Features of abdominal ultrasound with contrast: indications and advantages of the method. This is dangerous? Contrast ultrasound examination of liver neoplasms Side effects of the procedure with contrast

Ultrasound examination is performed daily for a large number of patients with pathologies of the digestive, cardiovascular, endocrine, urinary and reproductive systems. At the same time, diagnostic technology does not stand still.

The quality of sensors and the analyzing system is constantly improving, the Doppler effect is used to visualize blood vessels. New devices are also capable of creating three-dimensional models of organs under study. In recent years, more and more patients are offered ultrasound with the introduction of a contrast agent. But what is the difference between this technique? What significant benefits does it have?

What it is?

The first experiments using ultrasound contrast began in the 1960s. The researchers were inspired by the active use of barium preparations in X-ray diagnostics, which significantly increased its information content.

For a long time, these experiments did not go beyond the laboratories, and only in the early 1990s, the first Ehovist contrast appeared on the market, which significantly enhanced the echographic picture of the uterus in women.

Fundamentally, this type of diagnosis does not differ from conventional ultrasound. However, to enhance clarity, a special substance is introduced between the various layers of the patient's tissues, which contains microscopic gas bubbles.

This significantly changes the echogenicity of the vessels and tissues of individual organs. Therefore, the signals that the sensor picks up are quite different from the normal mode. For its processing, special equipment with software is required.

Today, two groups of medicines are used as a contrast in Russia: based on galactose (Ehovist-200, Levovist) and sulfur hexafluoride (Sonovue). They are available in the form of vials that contain powder. Separately, the kit comes with a syringe or a bottle with a solvent (saline solution).

Features of the procedure

The study is carried out in a conventional ultrasound room (in a clinic or hospital). At the appointed time, the patient arrives, takes off his outer clothing and lies down on the couch.

The procedure begins with ultrasound diagnostics in the usual mode. It is carried out to collect preliminary information about the state of organs. If necessary, the diagnostics are supplemented by a Doppler mode to check the blood supply and blood vessels.

After the end of the standard ultrasound, the doctor or nurse prepares the preparation for contrast (according to the instructions). After preparing the solution, it must be shaken to evenly distribute the microbubbles. Then it is necessary to place an intravenous catheter in the region of the cubital fossa. Depending on the drug, there are two types of drug administration:

1. Rapid single injection of contrast. In this case, it is diluted in 5-10 ml of saline and rapidly injected through the catheter in a few seconds. This ensures good distribution in the vessels of the liver.
2. Slow introduction with the help of an infusion pump. A special device is used, which at a constant speed (it can be adjusted) injects contrast into the vein. After 2-3 minutes, the required concentration of the drug in the blood is reached, and a diagnostic examination can begin.

When conducting a study, it is necessary to take into account the fact that the contrast disintegrates quite quickly in the body (depending on its type - from 5 to 15 minutes).

Contrast-enhanced ultrasound is most informative for the abdominal organs. His used to diagnose pathologies:

• liver;
• spleen;
• pancreas;
• gallbladder and bile ducts;
• lymph nodes of the peritoneum;
• stomach;
• small or large intestine;
• abdominal aorta and its branches;
• hepatic portal vein system.

What makes it possible to diagnose?

Carrying out this diagnostic method improves the information content of ultrasound examination. Different formations (tumors, cysts, inflamed tissues) accumulate contrast in different ways, which facilitates their differentiation.

Another method of ultrasound diagnostics, which allows you to more accurately recognize many diseases -

What symptoms are prescribed?

Ultrasound examination of the abdominal organs with contrast prescribed when a patient develops the following symptoms:

• pain in various areas of the abdomen (in the upper half, under the right rib, around the navel);
• changes in the consistency of feces, a tendency to constipation or diarrhea, the appearance of undigested food particles;
• nausea or vomiting after eating;
• decreased appetite or a sudden change in eating habits;
• the appearance of yellow color or severe pallor of the skin and mucous membranes;
• detection of blood impurities in the feces (visually or during a fecal analysis);
• sensations of rapid filling of the stomach;
• weight loss;
• enlargement of the liver, spleen, lymph nodes;
• heartburn or a burning sensation in the chest.

