RU2712104C1 - Method for ultrasonic examination with contrast enhancement of pelvic venous anastomosis - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to ultrasonic diagnostics, and can be used for ultrasound examination with contrast enhancement of pelvic venous anastomosis. That is ensured by ultrasonic angiography of the anastomosis in B-mode, and in the color Doppler mapping (DCM) mode, activating a special mode of the high-contrast contrast resolution "Resolution", the microbubbles tracing mode MTI, mechanicalIndex (MI) mechanical index low mode, the ultrasonic scanning sensor is installed in the zone of interest, the ultrasonic scanner is adjusted until a clear image is obtained, in the cubital vein of the hand, by a venous tee – a valve for infusion therapy, is introduced 2.4 ml of ultrasound contrast medium “Sonovue”, bolus is introduced with 10 ml of 0.9 % physiological solution, without changing the position of the sensor, recording the time of onset, duration of contrast enhancement, as well as intensity in the venous anastomosis, recording the visualization cine loop up to 1.5 minutes; the data are stored in the apparatus.EFFECT: invention provides accurate diagnosis of the functioning of the anastomosis by creating new evaluation criteria and improved visualization thereof – ultrasonic examination with contrast administration of the preparation.1 cl, 4 dwg, 2 ex

Description

The invention relates to medicine, namely to ultrasound diagnostics, and can be used in vascular surgery to diagnose the functioning of a venous anastomosis in women after surgical treatment for pelvic varicose veins caused by aorto-mesenteric compression, using ultrasound with a contrast injection of the drug.

The prior art method of ultrasound with contrast enhancement is a study of the veins of the lower extremities with the introduction of a contrast medium [1]. Contrast administration provides a statistically significant improvement in the degree of visualization of veins, increases the sensitivity of detection of deep vein thrombosis, especially the veins of the leg, allows you to describe the maximum distance at which you can see the vein, view its filling. The disadvantage of this method is its low accuracy. With the existence of anatomical features: a feature of the course of the vessel is its passage not in a "typical place"; a feature of the structure of the vein is its doubling; difficulty in determining the differences between arteries and veins are factors that, when examined, make it difficult to evaluate a vessel. In addition, during the study, re-introduction of a contrast medium is required, which is disadvantageously reflected in the economic indicators of the described method.

Closest to the claimed invention are studies using radiation methods. The method of radionuclide phlebography (radiophlebography) allows to obtain data on the nature and direction of blood flow through deep, superficial and perforating veins. The disadvantage of this method is that the method is inaccessible in routine clinical practice.

Computed tomography (spiral CT, CT venography) can help diagnose occlusal-stenotic lesions of the large pelvic veins, retroperitoneal space and chest. The disadvantage of this method is that it requires additional contrasting and does not provide information on the hemodynamics of veins. [2].

The method of radiopaque phlebography allows you to visualize deep and superficial veins and obtain comprehensive information about the morphological changes of the venous system, evaluate anastomoses and shunts. The disadvantage of this method is that the indication for its use today is only planning for surgery in patients with occlusion, or aplasia, veins.

A common drawback of all radiation methods is the use of iodine-containing drugs, the presence of radiation exposure, and the need for hospitalization of the patient, which is not economically feasible.

The purpose of the invention is the creation of an informative method for diagnosing the functioning of a venous anastomosis in women, after surgical treatment for varicose pelvic disease, applicable on an outpatient basis.

The invention consists in a combination of essential features sufficient to achieve the desired technical result, which consists in increasing the accuracy of diagnostics of the functioning of the anastomosis by creating new evaluation criteria and improving its visualization - ultrasound with a contrast injection of the drug.

