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Abstract: Article presents a review of the scientific literature containing data on the role of ultrasound examination of joints in the diagnosis of rheumatoid arthritis, ultrasound signs of damage of main elements of joints and periarticular tissues, modern semi-quantitative scales for assessing the severity of main pathological changes detected by ultrasound examination of joints and tendons in patients with rheumatoid arthritis. Aim: was to analyze scientific publications in domestic and world literature on ultrasound examination of joints in rheumatoid arthritis. Materials and methods: 38 scientific sources of leading domestic and foreign journals were analyzed. Results: currently, radiography is the gold standard in the diagnosis of rheumatoid arthritis and is widely used to monitor the progression of rheumatoid arthritis. However, it is not sensitive enough to detect changes at early stage of rheumatoid arthritis, since it only allows assessing bone structures that are involved in the pathological process 6-12 months after the onset of first signs of the disease. Ultrasound examination provides new possibilities for early detection of rheumatoid arthritis, since it allows to detect changes at early pre-radiological stage and to prevent the development of significant structural changes leading to early disability of patients. Conclusion: the use of ultrasound examination of joints in the diagnosis of rheumatoid arthritis accelerates the diagnosis, is used to dynamically assess the course of the disease, evaluate the effectiveness of therapy, and also to predict outcomes. The diagnostic effectiveness of ultrasound examination of joints in rheumatoid arthritis involves the identification of synovitis, tenosynovitis, structural changes in the articular cartilage and bone (erosion), and an assessment of the severity of the inflammatory reaction.
Abstract: Introduction: article provides a literature review on the role of various imaging methods used in the diagnosis and control of effectiveness of therapy for rheumatoid arthritis. Aim: to analyze domestic and foreign literature sources reflecting the state of the problem and aspects of radiological diagnosis of rheumatoid arthritis. Materials and methods: 52 scientific sources of leading domestic and foreign journals were analyzed. Results: conventional radiography today is the most widely used imaging technique for diagnosing and monitoring of progression of rheumatoid arthritis. However, it is not sensitive enough to detect changes in the early stage of rheumatoid arthritis, since it only allows assessment of bone structures. Establishing the diagnosis of rheumatoid arthritis at the stage of detecting structural abnormalities in joints indicates the presence of functional impairment and disability of patients. At the same time, early diagnosis of rheumatoid arthritis, at the stage of pre-radiological changes, leads to an improved prognosis of the disease and contributes to preservation of working capacity. In this regard, it becomes necessary to introduce into clinical practice sensitive advanced imaging methods aimed at identifying changes that precede the development of structural changes in bone. Conclusion: the diagnostic effectiveness of radiation research methods in rheumatoid arthritis implies the identification of synovitis, tenosynovitis, early inflammatory changes in the bone, structural changes in the articular cartilage and bone (erosion), assessment of the severity of the inflammatory response. References 1. Muravyev YuV. Extraarticular manifestations of rheumatoid arthritis. Nauchno-prakticheskaya revmatologiya. 2018; 56(3): 356-362 [In Russ]. https://doi.org/10.14412/1995-4484-2018-356-362 2. Nasonov EL, Olyunin YuA, Lila AM. Rheumatoid arthritis: the problems of remission and therapy resistance. Nauchno-prakticheskaya revmatologiya. 2018; 56(3): 263-271 [In Russ]. https://doi.org/10.14412/1995-4484-2018-263-271 3. Turan A, ?eltik?i P, Tufan A, ?zt?rk MA. Basic radiological assessment of synovial diseases: a pictorial essay. Eur J Rheumatol. 2017; 4(2): 166-174. https://doi.org/10.5152/eurjrheum.2015.0032 4. Galushko EA, Nasonov EL. Prevalence of rheumatic diseases in Russia. Al'manah klinicheskoj mediciny. 2018; 46(1): 32-39 [In Russ]. https://doi.org/10.18786/2072-0505-2018-46-1-32-39 5. Nasonov EL, Lila AM. The efficacy and safety of sarilumab, fully human monoclonal antibodies against interleukin 6 receptor, in rheumatoid arthritis: new evidence. Nauchno-prakticheskaya revmatologiya. 2019; 57(5): 564-577 [In Russ]. https://doi.org/10.14412/1995-4484-2019-564-57 6. Lila AM, Dreval RО, Shipitsyn VV. Assessment of organization of medical care and drug provision for patients with rheumatic diseases, and the socioeconomic burden of these diseases in the Russian Federation. Sovremennaya revmatologiya. 2018; 12(3): 112-119 [In Russ]. https://doi.org/10.14412/1996-7012-2018-3-112-119 7. Guo Q, Wang Y, Xu D, et al. Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies. Bone Res. 2018; 6: 15. https://doi.org/10.1038/s41413-018-0016-9 8. Sharif K, Sharif A, Jumah F, et al. Rheumatoid arthritis in review: Clinical, anatomical, cellular and molecular points of view. Clin Anat. 2018; 31(2): 216-223. https://doi.org/10.1002/ca.22980 9. Sapundzhieva T, Karalilova R, Batalov A. Hand ultrasound patterns in rheumatoid and psoriatic arthritis: the role of ultrasound in the differential diagnosis. Rheumatol Int. 2020; 40(6): 837-848. https://doi.org/10.1007/s00296-020-04559-8 10. Bollow M. Rheumatoid arthritis of the hand: Part 2: Imaging. Radiologe. 2021; 61(4): 362-374. https://doi.org/10.1007/s00117-021-00833-3 11. Mikhaylova AS, Lesnyak OM. Pannus growth regulators as potential targets for biological therapy in rheumatoid arthritis. Sovremennaya revmatologiya. 2018; 12(1): 55-59 [In Russ]. https://doi.org/10.14412/1996-7012-2018-1-55-59 12. Avdeeva AS, Artyukhov AS, Dashinimaeva EB, et al. Changes of cytokine profile measures during the treatment of rheumatoid arthritis with rituximab biosimilar (Acellbia, BIOCAD) and the original drug (MabThera, F. Hoffmann-La Roche Ltd., Switzerland). Nauchno-prakticheskaya revmatologiya. 2019; 57(1): 46-55 [In Russ]. https://doi.org/10.14412/1995-4484-2019-46-55 13. Korolev MA, Ubshaeva YuB, Banshchikova NY, et al. The results of investigating the efficacy and safety of non-medical switching from the original rituximab to its biosimilar in rheumatoid arthritis patients (AMBIRA study). Nauchno-prakticheskaya revmatologiya. 2020; 58(6): 663-672 [In Russ]. https://doi.org/10.47360/1995-4484-2020-663-672 14. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988; 31(3): 315-24. https://doi.org/10.1002/art.1780310302 15. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010; 69(9): 1580-8. https://doi.org/10.1136/ard.2010.138461 16. Emery P, Breedveld FC, Dougados M, et al. Early referral recommendation for newly diagnosed rheumatoid arthritis: evidence based development of a clinical guide. Ann Rheum Dis. 2002; 61(4): 290-297. https://doi.org/10.1136/ard.61.4.290 17. Sudo?-Szopi?ska I, Jurik AG, Eshed I, et al. Recommendations of the ESSR Arthritis Subcommittee for the Use of Magnetic Resonance Imaging in Musculoskeletal Rheumatic Diseases. Semin Musculoskelet Radiol. 2015; 19(4): 396-411. https://doi.org/10.1055/s-0035-1564696 18. Toyama S, Tokunaga D, Tsuchida S, et al. Comprehensive assessment of alterations in hand deformities over 11 years in patients with rheumatoid arthritis using cluster analysis and analysis of covariance. Arthritis Res Ther. 2021; 23(1): 66. https://doi.org/10.1186/s13075-021-02448-4 19. Shiraishi M, Fukuda T, Igarashi T, et al. Differentiating Rheumatoid and Psoriatic Arthritis of the Hand: Multimodality Imaging Characteristics. Radiographics. 2020; 40(5): 1339-1354. https://doi.org/10.1148/rg.2020200029 20. Kgoebane K, Ally MMTM, Duim-Beytell MC, Suleman F.E. The role of imaging in rheumatoid arthritis. South African Journal of Radiology. 2018; 22(1). https://doi.org/10.4102/sajr.v22i1.1316 21. Drosos AA, Pelechas E, Voulgari PV. Conventional radiography of the hands and wrists in rheumatoid arthritis. What a rheumatologist should know and how to interpret the radiological fndings. Rheumatology International. 2019; 39: 1331-1341. https://doi.org/10.1007/s00296-019-04326-4 22. Salaffi F, Carotti M, Beci G, et al. Radiographic scoring methods in rheumatoid arthritis and psoriatic arthritis. Radiol Med. 2019; 124(11): 1071-1086. https://doi.org/10.1007/s11547-019-01001-3 23. Vyas S, Bhalla AS, Ranjan P, et al. Rheumatoid Arthritis Revisited – Advanced Imaging Review. Pol J Radiol. 2016; 81: 629-635. https://doi.org/10.12659/PJR.899317 24. Llopis E, Kroon HM, Acosta J, Bloem JL. Conventional Radiology in Rheumatoid Arthritis. Radiol Clin N Am. 2017; 55: 917-941. http://doi.org/10.1016/j.rcl.2017.04.002 25. Forslind K, Eberhardt K, Svensson B. Repair of Erosions in Patients with Rheumatoid Arthritis. The Journal of Rheumatology. 2019; 46 (7) 670-675. https://doi.org/10.3899/jrheum.180557 26. Smirnov AV. Atlas of X-ray diagnostics of rheumatoid arthritis. M.: IMA-PRESS, 2009 [In Russ]. 27. Van der Heijde DM. How to read radiographs according to the Sharp/van der Heijde method. J Rheumatol. 1999; 26 (3): 743-5. 28. Van der Heijde DM, Dankert T, Nieman F, et al. Reliability and sensitivity to change of a simplification of the Sharp/van der Heijde radiological assessment in rheumatoid arthritis. Rheumatology (Oxford). 1999; 38(10): 941-7. https://doi.org/10.1093/rheumatology/38.10.941 29. Mathew AJ, Danda D, Conaghan PG. MRI and ultrasound in rheumatoid arthritis. Curr Opin Rheumatol. 