A standard protocol for superficial lymph node (LN) ultrasound is presented. The document consists of a technological (1) and descriptive (2) protocols. The technological protocol describes the technique of superficial LN ultrasound. The descriptive protocol contains a detailed report of the results of superficial LN ultrasound, which ends with a conclusion. Modern domestic and foreign clinical and diagnostic recommendations that determine the indications for superficial LN ultrasound are analyzed.The presented standard protocol for superficial LN ultrasound fully complies with current Russian clinical recommendations and does not contradict foreign clinical and diagnostic recommendations.

The article presents the most informative ultrasound (US) signs of unchanged, "reactive," lymphoproliferative and metastatic lymph nodes (LN). A literature analysis was conducted on the stratification of US-signs of malignancy of the LN, on the basis of which it was concluded that at present time there is no single classification of US-signs of pathological changes in the LN, existing classifications have been developed to assess the LN in some regions, include from 3 to 5 categories and are not used everywhere. Due to certain difficulties in interpreting the nature of the LN lesions associated with their localization, size, number, severity of response to the infectious process and presence of oncological history of the patient, it is justified to create a unified classification of US signs of the LN changes employing 6 categories that is similar to previously accepted classifications of radiation diagnostics TI-RADS, BI-RADS. For a wide discussion by experts, it is proposed a draft classification Node-RADS for stratification US-signs of surface LN.

The first clinical case describes the main ultrasound signs of a foreign body in the form of suture material after surgery on the stomach, the second clinical case presents the ultrasound signs of an installed intraperitoneal port for chemotherapy after extirpation of the uterus and appendages. The article compares the types of intraoperative foreign bodies, the clinical picture, and the main diagnostic methods.

The article is the consensus opinion of specialists involved in ultrasound examination, computed and magnetic resonance imaging of peripheral, abdominal and retroperitoneal lymph nodes, oncologists, authors of clinical recommendations of the Russian Society of Head and Neck Tumor Specialists based on an analysis of modern literary sources devoted to the problem of assessing the condition lymph nodes. The purpose of the publication is to bring ultrasound terms to uniform standards when describing lymph nodes, to introduce the Node-RADS system into the practice of ultrasound examination, to improve mutual understanding between diagnosticians and clinicians in the interpretation of ultrasound results in assessing the condition of lymph nodes, optimize the work of primary care ultrasound diagnostic doctors.

In this clinical case, the main ultrasound semiotic signs of infarction and other pathological changes in the spleen are presented, with which diծerential diagnosis should be carried out in cancer patients.

The present review shows a modern view on ultrasound differential diagnosis of hyperechoic benign breast lesions. The main ultrasound semiotic signs of the most common focal benign structures are noted, in comparison with the data of histopathological analysis.

Objective: to evaluate the possibilities of strain elastography (SE) in eSie Touch mode and shear wave elastography (SWE) with ARFI (Acoustic Radiation Force Impulse) technology in Virtual TouchTM Tissue Imaging (VTI) for diagnostics lymphomatous superficial lymph nodes (LN).Materials and methods. The prospective study included 168 patients with enlarged superficial LN. Based on a previous histological examination, patients were divided into three groups: group 1 (n = 108) – patients with lymphomas; group 2 (n = 30) – patients with metastatic superficial LN; group 3 (n = 30) – patients with reactive (inflammatory) changes in superficial LN. All patients underwent SE and SWE elastography of the enlarged LN using eSie Touch and VTI modes respectively.Results. The SE data: reactive LN was characterized by elastotypes 1 and 2 with a predominance of elastic structure in 90.0 % of cases. In patients with lymphomas, the elastotype 3 was more often determined (58.3 %). The stiffest LN with the elastotype 4 were metastatic LN, detected in 66.7 % of patients from this group. The results of VTI elastography showed that the stiffest structure is typical for metastatic LN (elastotypes 5–6 in 63.3 % of cases). Lymphomas had an intermediate degree of stiffness (elastotypes 3–4 in 81.5 % of cases). The lowest indicators of elasticity were found in patients with reactive LN (elastotypes 1–2 in 73.4 % of cases).Conclusion. The qualitative assessment of superficial LN stiffness, both using SE and VTI elastography, demonstrated statistically significant differences in the frequency of various types of superficial LN elastograms with lymphomatous, metastatic and reactive changes, which allows for more accurate differential diagnosis between these types of lymphadenopathy.

