Using 2-dimensional color superb microvascular imaging vascularization index technique in the assessment of thyroid surgical bed

Aim: The purpose of this study was to investigate the effectiveness of the vascularization index (VI) obtained using color superb microvascular imaging (cSMI) technique in the assessment of thyroid surgical bed for remnant thyroid tissue (RTT). Material and methods: We evaluated the thyroid surgical bed of 65 patients who had underwent total thyroidectomy (TT) due to papillary carcinoma (PC) using thyroid scintigraphy and cSMI. Color SMI was also performed for the examination of the thyroid parenchyma of 39 healthy asymptomatic participants. VI measurements were performed by manually drawing the contours of the RTT in those with remnant thyroid, the thyroid surgical bed in the patients’ group without remnant thyroid, and normal thyroid parenchyma in the control group, using the free region of interest (ROI) with 2-dimensional color SMI VI (2DcSMIVI) mode. The volume of ROI was measured and echogenicity was evaluated. The quantitative 2DcSMIVI values of the surgical bed with RTT (Group A), the surgical bed without RTT (Group B) and normal thyroid of healthy asymptomatic participants (Group C) were compared. Results: The mean 2DcSMIVI values of Group A was significantly higher than Group B and C (p=0.001). The presence of RTT can be diagnosed with 89.1% sensitivity and 87.5% specificity when 1.75 2DcSMIVI is designated as the cut-off value. Conclusion: The 2DcSMIVI is an effective imaging technique that can be used for the diagnosis of RTT.

Evaluation of parenchymal vascularity of the thyroid gland with vascularization index by color superb microvascular imaging in patients with Graves’ disease

Aim of the study: To determine the parenchymal vascularity of the thyroid gland with color superb microvascular imaging in patients with Graves’ disease, and compare the vascularization index values with healthy subjects. Materials and methods: The thyroid glands of 37 patients whose laboratory and clinical findings were consistent with Graves’ disease, and 40 asymptomatic subjects with normal laboratory values, were examined using color superb microvascular imaging. Measurements of the vascularization index were performed with a free region of interest which was drawn along the outer margin of the gland on the color superb microvascular imaging mode. The vascularization index values obtained in the Graves’ disease and control groups were compared. A correlation analysis was performed between the vascularization index values and laboratory and grayscale US parameters. Results: The median vascularization index value of the thyroid parenchyma in patients with Graves’ disease was significantly higher than in the asymptomatic group [median (min–max); 12 (2.3–32.1) vs 5.04 (1.1–10.8), p <0.001]. When the cutoff value of the vascularization index is determined as 6.3, Graves’ disease can be diagnosed with 83.8% sensitivity and 70% specificity. Conclusions: The vascularization index obtained with color superb microvascular imaging can be a quantitative indicator of parenchymal vascularity in the diagnosis of Graves’ disease, and serve as a supportive tool.

Efficacy of dynamic quadripolar radiofrequency assessed by advanced ultrasound technologies

Aim: to develop a postoperative rehabilitation program for women with pelvic organ prolapse (POP). Patients and Methods: sixty postmenopausal women aged 55–75 with POP were randomized into two equal groups. All women underwent surgical intervention, which included anterior and posterior colporrhaphy and colpoperineo-levator-plasty. Group 1 women underwent five courses of radiofrequency therapy with a 14-day interval 30 days after surgery. Radiofrequency exposure was addressed by dynamic quadripolar radiofrequency (DQRF). Group 2 women were followed up without any additional rehabilitation measures. Ultrasound (US) examination using compression elastography was performed in all women To assess tissue elasticity. Neovascularization of vaginal walls was evaluated by superb microvascular imaging (SMI). The vascular intensity of the selected area of the vaginal wall was measured by automatic calculation of the vascularization index. US was performed twice, e.g., before and after surgery and rehabilitation (in group 1) or three months after surgery (in group 2). Results: in women who underwent DQRF therapy, an increase in the elasticity of vaginal walls was reported that indirectly demonstrates the increase in type 1 collagen and improvement of tissue vascularization. After surgery and radiofrequency therapy, the vascularization index increased by 1.6 times in group 1 and 1.2 times in group 2 compared to baseline. No postoperative complications were reported. Conclusion: this rehabilitation program is recommended for women who underwent surgical intervention for POP, given the efficacy and safety of radiofrequency therapy in the postoperative period. KEYWORDS: pelvic organ prolapse, rehabilitation period, dynamic quadripolar radiofrequency, dynamic quadripolar radiofrequency therapy, tissue elasticity, neovascularization, elastography, superb microvascular imaging. FOR CITATION: Dobrokhotova Yu.E., Komagorov V.I., Il’ina I.Yu. et al. Efficacy of dynamic quadripolar radiofrequency assessed by advanced ultrasound technologies. Russian Journal of Woman and Child Health. 2021;4(4):311–316 (in Russ.). DOI: 10.32364/2618- 8430-2021-4-4-311-316.