2016; 28(3): 323-9. https://doi.org/10.1097/BOR.0000000000000282 30. Wang MY, Wang XB, Sun XH, et al. Diagnostic value of high-frequency ultrasound and magnetic resonance imaging in early rheumatoid arthritis. Exp Ther Med. 2016; 12(5): 3035-3040. https://doi.org/10.3892/etm.2016.3695 31. Waleed MH, Sherin MSh, Gehan AG. Role of magnetic resonance imaging and ultrasonography in diagnosis and followup rheumatoid arthritis in hand and wrist joints. The Egyptian Journal of Radiology and Nuclear Medicine. 2018; 49(4): 1043. https://doi.org/10.1016/j.ejrnm.2018.05.013 32. Sapundzhieva T, Karalilova R, Batalov A. Musculoskeletal ultrasound as a biomarker of remission - results from a one-year prospective study in patients with rheumatoid arthritis. Med Ultrason. 2018; 20(4): 453-460. https://doi.org/10.11152/mu-1609 33. Tan YK, Li H, Allen JC Jr, Thumboo J. Ultrasound power Doppler and gray scale joint inflammation: What they reveal in rheumatoid arthritis. Int J Rheum Dis. 2019; 22(9): 1719-1723. https://doi.org/10.1111/1756-185X.13653 34. Sun X, Deng X, Xie W, et al. The agreement between ultrasound-determined joint inflammation and clinical signs in patients with rheumatoid arthritis. Arthritis Res Ther. 2019; 21(1): 100. https://doi.org/10.1186/s13075-019-1892-0 35. Lee KA, Min SH, Kim TH, et al. Magnetic resonance imaging-assessed synovial and bone changes in hand and wrist joints of rheumatoid arthritis patients. Korean J Intern Med. 2019; 34(3): 651-659. https://doi.org/10.3904/kjim.2016.271 36. Seifeldein GS, Moussa DK, Galal MAA, et al. Grading of Ultrasonography in Rheumatoid Arthritis of Wrist and Hand Joints. Acad Radiol. 2020; 27(7): 937-943. https://doi.org/10.1016/j.acra.2019.09.033 37. Kaeley GS, Bakewell C, Deodhar A. The impor- tance of ultrasound in identifying and differentiating patients with early inflammatory arthritis: a narrative review. Arthritis Res Ther. 2020; 22: 1. https://doi.org/10.1186/s13075-019-2050-4 38. do Prado AD, Staub HL, Bisi MC, et al. Ultrasound and its clinical use in rheumatoid arthritis: where do we stand? Adv Rheumatol. 2018; 58(1): 19. https://doi.org/10.1186/s42358-018-0023-y 39. Filippucci E, Cipolletta E, Mashadi Mirza R, et al. Ultrasound imaging in rheumatoid arthritis. Radiol Med. 2019; 124(11): 1087-1100. https://doi.org/10.1007/s11547-019-01002-2 40. Henniger M, Rehart S. Tendinopathy in rheumatic diseases. Unfallchirurg. 2017; 120(3): 214-219. https://doi.org/10.1007/s00113-016-0291-0 41. Nishino A, Kawashiri SY, Shimizu T, et al. Assessment of both articular synovitis and tenosynovitis by ultra-sound is useful for evaluations of hand dysfunction in early rheumatoid arthritis patients. Mod Rheumatol. 2017; 27(4): 605-608. https://doi.org/10.1080/14397595.2016.1253813 42. Alekseeva OG. Joint ultrasonography in rheumatoid arthritis: pathogenetic rationale, possible use in diagnosis, therapy efficiency evaluation, and outcome prediction. Nauchno-prakticheskaya revmatologiya. 2018; 56(1): 82-92 [In Russ]. https://doi.org/10.14412/1995-4484-2018-82-92 43. Szkudlarek M, Terslev L, Wakefield RJ, et al. Summary findings of a systematic literature review of the ultra-sound assessment of bone erosions in rheumatoid arthritis. J Rheumatol. 2016; 43(1): 12-21. https://doi.org/10.3899/jrheum.141416 44. Hassan R, Hussain S, Bacha R, et al. Reliability of Ultrasound for the Detection of Rheumatoid Arthritis. J Med Ultrasound. 2019; 27(1): 3-12. https://doi.org/10.4103/JMU.JMU_112_18 45. Xu H, Zhang Y, Zhang H, et al. Comparison of the clinical effectiveness of US grading scoring system vs MRI in the diagnosis of early rheumatoid arthritis (RA). J Orthop Surg Res. 2017; 12(1): 152. https://doi.org/10.1186/s13018-017-0653-5 46. El-Gohary RM, Mahmoud AAMA., Khalil A, et al. Validity of 7-Joint Versus Simplified 12-Joint Ultrasonography Scoring Systems in Assessment of Rheumatoid Arthritis Activity. J Clin Rheumatol. 2019; 25(6): 264-271. https://doi.org/10.1097/RHU.0000000000000847 47. Zou X, Zou J, Guo D, et al. Role of 7-Joint Ultrasonic Score in Predicting the Prognosis of Rheumatoid Arthritis. Iran J Radiol. 2020; 17(4): e102875. https://doi.org/10.5812/iranjradiol.102875 48. M?ller I, Loza E, Uson J, et al. Recommendations for the use of ultrasound and magnetic resonance in patients with rheumatoid arthritis. Reumatol Clin. 2018; 14(1): 9-19. https://doi.org/10.1016/j.reuma.2016.08.010 49. Rubin DA. MRI and ultrasound of the hands and wrists in rheumatoid arthritis. I. Imaging findings. Skeletal Radiol. 2019; 48(5): 677-695. https://doi.org/10.1007/s00256-019-03179-z 50. Cikutovic P, Contreras O, Burdiles ?, et al. Magnetic resonance of the hands for the diagnosis and follow-up of rheumatoid arthritis. Rev Med Chil. 2020; 148(9): 1315-1327. https://doi.org/10.4067/S0034-98872020000901315 51. ?stergaard M, Peterfy C, Conaghan P, et al. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol. 2003; 30(6): 1385-6. 52. Smirnov A.V. Golimumab therapy-induced indicators of X-ray inflammation progression and magnitude according to magnetic resonance imaging evidence in patients with rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis. Sovremennaya revmatologiya. 2013; 7(2): 75-82 [In Russ].
