Ultrasound kidneys with contrast. Application of echocontrase drugs in the clinic

09.07.2020

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

What is X-ray?

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

Exposure in large doses is dangerous for the body and can cause mutations, anomalous development. In medical practice, low-energy rays are used, which are safe and do not cause side effects. The required dose for radiological studies is calculated depending on the diagnosed part of the body (organ) and the apparatus used.

Kidney X-ray: testimony for survey

In order to make a kidney x-ray, there are quite a lot of readings to which:

Pain in the lumbar back.
The presence of blood impurities in the urine.
Infectious damage to the urinary system organs.
Renal colic.
Injury, injury the bottom of the back.
Violation of the normal functioning of the kidneys.
Deviations in the results of urine tests.
Elevated blood pressure.
Suspicion of urolithiasis.
Control examination after surgery.

Appoints X-ray kidneys and urinary tracts attending physician (therapist, urologist) to each patient strictly according to indications. The method is often used as clarifying after other types of surveys, for example, ultrasound. Experts in the field of radiation diagnostics determine the type of research and procedure.

X-ray (urography) kidneys: types of research

Depending on the testimony, the patient prescribe a certain type of radiography of the urinary system and kidneys. Panoramic x-ray is considered the simplest, during which the size, shape, kidney localization can be estimated. Large stones consisting of calcium are shown. This is a standard survey of the urinary system during primary treatment for medical help.

The intravenous urography procedure is to introduce a contrast agent and observation of the excretory function of the kidneys. Pictures of the organ are made at a time when the kidneys begin to accumulate the substance, picking it out of the blood, and at the time of allocation. X-ray kidney with contrast allows you to get a clearer image on the film. If you need to introduce a large amount of substance with a dropper, such a study is called infusion urography.

Computed tomography is the most modern method of survey, which is based on the use of radiographic irradiation. Special machine - scanner - reads the information received and displays the result as a three-dimensional image. This allows you to see the condition of blood vessels and kidney tissues.

Contrasting urography

X-ray kidney with the use of a contrast agent allows you to see pathological changes in the structure of the organ, tumors, soft tissue breaks, various cysts and stones. This one of the most reliable methods for identifying the pathologies of urinary tract. Intravenous urography is carried out with the introduction of iodine-containing substances in Vienna ("Urography", "Ultravist", "Omnipak"). In order to study the state of the organs, the pictures are made at certain time intervals - by 6, 15 and 21 minutes. The specialist is monitored by the functioning of the kidney, the rate of blood plasma filtration and the ability to transform it in the urine.

Contrast pyelureterography implies the introduction of sterile preparations based on iodine with the urinary catheter. Assign the kidney X-ray with a contrast can only after familiarization with the patient's history. The method has some contraindications, so before the patient's procedure, you must pass laboratory tests. A few days before the urography with a contrasting agent need to begin training the body.

What will show kidney radiography?

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

Congenital developmental anomalies are the absence of one kidney.
An increase in the size of the kidneys is observed in hydronephrosis, polycystic, diabetes mellitus.
Uneven contours of the organ - testify to polycystic, pyelonephritis.
Outmunction of the kidney.
Reducing the size of the kidneys - speaks of chronic pyelonephritis, one kidney - about congenital hypoplasia.
Gap soft tissue organ.
The presence of stones in the kidneys.
Tumor.

For diagnosis various diseases Urinary system The most accurate method is x-ray. Stones in the kidneys of oxalate and phosphate type are well visible in the picture. You can find out their size, shape and exact location location. Urography with contrast gives a complete picture of the state of the whole urinary system. Uraban formations are practically not visible on ordinary radiography, so they are diagnosed with ultrasound examination.

Kidney x-ray

Radiography can be used in pediatrics on strict indications. It is possible to conduct a survey with this method at any age, even in newborns. The doctor at the appointment of X-ray tells about the need for such a type of diagnosis and possible consequences in the event of parental failure. Indeed, not everyone is ready to expose the child with irradiation, but modern medical x-ray devices reduce the negative effects of the procedure.

X-ray of the kidneys and the urogenital system with contrast do not conduct children in the first week of life, with the anomalies of development and the disorder of the functionality of the kidneys.

How is the procedure?

Before appointing X-ray, the attending physician must make sure that the patient has no contraindications to its conduct. The patient provides consent to the examination and introduction of a contrast agent (if necessary).

With such a type of diagnosis, many are familiar, but about how the kidney x-ray is done, not everyone knows. First of all, before the procedure it is necessary to remove all metal objects, decorations. Patient can offer to drink sedatives or make an anesthetic injection.

For a start, an overview urography is carried out, in the process of which the condition of the entire urinary system is estimated. If serious pathologies have not been detected, the nurse makes the trial introduction of contrast. This is necessary in order to check the body's allergic reaction. In the absence of such a patient, intravenously introduced contrast substance. If the contrast kidney X-ray is made to a child, then the specialist must calculate the dose of substance by age and weight before the procedure.

On the 5-7th minute, the first shot is made, on which the contrast is in a cup-laughter system. In the second shot (15-17 minutes) the substance passes the ureter. When the contrast falls into bladder, make the last x-ray (20-23 minutes). During the procedure, the patient may be both in a vertical and horizontal position.

Decoding results

The kidney x-ray with a contrasting agent allows you to get a clear picture of urinary tract, as well as a small pelvic organs. The pictures obtained in the radiotherapy office must be attributed to the attending physician, which must correctly interpret and put the final diagnosis.

The form, localization, contours of the organs is taken into account. Independently decipher the results of the survey, without having an appropriate formation, is quite difficult.

How to prepare for kidney x-ray

In order to get high-quality pictures, it is necessary to properly prepare for kidney radiography. A few days before the procedure, the patient must adhere to the dietary nutrition, which is directed to a decrease in gas formation. For cleansing the intestines, it is better to make an enema or take laxatives. Children also need preparation for kidney x-rays. Before the procedure, the kids give "Espumizan".

Before making X-ray kidney, you need to pass tests that will help to eliminate renal failure. If medicines are accepted, you need to warn your doctor about it. A few hours before the procedure cannot be eaten. Breast children allowed to drink. Plots of the body that are not examined are protected by a special screen, lead apron.

During the operation of the X-ray apparatus, it is necessary to comply with calm and not to move. With a small child can be one of the parents. If the result is greased, fuzzy images, the procedure will have to be repeated, and this is an excess radiation load and stress for the child.

Contraindications for kidney radiography

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

Breastfeeding period.
Renal failure.
Heavy condition of the patient (the need for intensive therapy, shock).
Allergic reaction and intolerance to the components of contrast substances.
Diabetes and pregnancy (X-ray is carried out only by strict indications if the potential benefits of diagnostics exceed the damage).

If the X-ray is prohibited from the testimony, the doctor selects alternative diagnostic methods. It can be magnetic resonance tomography (MRI) or ultrasound.

Possible side effects of X-ray with contrast

Most often an allergic reaction to the introduced contrast agent: swelling, redness, itching. In the event of such signs, antihistamines are injected by the patient.

In the place of the puncture of veins may appear suppuration, swelling. Patients complain about temperature rise and overall malaise. With such symptoms, urgent medical care is necessary.

To eliminate unwanted side effects In front of the x-ray, the patient needs to pass all the tests to make sure that there are no contraindications.

fB.ru.

Many people in the modern world are known to use contrast substances With many studies, such as computed tomography, magnetic resonance imaging, urography kidney, now in ultrasonic diagnostics Started apply contrast substances.
In the first in the Republic of Bashkortostan applied contrast substance. This project was implemented within " class Master"October 19, 2015 in the Republican Clinical Hospital of them G.G. Kuvatova in the department of ultrasound diagnostics. This feature was provided to us by Philips and manufacturer contrast substances BRACCO.
A large number of specialists in ultrasonic 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 understand why it is necessary to such a survey and how contrast substance Looks like a picture.
Contrast substance, the trade name of the Sonya is a solution with gas microbubbles 2.5 μm diameter (active component sulfur hexafluoride).

TRONG\u003e sulfur hexafluoride is an inert gas completely harmless to the human body, there is no nephrotoxicity, there is no radiation load, gas output for 15 minutes. Sound is intended only for diagnostics. The drug is used to increase blood echogenicity, for better visualization of organs, where ordinary ultrasound diagnostics Not quite informative. The drug improves the quality of research in Doppler mode.
The method of use, the special bottle with the drug is mixed with a physiological solution, shake vigorously to obtain a homogeneous white liquid, after which the drug is introduced through the peripheral catheter, after which the device includes a special program for contrasting substances and begin an estimate of the ultrasonic picture.
Application contrast substances in ultrasonic diagnostics This breakthrough, a new step in the ultrasound, this examination with the use of contrasting agents will have enormous help in the differential diagnosis of complex diseases and will help cure a huge number of patients.

Write your name and phone, and we will call you back and write to the ultrasound!

uzi-v-ufe.ru.

Main indications

This study can be appointed if available:

systematic infectious lesions of the urinary system organs;
signs renal colic;
blood in the urine;
signs of urolithiasis;
and also to identify complications after operations.

Information about research species

It is customary to distinguish such types of research:

overview of urography;
excretory urography;
infusion urography.

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

Under the excretory urography, an x-ray study is meant using contrast substances. With this method, it is possible to study the structure of the kidneys in more detail.

It is important! As an x-ray of a contrast agent, concentrated 60-80% iodine-containing solutions, such as sergozin, urograph, uritation, etc. These preparations are designed for slow intravenous inkjet). The amount of contrast is calculated depending on the weight of the patient.

With the help of excretory urograms, you can estimate:

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

One of the types of excretory urography is the infusion urography of the kidneys. Its essence is that the patient a contrast substance is introduced with a dropper and in more significant volumes, compared with the usual excretory urography. This allows you to get even more detailed image of the structure of the kidneys and find out all the features.

Procedure for holding

"\u003e Before studying the study, the patient needs to abandon those products that contribute to gas formation in 3 days. Immediately before urography, it is necessary to refrain from food for 8 hours. It is forbidden to drink a rich amount of fluid.

It is important! Before starting the study, the attending specialist must take a sample on allergies to contrast agents.

Immediately before carrying out urography, the patient needs to remove all metal decorations and items, should be pre-emptying the bladder. In some cases, the 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 stones in the kidneys, their location, size.

Basic contraindications

If we talk about contraindications to carry out urography, then they can be attributed to them:

Increased sensitivity to iodine-containing contrast agents;
The presence of acute glomerulonephritis;
Renal failure (acute and chronic);
Thyrotoxicosis
Consumption of glucophage drug in patients with diabetes;
Reduced blood coagulation;
Pregnancy;
Feochromocyti.

Complications after the urography with a contrast agent

Complications after this diagnostic event, in most cases depend on the number of radiological studies conducted for a long period of time.

It is important! A special place occupies a nephrotoxic effect and allergic reactions. A huge variety of modern x-ray contrast agents contain iodine atoms, and the conduct of intravenous urography is contraindicated with allergies to iodine.

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

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Indications for kidney radiography

If a patient has symptoms characteristic of kidney pathology, he may be recommended x-ray of this body.