The essence of the method of ultrasound with contrast enhancement of the venous anastomosis of the pelvis includes injection of contrast. Ultrasound angioscanning of the anastomosis is performed in B-mode and in color Doppler mapping (CDC) mode. Activate the high-resolution contrast-harmonic mode “Resolution”, the microbubble tracing mode (MTI), the low value of the mechanical index MechanicalIndex (MI). The ultrasonic scanning sensor is installed in the zone of interest, the ultrasound scanner is set up to obtain a clear image. 2.4 ml of Sonovue echocontrast are injected into the cubital vein of the arm, along the venous tee - a valve for infusion therapy, 10 ml of 0.9% saline are bolus injected. Without changing the position of the sensor, the start time, duration of contrast, and also its intensity in the venous anastomosis are recorded. Recording cinematic visualization is carried out up to 1.5 minutes, the data is stored in the device.

Ultrasound scanning in B-mode, and in CDK mode - is carried out for preliminary visualization of the anastomosis, evaluating it in these modes.

Activate the high-resolution contrast-harmonic mode “Resolution”, the microbubble tracing mode (MTI), and the MechanicalIndex (MI) mechanical index low value mode to maintain the integrity of the microbubbles of the contrast medium for the time required for the diagnostic procedure.

The ultrasound scan sensor is installed in the zone of interest for fixing the necessary indicators, because Two scanning modes are displayed on the device’s screen: B-mode is displayed on one part of the screen, and a mode for visualizing the stream with contrast amplification is displayed in the other part of the screen.

The introduction of 2.4 ml of Sonovue echocontrast into the cubital vein of the arm, using a venous tee-tap for infusion therapy, allows this vein to be filled with microbubbles filled with high molecular weight inert gas sulfur hexofluoride, and the subsequent bolus injection of 10 ml of 0.9% saline reduces loss (destruction) of microbubbles during administration. The dosage of 2.4 ml is recommended by the manufacturer, as it is sufficient for research. In recommended doses, the drug improves image quality and the duration of clinically significant signal amplification for image acquisition. This drug is hypoallergic, does not require hospitalization, can be used on an outpatient basis, which is economically significant.

Fixing the start time and the duration of the contrast in the venous anastomosis without changing the position of the sensor allows you to get a high-quality image.

The recording of the loop of visualization is carried out up to 1.5 minutes - this amount of time from the moment of administration of the contrast preparation is optimal for clearly filling the lumen of the vessels with micro bubbles. Contrasting of the studied vessels is evaluated visually. If the venous anastomosis is passable, it intensely contrasts (hypercontrasts) throughout, starting from 30-40 seconds. In ultrasound with contrast enhancement, in contrast to ultrasound in B-mode, and studies with CDC, due to the fact that the contrasting drug does not extend beyond the vessel walls, the veins under study are completely filled with the drug, the anastomosis is stained, which proves its functioning.

Storing data in the device allows you to measure the diameters of the vessels.

Thus, in the claimed method for conducting ultrasound with contrast enhancement, a completely new approach is implemented in assessing the functioning of the venous anastomosis, not previously known from the prior art. The specified technical result is achieved by the fact that in the method of ultrasound with contrast enhancement of the venous anastomosis of the pelvis, ultrasound is performed with the intravenous administration of a contrast medium, using the MTI microbubble tracing mode, the MechanicalIndex (MI) index of low mechanical index, and setting the focus over the anastomosis. Assessing the filling of the venous anastomosis of the pelvis with contrast and, optionally, recording a cineloop of the image of the anastomosis, allows retrospectively measuring the diameter of the functioning anastomosis.

Implementation of the proposed method for conducting ultrasound with contrast enhancement allows you to diagnose the functioning of the venous anastomosis, excluding the use of radiation diagnostic methods, which facilitates the choice of further tactics of the patient. The possibility of multiple use of ultrasound with contrast enhancement, as well as the use of the method on an outpatient basis, makes it possible to use this study in a wide network of various clinics, as well as in outpatient facilities that monitor and rehabilitate patients with pelvic varicose veins.