Abstract Aim: was to evaluate possibilities of puncture biopsy under ultrasound guidance of parasternal lymph nodes in patients with breast cancer. Material and methods: study included 34 patients with breast cancer. Criteria for inclusion in the study were: primary breast cancer with a central or medial tumor localization, and patients under observation after previously undergoing surgical treatment. All patients underwent an ultrasound examination of the breast and regional zones, including the parasternal lymphatic collector. All patients underwent biopsy. Results: in total, 39 parasternal lymph nodes suspicious on secondary lesion were detected, of which 17 (43,5%) lymph nodes had a specific lesion, 22 (56,5%) lymph nodes showed cystological signs of hyperplasia according to results of cytological examination. Parasternal lymph nodes metastases were detected in 16 (47,1%) of 34 patients included in our study. In all cases of specific lesion, lymph nodes were rounded, there was a violation of differentiation of anatomical structures, the absence of a central echo complex, a violation of differentiation and thickening of the cortical layer. In the group of primary patients, 3 (27,3%) patients with metastases in parasternal lymph nodes had distant metastases, remaining 8 (72,7%) patients, due to the lesion of the parasternal lymphatic collector, the stage of the disease were adjusted upwards (stage IIIA). Conclusion: fine-needle aspiration biopsy under ultrasound-guidance in case of suspected secondary lesion of parasternal lymph nodes, can be successfully used to obtain morphological material with minimal traumatic impact, without the use of anesthesia, which will more adequately assess the state of parasternal lymph nodes at the preoperative stage, correctly set the stage of the disease and prescribe the appropriate treatment. References 1. Хоперия В.Г. Тонкоигольная аспирационная пункционная биопсия узлов щитовидной железы: показания, техника, клиническое применение. Украинский научно-практический центр эндокринной хирургии и трансплантации эндокринных органов и тканей МЗ Украины. Номер: 1 (35), 2011 г. С. 57-67. 2. Федотов Ю.Н., Воробьев С.Л., Черников РА. Тонкоигольная аспирационная биопсия в диагностике заболеваний щитовидной железы. Корреляция между заключением цитолога и гистолога, технические аспекты. Клиническая и экспериментальная тиреоидология. 2009. Т. 5. № 4. С. 28-32. 3. Бурдюков М.С., Нечипай А.М. Тонкоигольная пункция под контролем эндоскопической ультрасонографии: осложнения и альтернативы. Российский электронный журнал лучевой диагностики. 2013. Т. 3. № 2. С. 26-37. 4. Марченко М.Г., Трофимов Е.И., Виноградов В.В. Современные методы выявления метастазов рака гортани и гортаноглотки в лимфатические узлы шеи. Российская оториноларингология. 2011. № 1 (50). С. 114-117. 5. TNM Classification of Malignant Tumours, 7th ed. Sobin L.H., Gospodarowicz M.K., Wittekind Ch., eds. New York: Wiley-Blackwell; 2009. 6. V. L. Kovalenko, M. F. Musafirov, R. V. Experience of video-assisted thoracoscopic parasternal lymph node dissection in breast cancer. Dal'nevostochnyj medicinskij zhural 2014 g. [In Russ.] 7. Ujmanov V.A., Nechushkin M.I., Trigolosov A.V.. Petrovskij A.V., Vishnevskaya YA.V., Zajceva A.A. Surgical techniques for morphological assessment of the state of the parasternal lymphatic collector as part of organ-preserving treatment in patients with breast cancer. Vestnik RONTS im. N.N. Blochina RAMN. Tom 23: 3(89), 2012: 29 34. [In Russ.] 8. McDonald E, Haagensen C.D. In: Diseases of the breast. 2nd ed. Philadelphia: W. B. Saunders; 1971. 9. Letyagin V.P., Laktionov K.P, Vysockaya I.V., Kotov V.A. Breast cancer. - M., 1996. - 150 s. [In Russ.] 10. Sinyakov A.G. Videothoracoscopic parasternal lymphadenectomy in the treatment of breast cancer. Mezhdunarodnyj zhurnal prikladnyh i fundamental’nyh issledovanij. №10, 2014. [In Russ.]
