The aim of the study was to continue hepatocellular carcinoma contrast enhancement characteristics evaluation in cirrhotic and non-cirrhotic liver. Retrospective analysis of 56 patients with morphologically verified hepatocellular carcinoma examination results was carried out. All patients were divided into two groups according to the clinical and morphological data: group 1 - 36 patients with cirrhosis, group 2 - 20 patients without cirrhosis. Liver CEUS was performed in all patients with ultrasound contrast agent (UCA) Sonovue (Bracco Swiss SA, Switzerland). Aixplorer (SuperSonic Imagine, France) with a convex 1-6 MHz probe and Acuson S2000 (Siemens, Germany) with a convex 2-6 MHz probe were used in the study. UCA arrival time to the liver parenchyma (beginning of the arterial phase) in group 1 (patients with cirrhosis) was significantly faster than in group 2 (patients without cirrhosis) (P = 0.001). UCA tumor wash-in and wash-out parameters were not significantly different in patients with liver cirrhosis and without one. Statistically significant moderate correlation was found between the tumor size and the hypoperfusion areaspresence (r_s = 0.47, P = 0.000). HCC, regardless of the tumor differentiation degree, were characterized by the UCA wash-out beginning after the 62^nd s after contrast administration. There were tumor wash-out values significant differences between the subgroups G1 and G2 and the subgroup G3 (P < 0.05). Wash-out beginning time <79 s sensitivity and specificity in HCC G3 degree predicting were 95.7 and 90.0%, maximum wash-out time <270 s - 69.6 and 90.0%, respectively.

The aim of the study was to evaluate the capabilities of point shear wave elastography (ARFI- elastometry) in liver fibrosis staging in patients with non-viral chronic diffuse liver diseases. The main group included 47patients with morphologically verified non-viral chronic diffuse liver diseases (autoimmune hepatitis - 9, Gilbert syndrome - 2, non-alcoholic fatty liver disease - 2, primary biliary cirrhosis - 14, primary sclerosing cholangitis - 5, toxic hepatitis - 6, chronic hepatitis of unknown etiology - 9). Control group consisted of 32 healthy volunteers. ARFI-elastometry was performed with the use of the Acuson S2000 ultrasound system (Siemens, Germany) with a convex 1-6 MHz probe. There was no significant difference in liver stiffness values between patients from control group and patients from main group with the liver fibrosis F0 and F1. But there was significant difference in liver stiffness values between patients from control group and patients from main group with the liver fibrosis F2, F3, and F4. The strong correlation (rs = 0.778, P < 0.001) between liver stiffness values in non-viral chronic diffuse liver diseases and liver fibrosis stages according to Metavir was found. Shear wave velocity cut-off value ≥ 1.39 m/s for the detecting of F ≥ 2 stage of liver fibrosis showed sensitivity 90.3%, specificity 68.8%, and AUC 0.800. Cut-off value ≥ 1.44 m/s for diagnosing stage F ≥ 3 fibrosis showed sensitivity 100.0%, the specificity 86.3%, and AUC 0.930. Cut-off value ≥ 1.89 m/s for diagnosing stage F4 fibrosis showed sensitivity 95.1%, specificity 96.7%, and AUC 0.950. ARFI-elastometry can be used in clinical practice for the liver fibrosis staging in non-viral chronic diffuse liver diseases.

The results of CEUS of the kidneys, performed in 93 patients with renal tumors (72 (77.4%) - malignant, 21 (22.6%) - benign), were analyzed. The examinations utilized Epiq 7 scanner (Philips, Netherlands) with QLAB software (Philips, Netherlands) and the Sonovue (Bracco Swiss SA, Switzerland) as ultrasound contrast agent. The qualitative CEUS analysis was performed in all 93 patients as the first step. The quantitative CEUS analysis was performed in 50 patients (29 (58.0%) with malignant tumors and 21 (42.0%) with benign ones) as the second step. Statistical analysis was carried out in accordance with standard qualitative parameters at the first stage and standard quantitative parameters (ascending slope (AS, dB/s), time to peak (TTP, s), peak intensity (PI, dB)) and their derivatives (indices), calculated as the ratio of tumor/normal parenchyma parameter value (AS index, TTP index, PI index) at the second step. Malignant tumor washout time was significantly shorter compared with the benign tumors (P = 0.001) and with the adjacent parenchyma (cortical layer) (P < 0.0001) (qualitative analysis). Malignant tumors AS index was significantly higher than in the benign ones (P < 0.000) (quantitative analysis). The test “tumor washout time ≤94 s - malignant renal tumor” was characterized by AUC 0.749, sensitivity 86.1%, specificity 61.9% (qualitative analysis). The test “AS index > 0.81 - malignant renal tumor” was characterized by AUC 1.000, sensitivity 100.0%, specificity 100.0% (quantitative analysis). After diagnosis of malignant renal masses using AS index threshold value 0.81 (1^st step), it is possible to predict the degree G > 1 (G2 and higher) with a TTP index threshold value 0.95 (AUC - 0.900, sensitivity - 85.0%, specificity - 88.9%) (≤0.95) (2^nd step). The study had some limitations, which requires further research for results confirmation.