Kidney X-ray is assigned as contrast, and without it. Diagnostics are needed in the following cases:

deviations from the norm of indicators in the analysis of urine (change in the 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 kidneys, ureters and bladder on ultrasound;
renal colic, diagnosis of urolithiasis, cyst, tumors;
constantly recurrent infectious diseases of the urinary system;
kidney injuries;
quality control of the surrelevant treatment.

Contraindications

X-ray kidney, like most hardware diagnostic techniques, has contraindications:

allergic reaction to a contrast agent (almost all of them contain iodine isotopes);
it took less than 3 days after the study of the busty organs with contrasting substances;
the pathology of the thyroid gland;
severe renal or liver failure;
reception of certain sugar-based drugs (the preliminary consultation of the endocrinologist);
feochromocytoma (adrenal tumor);
aggravation of glomerulonephritis;
existing active bleeding, patient's severe condition.

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

With pronounced obesity and ascite (cluster of fluid in abdominal cavity) The doctor may doubt the feasibility of kidney x-ray, since these factors significantly worsen the picture quality and make it difficult to diagnose. In such cases, computer or magnetic resonance imaging can be recommended.

Review radiography

To perform the procedure, the patient undresses, removes the decorations that can get on the picture (usually it is a navel piercing), and falls on a special table. Men to protect the genital organs from radiation to the inguinal region superimposed a special lead plate. Next, the patient needs to follow the instructions of the doctor.

Panoramic X-ray, obtained by the usual study, gives a general concept of body status. With it, you can see the location of the kidneys, additional kidney, if any, evaluate their contours and sizes, to see large formations, some types of stones. In addition, the spine and the pelvis bones are clearly visible, due to which it is sometimes possible to differentiate the cause of pain in the lumbar region.

Overview X-ray - far from the most informative method of renal research, but it gives general information about the state of the body and helps to draw up a further plan of the patient's survey.

Contrast radiography

Excretory Urography

A contrast substance is introduced to the patient to the Patient in Vienna and, as it propagates, several X-ray renal images and urinary tract perform along the vascular channel.

In this study, the doctor also receives an image of the kidneys using X-ray rays, however, the informativeness of the urography is at times higher than the usual overview radiography. The essence of the method is that the patient is intravenously introduced a contrast agent, which quickly accumulates in the urine. Then there are several pictures at certain intervals (after 5-7, 12-15 and 20-25 minutes after the introduction of the substance).

This study makes it possible to estimate the renal function, to identify violations in the structure of the cup-lowering system, detect stones, tumors, polyps, and not only in the kidneys, but also in ureters and bladder.

Before studying with the use of a contrast drug, an allergic test is necessarily carried out if it turns out to be positive, then the procedure becomes impossible. During the examination, the patient may experience a small nausea, dizziness, heat, possibly a small decrease in blood pressure. Such symptoms are permissible, but must be controlled by a doctor. In the case of a strong deterioration of the patient's condition, the procedure stops.

Infusion urography

This procedure has the same principle as the excretory urography described above, only the contrast drug is introduced intravenously, but drip. This method allows you to get the best quality pictures.

Any urography is necessarily performed under the supervision of a physician who controls the patient's condition and may assist if there is a deterioration.

There are several more options for the introduction of contrast drugs: percutaneously or retrogradi through urethra through a catheter.

Angiography of the kidneys

This is a kind of X-ray study of a vascular kidney system, in which the contrasting substance is introduced into their vessels. Thanks to angiography, it is possible to identify the narrowing of the lumen of the renal vessels, for example, with their atherosclerosis and thrombosis. The procedure is performed under local or general anesthesia.

Preparation for kidney radiography

Regardless of the type of surveys, it is necessary to prepare. The main reason for obtaining a not enough image is the accumulation of gases and cartium masses in the intestines. That's why it is better to prepare for research in 2-3 days.

From the diet should exclude products causing increased gas formation:

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

If the patient has a tendency to constitutions, then a few days before the study, the laxatives are prescribed. In the evening, the day before the dinner procedure should be easy, if possible, it is better to refuse him at all. If there are doubts that the intestine is quite purified, you can make a cleansing enema.

In the morning you must have breakfast, as gases are also formed in an empty intestine. You can eat a plate of porridge welded on the water, a sandwich from a white dried bread with cheese and drinking a walled tea. If necessary, drugs are accepted that reduce gas formation in the intestine, and sorbents.

If a doctor on a review radiograph wants to visualize and bladder (this body usually falls into the research area), he warns the patient that the bladder should be filled. To do this, 2 hours before the start of the survey, it is recommended to drink 1.5-2 liters of non-carbonated water, savory tea or compotes and not urinate.

Of course, when it comes to an emergency study, for example, with kidney colic, it does not matter any prior preparation.

Kidney radiography is an inexpensive accessible type of study, which can be performed in any hospital or clinic, unlike expensive and not everywhere available CT and MRI. In this case, information obtained with its help, in most cases enough to form a diagnosis and the choice of treatment tactics.

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Basic provisions

Ultrasonic contrasting study (uki) is very effective in identifying and characterizing local liver lesions (LPP), as well as for monitoring ablative therapy.

Ultrasonic contrast agents (VHF) are pure intravascular indicators with an excellent security profile that are ideally suited to assess changes in perfusion.

Restrictions include poor penetration and nonlinear distribution of artifacts.

Introduction

It is estimated annually 782,000 patients diagnosed primary liver cancer and 746,000 fatal outcomes from it. The liver is also the second most common place for metastasis, and significantly more patients suffer from metastases in the liver than from the primary cancer.

Ultrasound is the most commonly used liver visualization. It is an inexpensive, portable, non-ionizing method, which has an excellent security profile. Traditional sonography in shades of gray and color doppler still have characteristic limitations. First, the detection of LPL is complicated by the presence of similar echogenicity of the lesion and the surrounding parenchyma of the liver. Secondly, the exact characteristic of the LPP is problematic with various pathological lesions, which have the features of overlay or a non-discrete picture during seroschal. And, thirdly, although color and spectral doppler can be visualized to the basic dynamic characteristics of blood flow, it cannot determine microvascular lesions or high-quality gain.

The appearance of the VHF improved the characteristic of liver neoplasms by comparing the change in the dynamics of the accumulation of the drug by a lesion with a neighboring parenchy liver. In addition, the ability to evaluate the LPL in real time in all the vascular phases gives a temporary resolution, which exceeds most other visualization methods. The uki is a very useful method of differential diagnosis of LPL with an accuracy of 92% to 95%, according to the literature. Its use reduced the frequency of further research or biopsy.

In 2012, the World Federation for Ultrasound in Medicine and Biology (WFUB) and the European Federation of Ultrasound Society in Medicine and Biology (EFSUB), together with the Asian Federation of Ultrasound Society in Medicine and Biology, American Ultrasound Institute in Medicine, Australiazian Ultrasound Society in Medicine And the international society of contrast ultrasound published a number of guidelines in order to standardize the use of uki in diagnostic liver studies.

This review article covers all technical features of the test, VHF in assessing the characteristic liver neoplasms and their use with ablative therapy, restrictions of technology, underwater stones and future prospects.

Part 1: Technical Aspects

Ultrasonic contrasting substances

Physical properties

VHF contains gas bubbles, which are called microbubbles. Most of the VHF, which are used in clinical practice at present, belong to the second generation. The typical second generation of microbubbles has a stable outer sheath of thin (10-200 nm) biocompatible material (for example, phospholipids) and an inner core of hydrophobic gas (for example, perfluorocarbon, sulfur hexafluoride), which has high molecular weight, reduces the solubility and diffusion ability . These properties increase blood resistance to arterial pressure, which prevents the dissolution of microbubbles in the bloodstream.

Microbubbles are approximately 3 to 5 μm in diameter, which is slightly smaller than human red blood cells, but much more than the molecules of contrasting substances for CT and magnetic resonance tomography (MRI). They remain in the blood pool, because they cannot penetrate vascular endotheliums in interstonicia. At the same time, they remain small enough to move into a microcirculatory course of pulmonary capillaries for safe excretion. The Gas component of the VHF is expressed by the lungs after 10-15 minutes, while the shell is either collapsed in the liver or excreted by the kidneys.

Most VHFs gradually excreted from the bloodstain after a fifth minute. The exception is Sonazoid (Daiichi Sankyo, GE Tokyo, Tokyo, Japan), which remains in the liver of a person for several hours. This is explained by the fact that Sonazoid micropulings are phased by chipper cells, after being cleaned of blood pool. Sonazoid is thus compared with superparamagnetic substances based on iron oxide, which are used for MRI liver visualization. This is the only commercially available VHF with an effective post-colored phase.

Interaction of microbubbles with ultrasound

Despite the fact that microbubbles increase the reverse dispersion of ultrasound rays and cause a high-echolar signal, fluctuating microspheres are required for an efficient contrast image.

Natural resonance frequencies of microbubbles (in which they produce maximum oscillations) are between 3 and 5 MHz. This coincides with the frequencies that we use to visualize the abdominal organs. When exposed to a ultrasonic wave with low acoustic pressure, microfubling volumes are expanding and compressed controlled manner and are subjected to stable cavitation. At high acoustic pressure, microbubbles reach an unstable size and are destroyed by exposed to inertial cavitation (Fig. 1).

The oscillating microbubbles produce asymmetric, nonlinear signals. Human fabrics reflect largely linear signals with a minimum amount of low-acoustic pressure nonlinear signals. Harmonics arising from nonlinear signals from oscillating microbubbles are processed by specialized software for contrasting ultrasonography to obtain an image that displays exclusively micropuling echoes.

Fig. one. Oscillations of microbubbles. (A) Stable cavitation at low acoustic pressure. (B) inertial cavitation with high acoustic pressure.

Commercially allowed VHF

Sonovue (SPA, Milan, Italy) consists of sulfur hexafluoride gas, which is contained within the phospholipid shell. This VHF is currently approved for use in Europe, China, Korea, Hong Kong, Singapore, India, New Zealand and Brazil.

Sonazoid consists of perfluorobutan in the phospholipid shell. This VHF is licensed for use in Japan and South Korea.

Definity / Luminity (Lantheus Medical, Billerica, Massachusetts) consists of perfluten in a lipid shell. It is licensed in Canada, Mexico, Israel, New Zealand, India, Australia, Korea, Singapore and the United Arab Emirates.

Optison (GE Healthcare, Princeton, New Jersey) consists of a serum albumin of a person with a perfluten nucleus. Currently tested for visualizing liver.

LEVOVIST (Bayer AG, Schering AG, Berlin, Germany) consists of galactose, palmitic acid and air. This is the first generation of VHF, which was approved for visualizing the liver. This VHF is currently not affordable, although its production resumed Japan.

To date, there are no VHIs that would be approved by the Commission on Food Supervision and US Medications (FDA) to assess the pathology of the abdominal cavity. Optison and Definity were approved by the FDA only to visualize the heart and can be used legally not directly indicated to visualize the abdominal organs.