He will talk about 10 effective folk recipes for the treatment of gastritis, which will help get rid of stomach pain.

note

Ultrasound diagnosis of the abdominal organs is indicated if there are laboratory signs of liver dysfunction (increased levels of bilirubin, enzymes) or pancreas (increased concentrations of diastase or amylase).

What diseases of the stomach helps to identify?

The technique of using contrast is effective for detecting various kinds of inflammatory, oncological and degenerative pathologies:

Advantages and disadvantages of the method

Although this examination method is not very common in Russia, it has a number of significant advantages over the "classic" ultrasound and other imaging methods:

1. High information content. Unfortunately, ultrasound does not allow detecting a significant part of the pathologies of the digestive tract (especially when it comes to neoplasms at an early stage). The use of contrast makes it possible to visualize even small malignant processes (up to 1 cm in size), to find metastases in the lymph nodes or other organs.
2. Possibility of high-quality visualization of blood vessels. Contrast is a good addition to the Doppler mode. It allows you to show a violation of the blood supply, the development of thrombotic or thromboembolic processes, as well as to detect internal bleeding.

But at the same time, the study also has its drawbacks:

1. The need for a highly qualified doctor. After the introduction of contrast, a short-term “window” is created, during which the specialist must examine the organ of interest to him. This requires training and research experience.
2. Principle "one injection of the drug - one organ".
3. Lower information content than CT or MRI. Conducting tomography of the abdominal organs remains more accurate, and also covers a large number of anatomical structures that the doctor can examine in 1 diagnostic session.
4. Low availability. Ultrasound with contrast is performed only in large diagnostic centers or hospitals. At the same time, the cost of diagnostics exceeds even CT and MRI.
5. Impossibility of definitive diagnosis of cancer. After the detection of the tumor, you still have to do a biopsy with a cytological examination.

Is it harmful?

The contrast used for the examination differs from analogues in magnetic resonance or computed tomography. Modern contrasts for ultrasound of the stomach do not contain iodine, barium or other elements, the introduction of which leads to the development of complications (from the side of the kidneys, cardiovascular or nervous systems).

Also, drugs that are used for contrast do not have a radiation load on the body, and therefore the examination can be carried out or lactation (with caution). They cannot damage the kidneys or liver, because they do not enter into metabolic processes and have a short decay period.

The only contraindication to the examination is individual intolerance to the drug. Postponing the diagnostic measure is also recommended for severe cardiac decompensation.

Possible side effects include:

• burning sensation at the injection site;
• allergic reactions;
• tachycardia (increased heart rate);
• increased shortness of breath (with heart failure);
• fluctuations in blood pressure;
• sensation of numbness or tingling of various localization.

Training

Contrast-enhanced ultrasound requires preparation (including nutrition), which is no different from that before a conventional ultrasound examination of the abdominal organs. In short, it consists of several points:

1. If you have constipation or flatulence for several days prescribed a special diet, from which all products that can contribute to gas formation or stagnation of feces are removed.
2. Also, with flatulence, then on the day of the study take sorbents and the preparation of simethicone ("Espumizan"). All previously prescribed medications are drunk as usual.
3. They come to the ultrasound on an “empty” stomach, therefore on the day of diagnosis, the patient does not eat anything.

When parents should carefully monitor his diet.

Price

In Russia, this diagnostic method began to be practiced in the early 2010s. Therefore, the study is carried out only in the medical centers of several largest cities.

Procedure Compatibility:

• In Moscow ultrasound examination with contrast is carried out in several private and public clinics. Its price is 4500-11000 rubles.
• In St. Petersburg The pioneer of ultrasound with contrast is the National Medical Center of Oncology. N.N. Petrov. The price of examination of one organ is 4400 (if it is a liver or kidney) or 6600 rubles.
• In Novosibirsk the examination is carried out in a private medical center Albamed. The price of diagnostics of one organ is 5500 rubles.