The aim of the study was to assess the strain elastography value in myometrium changes according to the delivery method. The study included 159 women with full-term pregnancy, 30 of them after spontaneous labor (control group) and 129 after cesarean section (main group). The cesarean section was performed during the labor in 85 patients and before the onset of labor in 44 patients. The postpartum (postoperative) period was uncomplicated in all cases. The B-mode ultrasound was performed as a first step. At the second step, the elasticity of different parts of the uterus (anterior wall of the uterus, scar (isthmus), cervix) was evaluated with real-time tissue elastography. Elasticity indices (ratio of the region of interest elasticity to the reference area elasticity) were calculated. The reference area was in the posterior wall close to the uterine fundus. In all 159 cases examinations were performed on the 4^th day after delivery and additionally in 3 month after spontaneous labor in 26 women and after cesarean section in 34 women. The elasticity of the uterine tissue in the scar area was lower in compare to the other parts of the uterus in the early postoperative period and 3 months after delivery. The decrease of the elasticity was the most notable on the 4^th day after prelabor cesarean section. In 3 month the differences in elasticity indices values between groups of the prelabor and intrapartum cesarean section was not significant. Another feature was the combination of the low scar elasticity with the higher elasticity of the surrounding uterine tissue. Strain elastography allows to assess the myometrium elastic proprieties and to identify signs specific to the delivery method.

The article presents a description of the combined 11⁺¹-13⁺⁶ weeks preeclampsia and intrauterine growth restriction screening test based on FMF algorithm. The individual risks for preeclampsia and intrauterine growth restriction were calculated at the same time with Down syndrome screening. The screening for preeclampsia and intrauterine growth restriction was done by a combination of maternal factors, mean arterial pressure, uterine artery pulsatility index, pregnancy-associated plasma protein-A (PAPP-A) level and placental growth factor (PlGF) in the maternal blood. The predictive value of the each parameter of combined test is presented in the paper. The diagnostic significance and practical advantages of the early screening test for preeclampsia and intrauterine growth restriction according to FMF algorithm compared to the performance of screening for preeclampsia based on the risk factors from the medical history only were outlined.

The aim of the study was to assess the value of ultrasound elastography in the parathyroid glands pathology assessment in patients with secondary hyperparathyroidism, including the differential diagnosis of parathyroid hyperplasia types. A total of 76 patients with chronic kidney disease stage 5, treated with renal replacement therapy, were examined. Parathyroid glands enlargement with structural changes was found in 45 (59.2%) patients (66 parathyroid glands). A multiparametric parathyroid ultrasound (B-mode ultrasound, Color Doppler, strain and shear wave elastography) was performed. Hyperplastic parathyroid glands were mostly soft in strain elastography. Elastographic patterns types I and II were predominant (86.4%). Young’s modulus median in the hyperplastic parathyroid glands was 11.4 kPa, 5-95^th percentiles - 8.0-25.2 kPa, and the lowest - highest values - 7.2-30.2 kPa. Parathyroidectomy was performed in 9 patients. After morphological study of 23 parathyroid glands, diffuse hyperplasia was found in 9 (39.1%) of them and nodular in 14 (60.9%) ones. Significant differences in strain ratio (P = 0.02), Young’s modulus (P = 0.009), and stiffness index (P = 0.012) were found in diffuse type of hyperplasia in compare with nodular. The Young’s modulus median in diffuse parathyroid hyperplasia was 9.9 kPa (7.2-15.2 kPa and 7.2-15.2 kPa), in nodular parathyroid hyperplasia - 13.4 kPa (9.5-30.2 kPa and 9.5-30.2 kPa). There were a significant correlations between Young’s modulus and the largest linear dimension and parathyroid gland volume (r_s = 0.384, P = 0.002 and r_s = 0.326, P = 0.008), Young’s modulus and intensity of parathyroid vascularization (r_s = 0.327, P = 0.010). The significant correlation between elastographic pattern types and types of hyperplasia was found (r_s = 0.677, P <0.001). Ultrasound elastography, as a part of multiparametric parathyroid ultrasound, allows obtaining additional diagnostic information in patients with secondary hyperparathyroidism.