RU2744825C1 - Method for determining the time of arterial phase for echo contrasting of liver, kidney and spleen - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention can be used to determine the flow time of the arterial phase of echo contrast in an organ selected from the liver, kidneys or spleen. To do this, find the distance between the vascular portals of the organ under study and the first point of appearance of echo contrast in the peripheral regions of the liver, kidney or spleen. Then the time is calculated for the passage of the echo contrast of the given distance by dividing the length of the segment from the point of the first fixation of the echo contrast in the parenchyma of the organ to the point of the vascular gates of the organ by the average velocity of arterial blood flow of the corresponding organ. This time is subtracted from the total duration of the echo contrasting process from the beginning of the introduction of echo contrast to the moment the echo contrast appears in the zones of the organs under study, namely the liver, kidney or spleen.

EFFECT: invention provides time reduction for assessing the progression of the course of diffuse diseases of liver, kidneys and spleen.

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Description

The invention relates to medicine and can be used in radiation diagnostics and the clinic of internal diseases.

There is such a diagnostic method as contrast - enhanced ultrasound examination (CUUSI), the main advantages of which are the possibility of high-quality visualization of the vessels of the organ, the affected area not detected in the gray-scale mode, as well as the possibility of analyzing the microcirculation of the organ and detailing the process of neoangiogenesis. One of the indications for this method is organ developmental abnormalities, trauma, post-traumatic changes, focal and diffuse changes in the organ parenchyma, trauma.

For most organs, contrast - enhanced ultrasound examination is carried out in the form of determining the duration of the arterial and venous phases of contrasting parenchymal organs, in particular the liver, kidneys and spleen (Ultrasound examination using contrast agents / A.N. Sencha, M.S. Morgunov, Yu. Y. Patrunov, E. I. Penyaeva, A. V. Kashmanova, E. A. Sencha. - M .: Vidar - M, 2015; Contrast sonography / Hans - Peter Weskott - 1st edition - Bremen: UIN - MED, 2014). The disadvantage of this method is that the time of the onset of the arterial phase is not precisely determined from the moment the contrast medium enters the organ through the vascular gate, but is ascertained from the moment of visualization of the vascular echo signal in the peripheral zones of the liver and spleen, as well as in the parenchymal layer of the kidneys, which is associated with anatomical -physiological features of the hemodynamics of these organs. When conducting ultrasound in the B-mode in the projection of the vascular gate of a certain organ, the artery is distinctly, not visualized before the introduction of the echo about the contrast agent. Therefore, when the echocontrast enters the artery, it is impossible to establish its exact temporary fixation of the passage through the vascular doors of the organ during ultrasound examination. The peripheral zones of the liver, spleen and the parenchymal layer of the kidneys are abundantly supplied with blood from small arteries, which gives improved visualization of contrasting arteries during ultrasound examination. It is this imaging time that is noted by the operator as a fact of the onset of the arterial phase, when in fact the time of the onset of the arterial phase should be recorded precisely from the moment the echocontrast enters the vascular gate of the organ. (Atlas of human anatomy / R.D.Sinelnikov - Moscow: Medicine, 1966 in 4 volumes)

The technical result of the proposed invention is to determine the flow time of the arterial phase of echocontrast in an organ selected from the liver, kidneys or spleen when using a contrast-enhanced ultrasound (CUUS) examination of these organs, which simplifies the differential diagnosis of diffuse diseases of these organs.

The essence of the method lies in the fact that the exact beginning of the arterial phase of echo contrasting of the liver 1, kidneys 2 or spleen 3 is determined by finding the distance between the vascular gates of the organ 1-2-3 and the first point of appearance of the echo contrast in the peripheral parts of the organ 7-8-9, s the subsequent calculation of the time of passage of the echo contrast of a given distance by dividing the length of the segment 14-15-16 of the corresponding organ 1-2-3 by the average velocity of arterial blood flow in the examined organ 1-2-3 and subtracting this time from the total duration of the process of echo contrast from the beginning of the introduction of echo contrast until the appearance of echo contrast in zones 7-8-9.

The method is carried out as follows: during ultrasound examination in B-mode, the organ of interest is found, namely, the vascular gate, focusing on the presence of a vein (Fig. 1). FIG. 1: for the liver 1 - this is the portal vein 4, for the kidney 2 - the hepatic vein 5, for the spleen 3 - the splenic vein 6. When a stable ultrasound picture of the examined organ is obtained (1, 2, 3), they switch to the contrast mode - enhanced ultrasound examination organs (KUUZI) (1, 2, 3). For QUUZI, a contrast agent "SonoVue" (Bracco) is used, which is a lyophilized powder of sulfur hexafluoride, 2.5 mg of which is dissolved in 5 ml of solvent, in the form of 0.9% sodium chloride solution. A freshly prepared echocontrast solution is injected intravenously, jet, through the peripheral (ulnar) vein, using a 2-port peripheral venous catheter G19 (catheter diameter 0.19 mm) for the introduction, then, through the same 2-port peripheral venous catheter G19 intravenously ( ulnar vein) 10 ml of 0.9% sodium chloride solution is injected to enhance the effect of bolus administration of a contrast agent. A technical feature of ultrasound examination is the use of one sensor for contrast - enhanced ultrasound examination, which denies the possibility of simultaneously examining several organs (1, 2, 3).