Phases of amplification

A normal liver has a double blood supply, and approximately one third comes from the hepatic artery and two thirds of the portal vein. The vascular phases when the liver uki are similar to CT and MRI, progressing from arterial to the porto-bearing phase, and end in the late (delayed) phase. Strengthening Figure LPP throughout the vascular phase is crucial for identifying them.

The arterial phase begins with the hitting of VHF into the hepatic artery. Depending on the circulatory status, this, as a rule, occurs from 10 to 20 seconds after the injection of VHF. The portal phase begins when the VHF enters the main portal vein, and this occurs from about 30 to 45 seconds. The arterial and portal phase overlap, because the latter lasts up to 45 seconds. Late phase begins after 120 seconds and lasts before the disappearance of micropulings from the circulatory channel, from about 4 to 6 minutes. Additional post-colored phase is described for the Sonazoid preparation, which starts 10 minutes after the injection and lasts up to an hour or longer (Table 1).

Table 1.

The beginning of the vascular phases and their duration are shown.

Side Effects and Contraindications

VHF has a significantly better security profile compared with contrasting substances for CT or MRI, with a much lower frequency of allergic and anaphylactic reactions. They do not possess nephrotoxicity or hepatotoxicity. The most common side effects include: dizziness, nausea / vomiting, itching (all these effects are usually insignificant and transient). Some patients may have a moderate hypotension, although it is most likely a current answer. The only contraindication for Sonazoid is an allergy to eggs. Other contraindications, in addition to the known hypersensitivity to sulfur hexafluoride (Sonovue) and Perflutenne (Definity), are also: deterioration of stagnant heart failure in patients, acute coronary syndrome, severe pulmonary hypertension, acute respiratory distress syndrome and the presence of heart shunts in patients. Serious non-critical adverse reactions to VHF in patients with cardiac shunts are rare and occur about 0.01% - 0.03% of patients, most of which are anaphylactoid in nature. There is no connection between the use of VHF and an increase in the risk of death among patients.

With the introduction of VHF, resuscitation equipment and trained personnel should be available to eliminate adverse complications, including acute anaphylaxis. After the injection of VHF, patients should be observed at least within 30 minutes before discharge.

VHF is not licensed to use in pediatric patients, although they are widely appointed by direct readings in children. It is reported on single side effects without serious complications or fatal outcomes. There are data on the use of VHF during pregnancy or during breastfeeding.

EQUIPMENT

The image with a low mechanical index (M x) of the ultrasonic system is an approximate expression of acoustic pressure transmitted to the ultrasonic beam. To minimize the destruction of microbubbles and extend their presence in the blood, low images are needed. Low also reduces the number of nonlinear harmonic signals that occur in soft tissues.

Although insufficient acoustic power and gives a weak reverse signal, technological advances make it possible to obtain images of good quality at low mi. This is achieved through the use of a short pulse sequence that are modulated by amplitude, phase, or a combination of both. MI settings are less than or equal to 0.3, as a rule, are recommended for visualization when uki. The optimal parameters of the visualization differ between device manufacturers and may be much lower.

Visualization mode

Images of CAI are considered using the Side-BY-SIDE modes or imposing ultrasound images in a contrast mode. The author uses the type of double screen, which separates the display on the configured contrast mode and the image in B-mode with low mi. The latter image in the contrast mode is superimposed in the B-mode.

The image is important for the anatomical definition of structures. In addition, linear reflections from the biopsy needle or ablative probe (which are used in invasive procedures) cannot be displayed only in contrast mode, which makes parallel visualization necessary for instrumental guidance.

Programs for analyzing and quantifying

Special programs have been developed for the quantitative determination of perfusion parameters and in order to objectively identify the LPL by simultaneously analyzing images when scanning or in advanced evaluation. Most modern software products allow you to get a film of good quality by incorporating motion and / or breathing compensation. Examples of commercially available products include: Sonoliver (Tomtec Imaging Systems, Untershulasheim, Germany), Vuebox (Bracco Suisse SA-Software Applications, Geneva Switzerland) and QLab (Philips, Botella, Washington).

When using such programs, the gain pattern can be quantified as temporary intensity curves, by choosing a field of view within the lesion. This allows you to compare with neighboring parenchy liver and interval monitoring of observation of perfusion changes. When the parametric analysis of images is turned on, the pattern of dynamic amplification of the lesion can be objectively visualized, which increases the accuracy of the diagnosis (Fig. 2).

Fig. 2. Parametric Visualization of the Creek. Dynamic vascular pattern within the lesion is displayed in color and can be compared with the accompanying color scale.

Procedure for research

Introduction of ultrasonic contrasting

Microbubbles must be prepared according to methodical recommendations manufacturer. VHF can be entered as bolus injection or continuous infusion.

Bolus administration

The Bolus Introduction Method provides the rapid distribution of microbubbles in the vascular bed of the liver. Contrast injections should be performed through a shut-off valve and 20 caliber (or more) cannula into the elbow vein, without an additional tube. VHF is given in the form of a bolus followed by a rapid administration of 0.9% of the physiological solution. The dose should be counted in accordance with the management of the manufacturers to ensure the uniform distribution of VHF and avoid artifacts from the excessive number of micropulings. Bible injections can be repeated if it is required as soon as the previously entered micropulings disappeared. This can be achieved by a rapid temporary increase in mi to contribute to the destruction of microbubbles.

Infusion injections

Prior to the infusion of VHF, primarily prepared before diluting with saline in the syringe. The suspension must be carefully shackled in order to provide a permanent form of microbubbles and their uniform distribution. Then the VHF is introduced at a constant speed through the infusomat. As soon as the steady flow of microbubbles (2-3 minutes) is achieved, the dynamic characteristics of the flow can be determined using flash visualization. This is a technique at which a short series with increased acoustic pressure overlaps bubbles in the visualization plane. Microbubbles are then accumulated reused, which allows you to observe the gain characteristics. Repeated series may be required to increase diagnostic accuracy. The need for additional equipment and complex preparation makes this method of administration less preferred.

Visualization

Prior to injection of contrast, visualization should be carried out using conventional seroshkal and doppler ultrasonography to identify targeted lesions and optimal image positioning.

For subsequent visualization in contrast mode, before the contrast injection should be adjusted: dynamic range, image depth, focus depth and local zone size. Stopwatch is used to display the duration of the gain phases. Recording a film during the study allows you to spend a retrospective sortingline review, since the changes in the strengthening can leak quickly in the arterial phase.

In the first 2 minutes of research (arterial and porto-nose phase), the capture of the image should be carried out without a break in the same plane. In the late phase, a frequent intermittent scan is performed until microbubbles disappear. The vascular phase of the study using VHF should last at least 5-6 minutes. When using Sonazoid, the late phase of the study is considered less important and, as a rule, is replaced by the post-colored phase of images, which begins after 10 minutes.

PART 2

Evaluation of ultrasound contrast agents for liver neoplasms

Characteristic LPP

The exact characteristic of liver lesions can be problematic. One visualization method often leads to inconclusive or dubious results, which requires further research using alternative techniques. The characteristic of the LPL is the most common use for the uki. This method contributes to a confident diagnosis when pathognomonic gain characteristics are detected. In Japan, the uki is recognized as a study of the first line for the diagnosis of hepatocellular carcinoma (HCC).

Before the implementation of the study, medical history of the patient and the risk factors of the malignant liver tumor should be installed. Any previous liver studies should be considered, their comparison must also be carried out.

Characteristic benign lesions

Hemangioma

Hemangiomas are the most common benign liver neoplasms. This is the growth of vascular endothelial cells having a mesenchymal origin. As a rule, hemangioma has a peripheral cloud-like gain in the arterial phase. It is filled in fully or partially in the portal phase and shows isolation in relation to the liver parenchyma in the late stage (Fig. 3).

Fig. 3. Uncomfortable solid nodular formation in the liver (blue arrows): (a) Ultrasonography in the mode shows a clearly defined, hypo echogenic nodules in the 8th segment; (B, c) The corresponding MRI images of the same lesion, T2 hyperintensive and T1 hypo intensive. Uki and MRI with contrasting amplification, the estimate of the unspecified nodule: (D-F) the uki shows a picture of the peripheral integrated amplification in the arterial phase, with a gradual centripetal filling in the portal phase. Late phase reflects constant gain; (G-i) MRI with contrasting reinforce shows similar changes in the respective phases. These results for uki and MRI with contrasting amplification are characteristic of hemangioma liver.

The correct diagnosis is achieved up to 95% when typical features are visualized. Filling can be fast with a slight lesion, and the image in real time allows you to identify the lightning filling of the hemangioma, which can be skipped with CT and MRT.

Care should be taken, a small and rapid strengthening of blood flow during hemangiom can be erroneously taken for the highly differentiated ICC, while the impaired thrombic parts of hemangioma can be mistakenly taken for leaching.

Focal nodal hyperplasia

Focal node hyperplasia (fug) is a benign hyperplastic lesion, which develops in response to existing arteriovenous malformations. Characteristic features include: vascular pattern by the type of wheel spokes, feeding the vessel, the presence of the central scar. A confident diagnosis can sometimes be made on the basis of dopplerography. One of the three characteristic features can be determined in 75% of lesions of more than 3 cm; Reducing the size of the lesion reduces the frequency to 30%.

After the injection of VHF, the fugues usually have a picture of a rapid strengthening by the type of "wheel spokes", to centrifugal and homogeneous filling during the arterial phase. Uneven filling of the lesion is determined by 30% fugues. In the portal and late phases, the defeat can remain with hype or become amused. In the case when the central scar is present, it is impaired or with hypoxium (Fig. 4).

Fig. four. Fugue with the central scar. (A-C) Cooks shows the arterial strengthening of the defeat with the central scar. The lesion becomes amused against the liver in the late phase. The scar remains unnecessary. (D, E) The defeat has similar characteristics on the CT with a contrasting amplification, with an unnecessary central scar.

Occasionally, the damage fugues can completely lean, in most cases after 75 seconds. In such cases, an erroneous diagnosis of malignant lesion may be delivered if there are no characteristic features.

Hepatocellular adenoma

Hepatocellular adenoma are rare benign lesions associated with an excessive level of estrogen. They develop mainly in women of childbearing age and are closely related to the oral use of tableted contraceptives and anabolic / androgenic steroids. Their gap or malignant rebirth is possible, therefore surgical treatment is recommended for hepatocellular adenoma size greater than 3 cm. The arterial phase of the study demonstrates peripheral hype, followed by rapid centripetal filling. They become amused in the portal and late phases. Sometimes they show a picture of a small leaching, which can lead to incorrect formulation of the diagnosis of the ICC. Although the typical characteristics of hepatocellular adenoma enhancement are not pathogenomonic, family history and the history of the patient's disease can help to identify it.

Cystic lesions

Simple cysts can often be effectively diagnosed with the usual ultrasound research, where they manifest as thin-walled, clearly defined anechogenic damage with distal acoustic amplification. The debris or hemorrhagic component inside the cyst significantly complicates the differential diagnosis from the solid nodule. The uki is effective for estimating complex cyst due to the lack of intracistal dense gain or enhance the rim of the node, which eliminates the malignant disease (Fig. 5).