Abstract: According to current recommendations and orders of the Russian Ministry of Health, in the department of ultrasound diagnostics of the oncological center, it is necessary and lawfully to perform invasive manipulations to obtain a morphological verification of the oncological process. Nevertheless, there are significant gaps in the existing normative acts concerning organizational aspects. Aim: to conduct an analysis of the organization and results of morphological testing of malignant neoplasms in conditions of separation of ultrasonic diagnostics of the Kursk Regional Clinical Oncology Center. Materials and methods: 5,114 results of histological and immunohistochemical studies of material obtained with biopsies under ultrasound in the period 2012 - 2016 were analyzed. For the first time we included into department - 2 manipulation rooms, corresponding to sanitary requirements for conducting sterile manipulations. We first install Sonoscape S40 scanners in the manipulation rooms. All invasive examinations were performed by ambulatory and resident patients by ultrasound specialists who have a primary specialization in surgery, gynecology or urology Core biopsy was performed under local anesthesia with semi-automatic needles 14G or 16G; a gun-needle system biopsy was performed using a Bard-Magnum biopsy gun, Results. During the research, high efficiency of the proposed organizational model is revealed. A statistical relationship is revealed between the informativeness of the material and the physiciar who manipulates and organ-object. Ways of development are offered. References 1. Kaprin A.D., Starinskij V.V., Petrova G.V. The state of oncological care for the population of Russia in 2. Order of the Ministry of Health of the Russian Federation of 04.07.2017 No. 379n «On Amending the Procedure for the provision of medical care to the population in the field of oncology, approved by Order of the Ministry of Health of the Russian Federation of November15, 2012No.915n»].URL.:http://www.consultant.ru/document/cons_doc_LAW_220809/f891655c8c9f6864b656ef 38dba5a212e7e2b0e6/ (Data obrashhenija 23.10.2017) [In Russ]. 3. Chissov V.I., Dar'jalova S.L. [Oncology]. M.: «GJeOTAR-Media». 2007; 560 s [In Russ]. 4. Ponedel'nikova N.V., Korzhenkova G.P, Letjagin VP, Vishnevskaja Ja.V. Choice of the method of verifying the volume of newgrowth of the mammary gland at the preoperative stage. Opuholi zhenskoj reproduktivnoj sistemy. 2011; 1: 41-45 [In Russ]. 5. Nazarenko G.I., Hitrova A.N. Ultrasonic diagnostics of the prostate in modern oncological practice. M.: Izdatel'skij dom Vidar-M. 2012; 288s [In Russ]. 6. About the improvement of the service of radiation diagnosis: the order of the Ministry of Health of the RSFSR of August 2, 1991 № 132. URL.:http:// www.rasudm.org /information/docs.htm (Data obrashhenija 23.10.2017) [In Russ]. 7. Order of the Ministry of Health of the Russian Federation of December 27, 2011 N 1664n "ОП the approval of nomenclature of medical services". URL.:http://www.consultant.ru/cons/cgi/online.cgi?req=doc&base=LAW&n=27 8063&fld=134&dst=1,0&rnd=0.05494875175266367#0 (Data obrashhenija 04.11.2017) [In Russ]. 8. Decree of the Chief State Sanitary Doctor of the 10, 2016. URL.: http://base.garant.ru/12177989/ #ixzz4xU73XzAB (Data obrashhenija 04.11.2017) [In Russ]. 9. Attachment №2 to the order of the Ministry of Health of the 10. SPSS: the art of information processing. Analysis of statistical data and restoration of hidden regularities. Ahim Bjujul', Peter Cefel'.- DiaSoft, 2005; 608 s [In Russ].
Abstract: Aim: was to study features of ultrasonic imaging of local and septic forms of acute hematogenic osteomyelitis (AHO) in children. Materials and methods: 59 patients with AHO, treated in Children's hospital No. 4 of Tomsk, for the period from 2000 to 2010 - were examined. All patients with suspicion on osteomyelitis (n = 59; 100%) underwent x-ray of defeated area and ultrasonic diagnostics on the Ultrasonix 2,6 with the use of linear sensor of 9-12 MHz. All patients with AHO underwent surgical operation (n=59; 100%). Results: 47 patients had local form of disease. Each patient had one phase of osteomyelitis. Extramedullary phase, the development of which was due to the disease duration - was prevalencing^^,^. Prevalence of quantity of AHO phases (n=19) over total number of patients with a septic forms of disease (n=12), reflected existence of multiple osteomyelitis in four patients. In each patient with septic form of the AHO we found defeat of several bones in identical or different phases of an inflammation. Conclusion: obtained results will help the earlier identification of AHO signs and determination of disease phase in patients with local and generalized forms of disease. All that will help to proceed modern sanation of osteomyelitic defeat. Reference 1. Abaev Ju.K., Adarchenko A.A., Zafranskaja M.M. Gnojnaja hirurgija detskogo vozrasta. Menjajushhiesja perspektivy [Contaminated surgery of childhood. Changing perspectives.]. Detskaja hirurgija. 2004; 6: 4-7 [In Russ]. 2. Beljaev M.K., Prokopenko Ju.D., Fedorov K.K. K voprosu o vybore lechebnoj taktiki pri metafizarnom osteomielite u detej [The issue of choice of therapeutic tactics in the metaphyseal osteomyelitis in children.]. Detskaja hirurgija. 2007;4:27-29 [In Russ]. 3. Lobanov Ju.A., Cap N.A., Nagornyj E.A. Osnovnye principy diagnostiki i lechenija ostrogo gematogennogo osteomielita u detej [The basic principles of diagnosis and treatment of acute osteomyelitis in children.]. Konsilium 2007 g. Ural'skaja gosudarstvennaja medicinskaja akademija: 56-59 [In Russ]. 4. Zavadovskaja V.D., Polkovnikova S.A., Perova T.B. Vozmozhnosti ul'trazvukovogo issledovanija v diagnostike ostrogo gematogennogo osteomielita u detej [Possibility of ultrasonography in the diagnosis of acute osteomyelitis in children.]. Ul'trazvukovaja i funkcional'naja diagnostika. 2006;4:67-75 [In Russ]. 5. Brjuhanov A.V. MR-tomograficheskaja semiotika zabolevanij kostno-sustavnogo apparata [MR tomographic semiotics of diseases of bone and articular apparatus.]. Materialy Ill regional'noj konferencii 28--30 ijunja 2004 goda. Tomsk. 2004;248-250 [In Russ]. 6. Kotljarov P.M., Sencha A.N., Beljaev D.V. Ul'tra-zvukovaja diagnostika osteomielita [Ultrasound diagnosis of osteomyelitis.]. Ul'trazvukovaja i funkcional'naja diagnostika. 2008;5:110-120 [In Russ]. 7. Tas F., Oguz S., Bulut O. et al. Comparison of the diagnosis of plain radiography ultrasonography and magnetic resonance imaging in early diagnosis of acute osteomyelitis experimentally formed on rabbits. Eur. J. Radiol. 2005; 56 (1): 107-112. 8. Fitoussi F., Litzelmann E., Ilharreborde B. et al. Hematogenous osteomyelitis of the wrist in children. J. Pediatr. (Orthop. 2007; 27(7): 810-813. 9. Marochko N.V., Pykov M.I., Zhila N.G. Ul'trazvukovaja semiotika ostrogo gematogennogo osteomielita u detej [Ultrasonic semiotics of acute hematogenic osteomyelitis in children.]. Ul'trazvukovaja i funkcional'naja diagnostika. 2006;4:55-66 [In Russ].