When contrast is manifested in the arteries of the peripheral sections of the organ under study, the most stable zone is selected, which the operator sees initially (Fig. 2). FIG. 2: zone with the presence of echo contrast 7 in the peripheral part of the liver 1, a zone with the presence of echo contrast 8 in the arcuate and interlobular arteries in the parenchymal layer of the kidney 2, similar to zone 9 in the spleen 3. The entire sequence of this process is recorded in the memory of the ultrasound device in the form of a video loops with a simultaneous countdown of the stopwatch from the moment of the introduction of the echo contrast to the patient until the end of the study. The process of echocontrasting of the venous phase is continued according to the proposed method described in the books "Ultrasound examination with the use of contrast agents" by the authors of A.N. Sencha, M.S. Morgunov, Yu.Yu. Patrunov, E.I. Penyaeva, A.V. Kashmanova, E.A. Sencha, as well as Contrast Sonography by Hans - Peter Weskott. At the end of the study, the catheter is removed (Ultrasound examination using contrast agents / A.N. Sencha, M.S.Morgunov, Yu.Yu. Patrunov, E.I. Penyaeva, A.V. Kashmanova, E.A. Sencha. - M .: Vidar - M, 2015; Contrast sonography / Hans - Peter Weskott - 1st edition - Bremen: UIN - MED, 2014).

After the end of the manipulation, the analysis of video loops is carried out, on the basis of which the quantitative parameters of the QUUZI are estimated, in particular, on the stopwatch 10, the exact time of the appearance of echo contrast in the segmental zones of the liver 1, kidney 2 or spleen 3 is noted. Depending on the organs under study, the time obtained will be different. The next step is to measure the distance from the point of the first fixation of the echocontrast in the parenchyma of the organ to the point of the vascular gates of the organ, which is the zone of intersection of the border of the organ by the corresponding vein, with the device marker (Fig. 3). FIG. 3: in the liver - this is the distance from point 7 to point 11, in the kidney - from point 8 to point 12, in the spleen - from point 9 to point 13. The exact localization of points 11-12-13 is visualization of vein intersection 4-5-6 organ boundaries 1-2-3. Certain distances are obtained, different in length, measured in centimeters (cm), for each organ and the process of echo contrast: for the liver 1 is a distance of 14, for a kidney 2 - a distance of 75, for a spleen 3 - a distance of 16. Also, for each organ 1 -2-3 there is an exact value of the average velocity of arterial blood flow: in the hepatic artery - 92 cm / s, in the renal artery - 89 cm / s, in the splenic artery - 83 cm / s (Ultrasound examination in tables and diagrams / S.V. Kapustin, S.I. Pimanov, O.M. Zherko, A.N. Chukanov. - 7th ed. - M .: Smart Doctor, 2019. - 166 p.)

Knowing the length of the segment (see) 14-15-16 and the average velocity of arterial blood flow in each organ (cm / sec) 1-2-3 calculate the time (sec.) Of passage of echo contrast, passively moving, together with arterial blood through the organ, by dividing the length of the segment 14-15-16 of the corresponding organ 1-2-3 by the average velocity of arterial blood flow in the examined organ 1-2-3. The time indicator may vary depending on the organ being examined. After that, the transit time of the echo of the contrast agent, passively moving with the arterial blood through the organ, is subtracted from the total time of the stopwatch 10, recorded at the time of the appearance of the echo contrast in zone 7-8-9. This time is the exact time of fixing the beginning of the arterial phase of echocontrast of the organ of interest to us.

On the clinical base of the Problem Research Laboratory "Diagnostic Research and Minimally Invasive Technologies" of the SSMU (OGBUZ KB No. 1), 37 contrast - enhanced ultrasound studies were examined using this technique: 17 - contrast - enhanced ultrasound of the liver, 14 - contrast - enhanced ultrasound kidneys, 6 - contrast - enhanced ultrasound examination of the spleen.

Clinical example 1. Patient S., 59 years old

He was admitted to the infectious diseases department No. 1 of the OGBUZ "Clinical Hospital No. 1" on January 18, 2019 with a diagnosis of Chronic viral hepatitis C, an exacerbation stage.

History - intravenous drug use. An increase in blood pressure, diabetes mellitus in the anamnesis is not noted. During the examination, weakness, an increase in the abdomen in size, yellowing of the skin and sclera were observed.

According to the biochemical blood test: total protein - 65 g / l, total bilirubin - 18.2 μmol / l, direct bilirubin - 3.4 μmol / l, ALT - 315 U / l, ACT-250 U / l, ALP- 320 U / l, GGT - 98 U / l.

According to ultrasound of the abdominal organs: ascites in large quantities, the liver is enlarged, diffuse changes in the liver parenchyma by the type of cirrhotic transformation, expansion of v. portae and v. lienalis.

EGD: Varicose veins of the esophagus I st.

Liver transient elastography (TE): F4 degree of fibrotic changes, elasticity 13.1 kPa.