Conclusion

Ultrasound examination using contrast makes the diagnosis much more informative. The technique has the greatest sensitivity for diagnosing pathologies of the liver, spleen, pancreas and abdominal aorta.

It allows you to detect changes in tissue, cavity and tumors, even of a small size. But the procedure remains expensive, is carried out only in a few medical centers, and is inferior to CT or MRI in its informativeness.

Have you had any experience with contrast-enhanced ultrasound? How informative was this diagnostic technique? Share your impressions with our other readers.

X-ray visualizes the condition of the kidney, indicates the malfunction of the urinary system. Research methods:

1. Plain radiography (image) is done without contrast. The picture shows the location of the organs and the pathology of the urethra, the state of underdevelopment of the kidney, the abnormal structure of the urinary system. The normal location of the kidneys: on the left - at the level from 12th thoracic to 2nd lumbar vertebra; on the right - from 1 to 3 lumbar vertebrae. If the kidney looks humpbacked, then this is the norm.
2. CT scan. Much more expensive than a regular image, but much more informative, as it shows not just bean-shaped shadows of organs, but a layered image.
3. Contrast X-ray. X-ray of the kidneys with contrast establishes the cause of the disease. The study is carried out according to the doctor's prescription. Depending on the method of administration, the substances are divided into: intravenous urography (iv) and direct pyelography. These types of X-ray examinations consist of a series of sequential images within an hour with a different interval.

Characteristics and methods of carrying out:

• Intravenous urography is characterized by the introduction of urographine or omnipaque into the elbow area. After the introduction of the substance into the vein, the phase of the nephrogram begins. At this stage, the kidney vessels are filled with contrast and the density of the renal parenchyma is determined.

• The iodine-containing drug captures the kidneys and is excreted in the urine unchanged. The renal pelvis is completely filled with the substance. They can be seen after 5-7 minutes. At this stage, the first series of pictures is taken.

• The next urogram is performed at the 15th minute. At this stage of the examination, the renal pelvis and urethra are filled with urographin, the condition and position of the urethra are easily traced. At the 15th minute, the specialist will see not only the structure of the urinary tract system, but also the movement of matter.

• Final pictures - 21st minute. They are made in the left and right oblique projections and allow you to determine the state of the bladder. A prerequisite is the development of images in a horizontal and vertical position.

Prior to IV urography, concomitant tests are performed to determine if there are abnormalities in the functioning of the kidneys. If any are found, then urography is carried out with extreme caution: contrast is introduced in small portions, the radiologist monitors the work of the urinary system. This type of examination is called infusion urography.

There is another subspecies of VV - voiding cystography. This is the process of monitoring the release of urografin during urination.

Despite the rapid development of medical technology,

remains a popular method for detecting disorders of renal activity. Diseases

Unfortunately, they are very common, so there are currently a large number of methods for x-ray diagnosis of kidney diseases.

Many of the kidney diseases are asymptomatic. For a long time, a person may not be aware of the pathological process developing in them, since they retain their performance even with 80% - 85% damage to their structure.

In other cases, the manifestations of kidney disease are very bright and do not raise doubts in the diagnosis. You should know that timely competent diagnosis of kidney pathologies allows you to control the health of this irreplaceable organ and avoid terrible complications in the future.

The need for an X-ray of the kidneys

The kidneys are the most important organ of the urinary system, kidney diseases are dangerous for a person with serious consequences. Dysfunction of this organ can be caused by various reasons. These are congenital pathologies

Inflammatory, infectious, autoimmune diseases, metabolic disorders and many others. Kidney diseases can be unilateral or bilateral, since the kidneys are a paired organ.

Any kidney disease that is not diagnosed and not treated in time is fraught with the development of such a formidable condition as kidney failure. In this case, the kidneys are not able to perform their cleansing and excretory functions.