Abstract: The main part of the research is given to radiodiagnostics of tubercolisis lesion of backbone (traditional x-ray, ultrasound diagnostics, computed tomography, magnetic resonance imaging). We have exmined 452 patients: 40 patients (8,8%) had cervical spine lesions, 185 patients (41%) - thoracic spine lesions, thoracic-lumbar spine - 75 patients (16,8%), lumbar spine - 141 patients (31,1%), lumbar-sacral spine - 11 patients (2,5%). It is especially marked that combination of lungs tuberculosis and spondylitis is higher not only in patients with antibiotic resistant infection but n patients with tuberculosis combined with AIDS. References 1. Митусова Г.М. Лучевая диагностика туберкулезного спондилита у взрослых, осложненного неврологическими расстройствами. Дис. на соиск. к.м.н. С.-Пб. 2002. 2. Советова Н.А., Савин И.Б., Мальченко О.В. и др. Лучевая диагностика внелегочного туберкулеза. Проблемы туберкулеза. 2006; 11: 7-9. 3. Руководство по легочному и внелегочному туберкулезу. Под ред. Ю.Н. Левашева и Ю.М. Репина. ЭЛБИ-С.-Пб. 2008; 273-283. 4. Васильев А.В. Современные проблемы туберкулеза в регионе Северо-Запада России. Проблемы туберкулеза. 1999; 3: 5-7. 5. Лавров В.Н. Диагностика и лечение больных туберкулезным спондилитом. Проблемы туберкулеза. 2001; 4: 30-32. 6. Гусева Н.И., Иванов В.М., Потапенко Е.И. и др. Иммунный статус больных активным туберкулезным спондилитом. Проблемы туберкулеза и болезней легких. 2003; 6: 25-28. 7. Селюкова Н.В. Зонография в диагностике туберкулеза позвоночника на поликлиническом этапе. Проблемы туберкулеза и болезней легких. 2008; 11, 21-23. 8. Мердина Е.В., Митусова Г.М., Советова Н.А. Ультразвуковая диагностика забрюшинных абсцессов при туберкулезе позвоночника. Проблемы туберкулеза. 2001; 4: 19-21. 9. Лукьяненок П.И. Магнитно-резонансная томография в диагностике туберкулезного спондилита. Руководство для врачей. 2008. 10. Щ Советова Н.А., Джанкаева О.Б., Кравцова О.С. и др. Туберкулезный спондилит взрослых в условиях генерализации инфекции и лекарственной резистентности возбудителя. Невский радиологический форум 2-5 апреля 2011 г. С.-Пб.: Научные материалы. 2011; 223-224. 11. Шилова М.В. Туберкулез в России в 2009 г. М. 2009; 159-161.
