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.

The study objective is to assess the capabilities of ultrasonography in the diagnosis of oropharyngeal squamous cell carcinomas and in the evaluation of treatment efficacy (changes in tumor volume). Materials and methods. This study included 98 patients (27 (27.5 %) females and 71 (72.5 %) males aged between 20 and 78 years with oropharyngeal tumors; of them, 12 (12.2 %) patients had recurrent tumors. Sixty-seven (68.4 %) participants had their tumors located in the tonsils; 31 (31.6 %) patients had tumors of the root of the tongue; 47 (48.0 %) patients presented with tumors invading adjacent tissues; 57 (58.2 %) patients had their lymph nodes involved. Thirty-two patients were operated at the first stage of treatment, whereas 66 (67.3 %) individuals received induction chemotherapy followed by sequential chemoradiotherapy. Treatment efficacy was evaluated 2 weeks following the completion of the second course of induction chemotherapy. We assessed tumor volume, its structure, type and intensity of vascularization, and the number and size of lymph nodes affected by metastasis. Ultrasonography findings were compared with the results of fibroscopy, X-ray computed tomography (CT) and magnetic resonance imaging (MRI) performed 2 weeks following the completion of the second course of induction chemotherapy (no later than 7–10 days). Results. The disagreement between histology and ultrasonography findings reflecting tumor volume (of either newly diagnosed or recurrent tumor) was statistically insignificant. The results of X-ray CT were more likely to be in agreement with histology than the ultrasonography results (85.0 % vs 70.0 %); however, this difference was not statistically significant. Data of X-ray CT and ultrasonography on the tumor volume demonstrated no significant difference between them. MRI and ultrasonography findings on the tumor volume were consistent in 50 % of cases. We identified the most common changes in the structure of the oropharyngeal tumors typical of positive and negative dynamics after 2 courses of induction chemotherapy. Patients with positive dynamics demonstrated a significant decrease in tumor volume detected by all diagnostic methods used (ultrasonography, X-ray CT, and MRI). There was a significant negative correlation between the efficacy of treatment assessed by ultrasonography and the grade of therapeutic pathomorphosis assessed by histology (r = –0.69; р = 0.0014). Conclusion. The accuracy of ultrasonography for the estimation of oropharyngeal tumor volume and its spread is comparable with that of X-ray CT and MRI. The disagreement between these methods was statistically insignificant. Ultrasonography is a more sensitive method for the evaluation of patient response to treatment than clinical data.

The study objective is to evaluate the capacity of contrast-enhanced ultrasound in the diagnosis of head and neck squamous cell carcinoma.Materials and methods. We examined 34 patients with head and neck tumors (or suspected of having a tumor) using contrast-enhanced ultrasound imaging with sulfur hexafluoride.Results. Contrast enhancement of primary and recurrent tumors (developed within 3 months since the end of treatment) was characterized by rapid wash-in (including peak enhancement) and wash-out of contrast agent. However, recurrent tumors (developed within 3 months after treatment) demonstrated slightly slower wash-in than primary tumors. In patients with suspected relapse, which was not confirmed by histological examination, contrast agent accumulated only in the surrounding tissues and did not penetrate into the fibrous infiltrate; there were no wash-in and wash-out phases (although this did not exclude the presence of small tumors in the infiltrate). By contrast, tumors demonstrated rapid achievement of peak enhancement and fast wash-out. Laryngeal and laryngopharyngeal tumors accumulate and release contrast agent like any other oropharyngeal squamous cell carcinomas. Laryngeal cartilages have high echogenicity and don’t accumulate contrast agent. Tumor-altered vocal cords accumulate contrast agent, which significantly improves the visualization. Intact vocal cords appear as hyperechogenic symmetric structures on B-scans. Contrast-enhanced ultrasound imaging allows better visualization of the vocal cords. Contrast-enhancement can significantly improve the diagnostic value of ultrasound examination of the larynx, especially when B-scanning is hindered by some anatomical features (such as large Adam’s apple) or ossification of laryngeal cartilages.Conclusion. Contrast-enhanced ultrasound imaging of the head and neck is a highly promising diagnostic tool, although it requires further evaluation. Improved visualization with contrast-enhancement increases the diagnostic value of the method for the differentiation between various tumors and fibrotic changes and detection of tumor spread to the laryngeal cartilages, which is important for surgical treatment and planning anticancer therapy.

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.

The study objective is to evaluate the utility of ultrasound (US) examination in the diagnosis of laryngeal/hypopharyngeal squamous cell carcinoma and in the assessment of tumor spread. Materials and methods . We performed US examination in 100patients (7 females and 93 males) with laryngeal/hypopharyngeal cancer aged between 36 and 85 years. We evaluated vocal cord mobility, condition of the laryngeal cartilages, and tumor invasion to the adjacent tissues within the larynx and beyond it. In all patients, the diagnosis was confirmed by histological examination. Results. Seventy-five patients had primary laryngeal/hypopharyngeal tumors, whereas the remaining 25patients presented with recurrent cancer. Eighty-one participants were found to have laryngeal cancer; of them, 13 patients had tumors in the supraglottis; 67 patients had tumors located in the glottis; and 1 patient had a tumor of the subglottis. Nineteen patients were diagnosed with hypopharyngeal tumors. We have identified the most typical US signs of laryngeal/hypopharyngeal tumors considering their location and compared the results of US examination with histology of surgical specimens. US examination demonstrated a sensitivity of 94.1 %, accuracy of 91.9 %, efficacy of 47.0 %, and positive predictive value of 97.5 %. Specificity was not evaluated since we had no negative results. Conclusion. US examination is a highly accurate methodfor the diagnosis of both primary and recurrent laryngeal/hypopharyngeal tumors.