Infection / inflammation

Liver abscesses may have signs of arterial gain within their walls and partitions, as a result of which they have a picture of bee honeycombs. If the signs of hypersion are obvious, as a rule, an early washout is recorded for 30 seconds after the contrast injection. Lack of increased liquid sections is the most characteristic feature. Rare inflammatory pseudo-pumps have a variable painting picture at all stages, without significant distinctive features at uki.

Focal fat changes

Focal fatty infiltration (echogenic) and focal fat rebirth (hypoethogenic), as a rule, develop around a round ligament, next to a gallbladder straw and the adjacent liver gate. Atypical localization may make it difficult to make a diagnosis. The differential diagnosis from malignant lesions in patients with high risk is very important. Images of uka reflect focal fat changes as areas with isolation, in comparison with the surrounding parenchable liver in all vascular phases (Fig. 6).

Fig. 6. Focal fatty infiltration. (A) The image in the mode shows a fuzzy hyperheogenic area ahead from the main portal vein (orange arrow). (B, c) The hyperachege region remains in a state of isolation in relation to the liver at the end of the arterial and portal phases when the uki.

Characteristic malignant lesions

Cirrhosis of the liver is a predisposing factor in the development of the ICC, while 90% of the ICC have a stepped progression. Regenerative nodules that are formed during the liver attempt to restore cirrhotic tissue, have a double blood supply similar to a normal liver parenchyma. Progression of dysplasia The nodule leads to the loss of normal blood supply and portal blood supply. With the further development of the ICC, the focus of the lesion is bloodshed from the anomalous unpaired arteries, which leads to clean arterialization of the tumor. This angiogenesis increases in proportion to the progression of the tumor to the low-differentiated HCC (Fig. 7).

Fig. 7. Pathogenesis of the FCC. Changes in blood supply to progressing the lesion from the regenerative nodule to the low-differentiated FCC. RN is a regenerative nodule, DN - dysplastic nodules, WD is well differentiated, PD is poorly differentiated, HCC is a hepatocelular carcinoma. Blue color - Normal blood supply, red - normal portal blood supply, green - abnormal arterial blood supply.

Although the ICC is usually developing against the background of the liver cirrhosis, it can also develop in a normal liver. Some states (such as non-alcoholic fatty pathology), as is known, contribute to carcinogenesis in the liver in the absence of cirrhosis.

Regenerative nodes

A typical regenerative nodule shows isolation in all phases.

Dysplastic nodules

The dysplastic nodule is a cluster of hepatocytes that contain dysplastic characteristics, but do not correspond to histological criteria for the malignant process. With increasing dysplasia, intra-transmodular portal paths disappear and replaced with unpaired arteries depending on the degree of dysplasia. The dysplastic nodule can manifest themselves with hypoxium, isolation or hype in the arterial phase, and goes into a state of isolation or minimal hypowacing during the portorenous and late phases. Displanic nodules high degree (DUS) may have gain characteristics similar to the highly differentiated ICC. Due to the fact that the DUVS is considered precancerous diseases, some centers are more in favor of their resection or ablation than for dynamic observation.

Hepatocellular carcinoma

The CCC has the most variable intensity pattern among all malignant lesions. The classic increase in the GCC is arterial hype, followed by washing in late phase (Fig. 8 and 9).

Fig. eight. A typical sample of strengthening of the ICC with uki. (A) Practically isoehogenic neoplasm on ultrasonogram in in-mode. (C) Novo formation has a homogeneous hypersion in the arterial phase. (C) The neoplasm shows practically isolation in relation to the liver in the portal phase. (D) The neoplasm is characterized by washing and hypoxium with respect to the liver in the late phase.

Fig. nine. Relevant CT and COP images of the ICC (red arrows). (A, b) CT and uki images of new formation with arterial gain in 7-8 segments. (C, D) CT and COP images of the same lesion show leaching in a delayed (late) phase.

Practitioners doctors should know that the ICC may have isolation or even hypoxium during the arterial phase. The GCC, as a rule, has a disexesal, basic picture of blood supply with centripetal filling. Powering artery and S-shaped vessels are sometimes clearly defined within or near the tumor during the arterial phase. Heterogeneous amplification is more characteristic of larger tumors.

The duration of the flushing of the ICC is a variable, although this happens is usually slower compared to other malignant tumors. Extended visualization is necessary before the disappearance of VHF in the vascular phase (5-6 min.) In order not to miss the PCC (Fig. 10).

Fig. 10. The variability of the tumor gain of the ICC (red arrows). (A) The tumor, which is somewhat hypoethogenic on the ultrasonogram in the mode, has isolation in the arterial phase. (B) The tumor shows a certain leaching from only 3-4 minutes, which indicates the need for extended observation, at least 5 minutes.

The more undifferentiated tumor, the faster it is washed away. Sonazoid shows such damage as reinforced defects in the post-colored phase.

Sometimes the PCC has arterial hype without flushing. This can be seen in highly differentiated FCCs, in which there is a significant number of portal paths, and they can be mistaken for benign pathology. The index of alertness in arterial amplification of the lesion, therefore, should remain high, especially in patients against the background of the liver cirrhosis.

Portal thrombosis, which is not rare in cirrhosis, increases the level of amplification in the arterial phase and reduces the strengthening of the liver parenchyma in the portal phase. This can reduce the inconsistency between the very arterialized HCC and the adjacent liver cloth, which makes it difficult to characterize the lesions.

Cholangiocarcinoma

Most cholangiocarcin in the arterial phase have a hype due to non-Englishogenesis. There are four different arterial gain templates: peripheral amplification of the rim, heterogeneous hype, homogeneous hypersion and heterogeneous hypoints. The tumors with a high concentration of cancer cells are exhibiting an increased arterial hype, while the lesions with a proportionate content of fibrous tissue are amplified less. The pattern of peripheral amplification of the rim is more often determined in the liver without concomitant pathology, while heterogeneous hype is more characteristic of patients with liver cirrhosis or chronic hepatitis. Peridectal infiltrating intrahepatic cholangiocarcinoma most often has a heterogeneous amplification, which is due to an increase in the amount of fibrous tissue. Cholangiocarcinoma is washed out in the late phase with uki (Fig. 11), but can be characterized by slowing down the gain with CT with contrast or MRI with contrast. Paving the surface of the liver into the tumor, as a consequence of fibrous proliferation, is a useful radiological feature that should cause suspicion of the presence of cholangiocarcinoma. It is easy to define in the image. Cholangiocarcinoma is also wicked up early in contrast to low-differentiated FCCs or metastases.

Fig. eleven. Uncomfortable liver neoplasm (blue arrows). (A) The CT abdominal cavity without contrast shows a fuzzy heterogeneous neoplasm in the 8 segment. (B) The uki shows the arterial strengthening of heterogeneous neoplasm. (C) The defeat is quickly washed away at the beginning of the portal phase. The lesion biopsy shows the cholangiocarcin.

Metastase

Metastases are usually displayed when uki with arterial hypersion, because the tumor contains more arterial vessels than the surrounding liver parenchyma. The rapid increase in metastases is often characterized by a ring-shaped reinforcement or in the form of halo, which is associated with the presence of peripheral arterial vessels and a necrotic nucleus with a reduced vascular flow (Fig. 12). Metastatic lesions are squinted sooner and remain with hypointation, starting from the end of the arterial or from the beginning of the portal phase. Some metastases are manifested by hypoxium throughout the entire vascular phase, and this is more often occurring during the primary cavaluation cancer and the rectum and bronchogenic cancer.

Fig. 12. Strengthening the rim of liver metastases. (A - C) The liver metastases shows the amplification of the rim in the arterial phase with flushing in the portal and later phases. central partwhich consists of necrotic tissue is incused. (D, E) the corresponding CT with contrasting the same liver metastases in the arterial and portal phases.

Metastases can imitate low-differentiated ICC or cholangiocarcin at uki. The key points that help differentiate metastases include: the history of the patient's disease, the presence of a cirrhosis (increased probability of the ICC) and multiple lesions (increased probability of metastases).

Lymphoma

Primary liver lymphoma is rare enough. Most cases are developing in patients with weakened immunity, especially in a man in their 50 years. There is a small amount of published data on the liver lychestoma enhancement models. As reported, the gain characteristics are typical for malignant lesions with hypersion during the arterial phase and washing up in late phase.

Detection of lesions

The uki helps to increase the sensitivity in the detection of lesions of the liver, as it is capable of identifying small tumors up to 3 mm. Uki Detection of small liver metastases also exceeds a dynamic CT with a properly executed study. Thus, the guiding principles of WFUMB-ESFUB organizations recommend using a diet as an exclusive test for small metastases and abscesses.

Substances with post-colored phase (Sonazoid) are particularly useful for this purpose, given that malignant lesions are usually devoid of chipper cells (Fig. 13).

Fig. 13. Detection of metastases in the liver. Contrast of Sonazoid in the post-colored phase. The liver metastases are better visualized in the form of gain defects.

Up to half of all highly differentiated ICCs have signs of leaching, however, there may be misappropriate lesions (for example, cysts) may be mistaken for increasing defects. Thus, the additional injections of the Sonazoid bolus are shown to re-visualize in the arterial phase of all detected lesions.

Intraoperative contrasting ultrasonography

Intraoperative ultrasonic sonography (IOO-UZ) is used to help the surgeon to make a solution during liver resection by identifying the FPP. Adding VHF (IO uki), as shown, is a more sensitive method than CT with contrasting, MRI with contrasting and io-up to identify and characterize lesions. Io uki can change the volume of surgical intervention from 25% to 30% of cases. This leads to a higher frequency of effective therapeutic procedures, a lower frequency of residual tumor edges and an increase in the frequency of organ-brewing operations. To fulfill the IO-Cake, the use of special high-frequency intraoperative sensors is recommended. The duration of the contrast enhancing is shorter when Io-uki, because microbubbles are destroyed faster, due to the proximity of the sensor to the liver.

Cocks with ablative therapy

The uki improves the possibility of adequate placement of the sensor, more clearly depicting a smaller tumor and increasing the contrast resolution between the peripheral damage zone and the surrounding tissues. Studies have shown that the addition of VHF for ultrasound guidance during interventions leads to an improvement in the results of ablative procedures compared to ultrasonography without contrast. The uki is particularly effective when CT with contrasting, MRI with contrast or standard sonography cannot clearly visualize the lesion zone.

Peripochaled uki showed comparable results compared with CT with contrasting when the residual tumor tissue was detected and determining the success of treatment. Residual lesions, which are determined immediately after ablative treatment, can be immediately eliminated, eliminating the need to repeated anesthesia and increase the time of stay in the hospital. The uki must be performed about 5 minutes after ablation to ensure the gas removal, which is formed during the procedure (Fig. 14).

Fig. fourteen. Cooks with ablative therapy. (A) Pre-bacate uki confirms the presence of the arterial amplification of the ICC (orange triangle). (C) The image of the lesion in in-mode obtained during the radio frequency ablation. Pay attention to the presence of an ablative needle (Orange Star). The presence of gas (the artifacts "ring facing down" with a shadow) makes it difficult to evaluate this lesion immediately after therapy. (C, D) PREDIED \u200b\u200bCOKI shows a smooth, slightly hyperemic rim. This should not be mistaken for the residual tumor. The pre-phase zone is not enhanced in the portal lateral phase.