DOPPLER ASSESSMENT OF TROPHOBLASTIC BLOOD FLOW TO PREDICT ADVERSE PREGNANCY OUTCOME

Objective. To evaluate the diagnostic utility of trophoblastic blood flow Doppler parameters in predicting an adverse pregnancy outcome.Material and methods. This was a retrospective study of 218 pregnancies of women between 8 and 11 weeks’ gestation. Depending on the pregnancy outcome, patients were divided into 4 clinical groups. All women underwent an ultrasound examination using Voluson S8, Voluson E8 with high-quality grey scale, color flow mapping and pulsed-wave Doppler modes. We used a program for obstetric research with the following instrument settings: 100 MHz Doppler frequency, thermal index (TI) was <1, mechanical index (MI) was 1. The examination time did not exceed 20 minutes. There was no radiation exposure. Transvaginal and transabdominal sonographies were performed.Results. To form a risk group for an adverse fetal outcome due to fetoplacental insufficiency, it is necessary to identify ultrasound markers of inadequate placental perfusion by means of a Doppler study of fetoplacental blood flow. For this purpose, we examined 218 pregnancies of women between 8 and 11 weeks’ gestation to determine the diagnostic utility of various parameters: resistivity index, pulsatility index, systolic/diastolic ratio and chorionic vascularization index (k, %). We received results proving high sensitivity (76.9%) and specificity (89.7%) of the chorionic vascularization index (k, %), as well as low specificity (54.7%) and high sensitivity (81.5%) of trophoblastic blood flow resistivity index.Conclusion. Thus, the chorionic vascularization index (k, %) is of high diagnostic utility for predicting an adverse fetal outcome.

Influence of Ulipristal Acetate in 3D-PW-Doppler parameters of patients with uterine myomas: a prospective observational pilot study

Introduction: uterine fibroids are the most common benign tumors of the female genital tract. They associate a varied symptomatology, from the absence of symptoms to more disabling bleeding or pain [1,2]. There are multiple treatments directed against different targets such as ulipristal acetate which has proven effective in reducing the size of the fibroids and their symptoms [7]. Our preliminary study seeks to find the relationship between ulipristal acetate and angiogenesis of uterine fibroids, by measuring ultrasound vascularization of the fibroid throughout the treatment. Material and Methods: A prospective observational study has been designed, in which 24 patients with symptomatic uterine fibroids have been included and given 4 cycles of Ulipristal Acetate. The size and vascularization of the fibroids were measured at the beginning and end of treatment; as well as on several occasions throughout the follow-up. Myoma vascularization was measured by power doppler 3D ultrasound through different parameters that define the vascularization in a more objective way: Vascularization Index (VI), Flow Rate (FR), Flow Vascularization Index (FVI). Result: A significant reduction in the size of the fibroids has been observed, as well as their vascularization in terms of vascularization indices measured by 3D PW ultrasound. These changes were evident at the end of treatment and were maintained over time. Conclusion: There is a correlation between myoma vascularization and treatment with Ulipristal Acetate. SPRMs may provide effective treatment for women with symptomatic fibroids by two ways: supports selective progesterone receptor modulators and reduced angiogenesis. In addition, the use of vascularization markers of 3DPW ultrasound and the colour map allow us to monitor the response to medical treatment of myomas in a non-invasive and easily reproducible way. Keywords: Ulipristal Acetate; Esmya®; Uterine fibroids; Angiogenesis; 3D Power Doppler Ultrasound