Without immediate medical attention, a person may even die. A kidney x-ray is a serious study that is carried out for health reasons for people of all ages, in cases where other examination methods are not sufficiently informative.

What is a kidney x-ray and why is it done?

X-ray diagnostics is a very valuable method for detecting and confirming most of the existing diseases and pathologies of the kidneys. Modern X-ray equipment makes it possible to obtain both flat linear images of this organ and three-dimensional three-dimensional ones. High-precision images made in many projections and sections using the method

They allow to detect the smallest pathologies in the tissues and vessels of the kidneys, to determine the presence of sand, to identify tumor processes at an early stage.

Currently, the diagnosis and treatment of kidney pathologies have become much more effective due to the use of various types of x-rays with the introduction of contrast agents in urology. Their diversity allows you to choose the most appropriate method in each case.

The use of each of them is of independent diagnostic value. The combination of several types of kidney x-ray information supplements the results of each of them, allowing you to make a diagnosis even in the most difficult situations.

X-ray of the kidneys with contrast agents

X-ray diagnostics of the kidneys using contrast agents allows you to visualize the smallest structures of the renal tissue and blood vessels, evaluate the functionality of this organ, and also check the patency of the urinary tract.

It is necessary before surgery. It also helps to control the effectiveness of the treatment.

The choice of the method of contrast radiodiagnosis depends on how and for what purpose the contrast agent is administered.

Types of X-ray examination of the kidneys with the introduction of contrast agents are:

• intravenous excretory urography;
• intravenous infusion urography;
• direct pyelography;
• pneumatic radiography of the kidneys;
• urostereoroentgenography;
• angiography.

What contrast agents are used for kidney x-rays?

In contrast X-ray diagnostics of renal pathologies, ionic and non-ionic water-soluble iodine-containing preparations are used. Ionogenic drugs include substances such as urographin, triombrast. Non-ionic substances include omnipak, vizipak and other preparations. Contrast non-ionic agents belong to a new generation and are less toxic than ionic ones.

The following requirements are imposed on contrast agents used in renal x-rays:

• they should have low toxicity;
• they should not cause an allergic reaction;
• they should not accumulate in the tissues;
• they must have high contrast;
• they should not take part in exchange processes and others.

Iodine-containing contrast preparations are organic compounds

The molecule of which contains 1, 2, 3 iodine atoms. Domestic contrasts used in urography include 1-atom drug Sergosin, 2-atom cardiotrast, 3-atom triiotrast. Foreign 2 - 3-atom contrast agents contain 60 - 70% iodine.

Among them, such substances as diodone, urographin, hypak, renographin and others have found wide application. The highest image clarity is achieved when using contrast agents with 2-3 iodine atoms.

For different types of urography, certain contrast agents are used, in different concentrations and quantities. So in excretory urography, 35 - 50% aqueous solutions of 1, 2, 3-atomic contrast agents are used in an amount of 20 ml.

Angiography uses solutions of 2, 3-atom contrast agents with a concentration of 50 - 70%. For retrograde pyelography, 1, 2, 3-atomic contrast agents of 20 - 35% concentration are used.

The choice of drug concentration is based on the functional state of the kidneys, blood flow, density of the object under study.

Despite the development of pharmaceutical technologies, contrast agents used in urography can sometimes cause allergic reactions and serious complications, especially when they are rapidly administered in high quantities and concentrations. According to medical statistics, the highest quality images of the kidneys on urograms with minimal allergic and side effects are given by such drugs as triiotrast, hypak, renographin.

Intravenous contrast urography of the kidneys

Intravenous contrast urography is a generalized name for an X-ray method for examining the kidneys and urinary tract, which implies a jet (

as in excretory urography

) or drip (

as in infusion urography

) introduction of contrast into the elbow (

or another

) the patient's vein. Due to its availability and information content, it is the most commonly used method for detecting pathologies of the kidneys and urinary tract. In this case, radiographs are performed with the passage of contrast throughout the urinary tract at regular intervals.

