear. Piezoelectric elements in such a sensor are arranged linearly. Typically, the frequency of a linear probe is 5-10 MHz, which is why it gives a clear image of structures, but at a shallow depth.
• Convex. It features a fan-shaped arrangement of piezoelectric elements and a convex surface. The convex probe has a frequency in the range of 3 - 7.5 MHz, so it has average image quality and penetration depth.
• Sector. Such a sensor has a compact size and is intended for studying deep structures in a narrow sector. The frequency of the sector sensor is in the range of 1.5 - 5 MHz.

For the study of the abdominal organs, convex and linear sensors with a frequency of 5 - 7.5 MHz are used. Only sometimes it becomes necessary to use a sector sensor in cases where the patient is overweight. A focusing lens is built into the sensor, which allows concentrating a beam of ultrasonic waves from each piezoelectric element at the desired depth. The focusing lens is adjusted by computer methods.

For proper operation of the sensor, special gels are used to ensure the necessary contact of the sensor with the skin. Without this gel, ultrasonic waves would be scattered in the air gap between the skin and the transducer. The gel is transparent and neutral to the skin. It is based on glycerin and also contains water, fats, disinfectants.

Abdominal ultrasound protocol. How is abdominal ultrasound performed?

An abdominal ultrasound is performed in a special room, in the presence of a doctor and a nurse. The patient undresses to the waist and takes a horizontal position on the couch. The doctor gets acquainted with the direction for the study, the preliminary diagnosis from the patient's card, selects the appropriate ultrasound transducer. Before starting the test, he applies a small amount of a special gel to the skin and surface of the transducer.

During scanning, the doctor moves the ultrasound probe in different planes. In real time, an image appears on the screen of the ultrasound machine, which the doctor examines. The patient at this moment feels a slight vibration, similar to a massage. Sometimes the doctor asks the patient to change position, lie on his side, sit down, take a deep breath. This is done in order to obtain an optimal image of certain organs. The entire examination of the abdominal organs lasts no more than 30 minutes.

The entire upper abdomen is scanned to examine the abdominal organs. The sensor is installed longitudinally, transversely and obliquely. When performing ultrasound of the abdominal cavity with color Doppler mapping ( CDK), a special sensor is used, which is set in a certain position and kept motionless for a certain time. Certain experience is required from the doctor to conduct and interpret Doppler results.

Ultrasound of the abdominal cavity for a child

Ultrasound of the abdominal cavity can be performed on children from a very young age due to the complete safety of the study. The first ultrasound scan for children is performed in the hospital. The abdominal ultrasound technique for children does not differ from that used for scanning adults. However, when carrying out ultrasound, children use sensors of a higher frequency, respectively, of a higher resolution and a lower depth of penetration of ultrasonic waves. Scanning children takes less time due to the small size of the abdomen.

Ultrasound for children is carried out only in the presence of parents, as they help establish a positive contact between the doctor and the child during the study. The child must remain motionless during the exploration, he must be absolutely calm. Parents and the doctor's friendly attitude can help.

How is abdominal ultrasound performed for pregnant women?

For pregnant women, ultrasound is common because they undergo fetal ultrasound several times during pregnancy. Ultrasound of the abdominal cavity for pregnant women is relatively rare, in contrast to ultrasound of the kidneys, which can exacerbate chronic diseases. If necessary, an ultrasound of the abdominal organs is performed for pregnant women according to the generally accepted method. For pregnant women, proper preparation for an ultrasound scan, adherence to a diet that reduces gas formation, for 3 days before the study is also important.

Abdominal scans are performed in the upper abdomen, so the fetus does not interfere with their examination. For pregnant women, only one position is usually used during an ultrasound scan - lying on the back, since it is difficult for pregnant women to hold other positions for a long time. If necessary, a roller is used to support the body in certain positions.

Abdominal ultrasound at home

An abdominal ultrasound can also be performed at home. For this, a mobile unit for ultrasound scanning is used. An ultrasound scan at home is carried out in exceptional situations associated with a serious condition of the patient or difficulties in his movement. Ambulance teams are not equipped with this equipment, so home ultrasound can be performed only by contacting private clinics. However, this service is provided by a limited number of private medical institutions.

The examination technique for performing ultrasound at home is the same as for a standard examination. At the same time, there are no restrictions on the organs under study for ultrasound at home. The quality of an ultrasound examination of the abdominal cavity at home is not inferior to the examination carried out in an ultrasound office in a polyclinic.

Is it possible to perform an abdominal ultrasound scan under a compulsory health insurance policy ( OMS)?

An abdominal ultrasound can be performed under a compulsory insurance policy. This research is carried out free of charge with a policy. To do this, you need to get a referral for research in public medical institutions. An abdominal ultrasound can also be performed free of charge every 3 years according to the practice of dispensary observation. Dispensary observation provides for a complete examination of the body for preventive purposes, including a blood test, urinalysis, fluorography and other studies. It should be borne in mind that in private medical institutions it is, as a rule, impossible to perform an ultrasound of the abdominal cavity according to the policy.

Preparation for ultrasound of the abdominal cavity

Preparation for an abdominal ultrasound is an important component of a successful study. Thanks to this, you can achieve the best visualization of internal organs on the monitor screen. Preparation for an ultrasound of the abdominal cavity includes a set of simple measures aimed at reducing gas formation in the intestine. In addition, it is especially important for some patients and children to be psychologically prepared for the study. Knowing the main points of the study will help the patient avoid stress. All preparatory measures help the doctor in studying the ultrasound picture.