Purpose: To review the clinical case of deep infiltrative endometriosis in the patient with suspicious of colorectal cancer. Material and methods: Patient 47 years old with complaints of pain in the right hypogastrium for several weeks. Anamnesis of laparoscopic surgery for infertility, repeated removal of mammary fibroadenomas. At the initial examination, there is a suspicion of a primary tumor in the rectum with metastatic lesions in the liver, pancreas and peritoneum according to the results of ultrasound diagnosis. Contrast enhanced MRI of the abdominal cavity and pelvic, colonoscopy, lung radiography and PET/CT were performed for the purpose of detailed differential diagnosis of the identified lesions. Conclusion: The multimodal approach in the differentiation of deep infiltrative endometriosis and malignant neoplasms using various methods of radiation diagnosis allows to assess the spread of the pathological process and determine the tactics of treatment of the patient in the shortest time.

The present review shows a modern view on the issues of differential ultrasound diagnosis of hyperechoic malignant tumors of the mammary glands. On clinical examples, the main ultrasonic semiotic signs of hyperechoic malignant structures were noted in comparison with the data of histopathological analysis.

Objective: to determine the possibilities of contrast-enhanced ultrasound (CEUS) in identifying and evaluating the efficiency of chemotherapy in patients with colorectal liver metastases (CLM).Material and methods. The investigation enrolled 28 patients with CLM. The patients were divided into two groups: Group 1 – 15 pretreatment patients; Group 2 – 13 posttreatment patients with process stabilization. All the patients underwent standard B-mode ultrasound of the liver and that using the contrast agent SonoVue ® (Bracco, Italy), by recording and estimating the parameters of the intensity-time curve (CIV). Liver CEUS assesses the nature of contrasting metastases in three phases (arterial, venous, and delay ones).Results. The investigators identified three types of contrast agent accumulation in CLM in the arterial phase: along the periphery of the lesions (in 60% of the patients of Group 1, in 76.9% in Group 2), homogeneously over the entire volume (in 26.7% in Group 1 and in 0.08% in Group 2), in parallel with intact liver parenchyma (13.3% in Group 1 and 23.02% in Group 2). In the delay phase, more metastases were detected in 4 cases (14.3%). Estimation of CIV parameters showed a difference at the beginning of contrast enhancement stages between the patients in both groups. Group 1 exhibited the early contrasting of liver metastases (19.3 sec); Group 2 displayed the late washout of a contrast agent (65.9 sec).Conclusion. CEUS versus B-mode ultrasound improves the imaging of liver metastases. The change in the vascular architectonics and hemodynamics in CLM after chemotherapy is reflected in the alteration of the rate of contrast accumulation and washout from the metastases, which allows CEUS to be used in the evaluation of the efficiency of this treatment.

Purpose: Determination of informative value of a new method of ultrasound tomography, based on the properties of elasticity of soft tissues, in the differential diagnosis of metastatic lesions of the lymph nodes of the neck thyroid cancer.Material and methods: To assess the capabilities of shear wave ultrasound elastometry in the diagnosis of metastatic lesions of the lymph nodes in thyroid cancer, a study was carried out with 45 patients with suspected thyroid cancer. The work was performed by devices Acuson S2000 Siemens, Avius hi vision Hitachi using a linear sensor with a frequency of 5–12 MHz. For each object of the study, from 5 to 10 measurements of the shear wave velocity in m / s were made, depending on the size of the lymph nodes.Results: Reliable results were obtained in the group of altered lymph nodes (statistical significance p < 0.05). Interquartile intervals and the most common values of shear wave velocities do not overlap: in metastases — 2.20– 3.36 m/s, with hyperplasia of lymph nodes — 0.70–1.88 m/s, and medians show a significant difference in velocities: metastases — 3.00 m/s, hyperplastic lymph nodes 1.38 m/s.Conclusions: Shear wave elastography objectifies ultrasound studies, obtaining specific indicators of shear wave velocity in the areas of interest, and can be used as an additional diagnostic tool in the differential diagnosis of metastatic and hyperplastic lymph nodes.

Purpose: Assessment of the capabilities of the ultrasound method in the diagnostics of a rare Hurthle-cell tumor of the thyroid gland on the example of a clinical case of a patient with malignant neoplasms of independent primary multiple localizations in comparison with other research methods.Material and methods: A comprehensive study of materials from the history of the disease, the results of clinical, laboratory, instrumental, morphological research methods and their comparison with diagnostic cases from literature data.Results: Despite the full comprehensive examination of the patient, including ultrasound, MRI, PET/CT, puncture biopsy under ultrasound control, it was not possible to make the correct diagnosis before the operation. The presence of other malignant diseases in the patient’s history, the presence of altered paratracheal nodes in the same zone, and the rare occurrence of Hurthle thyroid tumors played a role.Conclusions: Hurthle-thyroid cell tumors are a rare disease, but it must always be taken into account in the diagnostic search, since even benign Hurthle tumors have a high risk of malignancy and spreading of distant metastases.

