The aim of the study was to identify the most informative absolute quantitative parameters of contrast enhanced transrectal ultrasound in the diagnosis of prostate cancer. The study group consisted of 75 patients with suspected prostate cancer (based on the results of digital rectal examination and/or increased level of total prostate-specific antigen in the presence of suspicious (hypoechoic) foci in the peripheral zone of the prostate on grayscale transrectal ultrasound. In all cases contrast enhanced transrectal ultrasound was performed before the final diagnosis was established. Ultrasound examinations were performed using Epiq 5 (Philips, Netherlands) with high-frequency (4-10 MHz) intracavitary probe. SonoVue (Bracco Swiss S.A., Switzerland) was used as ultrasound contrast agent. Hypoechoic foci - pre-selected regions of interest for quantitative contrast enhanced transrectal ultrasound - were underwent to targeted prostate biopsy. The studied foci were divided into two groups, depending on the results of histological examination: the foci with verified prostate cancer (n = 30) (main group with prostate cancer) and foci with absence of prostate cancer (n = 45) (control group without prostate cancer). The following parameters of time-intensity curve were analyzed: 1) wash-in rate (WIR), dB/s; 2) time to peak (TTP), s; 3) peak intensity (PI), dB; 4) mean transit time (MTT), s; 5) descending time/2 (DT/2), s; 6) rise time (RT), s. Statistically significant differences of WIR (P = 0.0026) and RT (P = 0.0047) between the groups were obtained. The test “WIR > 2.114 dB/s - prostate cancer” is characterized by sensitivity of 50.0%, specificity of 84.4%, positive predictive value of 68.2%, negative predictive value of 71.7%, AUC of 0.706. The test “RT ≤ 6.718 s - prostate cancer” is characterized by sensitivity of 70.0%, specificity of 66.7%, positive predictive value of 58.3%, negative predictive value of 76.9%, AUC of 0.694. Statistically significant correlations of the Gleason sum with WIR (r_S = 0.521, P = 0.0032), TTP (r_S = -0.503, P = 0.0046), and PI (r_S = 0.378, P = 0.0393) were obtained. The use of absolute quantitative parameters of contrast-enhanced transrectal ultrasound can improve the efficiency of targeted prostate biopsies.

Clinical case of follow up after radiofrequency ablation of tumor in solitary kidney by contrast-enhanced ultrasound is presented. A metachronous multiple primary cancer was diagnosed in patient N., 49 years old. A right radical nephrectomy (right kidney cancer, pT2N0M0, stage II) was performed in 2010, and a radiofrequency ablation of tumor in solitary left kidney (left kidney cancer, cT1N0M0, stage I) - in June 2016. The contrast-enhanced ultrasound control examination, performed in September 2016 (in 3 months after radiofrequency ablation), demonstrated nonenhancing ablation area during the arterial and venous phases. The contrast-enhanced ultrasound findings confirmed by contrast-enhanced computed tomography in December 2016 (in 6 months after radiofrequency ablation). The presented clinical case demonstrates the contrast-enhanced ultrasound value in the assessment of radiofrequency ablation of renal tumors.

The aim of this study was to test the performance of ultrasound examination in the third trimester of pregnancy in prediction of small-to-gestational age term neonates. This was a retrospective analysis of the results of ultrasound examinations of 1 151 singleton pregnancies with anatomically healthy fetuses, carried out in Fetal Medicine Center Medica (Moscow) in 2015-2017 at gestational age of 11⁺¹-13⁺⁶ weeks, 30⁺⁰-33⁺⁶ weeks, and 35⁺⁰-36⁺⁶ weeks of pregnancy. The gestational age was determined by fetal crown-rump length at 11⁺¹-13⁺⁶ weeks of pregnancy. In the third trimester of pregnancy the estimated fetal weight was calculated using the Hadlock formula, based on the biparietal size, circumferences of the head and abdomen, and the length of fetal femur. The main outcome was the birthweight of a full-term newborn of less than 10th percentile. Finally, 1 087 (94.44%) newborns had birthweight ≥10th percentile. 64 (5.56%) full-term newborns had birthweight <10th percentile - were small-to-gestational age term. ROC-analysis established the good quality of the model for predicting of small-to-gestational age term based on the estimated fetal weight at 30⁺⁰-33⁺⁶ weeks (AUC - 0.830, 95% confidence interval - 0.760-0.902) and at 35⁺⁰-36⁺⁶ weeks of pregnancy (AUC - 0.888, 95% confidence interval - 0.818-0.958). At the gestational age of 30-34 weeks, in order to achieve effective prediction of small-to-gesta tional age term with a selected sensitivity of 80%, patients with estimated fetal weight <42nd percentile could be rescanned at 35⁺⁰-36⁺⁶ weeks of pregnancy. At this gestational age cases with estimated fetal weight <23rd percentile should be managing as a high risk of small-to-gestational age term and perinatal complications. An improvement of prediction of cases with a high risk of small-to-gestational age term can be achieved by scheduling of ultrasound examinations later in pregnancy.

The aim of the study was to compare the effectiveness of the ROMA and RMI algorithms in the ovarian masses malignancy prediction. A total of 188 women with uni- or bilateral ovarian masses were examined. Postoperative histological evaluation was performed in all patients. In 126 (67.0%) of them benign ovarian masses were revealed (first group), in 62 (33.0%) ovarian masses were malignant (second group). The menopause subgroup of the first group consisted of 78 out of 126 (61.9%) patients, of the second group - 48 out of 62 (77.4%) (P < 0.05). When comparing groups and subgroups of patients, significant differences of ROMA and RMI values were obtained (P < 0.05). The RMI has higher diagnostic accuracy compared to the ROMA (AUC, sensitivity, and specificity of 0.93, 85.5%, and 96.8% versus 0.89, 87.1%, and 83.3%, respectively). The RMI assessing can be recommended as the first step of the ovarian masses characterization.

Diagnosis of heart failure with preserved ejection fraction is challenging due to many patients have only mild left ventricular diastolic dysfunction and normal left ventricular filling pressure at rest. The diastolic transthoracic stress echocardiography with incremental workload (diastolic stress test) refers to the assessment of the diastolic function during exercise, thus enhancing the verification of heart failure with preserved ejection fraction. The present expert consensus statement provides the clinical and pathophysiological rationale for diastolic stress test in the evaluation for heart failure with preserved ejection fraction, the methodology of diastolic stress test, the principles of data interpretation, and applicability for the specific groups of patients.

The article analyzes the current regulatory documents governing the operation of the diagnostic ultrasound service. An example of work standardization of a multidisciplinary hospital department of diagnostic ultrasound is considered, including the creation of internal regulatory documents.