RU2202954C1 - Method for diagnosing urinary bladder neoplasms - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves performing ultrasonic examination and urinary bladder tomography images analysis. The ultrasonic gage is moved in the same direction and at the same speed during 10-12 s in performing examination. The tomographic images are superimposed to build spatial echograms subjected to analysis by means of 3D VIEW computer program with transparent image display mode being used. Hyperechogenic areas being detected and their spread being determined on the wall surface, neoplasm and tumor lesion degree of mucous membrane are predicted. EFFECT: enhanced accuracy of prognosis. 2 dwg

Description

 The invention relates to medicine, namely to oncourology, and may find application in the treatment of tumors of the bladder.

 Tumors of the bladder (MP) take a leading place among diseases of the genitourinary system. Most often they are found in elderly men and, as a rule, are represented by transitional cell carcinoma. The first sign of an MP tumor is hematuria, which is not always detected by patients. In this regard, most of them go to the doctor with an already common tumor process.

 Treatment of MP tumors includes the use of surgical, chemotherapeutic, immunological methods in various combinations. The choice of treatment tactics depends on the type of tumor and the extent of its spread. The fundamental difference in this case are surface and invasive tumors.

 Surface are characterized by the spread within the submucosal layer of the MP wall. Such tumors develop inside the cavity of the MP, most often they are connected to the wall with a thin leg, but they can also line the mucous membrane over a large extent.

 Invasive tumors extend deep into the wall with the infiltration of muscle layers and underlying tissues.

 With a localized tumor, transurethral resection is used. However, with an increase in the area and depth of the tumor lesion, its resection becomes difficult and such effects as chemotherapeutic, radiation or cystectomy are used. In this regard, when choosing a treatment method, a reliable determination of the degree of local spread of the tumor is necessary.

 For the diagnosis of MP tumors, radiation and endoscopic methods are used. Endoscopic, namely cystoscopy, plays a leading role in detecting a tumor. Inspection of the inner surface of the bladder through an endoscope reveals a tumor in the mucous membrane of the MP, but does not make it possible to detect the depth of its invasion. In contrast to cystoscopy, non-invasive radiation methods (ultrasound (ultrasound), X-ray computed tomography (CT), magnetic resonance imaging (MRI), radioisotope methods) make it possible to obtain tomographic images of the MP and thereby evaluate the depth of damage to its wall.

 The most accessible and widely used method for the diagnosis of neoplasms is ultrasound, which provides visualization of the cavity and walls of the MP.

 A known method for the diagnosis of MP tumors described in the work [Mitkov Century Century Century. Clinical guide to ultrasound. - M .: "Vidar", 1996, v. 1, p. 494]. It lies in the fact that an ultrasound scan of the pelvis in the horizontal and sagittal planes is performed and, when bulges are detected along the inner contour of the MP, a neoplasm is diagnosed. This method allows you to identify tumors that are close to a rounded shape and significantly protruding into the cavity of the MP. However, flat, creeping along the surface of the wall of the bladder tumors, not giving a significant thickening, are difficult to recognize because of the complex differential diagnosis with a number of non-tumor diseases. For the same reason, it is difficult to determine the extent of the tumor lesion of the MP wall. Ego indicates the lack of accuracy of the described method for choosing a treatment method.

 A known method for determining the spread of the tumor MP [Owen R.H., Dunnick N.R., Sandler C.M., Newhouse J.H., Amis E.S. Textbook of uroradiology. -3d edn. Philadelpliia: Lippincott Williams & Wilkins, 2001, p. 347], including ultrasound. If a tumor is detected, the residual volume of urine is additionally determined. Since tumor damage to the MP wall is accompanied by a decrease in its contractility, measuring the residual amount of urine after emptying the bladder makes it possible to judge the extent of the tumor. This method, in comparison with the above, is more accurate, since it allows to draw a conclusion about the degree of damage to the bladder wall by increasing the residual volume of urine. However, this conclusion is presumably about the degree of spread of the tumor process, as it is based on the definition of an indirect sign.