Pressure monitoring with the help of uki is also useful for detecting local recurrences. The radiologist must keep in mind the preservation of the enhancement of a hypervascularized rim, which is often determined within a month after treatment, and this should not be mistakenly taken for the recurrence of the tumor.

Restrictions

The uki suffers from the same restrictions, as well as standard ultrasonography, so poor scanning quality without contrasting is unlikely to ensure good quality of the image of the image. Subdiaphragmal lesions can be difficult to detect and their characteristics. In addition, the image of deep lesions is problematic, especially in patients who suffer obesity or have severe liver or cirrhosis dystrophy. Practitioners doctors should know that ultrasound waves are weakened by microbubs, and this phenomenon is known as self-definition. This is important because an overly high dose of micropulings limits penetration. In addition, when ultrasonic waves apply through micropusages, they change and contribute to the formation of nonlinear echo signal (nonlinear distribution), which leads to the appearance of artifacts in the far field.

Although the smallest detected lesion when the uki is from 3 to 5 mm, the diagnostic confidence interval increases with the size of the lesion more than 1 cm. This is not unexpected, since the smaller the defeat, the harder it is to evaluate its strengthening pattern.

Underwater rocks

It is important to remember the possible overlap of the templates of amplifying benign and malignant lesions. Bhayana and others report about 97% cancer tumors that determine the washing and this fact has a positive prognostic value of 72%. Although the flushing of contrast is a key element for the differential diagnosis of benign and malignant lesions, about 30% of benign lesions have a sign of flushing, while some HCC do not have it.

The ability to differentiate tumors a significantly more complex process, with a specificity of only 64%. Classic arterial hypersion, followed by washing, is determined not only at the ICC, but also with cholangicarcinoma, lymphoma and metastases.

The CCC is currently the most common malignant tumor, which in most cases is characterized by slowly washed. In doubtful cases, additional conducting CT with contrast or MRI with contrasting is recommended. Biopsy is recommended for histological correlation, if the diagnosis remains doubtful.

Part 3:

Perspectives

Quantitative determination of tumor perfusion

The study of the criteria for the reaction of solid tumors is a modern standard used to assess the response to the treatment of liver cancer. However, they are intended to measure the decrease in tumors after cytostatic therapy, limiting their effectiveness to the reaction assessment to citostatic drugs. As purely intravascular substances, microbubbles are ideal for quantifying perfusion. Dynamic uki is a potential biomarker to assess the response to treatment, especially for anti-angiogenic substances.

3D and 4D studies with microbubbles

3D visualization allows you to carry out a better estimate of the morphology and the volume of the entire tumor, while 4D visualization allows you to evaluate 3D images in real time. Simultaneous use of a multi-section software package (which displays the resulting 3D picture in the form of serial images) allows you to effectively detect small lesions (Fig. 15).

Fig. fifteen. 3D ultrasonography. (A) Formation of a 3D image by imposing multisps in the study of the entire contracting zone. In this case, the volume (dense) recurrent tumor can be estimated better. (B) 3D visualization of fugue shows its central artery and branch branch.

3D Real-time visualization can also improve the definition of the characteristics of the Vascularization of the FPP.

Targeted (targeted) visualization

Microbubbles covered with surface antigens and aimed at specific cell receptors are under development. Their goals include: the growth factor of the endothelium of vessels 2 and AVB3 Integrin. These developments may be valuable in detecting lesions and their differential diagnosis. It can also help facilitate treatment planning by identifying cellular surface mutations that are susceptible or impenetrable for certain treatment modes.

SUMMARY

The uki is a valuable diagnostic tool that is cost-effective, safe and does not have ionizing radiation. Its use in real time and the use of purely intravascular contrasting substances are unique features that other visualization methods are not available. Continuous technological advances and improvement of contrast methods are necessary in order to firmly establish the role of uki when visualizing the liver. For research, we recommend using the device from the company GE.

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

Unlike x-ray method Studies ultrasound can be carried out quite often, and this allows you to track the patient's condition in the dynamics. Thus, the risk of error in the diagnosis and appointment of treatment is excluded.

Ultrasound examination is completely painless, as comfortable as possible for the patient, in 90% of cases does not require preliminary training.

Ultrasound with contrasting

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

Contrast ultrasound is used mainly in:

obstetrics;
angiology;
hepatology;
cardiology;
oncology;
orthopedics;
uronhephrology.

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

Ultrasound during pregnancy

Ultrasound studies are needed both at the planning stage and in the process of pregnancy.

Uzi allows you to identify violations that can interfere with conception and having to wear a child. In the early stages of pregnancy - to eliminate the ectopic pregnancy, the improper fastening of the fertilized egg.

In the course of further diagnosis using ultrasound research, not only the sex of the future child is determined, but they track its development.

Timely detections of pathologies of development, intrauterine diseases, disorders in the urinary and sexual systems of the mother itself make it possible to avoid many risks associated with the pregnancy, childbirth and the health of the future kid.

Modern myths

Many mothers, due to prejudice or too strong pressure of the older generation, be afraid to undergo this procedure, as they believe that it can damage the child. However, perennial studies have shown that ultrasound is absolutely harmless to the fetus.

Gel, which is used when conducting a procedure, does not cause allergic reactions. It is sterile, does not penetrate deep subcutaneous layers and does not cause complications with inflammation of internal organs, including uterus, ovaries and rectakes.

With a transvaginal inspection during pregnancy, the gel does not affect the nature of the formation of the fetus, the number of accumulating waters and other factors. Just as the frequency on which the ultrasound apparatus works, does not affect the formation of a child and in no case harm the formation of internal organs, brain, etc.

Proved - ultrasound is not just safe, but strictly shown in pregnancy.

Contraindications

Ultrasound examination should not be carried out at:

infectious skin diseases;
suppurations on the surface of the epidermis and mucous covers;
rashes unclear etiology;
mental disorders.

You should also postpone the designated study if a patient has an exacerbation with inflammatory processes Kidneys, ureters, liver. At the peak of the disease, even a small nozzle pressure can cause acute pain.

All other contraindications are not associated with health hazard, but with low informativeness for the diagnosis of a particular disorder or need to study only during a certain period. For example, some gynecological or monologic types of surveys are carried out only in the duplicate days of the cycle.

Basic provisions

Ultrasonic contrasting study (uki) is very effective in identifying and characterizing local liver lesions (LPP), as well as for monitoring ablative therapy.

Ultrasonic contrast agents (VHF) are pure intravascular indicators with an excellent security profile that are ideally suited to assess changes in perfusion.

Restrictions include poor penetration and nonlinear distribution of artifacts.

Introduction

Part 1: Technical Aspects

Ultrasonic contrasting substances

Physical properties

Interaction of microbubbles with ultrasound

Despite the fact that microbubbles increase the reverse dispersion of ultrasound rays and cause a high-echolar signal, fluctuating microspheres are required for an efficient contrast image.

Fig. one. Oscillations of microbubbles. (A) Stable cavitation at low acoustic pressure. (B) inertial cavitation with high acoustic pressure.

Commercially allowed VHF

Sonazoid consists of perfluorobutan in the phospholipid shell. This VHF is licensed for use in Japan and South Korea.

Optison (GE Healthcare, Princeton, New Jersey) consists of a serum albumin of a person with a perfluten nucleus. Currently tested for visualizing liver.

Phases of amplification

Table 1.

The beginning of the vascular phases and their duration are shown.

Vascular phase

Arterial phase

Porto-bench phase

Late phase

Postscool / Khosphew Phase

Side Effects and Contraindications

VHF has a significantly better security profile compared with contrasting substances for CT or MRI, with a much lower frequency of allergic and anaphylactic reactions. They do not possess nephrotoxicity or hepatotoxicity. The most common side effects include: dizziness, nausea / vomiting, itching (all these effects are usually insignificant and transient). Some patients may have a moderate hypotension, although it is most likely a current answer. The only contraindication for Sonazoid is an allergy to eggs. Other contraindications, in addition to the known hypersensitivity to sulfur hexafluoride (Sonovue) and Perfludene (definity), are also: deterioration of congestive heart failure in patients, acute coronary syndrome, severe pulmonary hypertension, acute respiratory distress syndrome and the presence of heart shunts in patients. Serious non-critical adverse reactions to VHF in patients with cardiac shunts are rare and occur about 0.01% - 0.03% of patients, most of which are anaphylactoid in nature. There is no connection between the use of VHF and an increase in the risk of death among patients.

EQUIPMENT

Visualization mode

Programs for analyzing and quantifying

Fig. 2. Parametric Visualization of the Creek. Dynamic vascular pattern within the lesion is displayed in color and can be compared with the accompanying color scale.

Procedure for research

Introduction of ultrasonic contrasting

Microbubbles must be prepared according to the manufacturer's guidelines. VHF can be entered as bolus injection or continuous infusion.

Bolus administration

Infusion injections

Visualization

Prior to injection of contrast, visualization should be carried out using conventional seroshkal and doppler ultrasonography to identify targeted lesions and optimal image positioning.

Tips for visualization

The image plane should be preferably parallel to the diaphragm movement so that the lesion focus remains in the field of view throughout the entire study.

Frame rate should be enlarged at least up to 10 Hz to visualize vessels.

The output power (mi) can be gradually increased to visualize contrasting micropulings for lesions at depth.

PART 2

Evaluation of ultrasound contrast agents for liver neoplasms

Characteristic LPP

Imprint nomenclature

The gain points to perfusion, and the lack of amplification denotes avascular status. The intensity of the amplification of the LPL is described in comparison with the intensity of the adjacent tissue.

Hire (significant accumulation of VHF) indicates a relative increase in vascularization.

Hypulation (reducing the accumulation of VHF) indicates a relative decrease in vascularization.

Isoicing indicates a similar vascular status.

No gain indicates full avascular status.

Filling indicates a progressive gain.

Washing indicates a gradual reduction in gain.

Characteristic benign lesions

Hemangioma

Typical gain scheme

Peripheral nodal strengthening in the arterial phase.

Sequential partial or complete centripetal filling.

Isoicing towards the liver in the portal and late phases.

Attention

Hemangiomas with rapid filling with high bloodstream can be mistaken for highly differentiated hepatocellular carcinoma.

Unreasonable thrombic portions of hemangioma can be mistaken for leaching.

Focal nodal hyperplasia

Typical gain scheme

Fast arterial gain by the type of wheel spokes and centrifugal filling.

It remains in a state of hyper- or isolation in the portal and late phases.

Central scar (if present) non-heaven or hypoxium.

Attention

30% of fugues have a picture of uneven filling.

Fug is rarely washed out.

Hepatocellular adenoma

Typical gain scheme

Fast peripheral arterial gain and centripetal filling.

Isoicing in portorenoic and late phases.

Attention

Hepatocellular adenoma can sometimes have a picture of a small washing.