ENDOMETRITIS ULTRASOUND DIAGNOSIS: FEATURES OF BLOOD SUPPLY OF DIFFERENT MORPHOLOGICAL TYPES

Aim. Despite significant advances in modern gynecology, endometritis is often unrecognized, being the main reason leading to persistent infertility or repeated pregnancy loss. There are 3 morphological types of chronic endometritis: hyperplastic, hypoplastic and mixed. The aim of the study was to develop ultrasound signs and hemodynamic features of various morphological types of chronic endometritis. Matherials and Methods. A retrospective analysis of 162 patients of reproductive age (22-50 years old) diagnosed with endometritis was carried out. The comparison group consisted of 96 women 17-42 years old without gynecological pathology (P > 0.05). The study was conducted in the proliferative phase of the cycle up to 10 days. The hemodynamics of the uterus and endometrium was evaluated on the basis of Doppler blood flow parameters in the uterine arteries, the calculation of arterial perfusion index (API), vascularization index (VI) and flow index (FI) of the uterus and endometrium obtained by 3D Doppler. Results. Depending on the morphotype of endometritis, hemodynamic features were evaluated. It was revealed that in the hypoplastic type, to which patients are related with the ratio of the endometrial volume to the volume of the uterus less than 2.5%, there is a significant (P < 0.05) decrease API, as well as hypovascularization of the uterus. Hypervascularization of the uterus and endometrium was observed both with a mixed morphotype, when the ratio of the endometrial volume to the volume of the uterus was from 2.5 to 9.0%, and in the case of a hyperplastic morphotype, when the volume of the endometrium to the volume of the uterus exceeded 9.0%. AIP was no different from healthy women. Conclusions. Diagnosis of impaired blood supply to the uterus will allow reasonable treatment and restore the reproductive function of women.

Ultrasonic Predictors of Dry Eye Syndrome in Sarcoidosis

Objective. To identify clinical and morphofunctional changes in the lacrimal gland in sarcoidosis.Material and methods. Ultrasonography was conducted in 53 patients (106 eyes) with a verified diagnosis of systemic sarcoidosis (7 men and 46 women) whose age was 31 to 72 years.Results. Different types of lacrimal gland structural changes in sarcoidosis were detected. Comparing the acoustic and functional findings revealed a high correlation (r > 0.7) between these parameters as vascularization index, a reflex component of tear secretion, and the presence of tubular structures. Types of changes in the acoustic structure of the lacrimal glands were identified, which were designated as edematous and polymorphic changes, as well as atrophic changes with a necrotic component.Conclusion. The findings can be used to diagnose lacrimal gland changes in patients suffering from sarcoidosis.

Ultrasound diagnosis of endometritis: hemodynamic features of the uterus

Objective.To determine the characteristics of hemodynamics of the uterus with endometritis.Material and methods.A retrospective analysis of 420 patients of reproductive age (19–53 years old) diagnosed with endometritis. The comparison group consisted of 323 women aged 17–52 without gynecological pathology.Blood flow indicators in the uterine arteries, such as maximum systolic, end-diastolic, and average blood flow velocity (Vmax, Vmin, Vmean), were estimated, and an arterial perfusion index (API) was calculated. With 3D reconstruction of the uterus in angioregime, a vascularization index (VI), a flow index (FI) and a vascular flow index (VFI) of the uterus and endometrium were obtained.Result.An increase in Vmax, Vmin, Vmean, as well as VI, VFI of the uterus and VI, FI and VFI of the endometrium in the early and middle proliferative phase of the cycle. API had monotonous values, but it should be taken into account in conjunction with VI.Conclusions.Echography combined with color mapping, spectral Doppler graphics and vascularization index determination using 3D in angio mode is a highly effective method for the diagnosis of endometritis. Characteristic changes in hemodynamics in endometritis manifest as a violation of the venous outflow in the uterus and, especially, in the endometrium, in the presence of hypervascu larization according to data VI in the aggregate of regulatory or reduced indicators of API.

Endometrial Volume, and Sub-Endometrial Blood Flow Indices as Predictors of ICSI Success

<p><strong>Objective:</strong> This study designed to evaluate the endometrial volume, and the sub-endometrial flow indices as predictors of ICSI success.</p><p><strong>Study Design:</strong> Fifty infertile women included in this study, and received long pituitary downregulation protocol followed by hMG controlled hyperstimulation until ≥ 3 ovarian follicles 18-20 mm in diameter detected. Ovulation triggered by hCG, followed by oocytes retrieval 34-36 hours after hCG trigger. Day 2 or 3 embryo transfers done for all studied women, followed by quantitative β-hCG 14 days after the embryo transfers, and transvaginal sonography to diagnose clinical pregnancy. Studied women evaluated by the 3D ultrasound, and 3D power Doppler angiography at the day of the embryo transfers to assess the endometrial volume, and the sub-endometrial flow indices as predictors of the ICSI success.</p><p><strong>Results:</strong> The endometrial volume, sub-endometrial vascularization index, flow index, and vascularization flow index were higher in successful ICSI compared to unsuccessful ICSI group, but the difference was not significant. The ROC analysis showed that the endometrial volume and the 3D power Doppler angiography parameters (vascularization index, flow index, and vascularization flow index indices) were not conclusive for prediction of successful clinical pregnancy after the current ICSI trials.</p><p><strong>Conclusion:</strong> The endometrial volume and the 3D power Doppler angiography indices were not predictive for the clinical pregnancy after the current ICSI trials.</p>