The method is illustrated by the attached illustrations, where:

In FIG. 1 and FIG. 2 - shows the results of the study one year after the operation of patient K. (clinical example 1): in FIG. 1 - in the B-mode, an apovaric-iliac anastomosis is visualized, diameter 0.56 cm; in FIG. 2 - with contrast enhancement, a functioning ovarian-iliac anastomosis (indicated by arrows) is clearly visible, diameter 0.6 cm;

In FIG. 3 and FIG. 4 - the results of the study one year after the operation of patient X. (clinical example 2): in FIG. 1 in the CDC mode, an ovarian-iliac anastomosis is visualized, diameter - 0.53 cm; in FIG. 4 - with contrast enhancement, a functioning ovarian-iliac anastomosis (indicated by arrows) is visible, diameter - 0.56 cm.

The method is as follows.

Ultrasound angioscanning of the anastomosis is performed in B-mode and in color Doppler mapping (CDC) mode. Activate - a special high-resolution contrast-harmonic mode “Resolution”, a MTI microbubble tracing mode, a MechanicalIndex (MI) mechanical index low value mode that allows you to maintain the integrity of the contrast medium microbubbles for the time required for the diagnostic procedure, up to a maximum of 3 minutes. An ultrasound scan sensor is installed in the zone of interest.

Two scanning modes are displayed on the instrument screen: B-mode is displayed on one part of the screen, and a mode for visualizing the stream with contrast amplification is displayed on the other part of the screen.

After setting up an ultrasound scanner, and obtaining a clear image, 2.4 ml of a contrast drug is injected into the cubital vein of the arm, along the venous tee - a crane for infusion therapy. The echo contrast of BraccoSonovue (“Sonovue”) company is used, having “Decision on state registration of a medicinal product No. 20-2-404006 / R / RLP-U dated 05.08.2013, the Ministry of Health of the Russian Federation”.

"Sonovue" consists of micro bubbles filled with a high molecular weight inert gas, sulfur hexofluoride. Following, bolus, inject 10 ml of 0.9% saline solution, which reduces the loss (destruction) of microbubbles during administration.

After the start of visualization of the signal with contrast, without changing the position of the sensor, the start time, the duration of contrasting, as well as the intensity, i.e. the degree of contrast in the venous anastomosis. Recording cinematic visualization is carried out up to 1.5 minutes. This amount of time from the moment the contrast agent is administered is optimal for clearly filling the vascular lumen with micro bubbles. After the end of the ultrasound examination, the obtained data is stored in the apparatus, work with them is continued, measuring the diameters of the vessels.

The contrast of the studied vessels is evaluated visually. If the venous anastomosis is passable, it intensely contrasts (hypercontrasts) throughout, starting from 30-40 seconds. In ultrasound with contrast enhancement, in contrast to ultrasound in B-mode, and studies with CDC, due to the fact that the contrasting drug does not extend beyond the vessel walls, the veins under study are completely filled with the drug, the anastomosis is stained, which proves its functioning.

The achievement of the technical result, and its applicability, is confirmed by clinical examples.

Clinical example No. 1.

Patient K., 31 years old, was admitted with a diagnosis of varicose vein disease of the pelvis, chronic pelvic pain syndrome. During the ultrasound examination, a narrowing of the lumen of the left renal vein was revealed to 0.17 cm, distal, with an expansion of 1.0 cm, the left ovarian vein was expanded to 0.85 cm. Further, during multispiral computed tomoangiography, stenosis of the left renal was verified veins, and expansion of the left ovarian vein. When performing angiography, the renocaval gradient was 7 mm Hg. - significant stenosis of the left renal vein. Intraoperative pressure measurement confirmed stenosis of the left renal vein. An ovarian-iliac anastomosis application was performed. The choice of this method of surgical treatment allowed to restore impaired hemodynamics in the veins of the small pelvis and led to an improvement in the quality of life of the patient.

