[Ultrasound in a differentiated treatment approach for liver diseases]. / Ul'trazvukovoe issledovanie v vybore taktiki lecheniya bol'nykh s zabolevaniyami pecheni.

OBJECTIVE: Prospective assessment of the proposed diagnostic algorithm aimed at increasing the reliability of diagnosis of diffuse and focal liver diseases, reducing diagnostic invasiveness, economic costs, developing management strategy of patients with liver tumors and early diagnosis of hepatocellular carcinoma. MATERIAL AND METHODS: A prospective case-control study included 336 patients with a preliminary diagnosis of diffuse focal liver damage for the period from January 2015 to April 2019. RESULTS: The authors described a diagnostic algorithm for focal liver lesions based on various ultrasound modes including gray-scale scanning (B-mode), Doppler ultrasound and pulse-wave Doppler. Moreover, 2D-SWE for assessing the liver stiffness and fibrosis grade (METAVIR grading system) and CEUS for differential diagnosis of liver neoplasms are applied.

[Contrast-enhanced ultrasound in differential diagnosis of focal liver lesions]. / Ul'trazvukovoe issledovanie s kontrastnym usileniem v differentsial'noi diagnostike ochagovykh novoobrazovanii pecheni.

AIM: To continue studying the features of visualization of focal liver lesions by using of contrast-enhanced ultrasound (CEUS). MATERIAL AND METHODS: A retrospective analysis included 106 patients with morphologically confirmed benign liver tumors and metastases (MTS). Patients were divided into groups regarding morphological criteria: focal-nodular hyperplasia (FNH) - 22 patients, hemangiomas - 26, hepatocellular adenoma (HCA) - 15 and 43 patients with liver MTS. All patients underwent multiparametric ultrasound examination with CEUS. RESULTS: Characteristic signs of FNH are early contrasting in the arterial phase (AF) and significantly different 'contrasting onset in focus' in comparison with hemangiomas (p<0.001), HCA and MTS (p<0.05). Specific signs: 'spokes of the wheel' symptom and advanced contrast accumulation (96%), 'center-to-edge' filling (86%). There was no contrasting in AF in 42% of patients with hemangiomas. Specific signs are 'peripheral nodular exacerbation' (92%) and 'edge-to-center' filling (76%). WASH-OUT sign is not typical. HCA is characterized by complete (100%) and intensive (80%) centripetal filling. WASH-OUT sing was detected in 6 (40%) patients (p<0.001 for 'wash-out onset' and p<0.005 for 'maximum wash-out time' in comparison with MTS). We did not find specific types of vascular pattern. The most important differential sign of MTS was WASH-OUT sign (100%). Me of 'wash-out onset' sign was 40 (35-56) seconds. Specific signs: 'black hole' symptom - 50% of patients, asymmetric vascular pattern - 39.5%, circumferential exacerbation (27.9%) and hypoperfusion zones in AF (32.6%).