In the process of diagnosis, two types of ultrasound are distinguished: echography and ultrasound dopplerography. Ultrasonography allows you to examine the structure of the tissues of the kidney, determine the location of the organ, its size, while the entire anatomy of the kidneys is visible.

The data is transferred to the computer monitor, so the doctor sees the scan results in real time. This diagnostic method provides a lot of information, but it is impossible to identify the pathology of the renal blood flow.

Doppler ultrasound scanning of the kidneys reveals abnormalities in the functioning of the renal vessels. During the study, sound waves are reflected from red blood cells.

In this case, the doctor evaluates the speed of blood flow, the structure of blood vessels and the presence of pathologies in them. The information is provided as a table with a graph showing the deviation from the norm.

The doctor can determine if there are blood clots in the body or blockage of the veins, how narrowed they are.

In addition to Doppler, color flow scanning is often used, in which the speed of blood flow is recorded in the form of colored stripes. The sonogram of the kidney and the obtained data are combined and the most accurate picture of the study is obtained.

There are several types of kidney ultrasound:

• Ultrasound of the kidneys with a diuretic load;
• Ultrasound of the kidneys with a contrast agent;
• Doppler ultrasound of the kidneys;

Ultrasound of the kidneys with a load

Ultrasound of the kidneys with a diuretic load is a study using the diuretic drug Lasix. Most often, such a study is used in children.

The indications are:

• Suspicion of the expansion of the pelvis of the kidneys;
• Suspicion of hydronephrosis and pyelectasis in children.

Before conducting this study, the patient is administered an intravenous glucose solution, i.e. carry out a water load for subsequent ultrasound of the kidneys. Then they are asked to empty the bladder and with the help of an ultrasound examination of the kidneys, the dimensions of the pelvis and calyces are measured. After that, they suggest taking the powerful diuretic drug Lasix, and after taking it, a similar measurement is made several more times.

Ultrasound of the kidneys with color doppler: what is it?

Color Doppler imaging (CDC) is one of the subtypes of ultrasound based on the Doppler effect. To assess the blood supply to the organ, ultrasound of the kidneys with vascular Doppler is performed. Doppler ultrasound of the kidneys allows you to assess how the large vessels involved in the blood supply to the kidneys are located, as well as to assess the volume and speed of blood flow.

Contrast ultrasound of the kidneys

Ultrasound of the kidneys with a contrast agent is a modern and very accurate method for diagnosing kidney diseases. Ultrasound of the kidneys with contrast is indicated for:

• chronic inflammatory lesions of the kidneys;
• urolithiasis;
• suspicion of renal colic;
• the appearance of blood in the urine.

In order to make a clear diagnosis, the doctor may prescribe tests, in particular a general blood test, a general urinalysis, a biochemical blood test, as well as a urine test according to Zemnitsky and Nechiporenko.

Examination in children

The procedure takes place necessarily under local anesthesia, the study is carried out only by two doctors. If the result of the examination requires a repeat of the procedure, then this will be possible only after a long period of time.

Ultrasound of the kidney during pregnancy

• with pain in the lumbar region;
• if the urine test shows poor results;
• with the development of symptoms of infection of the genitourinary system;
• with injuries to the back and lower back.

If an ultrasound of the kidneys is done in time, it will be possible to timely diagnose and begin treatment of such dangerous diseases as pyelonephritis, urolithiasis, kidney formation of various etiologies. Most often, inflammation occurs due to hormonal changes in the body, the growing uterus and fetus, and chronic diseases that have not been cured in a timely manner.

Therefore, ultrasound of the kidneys and bladder is so important in the process of pregnancy, as it determines kidney disease and urea disease in the early stages, which is important for curing the disease.

Procedure

Before the study, the patient needs to give up those products that contribute to gas formation in 3 days. Immediately before urography, you need to abstain from food for 8 hours. It is forbidden to drink plenty of fluids.

It is important! Before starting the study, the attending specialist must take a test for an allergy to contrast agents.