The patient, 1 year after the operation, was performed ultrasound with contrast enhancement of the venous anastomosis. In the study of the anastomosis, ultrasound angioscanning was performed in the B-mode, and in the CDC mode, the anastomosis was located, its diameter was 0.56 cm (Fig. 1). We activated a special high-resolution contrast-harmonic mode “Resolution”, a mode for tracing microbubbles MTI, and a low value mode for the mechanical index MechanicalIndex (MI). The sensor was installed in the zone of interest, the ultrasound scanner was set up to obtain a clear image. Then, 2.4 ml of Sonovue echo-contrast were injected into the cubital vein of the arm, along the venous tee - a valve for infusion therapy, bolus was injected 10 ml of 0.9% saline solution without changing the position of the sensor, and the start time was recorded. The cinema loop visualization was carried out for 1.5 minutes, the data was stored in the device. In retrospect: the anastomosis began to contrast (hypercontrast) from 30 seconds, throughout its length was 0.6 cm (Fig. 2). The use of a contrast medium made it possible to obtain a clearer visualization of the work and the true diameter of the anastomosis, which is usually only possible with phlebography. Conclusion: venous ovarian-iliac anastomosis is functioning.

Clinical example No. 2.

Patient X., 33 years old, was admitted with a diagnosis of varicose vein disease of the pelvis, chronic pelvic pain syndrome. Ultrasound examination revealed aorto-mesenteric tweezers: the lumen of the left renal vein up to 0.2 cm, distal to 0.85 cm, the left ovarian vein expanded to 0.8 cm. When conducting multispiral computed tomoangiography - stenosis of the left renal vein and expansion left ovarian vein. When measuring pressure angiographically, and intraoperatively, significant stenosis of the left renal vein was confirmed. An ovarian-iliac anastomosis application was performed, which led to an improvement in the quality of life.

1 year after surgery, the patient underwent ultrasound with a contrast enhancement of the venous anastomosis. In the study of the anastomosis, ultrasound angioscanning was performed in the B-mode and in the CDC mode, the anastomosis was located, its diameter was up to 0.53 cm (Fig. 3). We activated the special resolution resolution contrasting harmonic mode “Resolution”, the MTI microbubble tracing mode, the Mechanical Index (MI) low index mode, the sensor was placed in the zone of interest, and the ultrasound scanner was set up to get a clear image. Then, 2.4 ml of Sonovue echo-contrast were injected into the cubital vein of the arm, along the venous tee - a valve for infusion therapy, bolus was injected 10 ml of 0.9% saline solution without changing the position of the sensor, and the start time was recorded. Cinema loops were recorded up to 1.5 minutes, data was stored in the unit. In retrospect: the anastomosis began to contrast (hypercontrast) from 40 seconds, over its entire length, its diameter was 0.56 cm (Fig. 4). The use of a contrast medium allowed us to visualize the true diameter of the anastomosis, and its functionality. Conclusion: venous ovarian-iliac anastomosis is functioning.

Sources of information

1. Smith AGW, Parker P., Byass O., Chiu K. .. Contrast sonovenography - Is this the answer to complex deep vein thrombosis imaging? Ultrasound 2016, Vol. 24 (1) 17-22 DOI: 10.1177 / 1742271X15625432].

2. Russian clinical guidelines for the diagnosis and treatment of chronic venous diseases. Phlebology. 2018, No. 3.

Claims (1)

An ultrasound method with contrast enhancement of the venous anastomosis of the pelvis, including injection of contrast, characterized in that they conduct ultrasound angioscanning of the anastomosis in B-mode, and in the color Doppler mapping (CDC) mode, a special high-resolution contrast-harmonic mode “Resolution” is activated, mode trace of microbubbles MTI, the mode of low value of the mechanical index MechanicalIndex (MI), the ultrasonic scanning sensor is installed in the zone of interest, produce adjusting the ultrasound scanner until a clear image is obtained, 2.4 ml of Sonovue echo contrast is injected into the cubital vein of the arm, along the venous tee - a valve for infusion therapy, 10 ml of 0.9% saline are bolus injected without changing the position of the sensor, the time is fixed the beginning, the duration of contrast, as well as the intensity in the venous anastomosis, the recording of the visualization cineloop is carried out up to 1.5 minutes, the data is stored in the device.

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