The article presents the literature review of modern approaches in the diagnosis and treatment of squamous cell cancer of the oropharyngeal region and larynx. Various views on the treatment of patients with oropharyngeal tumors are presented. Special attention is paid to the ultrasound examination of patients with laryngeal tumors and to the possibilities of ultrasound in assessing the integrity of the laryngeal cartilage. Various ultrasound techniques for assessing the thickness and depth of invasion of oral tumors are highlighted. The features of regional anatomy that affect the informative value of visualization techniques are discussed. In the article presents criteria for assessing the prevalence of the tumor process in the adjacent organs and tissues, metastasis in regional lymph nodes.

Objective : to evaluate the possibilities of ultrasound elastography for differentiation of reactive and lymphomatous superficial lymph nodes (LN). Materials and methods. The prospective study included 138 patients with enlarged superficial LN. Based on a previous histological examination, patients were divided into two groups: 1st group (n = 108) – patients with non-Hodgkin’s lymphomas and Hodgkin’s lymphoma; 2nd (n = 30) – patients with reactive (inflammatory) changes in superficial LN. All patients underwent ultrasound elastography of the enlarged LN using ARFI technology. Results . According to the results of ultrasound elastography, the average, minimum, and maximum shear wave velocities for enlarged LN in lymphoma (1st group) were 2.616 ± 0.684; 1.980 ± 0.557 and 3.351 ± 0.987 m / s, respectively; for LN with reactive changes (2nd group) – 1.704 ± 0.223; 1.414 ± 0.209 and 2.027 ± 0.261 m / s, respectively. Thus, the average, minimum, and maximum values of shear wave velocities significantly different between the groups (p ˂0.001). The cut off values of the average shear wave velocity in the differential diagnosis of lymphoma and hyperplasia are determined at the level of 2.05 m / s, with a sensitivity of 88.5 %, specificity of 100 %, and AUC of 0.942 (p ˂0.001). Conclusion . Ultrasound elastography demonstrated statistically significant differences in shear wave velocity in the enlarged superficial LN in lymphoma and in inflammatory processes that can be used as a preliminary non-invasive differential diagnosis of enlarged superficial LN in these conditions.

Objective: to evaluate the possibilities of ultrasound elastography for differentiation of reactive and lymphomatous superficial lymph nodes (LN).Materials and methods. The prospective study included 138 patients with enlarged superficial LN. Based on a previous histological examination, patients were divided into two groups: 1st group (n = 108) – patients with non-Hodgkin’s lymphomas and Hodgkin’s lymphoma; 2nd (n = 30) – patients with reactive (inflammatory) changes in superficial LN. All patients underwent ultrasound elastography of the enlarged LN using ARFI technology.Results. According to the results of ultrasound elastography, the average, minimum, and maximum shear wave velocities for enlarged LN in lymphoma (1st group) were 2.616 ± 0.684; 1.980 ± 0.557 and 3.351 ± 0.987 m / s, respectively; for LN with reactive changes (2nd group) – 1.704 ± 0.223; 1.414 ± 0.209 and 2.027 ± 0.261 m / s, respectively. Thus, the average, minimum, and maximum values of shear wave velocities significantly different between the groups (p ˂0.001). The cut off values of the average shear wave velocity in the differential diagnosis of lymphoma and hyperplasia are determined at the level of 2.05 m / s, with a sensitivity of 88.5 %, specificity of 100 %, and AUC of 0.942 (p ˂0.001).Conclusion. Ultrasound elastography demonstrated statistically significant differences in shear wave velocity in the enlarged superficial LN in lymphoma and in inflammatory processes that can be used as a preliminary non-invasive differential diagnosis of enlarged superficial LN in these conditions.

Purpose: To evaluate the capabilities of ultrasound elastography in assessing the effectiveness of treatment of patients with special lesions of peripheral lymph nodes in lymphoproliferative lesions.Material and methods: To evaluate the capabilities of ultrasound elastography in assessing the effectiveness of treatment, an ultrasound study was carried out for 93 patients with lesions of peripheral lymph nodes with lymphoma in dynamics before treatment and after 2/3 courses of chemotherapy using Acoustic Force Radiation Impulse (ARFI — shear wave elastography) and eSie Touch (compression elastography).Results: Assessment of the dynamics of the average, minimum and maximum values of the shear wave velocity showed statistically significant differences. The most reliable changes were recorded when assessing the average and maximum indicators of the shear wave velocity (p = 0.0000001). Also, after two / three cycles of chemotherapy, the indicator X, XX m/s (p = 0.00001) was significantly less frequent, which was previously detected in the LN with the most rigid structure. Compression ultrasound elastography revealed softening of the LN structure in the form of an increase in the frequency of occurrence of I and II elastotypes.Conclusions: Our study confirms that ultrasound elastography allows, in a short time and without negative ionizing effects on the patient, to assess the effectiveness of the selected chemotherapy routes.