 Closest to the proposed is a method for the diagnosis of neoplasms of the MP [A.F. Tsyb, G.N. Grishin, G.V. Nestayko. Ultrasound examination of the bladder. - In the book: Ultrasound tomography and targeted biopsy in the diagnosis of pelvic tumors. - M .: Kabur, 1994, p. 39], taken as a prototype. It consists of a polypositional ultrasound scan. When scanning the MP, the ultrasonic sensor is moved along the MP, while receiving a series of tomographic images. Their analysis allows you to get an idea of the nature of the surface of the MP wall and by the presence of thickenings of its contour in the resulting images when comparing them to judge the shape and extent of the tumor. This method is taken by us as a prototype.

 This method provides more complete information about the type of tumor, the nature of growth and its degree of spread compared to the above. However, the analysis of the wall surface based on the mental comparison of a series of images of its contour cannot be considered objective. Diagnosis of a tumor is based solely on the detection of thickening of the MP wall.

 As for the type of tumor growth, its assessment largely depends on the image of the base of the volumetric formation, which must be displayed on the contour of the tomogram. However, the orientation of the obtained tomograms is limited, and the image of the base of the tumor may not be obtained by the prototype method in all cases.

 The disadvantages of the method also include the low reproducibility of the obtained tomographic images due to the arbitrary direction of the beam by the researcher during unsystematic scanning of MP. All this indicates the lack of accuracy of the prototype method.

 The technical result of the present invention is to improve the accuracy of diagnosis of neoplasms of the MP due to changes in research conditions.

 This result is achieved by the fact that during the study of MP, the ultrasonic sensor is moved in the same direction at the same speed for 10-12 seconds, tomographic images are summarized to obtain volumetric echograms that are analyzed by 3D VIEW using the transparent image mode and when hyperechoic areas are detected on the surface the walls diagnose a neoplasm, and by their extent they judge the degree of spread of the tumor lesion of the mucosa.

 In clinical practice, three-dimensional reconstruction of ultrasound images is currently used to study various organs. In this case, only a few works are devoted to the investigation of magnetic fields and concern the measurement of its volume, since it is known that three-dimensional images provide a more accurate determination of the volumes of the structures under study. However, for MP, such a study was not practical [Nelson T.R., Downey D.B., Pretorius D. H., Fenster A. Three-dimensional ultrasound. Philadelphia: Lippincott Williams & Wilkins, 1999, p. 304]. Other works on the study of MP are unknown to us.

 As for the diagnosis of MP tumors by the ultrasound method using three-dimensional images, this is our first suggestion. At the same time, a technique for scanning the MP was developed, a program was selected, and an image mode was found for analyzing the resulting echograms, which allows, as shown by us, to obtain objective signs of tumor lesion of the MP.

 Scanning during the study with the ultrasound probe moving in one direction creates the conditions for obtaining a volumetric image of the magnetic field as a result of summing the initial tomographic images obtained by scanning. The same speed of the sensor during scanning provides real proportions of the magnetic field in the resulting three-dimensional image. 10-12 s of scanning for obtaining the source images, as shown by us, provides after reconstruction the most informative three-dimensional images of MP.

 Summing the tomographic images creates a three-dimensional image of the surface of the MP wall, which makes it possible to objectively evaluate it. In addition, a three-dimensional image allows you to get inaccessible with traditional ultrasound imaging planes, which provide additional research accuracy.

 Analysis in the selected 3D VIEW program (Kretzlechnik company) allows you to view volume echograms from any angle by rotating the image, which provides an objective assessment of the entire surface of the MP, as well as determining the shape and spatial location of the neoplasm in the MP cavity. The image transparency mode used by us provides a higher echogenicity of the signal from the tumor tissue compared with unchanged tissues of the MP wall. This allows you to more reliably identify tumors, including flat ones, invisible with traditional ultrasound, and by the length of the hyperechoic region corresponding to pathological changes, it allows us to judge the prevalence of the tumor process.

 The essence of the method is illustrated by examples.

 EXAMPLE 1. B. T., 59 years old, and / b 968, was sent for consultation at TsNIRRI with suspected tumor of MP.

 From the anamnesis for 3 years was observed by a urologist in a clinic at the place of work about prostate adenoma. A follow-up examination in September 2001 revealed erythrocyturia. Ultrasound: MP is deformed by an enlarged prostate gland protruding along the posterior contour, the walls of the bladder are smooth, not thickened. Conclusion: benign prostatic hyperplasia, pathological changes in MP were not detected. Cytological examination of urine sediment revealed single atypical cells. The patient was sent to TsNIRRI for further examination.