Cystic lesions

Infection / inflammation

Liver abscesses may have signs of arterial gain within their walls and partitions, as a result of which they have a picture of bee honeycombs. If the signs of hypersion are obvious, as a rule, an early washout is recorded for 30 seconds after the contrast injection. The lack of increased fluid plots is the most characteristic feature. Rare inflammatory pseudo-pumps have a variable painting picture at all stages, without significant distinctive features at uki.

Focal fat changes

Characteristic malignant lesions

Regenerative nodes

A typical regenerative nodule shows isolation in all phases.

Dysplastic nodules

The dysplastic nodule is a cluster of hepatocytes that contain dysplastic characteristics, but do not correspond to histological criteria for the malignant process. With increasing dysplasia, intra-transmodular portal paths disappear and replaced with unpaired arteries depending on the degree of dysplasia. The dysplastic nodule can manifest themselves with hypoxium, isolation or hype in the arterial phase, and goes into a state of isolation or minimal hypowacing during the portorenous and late phases. Dysplastic nodules of high degree (DUS) may have gain characteristics similar to the highly differentiated ICC. Due to the fact that the DUVS is considered precancerous diseases, some centers are more in favor of their resection or ablation than for dynamic observation.

Typical gain scheme

Regenerator nodules have isolation in all phases.

Degenerative low-degree degree nodules have iso-or hypoints in the arterial phase and isolation in the portal and late phases.

Dyspastical nodules of high degree may have a hype in the arterial phase and a small flushing in late phase.

Attention

Dysplastic nodules of high degrees may have gain characteristics similar to highly differentiated FCC.

Hepatocellular carcinoma

The CCC has the most variable intensity pattern among all malignant lesions. The classic increase in the GCC is arterial hype, followed by washing in late phase (Fig. 8 and 9).

The more undifferentiated tumor, the faster it is washed away. Sonazoid shows such damage as reinforced defects in the post-colored phase.

Typical gain scheme

The GCC, with a classic picture, has arterial gain and subsequent washing.

The more undifferentiated ICC, the faster the washing occurs.

Attention

The FCC may have iso- or hypoints in the arterial phase.

High-thinned ICCs may not have lean.

Low-differentiated FCCs have faster flushing.

Portal thrombosis can reduce differences between highly arterialized HCC and adjacent liver cloth.

Cholangiocarcinoma

Typical gain scheme

Cholangicocarcinoma has a painting of blood gain and early washing.

Attention

The drawing enhancement imitates the low-differentiated FCC and liver metastasis.

Metastase

Fig. 12. Strengthening the rim of liver metastases. (A - C) The liver metastases shows the amplification of the rim in the arterial phase with flushing in the portal and later phases. The central part, which consists of necrotic tissue, is incused. (D, E) the corresponding CT with contrasting the same liver metastases in the arterial and portal phases.

Typical gain scheme

Metastases have a picture of arterial gain and early washed.

Metastases are intensified as a halo with a hypoxilenent necrotic core.

Attention

Some metastases can have hypoxium throughout the phases.

The amplification pattern imitates the picture of the low-differentiated FCC and the cholangiocarcinoma.

Lymphoma

Detection of lesions

Substances with post-colored phase (Sonazoid) are particularly useful for this purpose, given that malignant lesions are usually devoid of chipper cells (Fig. 13).

Fig. 13. Detection of metastases in the liver. Contrast of Sonazoid in the post-colored phase. The liver metastases are better visualized in the form of gain defects.

Intraoperative contrasting ultrasonography

Cocks with ablative therapy

Restrictions

Underwater rocks

Part 3:

Perspectives

Quantitative determination of tumor perfusion

The study of the criteria for the reaction of solid tumors is a modern standard used to assess the response to the treatment of liver cancer. However, they are intended to measure the decrease in tumors after cytostatic therapy, limiting their effectiveness to the evaluation of the reaction to cytostatic drugs. As purely intravascular substances, microbubbles are ideal for quantifying perfusion. Dynamic uki is a potential biomarker to assess the response to treatment, especially for anti-angiogenic substances.

3D and 4D studies with microbubbles

3D Real-time visualization can also improve the definition of the characteristics of the Vascularization of the FPP.

Targeted (targeted) visualization

SUMMARY

A special role is played by magnetic resonance tomography in the diagnosis of liver diseases. The sensitivity of MRI in identifying focal lesions is not currently inferior to computer tomography. The undoubted advantage of the method is its very high specificity. Even without the introduction of a contrast agent, good diagnostic results are achieved in the detection of abscesses, cysts, hemangiomes and nodal hyperplasia.

The liver is an organ that provide metabolic processes in the body. With her participation, the transformation of one substances into others occurs. Another important function is a barrier, lies in the neutralization of poisonous substances entering the body.

Due to its barrier function, the liver is exposed to large loads, which often leads to various illnesses. Most often diagnosed:

abscesses organ;
cirrotic changes;
neoplasms of a benign and malignant character;
dystrophic changes;
hepatitis viral and not only nature;
fibrosis - replacement of healthy cells connective tissue other.

The direction of the liver scan with MRI usually gives a hepatologist or gastroenterologist. The grounds for the directions for tomography may be symptoms of body pathology: complaints of pain in the field of right hypochondrium, decline in appetite, yellowing of eye proteins, darkening of urine, etc.

The study can also be appointed in the following cases:

with suspected malignant neoplasm in the tissues of the liver or the bodies closest to it;
hepatomegaly (increasing the body in size) was diagnosed, the cause of which the disease became or if the reason is unknown;
to clarify these other diagnostic methods;
there is reason to suspect that stones or salt deposits that prevent the flow of normal processes were formed in the authority;
to clarify the etiology of hepatitis and the consequences of this disease for the organ;
the liver cancer was previously diagnosed and there is a threat of metastatic damage to nearby organs;
evaluation of the effectiveness of the treatment carried out, for example, after chemotherapy or surgical intervention;
assessment of the condition of the liver under cirrhosis and so on.

With the help of MRI not only diagnose diseases, but also control the course of treatment.

Magnetic resonance imaging is a study during which not only the structure of the liver is estimated, but also the bloodstream, biliary paths. A comprehensive assessment allows doctors to most accurately diagnose the disease and draw conclusions about its causes to fully treat.

MRI will show such diseases like:

hemangioma;
These are small benign neoplasmswhich pictures look in the form of hypostensive foci. In contrasting, the contrast substance from the periphery will be washed out, this will allow differentiation with malignant neoplasms.
nodic focal hyperplasia;
The second frequency appearance is a benign liver tumor. The pictures look like a single or multiple form that has a pronounced capsule with clear and smooth circuits.
gemosiderosis;
The disease is associated with excessive accumulation of iron in hepatic fabrics. In the pictures, the body will be hypo intensive, as iron - ferromagnet.
cyrrotic changes;
Cirrhosis is a fatal, non-treatable disease, which using MRI can be revealed in the early stages and thereby significantly extend the life expectancy. Magnetic resonance tomography will show that the proportion of the liver on the right is reduced in comparison with the norm, and the tail fraction and the lateral segment, on the contrary, are increased. In the structure of parenchyma, diffuse hypostensive foci will be visible.

MRI with cirrhosis also makes it possible to estimate the condition of the portal vein, which is also affected by the disease. By pictures, you can judge the presence of stagnation in it, increase pressure.
abscesses;
Abscess on MRI will look like rounded education, echogenicity (intensity of staining in the picture) of which may vary depending on the process stage. The contours are usually fuzzy.
cysts and the friend;
Cysts on MRI liver are visible in the form of formations with clear contours. Echogenicity may also vary depending on the variety of cysts.

MRI with contrast is prescribed to patients who have a neoplasm in the liver, but to accurately establish its nature for some reason cannot be. Using the use of contrast, it is possible to differentiate with accuracy in almost 100% malignant neoplasm from benign.

Another indication for the MRI liver with contrast is the presence of any symptoms of the damage to the organ in combination with the lack of objective data of other previously conducted studies. Since the method has high accuracy, it is possible to identify even very small neoplasms or minor changes in the organ.

Contrasting allows you to establish the most accurate diagnosis, and the effectiveness of treatment depends on it!

MRI liver is a procedure that usually does not require complex preparation. 24 hours before the study from the diet of the patient, gas-forming products are excluded. Immediately before the study within 2-3 hours, food is not recommended at all.

Patient, having come to the office, removes all metal objects and falls on the tomographic table, which is placed inside the apparatus.

In the course of the study, a person does not experience unpleasant sensations, calmly lying in the device for half an hour. In some cases, an attack of claustrophobia can occur, but you can fight it, talking to a doctor with a special microphone mounted in the device.

Sometimes the study is prolonged to 1-1.5 hours if you need more accurate information. It is important for all this time to maintain immobility so that the pictures were high quality.

If the MRI is carried out with contrast, then a contrast agent is introduced before the patient's procedure in Vienna, which is one of the stages of preparing for research.

The main advantage of the MRI liver is that the procedure is completely safe for the human body and highly informative. The study is prescribed not only to children at any age, but also pregnant women, which speaks of high security of magnetic resonance tomography. During the diagnosis, X-rays or other harmful radiation are not available on the patient.

One of the alternative diagnostic methods is a computed tomography. When CT on the patient's body, X-rays affect the body, which is why its use is not always possible in the early stages of the disease so as not to provoke its progression.

CT is also a less informative diagnostic method, despite the fact that it is often conducted with contrast. The most accurate data Computed tomography gives with volumetric lesions of the organ. It is prescribed under the following diseases:

a strong increase in the organ in volume and mass;
massive lesion of liver tissues with cirrotic changes;
neoplasia detected;
there is a constant and long sense of discomfort or pain in the field of liver.

Ultrasound is one of the routine studies that are appointed to all patients with abdominal pathologies. If the data obtained after the doctor's ultrasound is sufficient to form a diagnosis, it will be limited only to this diagnostic study. If there is too little for the diagnosis of information, additionally, CT and MRI may be carried out to estimate the liver condition.

It is impractical to compare the effectiveness of ultrasound and MRI, since MRI is never appointed as a study of the first level, in contrast to the ultrasound.

Ultrasound diagnostics will help the doctor, saving the patient's funds, diagnose simple diseases or, if the patient suffers from claustrophobic, to get at least some data for diagnosis. MRI in turn will refine the diagnosis in doubtful cases, determine the presence of a neoplasm and its nature.

MRI liver is an effective, but still quite expensive examination method appointed by patients in controversial cases when the diagnosis is not entirely clear. The technique has a high permissive ability, which allows it to be used to diagnose oncology in the early stages.

If you suspect the liver dysfunction, computed tomography refers to preferred diagnostic methods. CT liver allows you to get high-quality pictures for which the doctor reveals the type, stage, shape and degree of body damage, will determine the tactics of treatment (surgical or therapeutic), predicts the further course of pathology. The essence of CT is the radiation of the body with X-rays, but the doses of irradiation are safe for the body. CT data is transmitted to the patient 1.5 hours after the procedure in digital or printing form.

Tomography is a radiation hardware and software research of the health of the internal organs.