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

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

Main indications

This study may be ordered if:

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

Information about types of research

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

• survey urography;
• excretory urography;
• infusion urography.

Under the survey urography of the kidneys, it is necessary to understand an ordinary x-ray image of the internal organs that are located in the region of the kidneys.

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

It is important! Concentrated 60-80% iodine-containing solutions, for example, sergosin, urografin, urotrast, etc., can be used as an x-ray contrast agent. These drugs are designed for slow intravenous jet administration. The amount of contrast is calculated depending on the weight of the patient.

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

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

Performing an x-ray of the kidneys is an important and necessary study, which doctors resort to when it is impossible to diagnose their pathology by other methods. Initially, to detect kidney diseases, the doctor prescribes laboratory tests of urine, blood, ultrasound of the kidneys, functional

and Nichiporenko. If the cause of the malaise as a result of the measures taken could not be found, X-ray methods for examining the kidneys are used as highly effective in these cases. However, sometimes an x-ray of the kidneys cannot be used, due to the patient's contraindications to its conduct.

Indications for a kidney x-ray

Complications after urography with a contrast agent

Complications after this diagnostic measure, in most cases, depend on the number of X-ray studies performed over a long period of time.

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

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

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

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

How does Sonovue work?
The drug is administered intravenously through a polyvinyl chloride catheter installed before the study. The drug bubbles enter the venous bed and begin to circulate in the blood vessels, reaching the area of ​​interest (pathological formations of various localization).
Despite their small size, gas microbubbles greatly enhance the reflection of the ultrasound wave, which leads to the formation of a much clearer image than with conventional ultrasound. This is especially important for assessing the structure of the pathological formation and blood flow in it. The latter is the most important indicator in determining the nature of the studied formation (benign, malignant).

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

What advantages does SonoVue have over other contrast studies performed in radiology (computed tomography, magnetic resonance imaging)?
When using Sonovue, there is a high safety for the patient:

• almost complete absence of allergic reactions;
• no toxic effects on the kidneys (nephrotoxicity);
• when performing ultrasound with Sonovy there is no radiation effect on the body;
• there are no contraindications associated with the presence of metal structures in the body, pacemakers and other devices;
• there are no restrictions for use in patients with claustrophobia.

The procedure for ultrasound with the use of echo-contrast preparation Sonovue.

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

After clarification of the localization of the pathological focus under ultrasound, the introduction of the Sonovue drug is carried out with an assessment of its diffusion into the pathological focus. The study lasts no more than 5-8 minutes.

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

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

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

Contrast-enhanced ultrasound is now considered one of the most promising technologies in radiodiagnosis. In Europe and the USA, it has found wide application in clinical practice about 10 years ago. In Russia - about 3 years ago, when preparations for echo contrast were registered.

Andrey Vladimirovich Mishchenko, Doctor of Medical Sciences, Head of the Department of Radiation Diagnostics, N.N. N.N. Petrov» of the Ministry of Health of Russia.

What is the difference between contrast-enhanced ultrasound and conventional ultrasound?

The use of a contrast medium has opened up a new area of ​​expertise for ultrasound. Oncology is one of the most promising areas of application for contrast-enhanced ultrasound diagnostics.

Thanks to this technology, with the help of staining, we can show the true vascularization of the tumor, i.e. growth of additional blood vessels. Until recently, we could judge vascularization only with the help of Doppler studies - by the flow characteristics of blood movement inside the vessels. Now, already at the initial stage of differential diagnosis, we can, by the nature of vascularization, suggest a benign or malignant nature of the changes, understand whether there is a blood supply to the pathological tissue, and also trace the dynamics of changes in vascularization.

Ultrasound with echocontrast allows you to find answers to many other questions without resorting to other methods of radiation diagnostics: CT, MRI, PET-CT - high-tech, but also having a certain harmful effect on humans due to X-ray, gamma radiation, nephrotoxic contrast agents.

And how toxic is the drug for echocontrast?