Abstract: Aim: was to determine possibilities of ultrasound in estimation of the status of parathyroid glands (PTG) in patients with secondary hyperparathyroidism (SHPT) treated with percutaneous ethanol injections. Materials and methods: we examined 200 patients with end-stage of renal disease on dialysis. Enlargement and structural alteration of PTG were noted in 125 patients (62,5 %). Higher level of intact parathyroid hormone (iPTH) over 300 pg/ml was noted in the majority of patients with diagnosed parathyroic hyperplasia (81,6 %). Percutaneous ethanol injection therapy under ultrasound guidance was performed in 13 patients with SHPT resistant to medical therapy Average number of injections was 2,8 (from 1 to 6). Treatment effect was assessed based on iPTH level, calcium-phosphorus product level, as well as ultrasound evaluation. Results: statistically significant decrease of iPTH after injections was noted averaging by 57,3% (p=0,0007), calcium-phosphorus product - by 12,2% (p=0,003). The biggest effect was noted in case of single hyperplastic PTG. During the follow-up, tendency to continued decreasing in levels of iPTH remained in 61,5 %. Decrease of the largest dimension of PTG after ethanol injections was noted on average by 15,1%, decrease of volume by 31,6%. Significant decrease in systolic velocity as well as resistive index of the feeding artery of PTG were observed (p=0,001 and 0,03 respectively). An important sign of diminished functional activity in the injected gland was statistically significant decrease in the vascularization index as assessed by the color Doppler during the process of injections (p=0,002). Conclusion: ultrasound method provides information necessary for patients' selection for conduction of percutaneous ethanol injection therapy It assists at the time of the manipulation as well as during the follow-up assessing the condition of PTG and effectiveness of treatment. References 1. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int. 2009; 113: 1-130. 2. Cunningham J., Locatelli F., Rodriguez M. Secondary Hyperparathyroidism: Pathogenesis, Disease Progression, and Therapeutic Options. Clin. J. Am. Soc. Nephrol. 2011;6: 913-921. 3. Fukagawa M., Nakanishi S., Kazama J.J. Basic and clinical aspects of parathyroid hyperplasia in chronic kidney diseases. Kidney Int. 2006; 70 (102): 3-7. 4. Tominaga Y, Matsuoka S., Sato T. et al. Clinical features and hyperplastic pattern of parathyroid glands in hemodialysis patients with advanced secondary hyperparathyroidism refractory to maxacalcitol treatment and required parathyroidectomy. Ther. Dial. Apher. 2007; 11: 266-273. 5. Latus J., Renate Lehmann R., Roesel M. et al. Analysis of -Klotho, Fibroblast Growth Factor, Vitamin-D and Calcium-Sensing Receptor in 70 Patients with Secondary Hyperparathyroidism. Kidney Blood Press Res. 2013; 37: 84-94. 6. Tokumoto M., Taniguchi M. The mechanisms of parathyroid hyperplasia and its regression. Clin. Calcium. 2007; 17 (5): 665-676. 7. Onoda N., Fukagawa M., Tominaga Y et al. New clinical guidelines for selective direct injection therapy of the parathyroid glands in chronic dialysis patients. Nephrol. Dial. Transplant. Plus. 2008; 1 (3): 26-28. 8. Solbiati L., Giangrande A., Pra L.D. et al. Percutaneous ethanol injection of parathyroid tumor under US guidance: treatment for secondary HPT. Radiology. 1985; 155: 607-610. 9. Gerasimchuk R., Zemchenkov A., Kondakov S. Maloinvazivnyj metod korrekcii vtorichnogo giperparatireoza pri hronicheskoj bolezni pochek. [Miniinvasive technique in the correction of secondary hyperparathyroidism in cronic renal disease]. Vrach. 2009; 11: 15-22 [in Russ]. 10. Fukagawa M., Kitaoka M., Tominaga Y et al. Guidelines for percutaneous ethanol injection therapy of the parathyroid glands in chronic dialysis patients. Nephrol Dial Transplant. 2003; 18 (3): 31-33. 11. Koiwa F., Kakuta T., Tanaka R. et al. Efficacy of percutaneous ethanol injection therapy (PEIT) is related to the number of parathyroid glands in hemodialysis patients with secondary HPT. Nephrol. Dial. Transplant. 2007; 22: 522-528. 12. Yumita S. Intervention for recurrent secondary hyperparathyroidism from a residual parathyroid gland. Nephrol. Dial. Transplant. 2003; 18 (3): 62-64. 13. Polukhina E.V., Glazun L.O. Ul'trazvukovaja diagnostika patologii parashhitovidnyh zhelez u bol'nyh hronicheskoj pochechnoj nedostatochnost'ju, nahodjashhihsja na zamestitel'noj pochechnoj terapii. [Ultrasound diagnosis of the parathyroid glands pathology in patients being on replacement therapy in case of chronic renal insufficiency]. Ul'trazvukovaja i funkcional'naja diagnostika. 2008; 1: 35-42 [in Russ]. 14. Anari H., Bashardoust B., Pourissa M. The Diagnostic Accuracy of High Resolution Ultrasound Imaging for Detection of Secondary Hyperparathyroidism in Patients with Chronic Renal Failure. Acta Medica Iranica. 2011; 49 (8): 527-530. 15. Meola M., Petrucci I., Cup-isti A. Ultrasound in clinical setting of secondary hyperparathyroidism. J. Nephrol. 2013; 26 (5): 848-855. 16. National Kidney Foundation. K/DOQI clinical practice guidelines for Bone Metabolism and Disease in Chronic Kidney Disease // Am. J. Kidney Dis. 2003; 42: 1-202. 17. Kakuta T., Tanaka R., Kanai G. et al. Can cinacalcet replace parathyroid intervention in severe secondary hyperparathyroidism? Ther. Apher. Dial. 2009; 13 (1): 20-27. 18. Kalinin A.P., Pavlov A.V., Aleksandrov Ju.K. et al. Metody vizualizacii okoloshhitovidnyh zhelez i paratireoidnaja hirurgija: rukovodstvo dlja vrachej; Pod. red. A.P. Kalinina. [Parathyroid imaging techniques and parathyroid surgery: The management for doctors. Ed. A.P. Kalinin]. M.: Vidar M, 2010; 311 [in Russ]. 19. Chen H.H., Lu K.C., Lin C.J. et al. Role of the Parathyroid Gland Vascularization Index in Predicting Percutaneous Ethanol Injection Efficacy in Refractory Uremic Hyperparathyroidism. Nephron Clin. Pract. 2010; 117 (2): 120-126.