Shear wave elastography (2D-SWE) - F4 (10.8 kPa; 1.9 m / s).

A contrast was carried out - an enhanced ultrasound examination of the liver with an assessment of the onset of the arterial phase according to the proposed method: the time of the onset of the arterial phase is 8, 42 seconds, which confirms cirrhosis of the liver in a patient with hepatomegaly. This technique is confirmed by clinical and anamnestic data.

Clinical example 2. Patient A., 65 years old

She was hospitalized in the chronic hemodialysis department of the OGBUZ "Clinical Hospital No. 1" on January 18, 2020 with complaints of pain in the lumbar region, lack of urine in the last 24 hours, headaches, severe fatigue.

History - arterial hypertension, type II diabetes mellitus.

General urine analysis: glomerular filtration rate (GFR) - 28 ml / min, specific gravity - 1004.

Complete blood count: erythrocyte sedimentation rate (ESR) - 53 mm / h;

Biochemical blood test: creatinine - 487 mmol / l; urea 8.8 mmol / l.

According to ultrasound of the abdominal cavity and kidneys: diffuse changes in the parenchyma of the liver and pancreas.

Shear wave elastography (2D-SWE) - F4 (11.8 kPa; 1.6 m / s).

Was diagnosed with Chronic kidney disease, stage 4.

A contrast was carried out - an enhanced ultrasound examination of the kidney with an assessment of the onset of the arterial phase according to the proposed method: the time of the onset of the arterial phase is 6, 51 seconds, which confirms the presence of atherosclerotic nephrosclerosis in the patient. This technique is confirmed by clinical and anamnestic data.

Clinical example 3. Patient P., 69 years old

Hospitalized in the gastroenterology department of the OGBUZ "Clinical Hospital No. 1" on December 28, 2019 with complaints of aching pain and heaviness in the right hypochondrium, dry mouth, recurrent nausea, severe general weakness.

History - long-term alcohol abuse, periodically takes hepatoprotectors on his own for 1-2 weeks.

General analysis of urine and blood: no pathological changes

Biochemical blood test: total protein - 69 g / l, total bilirubin - 35 kmol / l, direct bilirubin - 5.9 μmol / l, ALT - 87 U / l, ACT - 150 U / l, alkaline phosphatase - 375 U / l , GGT - U / l.

Blood test for viral hepatitis B and C: negative

According to ultrasound of the abdominal organs: hepatosplenomegaly, diffuse changes in the parenchyma of the liver and pancreas, enlargement of v. portae and v. lienalis.

Spleen shear wave elastography (2D-SWE) - F4 (9.69 kPa).

Was diagnosed with splenomegaly syndrome against the background of chronic alcoholic hepatitis.

A contrast was carried out - an enhanced ultrasound examination of the spleen with an assessment of the onset of the arterial phase according to the proposed method: the time of the onset of the arterial phase is 7.75 seconds, which confirms the presence of splenomegaly syndrome in a patient with alcoholic fatty liver disease, developing cirrhosis of the liver. This technique is confirmed by clinical and anamnestic data.

Knowing the approximate data on the duration of the arterial phase during contrast - enhanced ultrasound examination for the organs under study (10-20 sec.), It can be concluded that the proposed method for determining the time of the onset of the arterial phase during echocontrast is more accurate, since it allows to determine the presence of diffuse pathology of organs on microcirculatory level. (Ultrasound examination using contrast agents / A.N. Sencha, M.S. Morgunov, Yu.Yu. Patrunov, E.I. Penyaeva, A.V. Kashmanova, E.A. Sencha. - M .: Vidar- M, 2015).

The introduction of this method made it possible to objectify the onset of the arterial phase in contrast-enhanced ultrasound examination, which in turn greatly simplifies the detection of diffuse organ pathology, and also reduces the number of false-positive and false-negative values.

Thus, the proposed method for determining the flow time of the arterial phase of echocontrast when performing contrast-enhanced ultrasound examination of the liver, kidney and spleen makes it possible to diagnose diffuse changes in the organs under study that correspond to clinical and anamnestic data. The advantage of this method is the elimination of invasiveness, a reduction in the time for assessing the arterial phase of contrast-enhanced ultrasound, as well as the possibility of dynamic monitoring of the course of the disease.

Claims (1)

A method for determining the flow time of the arterial phase of echocontrast in an organ selected from the liver, kidneys or spleen, which consists in determining the beginning of the arterial phase of echocontrast in an organ selected from the liver, kidneys or spleen by finding the distance between the vascular gates of an organ selected from the liver , kidneys and spleen, and the first point of appearance of echo contrast in the peripheral areas of the liver, kidney or spleen organ, followed by calculating the time of passage of the echo contrast of this distance by dividing the length of the segment from the point of the first fixation of echo contrast in the parenchyma of the organ to the point of the vascular gates of the organ selected from the liver, kidney or spleen, on the average velocity of arterial blood flow of the corresponding organ, namely the liver, kidney or spleen, and subtracting this time from the total duration of the echo contrasting process from the beginning of the introduction of echo contrast until the appearance of echo contrast in the zones of the studied organs, namely the liver nor kidney or spleen.

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