The echocontrast drug is non-toxic, well tolerated by patients, it is extremely inert for humans, these are gas bubbles that dissolve and then are excreted through the lungs. No side effects from the use of echocontrast have been registered in the world.

Ultrasound with contrast, if necessary, can be done frequently without fear of consequences. However, today there are still restrictions on the use of this drug, mainly associated with special requirements for "everything new" in medicine.

What is the experience of practical application of echocontrasting at N.N. N.N. Petrov?

We were one of the first to use echocontrast, right after it was licensed in our country. Actively used the European experience, analyzed the data of foreign colleagues.

For three years, the specialists of the National Medical Research Center of Oncology conducted more than 1,500 ultrasound studies with contrast. This method is used by us for the diagnosis of tumor diseases of various localizations: from the neck to the small pelvis.

For what diseases is this method of research especially effective?

The technique of contrasting in oncological practice is used for lesions of various organs: the liver, kidneys and bladder, lymph nodes, thyroid and mammary glands, uterus, ovaries, soft tissue tumors, there is also evidence of the successful use of echocontrasting in the study of the prostate and pancreas. These studies are carried out in full at the N.N. Petrov National Medical Research Center of Oncology.

How long have you been doing ultrasound with EC for the gynecological area?

Ultrasound in gynecology is used less frequently than in other areas. We are cautious about new technologies. Before using it in routine practice, we accumulated our research experience for about a year, and also carefully studied the achievements of European and American specialists. With the help of ultrasound with EC, we check cases already known to us and, thus, we can evaluate the effectiveness of the new technique.

Now at the National Medical Research Center of Oncology. N.N. Petrov, an ultrasound examination with contrast enhancement of the cervix, as well as the ovaries and the body of the uterus is performed for the purpose of differential diagnosis and assessment of the prevalence of tumors. Most often this is a transvaginal study, it gives a better picture than a transabdominal one.

Specialists who carry out this procedure: Meshkova Irina Evgenievna, Candidate of Medical Sciences, and Holotkina Yulia Andreevna.

It is now common practice when an ultrasound is done by the gynecologist himself.

This is quite convenient and is practiced in our center, mainly for screening and primary examinations. However, the gynecologist is not always qualified to determine the detailed characteristics of the tumor process. Patients with a diagnosis, in the process of treatment or rehabilitation, who require a more detailed in-depth examination, undergo it with an ultrasound doctor. The technique of echocontrasting requires even higher qualification.

By the way, the doctor of the Department of Radiation Diagnostics, I.E. Meshkova, has a basic education as an oncologist-gynecologist.

Will this method be introduced into the practice of medical institutions in the regions of Russia?

Our goal, as the National Medical Research Center, is to inform about the technology and help its adequate implementation in routine medical practice. We are ready to share our experience, share our knowledge.

Today, cancer patients are examined not only in specialized medical institutions, but also in multidisciplinary medical institutions, as well as polyclinics.

Many specialists have the qualifications necessary to conduct this study, and institutions have high or expert class equipment. At the same time, there is a lack of understanding of all the nuances of the methodology, and skepticism regarding the results of using this new technology.

We are actively studying existing and developing new algorithms for conducting a survey and interpreting its results. The methodology is very important. Having received this “golden microscope”, we must learn how to use it.

There are certain indications for ultrasound with echocontrast, it is not necessary for all patients.

It is also very important to properly prepare the contrast solution. This is a rather rigorous process, a violation of the solution preparation technology, its incorrect introduction can lead to unreliable research results.

Department of Radiation Diagnostics, N.N. N.N. Petrova regularly conducts training courses for ultrasound doctors on the most pressing issues of imaging in oncology. Including a scientific and practical school on the use of echocontrast in oncological practice, with a master class, with an analysis of clinical cases demonstrating the advantages and features in the study with echocontrast.

Doctors from various regions of Russia and neighboring countries come to study with us. The experience of our doctors is recognized in Europe - we regularly present our results at the European Congress of Radiology over the past few years.