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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.

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.

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.

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. The possibilities of ultrasound elastography of the lymph nodes as an additional technique for the intermediate control of treatment of patients with Hodgkin’s lymphoma are determined.Materials and methods. A prospective study included patients with a diagnosis of classical Hodgkin’s lymphoma with affected superficial lymph nodes. Patients underwent ultrasound elastography (compression elastography and shear wave elastography) of the enlarged lymph nodes before treatment and after two cycles of chemotherapy. The reasons for the ultrasound examination of superficial lymph nodes after the second chemotherapy cycle were: an earlier ultrasound examination with revealed changes in the superficial lymph nodes (in 100% of cases), preservation of the palpable formation in the projection of the superficial lymph nodes (in 56.9% of cases). Before ultrasound elastography of the studied group of patients, the positive dynamics after two cycles of chemotherapy was confirmed by PET/CT (Deauville scale 2—3).Results and conclusion. According to strain elastography, stiff heterogeneous (third type of elastogram) and stiff structure (fourth type of elastogram) of affected lymph nodes were noted in 53.5 and 42.3% of cases, respectively, before treatment. After two cycles of chemotherapy, these types of elastogram were 52.1 and 43.7% of cases, respectively. According to the results of shear wave elastography before and after treatment, a decrease in the average shear wave velocity in the affected lymph nodes from 2.67 + 0.69 to 2.21 + 0.40m/s (p = 0.000003) was revealed.

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.

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.