 09/26/2001, the patient was examined by a urologist TsNIRRI, no complaints. An ultrasound scan was scheduled for the same day. In preparation for the study, the patient drank 2 liters of water. Ultrasound was performed on a Sonoace 8800 apparatus (Medison, Seoul), created on the basis of the Intel Pentium 230 processor, with external access using a convex multi-frequency ultrasonic sensor. Used the frequency of 3.5 MHz. Determined the position and size of the MP. Then the sensor was installed in parallel and 5 cm to the left of the white line of the abdomen, above the pubis, at the left side wall of the MP. The MP was scanned with the sensor moving uniformly to its right wall for 10 s. The resulting tomograms were converted into a three-dimensional image. Saved it in the form of a file. The file was placed in the 3D VIEW 3.4 program (Kretzteclinik) installed in the ultrasound machine. Enabled transparency mode. As a result of image analysis, it was found that the MP walls are not thickened, a portion of the uneven surface in the back-left segment of the MP, characterized by a hyperechoic signal with a size of 25x11 mm. Conclusion: a neoplasm from the posterior left segment of the MP wall without signs of invasive growth (Fig. 1).

 September 27, 01, the patient was hospitalized in the urological department of TsNIRRI. A cystoscopy performed for him showed the presence of a neoplasm from the posterior left wall of the MP, which was resected. Histological examination: transitional cell carcinoma.

 EXAMPLE 2

 B-th M., 62 years old, and / b 1341, was admitted to the Central Research Institute of Radiotherapy, 05.11.2001, with a diagnosis of Bladder cancer.

 From the anamnesis: about a year ago I first noticed an admixture of blood in the urine. Since the next day the urine was a straw-yellow color, he did not go to the doctors. In the summer of 2001, there were several more episodes of staining of urine from light pink to brown, pain appeared at the end of urination. An examination in September 2001 revealed a neoplasm of the bladder and performed its transurethral resection. The result of histological examination is an invasive transitional cell carcinoma. The patient was sent to TsNIRRI for specialized treatment.

 Upon receipt of a complaint of pain and burning in the lower abdomen at the end and some time after urination, a constant admixture of blood with clots after the operation. Urinalysis - macrohematuria. With CT: there are two neoplasms in the bladder, on the back wall 20x14 mm and on the left wall 33x19 mm without extravesical spread.

 November 12, 2001 performed an ultrasound as in example 1. When ultrasound: MP contains 250 ml of anechogenic fluid. In the lower left segment of the MP, the wall is thickened with the formation of exophytic hyperechoic formation of 30x22x12 mm on a wide base, behind which an increase in the echogenicity of the signal along the surface of the MP wall is determined on average 10 cm wide and length to the neck of the MP. Behind the neck, increased echogenicity is determined by an exophytic-endophytic formation of 10x15x15 mm, at the base of which an increase in the echogenicity of the wall surface with an area of 20x25 mm is determined. Conclusion: Neoplasm of the MP with damage to the lower left and rear segments of the wall and spread to the neck of the MP with invasion of the muscle layer (Fig. 2).

 Performed cystoscopy confirmed the diffuse nature of the surface lesion involving the mucous membrane of the MP neck. A biopsy from several sections of the altered wall revealed cells of transitional cell carcinoma.

 To date, the proposed method has been studied 125 patients with neoplasms of MP, in 118 of which it was possible to reliably determine the degree of local spread of the tumor process.

 The proposed method in comparison with the known allows more accurately detect tumor lesion of the MP and determine the degree of its spread, because it is based on obtaining objective signs of tumor lesion of the MP using volumetric images and the mode found for their analysis.

Claims (1)

 A method for the diagnosis of bladder neoplasms, including ultrasound examination and analysis of tomographic images, characterized in that when examining the ultrasonic sensor is moved in the same direction at the same speed for 10-12 seconds, the tomographic images are summarized to obtain volumetric echograms that are analyzed in 3D VIEW using a transparent image mode, and when detecting hyperechoic areas and their extent on the wall surface, a neoplasm and a step are diagnosed Hb spread of tumor lesions of the mucous.

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