Instructions for the patient before ultrasound. How to prepare for an adult abdominal ultrasound?

Preparation for ultrasound of the abdominal cavity is carried out within a few days. For the convenience of the patient, you can ask the doctor for a special memo containing all the necessary recommendations before the study. They relate to dietary rules and some habits. An ultrasound scan can be performed without following these recommendations, but in this case, the ultrasound result may be inaccurate.

The Patient's Memo for an abdominal ultrasound scan contains the following recommendations:

• for 2 - 3 days, you must follow a special diet that reduces the formation of gases and toxins in the intestines;
• with constipation and flatulence, you need to take medications that improve digestion in advance ( activated carbon, espumisan and others);
• the last meal should be 6 to 8 hours before the study;
• smoking and drinking alcohol is not allowed before the ultrasound of the abdominal cavity;
• after EGD and X-ray of the abdominal organs using contrast agents, at least 24 hours should pass;
• in case of chronic diseases and constant use of medications, their use should be continued, despite the forthcoming ultrasound examination.

Thus, the main recommendations concern the preparation of the gastrointestinal tract. The stomach and intestines should be as empty as possible, and most importantly, free of gas. If necessary, during an ultrasound examination, a water-siphon test is performed, as a result of which the patient drinks water and, thus, fills the gastrointestinal tract. This takes place directly in the ultrasound diagnostic room.

Diet before ultrasound of the abdominal cavity. What can you eat before testing?

Diet is the foundation of preparation for an ultrasound scan. Only certain foods cause flatulence in the intestines. Intestinal gases greatly complicate the examination of not only the stomach and intestines, but also other internal organs. Therefore, before an ultrasound of the abdominal cavity, it is advisable to adhere to certain dietary restrictions.

• some vegetables ( cabbage, onions, mushrooms);
• legumes ( beans, peas, soy);
• dairy products;
• eggs;
• bread, pastry and flour products;
• carbonated drinks;
• alcohol.

All of them, to one degree or another, increase the formation of gas in the intestines. The physician will notify the patient of this list of products when they issue a referral for an abdominal ultrasound. Also, this list of products is contained in the patient memo. For food before an ultrasound of the abdominal cavity, you can use steamed lean meats ( chicken's meat), cereals, vegetable soups.

Can I drink tea, coffee, water before an abdominal ultrasound?

Usually, an abdominal ultrasound is done in the morning on an empty stomach. Before that, the last meal should be on the evening of the previous day. Drinking liquids is also not recommended, but usually does not cause negative consequences. Therefore, before leaving the house, you can drink tea or coffee, but without sugar. If the ultrasound is performed in the afternoon, after 15:00, then in the morning you can eat a full breakfast. For people who do not tolerate fasting, especially with diabetes mellitus, you can eat a small amount of food 3 to 4 hours before the ultrasound.

When performing an ultrasound of the abdominal cavity with a water-siphon test, the patient drinks water, but does it right in the ultrasound room. In any case, the doctor is interested in what foods the person ate before the study. With negative results of the study, it may be necessary to repeat it, but with stricter adherence to the diet.

Should I take medication ( activated carbon, espumisan, fortrans, enterosgel) before an abdominal ultrasound?

Some patients are advised to take certain medications before an abdominal ultrasound in order to normalize bowel function and reduce gas production. First of all, it is required for those who usually suffer from bloating, flatulence, constipation. This prophylactic treatment is not intended for continuous use, but is very effective as preparation for ultrasound imaging.

Activated carbon is a substance with a high ability to absorb toxins and waste products from the gastrointestinal tract. It is taken in the form of tablets, 1 - 2 grams 3 times a day, one hour after meals. It helps with diseases such as diarrhea, flatulence, colitis, and gastric acidity. It can also be taken the day before an abdominal ultrasound.

Espumisan is a drug with a narrower application than activated carbon. It deliberately reduces the formation of gases in the intestines, helps to eliminate them naturally. To prepare for an ultrasound scan, take 2 capsules 3 times a day before the study, as well as 2 capsules in the morning of the study day.

Before an ultrasound of the abdominal cavity, alcohol intake leads to vasoconstriction. The toxic effect of alcohol can lead to slight enlargement of organs and their inflammatory edema. Gas production increases in the intestine, making it difficult to visualize the abdominal organs. Drinking alcohol and smoking cigarettes should be stopped not only for the duration of the study, but also on an ongoing basis, since these habits only harm the body.

What does preparing children for an abdominal ultrasound include?

Ultrasound of the abdominal cavity for young children is performed in the presence of parents. Parents play a very important role in preparing children for research. It is the responsibility of parents to explain to children the main points of the study. Thanks to this, children will behave more calmly while communicating with the doctor and using the ultrasound probe. A good relationship between the child and the doctor is the key to high-quality diagnosis and successful treatment.

It is very important for children to follow the same rules for preparing for the research as for adults. Mom and Dad should monitor the diet of the children, as well as give them activated charcoal in appropriate proportions a few days before the ultrasound. Required dose activated carbon is 0.05 grams per kilogram of the child's weight three times a day. It is recommended to exclude sweets and carbonated drinks from the diet of children a few days before the ultrasound of the abdominal cavity.