Abstract: Aim: was to increase the level of differential diagnosis of thyroid nodules by evaluating their rigidity according to two ultrasound techniques - compressive elastography and shear wave elastography. Materials and methods: study is based on the result of analysis of complex clinical anc ultrasound diagnostics, performed for the period from 2010 to 2015 , on the base of ultrasound department of «Central Clinical Hospital of Ministry of Internal Affairs» of the RF in Moscow, and Medical Radiological Research Center named after AF Tsyba - FGBU branch of «National Medical Research Radiological Center» MoH Obninsk. Results: performed shear wave elastography, obtained quantitative data of rigidity of benign nodules and papillary carcinoma. Used methods of nonparametric statistics and ROC-analysis. Statistical processing was performed in SPSS 13.0 program. For benign nodes median of regidity was 15.6; 2,5-97,5 percentiles - 3,6-81,3; for papillary cancer: median 112.92; 2,5-97,5 percentiles - 13,5-196,4. Then followed an orange and yellow-red: blue color was not more than 20%, but mostly he was absent. In case of papillary cancer we observed two-color, three-color, four-color and six-color color, with prevailing of two colors - purple and blue. Conclusions: both types of elastography - compressive and shear wave elastography - help to improve the differential diagnosis of thyroid cancer. Informativeness of shear wave elastography is higher, in comparison with compressive elastography. References 1. Kotljarov P.M., Harchenko V.P., Aleksandrov Ju.K., Mogunov M.S., Sencha A.N., Patrunov Ju.N., Beljaev D.V. Ul'trazvukovaja diagnostika zabolevanij shhitovidnoj zhelezy [Ultrasonic diagnosis of thyroid diseases.]. M.: VIDAR. 2009: 239S [In Russ]. 2. Mit'kov V.V., Huako S.A., Cyganov S.E., Kirillova T.A., Mit'kova M.D. Sravnitel'nyj analiz dannyh jelastografii sdvigovoj volnoj i rezul'tatov morfologicheskogo issledovanija tela matki (predvaritel'nye rezul'taty) [Comparative analysis of data of shear wave elastography and results of uterine body morphological study (preliminary results)]. Ul'trazvukovaja i funkcional'naja diagnostika. 2013; 5: 99-114 [In Russ]. 3. Sencha A.N., Mogutov M.S., Patrunov U.N. et al. Kolichestvennie i kachastvennie pokazateli ul’trazvukovoi jelastografii v diagnostike raka shhitovidnoj zhelezy [Quantitative and qualitative indicators of ultrasound elastography in the diagnosis of thyroid cancer.]. Ul'trazvukovaja ifunkcional'naja diagnostika. 2013; 5: 85-98 [In Russ]. 4. Osipov L.V. Tehnologii jelastografii v ul’trazvukovoi diagnostike. Obzor. [ Elastography technologies in ultrasound diagnostics. Overview.] Diagnosticheskaya radiologiya i onkoterapiya. 2013; 3,4: 5-23 [In Russ]. 5. Parshin V.S., Yamasita C, Cib A.F. Zob. Ul'trazvukovaja diagnostika. Klinicheskii atlas [Ultrasound diagnostics. Clinical atlas]. Nagasaki-Obninsk. Universitet Nagasaki, 2000; S 106 [In Russ]. 6. Parshin V.S., Cib A.F., Yamasita C. Rak shhitovidnoj zhelezy. Ul'trazvukovaja diagnostika. Klinicheskii atlas [Thyroid cancer. Ultrasound diagnostics. A clinical atlas. In Chernobyl materials.]. Po materialam Cyernobilya. Obninsk. MRNC RAMN. 2002; S 230 [In Russ]. 7. Parshin V.S.,Yamashita S., Tsyb A.F. Ultrasound Diagnosis of Thyroid Diseases in Russia. Obninsk-Nagasaki. 2013; S147. 8. Cib A.F., Parshin V.S., Yamasita C. Ul'trazvukovaja diagnostika zabolevanij shhitovidnoj zhelezy [Ultrasonic diagnosis of thyroid diseases.]. M.: Medicina. 1997; S 329 [In Russ]. 9. Asteria C., Giovanardi A., Pizzocaro A., Cozzaglio L., Morabito A., Somalvico F., Zoppo A. US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid. 2008; 18: 523-531. 10. Cantisani V., D'Andrea V., Biancari F., Medvedyeva O., Di Segni M., Olive M., Patrizi G., Redler A., De Antoni E.E., Masciangelo R., Frezzotti F., Ricci P Prospective evaluation of multiparametric ultrasound and quantitative elastosonography in the differential diagnosis of benign and malignant thyroid nodules: preliminary experience. Eur. J. Radiol. 2012; 81: 2678-2683. 11. Vorlander C., Wolff J., Saalabian S., Lienenluke R.H., Wahl R.A. Real-time ultrasound elastographya non-invasive diagnostic procedure for evaluating dominant thyroid nodules Langenbecks Arch. Surg. 2010; 395: 865-871. 12. Bojunga J., Herrmann E., Meyer G., Weber S., Zeuzem S., Friedrich-Rust M. Real-time elastography for the differentiation of benign and malignant thyroid nodules: a metaanalysis Thyroid. 2010; 20: 1145-1150. 13. Gharib H., Papini E., Paschke R., Duick D.S., Valcavi R., Hegedus L., Vitti P American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr. Pract. 2010;16: 1-43. 14. Moon H.J., Kim E.K., Yoon J.H., Kwak J.Y Clinical implication of elastography as a prognostic factor of papillary thyroid microcarcinoma. Ann. Surg. Oncol. 2012; 19: 2279-2287.