The objective: to evaluate the possibilities of ARFI technology (Acoustic Radiation Force Impulse), including Virtual Touch™ Tissue Imaging (VTI) and Virtual Touch™ Tissue Quantification (VTQ) for differentiation of lymphomatous and metastatic superficial lymphadenopathy.Materials and methods. The prospective study included 138 patients with enlarged superficial lymph nodes (LN). Based on a previous histological examination, patients were divided into two groups: 1st group (n = 108) – patients with non-Hodgkin’s lymphomas and Hodgkin’s lymphoma; 2nd group (n = 30) – patients with metastasis of solid tumors in superficial LN. All patients underwent ultrasound elastography of the enlarged LN using ARFI technology. In VTI study the Area Ratio parameter was evaluated, and the minimum and average values of the shear wave velocity were estimated in VTQ study.Results. According to the results of VTI study the Area Ratio parameter for enlarged LN in lymphoma (1st group) and for metastatic lymphadenopathy (2 nd group) were 1.031 ± 0.197 and 0.851 ± 0.15, respectively (p = 0.000009). The cut off value of the Area Ratio parameter was 0.901 with sensitivity, specificity and accuracy 80.6, 70.0 and 78.8 %, respectively. Minimum values of shear wave velocities for 1st and 2 nd groups were 1.980 ± 0.557 and 2.214 ± 0.367 m/s, respectively (p = 0.032). The cut off values of the average shear wave velocity in the differentiating of lymphomatous and metastatic lymphadenopathy are determined at the level of 2.00 m/s, with sensitivity of 70.0 %, specificity of 59.3 %, and accuracy of 61.6 %.Conclusion. Ultrasound elastography with ARFI technology demonstrated statistically significant differences in the Area Ratio parameter and in the minimum shear wave velocity in the enlarged superficial LN in lymphoma and with metastasis that can be used as a preliminary non-invasive differential diagnosis of enlarged superficial LN in these conditions. Moreover, the Area Ratio parameter has a statistically more significant effect on differentiating of lymphomatous and metastatic lymphadenopathy.

Purpose : To evaluate the possibilities of ultrasound examination with contrast enhancement (CEUS) in assessing the effectiveness of treatment of patients with specific lesions of peripheral lymph nodes with lymphoproliferative lesions. Material and methods : To assess the capabilities of CEUS in assessing the effectiveness of treatment, a study was carried out for 15 patients with lesions of peripheral lymph nodes in lymphoma in dynamics before the treatment and after 2 or 3 courses of chemotherapy using a contrast agent SonoVue® in a volume of 4.8 ml. The results of the study were analyzed and compared with traditional ultrasound techniques. Ultrasound examination was performed using Siemens Acuson S2000 and Philips Affiniti 70 devices with high-frequency linear transducers from 5 to 12 MHz. Results : CEUS revealed a significant increase in the TTP parameter from 27 ± 12 s to 36 ± 13 s ( p = 0.0496) and a significant decrease in the PI parameter from 9 ± 5 dB to 4 ± 3dB ( p = 0.00047). Conclusions : CEUS at any stage of the treatment seems to be promising since it allows diagnosing of structural changes in the affected lymph nodes even after one cycle of chemotherapy.

In this article, based on two clinical examples, the possibilities of multiparametric ultrasound in the differential diagnosis of metastatic and lymphoproliferative changes in lymph nodes in primary-multiple malignant tumors, including breast cancer and lym - phoma, are evaluated. Multiparameteric ultrasound includes B-mode, color and energy Doppler imaging, strain elastography, shear wave elastography and contrast-enhanced ultrasound (CEUS). Standardization and reproducibility of these ultrasound techniques will allow to objectify the study, obtaining specific indicators of shear wave velocity in the zones of interest and specific signs of contrast enhancement, which can be used as impor tant differential diagnostic tool in oncology.

Purpose: Assessmen of the capabilities of ultrasound elastography, elastometry in the diagnosis of thyroid cancer recurrence. Material and methods: In order to assess the capabilities of ultrasound elastography and shear wave elastometry in the diagnosis of thyroid cancer recurrence, a complex study was conducted using 50 patients with suspected recurrence of the disease. All the patients were examined using the B-mode, as well as ultrasound elastometry in black and white or color coding and shear wave elastometry. The results of the study were analyzed and compared with traditional methods of the ultrasound research. Ultrasound examination was performed by means of the Acuson S2000 Siemens and Avius hi vision Hitachi devices using a linear sensor with a frequency of 5–12 MHz. Results: Ultrasound elastography improves visualization of relapses of thyroid cancer, increases the sensitivity of ultrasound diagnostics to 95 %. The elastography allows to reach specific indicators of shear wave velocity in the areas of interest. Conclusion: The results obtained allow the timely detection of disease recurrence, to assess the prevalence of the process, the need for reoperation, as well as its complexity and planned details, to reduce the time and cost of examining of the patients.