CT liver is a diagnostic method that allows you to determine the pathology of the liver. The method refers to a productive and informative when identifying early stages. The procedure is carried out by radiation scan to obtain full and detailed liver data data. Computed liver tomography makes it possible to detect the disease in the asymptomatic stage. When diagnosing a neoplasm in the liver using the method, a specification is possible. For example, hemangioma is detected when its value has not yet reached 10 mm.

Liver tomography consists of a procedure for scanning an organ for detecting deviations.

Opportunities of liver tomography:

determination of the state of the hepatic parenchyma;
clear visualization of neoplasms of different types;
setting the causes of an increase in the organ;
clarification of the type of pathology that caused jaundice;
visualization of internal bleeding, degree of danger, blood cluster location when injuring the liver.

The opportunities of the early detection of any liver pathology makes the QT in demand for the diagnosis method that benefits from the other diagnostic procedures. Rauchery scanning allows you to determine even functional deviations in the work of the liver due to the use of a contrast agent. As a result, the doctor can make an accurate diagnosis, determine the treatment regimen or adjust the therapeutic tactics. When recognizing the disease at an early stage, the chances of healing the patient without surgical intervention increases. Thus, the benefits of the procedure are:

Tomography allows you to identify the ailments of the liver in the earliest stages.

accurate diagnosis of diseases of any etiology;
the possibility of simultaneous study of the liver and regional organs;
the possibility of emergency scanning without preparation to obtain rapid results;
the use of less sensitive motion sensors, which allows you to get better pictures;
the ability to create a 3D picture for consideration at different angles in the original and enlarged version;
minimum side effects;
minimal sensitivity to metal implants, insulin pumps, pacemakers in the body of the patient and the lack of influence on their work;
painlessness.

To improve the performance of the method, the use of contrast is recommended. Using an auxiliary substance, the norms in the form, the size, structure, the contours of the organ, the structure of the poles, the state of the fat capsule, intrahepatic vessels and joy canals are determined. Indicators normally according to the results of CT of hepatic tissues are visualized as follows:

structural homogeneity of parenchymal fabric;
large tissue density than the pancreas, kidneys, spleen, gallbladder;
less dense areas in the structure of parenchymal fabric, corresponding to the hepatic vessels;
lack of visualization of hepatic artery and bile ducts inside
detection of a portal vein, a common liver and biliary canal.

The liver disease according to the results of CT is displayed in color saturation and extensions in certain areas of the organ.

Pathology is determined by the following features:

Benign tumors (classic cysts, adenoma, hemangioma) CT shows as blackout with smooth edges with clear boundaries, but a wavy structure. Growth type - slow to small values.
Malignant neoplasms CT shows as darkening with uneven, fuzzy, bugister edges. Type of growth - fast, aggressive to large quantities.
Problems with ducts for blood supply and outflow of bile are visualized by changing the saturation of the color (more often - in strengthening) in separate places, as well as on the disappearance of some channels and visualization of others.

To scan the liver on tomograph, the X-ray bundle is used, which shines the body from all sides. The device fixes the rate of radiation through the hepatic tissues, and then processes using a special software. The computer creates three-dimensional color pictures of the organ with a clear visualization of the pathological site. To form an accurate diagnosis, one of the following types of CTs can be applied:

Tomography is carried out hardware, followed by primary data processing.

CT (spiral tomogram) is a classic technique using rotating rays of X-ray on a helix, which allows you to get one or more pictures for turnover. The speed of rotation is selected by the doctor individually.
MSCT liver is a multispiral technique (upgraded CT) with an increased resolution. Scan speed - 300 pictures / turnover. Often applied in emergency diagnostics.
CT liver with contrasting - machinery is often used to identify problems with vessels and biliary ducts. For this purpose, a contrast agent is used with the main component, - iodine, introduced into the elbow vein to the patient and can accumulate in structures with increased blood supply.
Liver Peckete - single-photon emission equipment that allows you to get layered pairs of parenchymal fabric after intravenous administration RadioInDicator (isotope technetium). The technique allows you to identify the insufficient or excess accumulation of isotopes of the tumor of different character and etiology. Colored layered pictures can be folded in a 3D image.

The procedure is assigned to diagnose the disease or as control after the operation on the gland, after transplantation or excision of the liver part, after chemotherapy or irradiation on the background of cancer in order to detect the changes in the body, tracking its condition. CT liver lobes is recommended for suspected pathologies and conditions:

Tomographic research makes it possible to diagnose cysts, oncology, inflammation, injuries of internal organs.

cystic metastases;
polycystic;
hypertension of the portal vein, disorders of general blood flow in the organ or infarction of the liver;
pathological increase in liver unclear etiology;
all types of cirrhosis;
fatty infiltration;
radiation defeat;
tuberculosis, hepatitis, abscesses;
thrombosis, vest obstruction;
cancer, blastoma;
lymphoma, focal metastases;
hemangioma, echinococcosis, lipoma;
brush injuries.

Like any other normal procedure, computer liver tomography has some limitations and precautions to use, such as:

Pregnancy, especially in the first trimester.
Children up to 16 years old. The procedure is prescribed extremely rare, as radiation may affect an unexpectedly faster organism.
Increased sensitivity to x-ray, contrast, radio and radio.
Heavy pathologies and conditions. We are talking about cardiac, renal dysfunction, diabetes mellitus, myeloma, problems with thyroid.

The classic method of CT special preparatory measures does not require. An exception is a contrast technique. The condition of a successful conduct of the procedure is to failure to eat 6 hours before the start of scanning. To tomography, you need to take all available health entries, and the doctor should be reported on existing pathologies, phobias (for example, fear of closed space), pregnancy, lactation. In order not to make trouble, you should prepare morally to the procedure. With particularly nervous condition of the patient, the doctor prescribes a sedative preparation as a preparation. If there is a disgust for the contrast when oral receptionThe doctor will allow you to dissolve it with juice or tea.

The procedure is carried out in a special room with irradiation protection. In a separate room there is a computer, reading data from tomograph. The patient is placed on a special rolling table in a supine position (on the back). The table is moved inside the device where X-ray devices are mounted. For the highest quality and clear pictures, the patient must lie motionless. Often the patient is fixed with special belts. Sometimes breathing is required for a while. Data obtained with CT is issued to the patient in an hour.

The indicator substance allows you to obtain more accurate snapshots of soft tissues to identify the state of the vessels, lymphatic system, and tumor detection. When applying contrasting before the table, the patient is pushed into the device or gives a drink indicator. Subsequently, the contrast will be disabled naturally after a while after CT. So that it happens faster, it is recommended to drink more liquid - on the second day the body will completely get rid of the indicator.

CT implies the irradiation of the body, but one-time use will not lead to consequences. But despite the minimum doses, frequent procedures are not recommended due to the properties of radiation to accumulation in tissues. Therefore, if necessary, multiple control of the condition of the CT patient is replaced by alternative methods, for example, an ultrasound. Frequent to tons are fraught with oncology.

Unwanted reactions to the use of a contrast agent are possible, although the risk of appearance is minimal. There are always drugs in the diagnostic office. emergency To normalize the patient's condition at an unexpected allergic reaction. To exclude side effects, it is recommended to prepare before the procedure to analyze the blood of creatinine. If the patient has background pathologies, the procedure is carried out in the presence of anesthesiologist, which can help in an emergency.

The quality of the results obtained with a computer-radiation liver study affects recent surveys using a contrast substance based on barium or a special amplifier. This substance may not yet fully remove from the body and when exposed to X-rays will give false results. Prevent the normal course of liver research can metal objects in the form of surgical clamps in the peritoneum.

There are a number of surveys like tomography, the safety of the procedure and the quality of the results.

There are a lot of similar CT methods. All of them are interchangeable, but more often appointed in the complex, especially in difficult cases. Often addicted to the radiation scan, when the accuracy of the other diagnostic techniques is not at the height. Only MRI can be compared for informativeness with CT from Hercarpecific Methods as the same fast and accurate way to diagnose liver pathologies, vessels and biliary ducts. Less frequently CT is replaced by a conventional x-ray or ultrasound, which is lower in terms of one survey. For comprehensive liver surveys and the body, the newest development of nuclear medicine is recommended - PET CT, exploring pathological changes in real time.

The main advantage of tomography before ultrasound is obtaining a clearer and detailed image of the liver. With the help of high patency, X-rays are possible diagnosing the condition of the gland in obese patients, when the fat layer does not give ultrasonic waves to reach destination. But ultrasound also has an advantage over CT - lower cost, which for some patients is preferable.

The fabric liver structures are much densely tissue of other organs, in particular, spleen or pancreas. Therefore, the use of ultrasound in the diagnosis of hepatocytic changes is not so effective. The best alternative is now being tomography (computer and magneto-resonant), the sensitivity of which is 100%, and the diagnostic accuracy of 82.1% and 90.4%, respectively. The choice of a specific type of tomography is carried out individually according to the indications, but mostly adopted a combination of ultrasound, CT and MRI to clarify the diagnosis, especially if the size of focal inflammations or formations is less than 1 cm.

The principle of liver study by CT is based on X-ray influence - electromagnetic waves penetrate the tissues deep into and capture the difference in densities. As a result, about 10-12 sections (snapshots) are made, which are sent to the matrix and read by a computer. In a healthy person, the hepatic cloth is homogeneous and dense, and the location of a smaller density correspond to the localization of large blood vessels. Hepatic and bile ducts are clearly visible on the tomogram, but intrahepatic vessels and arteries are invisible, therefore a contrast agent is introduced to the patient to visualize them.

In addition to comparing tissue density during the CT liver, other diagnostic markers are used. For example, tumors and blood clots at an early stage of education have a density similar to Parenchima, but they also indicate distorted liver contours. And if bile ducts are expanded, then it can be argued by 70%, that the patient has a mechanical jaundice (obstruction bile ducts). A study was conducted, the purpose of which was compared to the diagnostic capabilities of CT and MRI:

Interest values \u200b\u200bare the maximum diagnostic accuracy of the method in the study of certain pathologies. Pathological formations are located in the table ascending the density coefficient relative to each other.

The contrast agent allows you to distinguish conventional cysts from cystic metastases, which accumulate contrast around the edges.

The results have shown that the diagnosis is more effective for identifying MRI neoplasms, but CT has its advantages over magnetic resonance:

the best visualization of the walls of vessels and ducts, due to which the probability of discomfort and obstruction;
the ease of determining pathology at an early stage of development;
the speed of the procedure (only a few minutes compared to 60-120 minutes necessary for MRI);
visualization gives a three-dimensional image of the liver;
when studying the abdominal cavity of CT more informative;
the gall bubble is worse than the MRI study;
available cost.

It is the speed of the procedure and a smaller cost regarding MRI led to the wide use of a computer tomograph. In addition, it can be examined by patients who are contraindicated with magnetic resonance. These are people suffering from claustrophobia and overweight (more than 110 kg), as well as patients who have metal prostheses and implants in their body.

People over 50 years old having tattoos, even with testimony to MRI, CT is made, since before the coloring substances for the tattoo contained iron. A strong magnetic effect causes an attraction of FE particles, causing colossal pain in the patient.

When diagnosing neoplasms in the liver is very important a complex approachSince sometimes even the sharing of MRI and CT does not make it possible to distinguish a benign tumor from malignant. In this case, biopsy is shown. Most often doctors first assign ultrasound as the first stage of diagnostics, and then CT. This is due to the fact that with the same echogenicity of the tumor with the parenchyma, it can only be visible on CT and vice versa.

So, the identification of neoplasms in the liver is better to take MRI, if possible, and the establishment of other abdominal diseases should be trusted by CT, which has features:

Contraindications to CT are due to a high dose of irradiation, although it is still less than with a conventional x-ray. Effective radiation load for one procedure is a dose of radiation that a person receives from background radiation for 3-5 years. Ideally, computer tomography liver, as well as other organs, is allowed 1 time per year. If the alleged benefit from the procedure exceeds the possible risk, it is appointed three times a year, but with breaks at least 5 weeks.

The probability of occurrence of serious allergies to iodine, which is used as a contrast agent, is small. And the individual intolerance of iodine is a very rare phenomenon associated with any violations of the endocrine system and the thyroid gland.

Contrast is administered with caution to patients with renal failure and diabetes mellitus, as the body may not withstand the load.

Although the CT is carried out quickly, it is necessary to prepare for the procedure in advance:

For 5 days you need to pass general analyzes And do ultrasound.
For 2 days, it is necessary to abandon the use of drift, legumes, milk and other products causing enhanced gas formation, since the inflated intestine presses on neighboring organs, causing a distortion of scanning results.
In the evening, the on the eve should be abandoned from a dense dinner, as well as doctors recommend to make an enema for cleaning the body (volume up to 1 l).
The procedure needs to arrive on an empty stomach and take with you comfortable clothes (pajamas or bathrobe without numerous jewelry and fasteners).
If the patient feels nervousness, the doctor gives him sedatives, because it is necessary to relax as much as possible and motionlessly lie during scanning.
In some cases, the limbs of the patient can be fixed.

During the procedure, the patient puts the pure simple clothing and removes all the decorations. It falls on a special table that moves inside the ring equipped with X-ray sensors. When the patient is injected with contrast, it can feel a metal taste in the mouth, dizziness and nausea. At the same time there will be a feeling of the flow of warm waves throughout the body. If this symptom is enhanced, you must inform the doctor. The duration of the procedure may vary from the functionality of the instrument used - from 1-2 to 10 minutes. At the end of the CT, the patient needs to drink a lot of fluid to bring contrast from the body to faster.

People suffering from diabetes and accepting metformin, it is necessary to abandon the use of drug 2 days after the procedure, since the contrast delays the removal of the toxic substances contained in the medication.

The first results can be found immediately after the procedure, for example, to distinguish diffuse diseases of the abdominal organs and hepatic veins thrombosis from tumors, cysts and abscesses. A more accurate diagnosis becomes clear after a detailed study of the obtained images and comparison them with the results of other analyzes.

Magnetic resonance imaging is an informative, safe, painless modern diagnostic method, with which you can find various violations and diseases of the organs in the earliest stages. MRI liver allows you to explore the structural and functional state of the organ, to identify the localization of inflammatory foci and put an accurate diagnosis.

The basis of magnetic resonance imaging is the impact on the surveyed section of the magnetic field and the preparation of response electromagnetic radiation from hydrogen atoms present in the cells of the body (in the water composition).

Diagnostics is carried out by a special device - a tomograph that creates magnetic radiation and radio wave. The device scans the test area, wave oscillations are transmitted to the computer, are converted to the image. After the scanning is completed, the doctor can explore the obtained images on which all parts of the studied area are displayed in various projections, as well as layers in a section (with a step of step 1 cm, and if necessary, detecting tumors and metastases - 0.5 cm).

MRI allows you to evaluate the structure of the liver tissues and the state of biliary ducts

What shows

Magnetic tomography provides detailed information on the state of the liver tissue, detects pathological foci, their character, location, extensity. The procedure is carried out for the formulation and clarification of the pre-delivered diagnosis, in the presence of contraindications to other types of diagnostic research.

What shows MRI liver, you can learn in detail from a diagnostic doctor. Scanning allows the specialist to study in detail and identify structural changes in the liver tissues, internal and external biliary ducts, detect a neoplasm.

If a malignant tumor is revealed, MRI helps to estimate the size of the neoplasm, detect metastases in the tissues of nearby organs.

Diagnostics MRI method allows you to detect:

congenital or acquired structural anomalies of the body;
the presence of stones and salt formations;
dystrophic, purulent, malignant processes in tissues (development of cirrhosis, fat hepatosis, hepatocerebral dystrophy, hepatic abscess);
sewing and localization of tissue damage during injury;
the narrowing of biliary ducts.

MRI shows:

with frequent pains in the liver when the reason cannot be determined;
jaundice of unexplained origin;
circulatory impairment in the body;
blocking of biliary tract;
suspicion of the formation of salt sediments and stones;
suspicion of the development of noncommunicable hepatitis, cirrhosis, fatty dystrophy, abscess;
presumptive development in the liver and nearby malignant education bodies;
hepatomegaly (increasing body size).

Also, MRI allows you to determine the suitability of the body to transplantation, assess the effectiveness of the therapy after the transplantation of the body or under cancer.

MRI makes it possible to choose the optimal therapeutic tactics

Procedure

MRI liver can be carried out with contrast or without the use of contrasting substances. Preparation for the examination in each case is slightly different.

To prepare for MRI without contrast, it is necessary:

in the case of a procedure for a child or patient with increased anxiety to pre-visit anesthesiologist for sedative sedatives;
in 3 days before the survey, refuse to consume products causing bloating, increased gas formation;
during the day to the examination, start taking enterosorbents (activated carbon), and, if necessary, preparations from meteorism appointed by the doctor;
in the evening, on the eve of the study to conduct a cleansing enema;
for 5-7 hours before the procedure, refrain from meals and fluid;
before the examination, with a strong excitement, adopt sedative, with constant chronic pain - analgesic;
on the day of scanning does not use cosmetics.

On the eve of the survey, the reception of sorbents is required

Preparations for MRI liver using contrast substances In addition to the listed recommendations, implies:

Ultrasound or test for pregnancy;
samples for determining the portability of a contrast agent;
laboratory tests of blood and urine to eliminate renal failure.

With excessive anxiety, patient before the procedure is prescribed sedatives. With pronounced mental disorders and surveys of young children, they can resort to total anesthesia.

Immediately before carrying out any kind of MRI, the patient must remove all metal items (jewelry, hairpins, clock, piercing), leave the bank cards, phones and other electronic devices outside the office.

The tomograph chamber is equipped with light and ventilation system, a negotiation device for a double-sided communication of the doctor and a patient, an alarming button for calling a doctor (if the patient's well-being is sharply deteriorated during the survey).

Tomography Procedure Standard:

the patient is placed on the table of the device in a horizontal position, to immobilize its limb fixed with special belts;
the table is moved to the tomograph tunnel;
a specialist conducts scanning, during which the surveyed does not feel discomfort and pain, easily withstands the laid time;
after the survey is completed, the table automatically extends from the tunnel.

The procedure lasts from 30 minutes to 1.5 hours. To decrypt snapshots and processing results, the doctor takes 40-60 minutes. If you need to consult other specialists, the conclusion of the patient can get the next day.

In order for the results to be reliable, the patient must remain fixed during the procedure. At the slightest movement, the picture is distorted, the diagnosis can show deviation from the norm.

Before making a conclusion, the doctor must decipher the pictures received.

To identify the neoplasm, the narrowing of bile ducts and estimates of the state of the vessels are carried out by MRI liver with a contrast - an intravenous contrast agent is introduced shortly before the study. Quite often for contrasting the modern preparation is used, good and fast distributing in liver cells.

MRI with a profitsist allows to detect the neoplasm in the early stages of development, to distinguish a malignant tumor from cyst and other benign hearth, evaluate the degree of damage to metastases, distinguish the maternal neoplasm from secondary metastasis.

Absolute contraindications to the conduct of MRI are:

the presence in the body of metal structures (implants, prostheses, pacemakers, insulin pumps, defibrillators, vascular clips, artificial joints, shell fragments, bullets);
the presence of an artificial valve in the heart;
tattoos on the body, made using ferromagnetic particles;
overweight, obesity;
pregnancy (first trimester, in the second and third procedure are carried out with extreme necessity).

Most of the tomographs are designed for weight up to 130 kg, and only in some clinics installed devices that allow you to examine patients with weight up to 250 kg.

Relative contraindications include mental disorders, including claustrophobia, i.e., fear of a closed space and hyperkinosis (inability to control the movements of his own body).

Patients with claustrophobic diagnostics are carried out only in open-type tomographs

MRI with contrast contraindicated:

with renal failure;
in the case of allergies on a contrast agent;
patients in hemodialysis;
during pregnancy and breastfeeding.

It is impossible to conduct an MRI patient in serious condition, with acute respiratory or heart failure.

To the advantages of the method can be attributed to:

high informativeness;
safety (based on the study is the effect of magnetic radiation, there is no harmful radiation impact);
minimum number of contraindications;
painlessness.

Along with MRI, common diagnostic methods are ultrasound research and computed tomography. It is not entirely correct to compare, since research has different goals and objectives.

MRI is the most informative, but expensive procedure, which is more often held to confirm the results of ultrasound or CT

Ultrasound examination is a screening procedure, as a rule, is assigned to the initial stages of diagnosis. And MRI is done to confirm or clarify the results of the ultrasound. What is better - MRI or ultrasound, in each case the doctor should solve. The main advantage of the study of ultrasound is absolute security, the possibility of holding pregnant women and children. However, ultrasound does not recognize the initial stages of the oncological process, and the results of the study directly depend on the qualifications and professionalism of the doctor.

To the question of which method is more informative - MRI or CT, it is impossible to unambiguously answer. Computer tomography with contrast is also informative enough. However, with CT on the patient, there is a radiation impact that, in the development of oncology, it is extremely undesirable and can contribute to the aggravation of pathological processes. Nevertheless, if it is impossible to carry out MRI computed tomography becomes an alternative.

The most accurate results of CT gives with a volumetric damage to the organ - a significant increase, massive cirrhosis, an extensive neoplasm.

Ultrasound kidneys with contrast. Application of echocontrase drugs in the clinic

What is X-ray?

Kidney X-ray: testimony for survey

X-ray (urography) kidneys: types of research

Contrasting urography

What will show kidney radiography?

Kidney x-ray

How is the procedure?

Decoding results

How to prepare for kidney x-ray

Contraindications for kidney radiography

Possible side effects of X-ray with contrast

Main indications

Information about research species

Procedure for holding

Basic contraindications

Complications after the urography with a contrast agent

Indications for kidney radiography

Contraindications

Review radiography

Contrast radiography

Excretory Urography

Infusion urography

Angiography of the kidneys

Preparation for kidney radiography

Ultrasound with contrasting

Ultrasound during pregnancy

Modern myths

Contraindications

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