Shestakova, Daria Yuryevna

Shestakova D.Y., Borsukov A.V.

Rationale: Due to rising prevalence of metabolic syndrome, obesity and type 2 diabetes mellitus, the prevalence of metabolic-associated hepatic steatosis has amounted to 38–42% worldwide. The burden of its dangerous complications, such as steatohepatitis, liver fibrosis and cirrhosis, hepatocellular carcinoma, make the search for effective diagnostic methods of liver steatosis a priority. However, lack standardization of assessments reduces the accuracy and reproducibility of their results and requires elaboration of unified protocols for such assessments. Aim: To develop a unified algorithm for quantitative ultrasound steatometry of the liver and to evaluate its diagnostic accuracy (sensitivity, specificity, and reproducibility). Methods: This was a three step study, with its 1st part including 34 specialists on echography diagnostics aged 28 to 64 years with varying levels of experience (1 to 3 years, n = 5, 15.6%; 4 to 10 years, n = 18, 50%; 11 to 20 years, n = 8, 25%; ≥ 21 years: n = 3, 9.4%). The accuracy of quantitative ultrasound steatometry procedure evaluated with a test questionnaire, by analysis of archived echograms (340 clinical cases), and real-time ultrasound steatometry performed in 102 patients under the direct or remote supervision of the authors. In the 2nd part of the study we examined 173 patients with liver steatosis confirmed by multiparametric echography, comprehensive clinical and biochemical SteatoTest, magnetic resonance spectroscopy, multiaxial computed tomography with color mapping, dual-energy X-ray absorptiometry in the "whole body" mode, and histological examination of liver biopsy samples. In the 3rd part of the study we assessed the reproducibility of the quantitative ultrasound steatometry algorithm proposed by the authors, 12 ultrasound diagnostic physicians with varying levels of experience were involved (1 to 3 years: n = 3; 4 to 10 years: n = 3; 11 to 20 years: n = 3; more than 21 years: n = 3). Each physician examined 20 patients (5 patients in groups with no steatosis and with histologically confirmed steatosis of grades 1 to 3). Results: In the 1st part of the study, we identified the main patterns of quantitative ultrasound steatometry of the liver by specialists in the ultrasound diagnostics. Based on the international and Russian guidelines, as well as our own research, we proposed standardized operational procedure for quantitative ultrasound steatometry. The comparative analysis in the 2nd part of the study showed that the implementation of the operational procedure proposed by the author was associated with more narrow intervals for the ultrasound wave attenuation coefficient and better reproducibility, compared to the most common “rules” used by specialists in the ultrasound diagnostics. There were significant differences in the diagnosis of moderate and maximal steatosis with these two approaches (p 0.05). The sensitivity and specificity of the operational procedure proposed by the authors were 89% and 94%, respectively, compared to 75% and 79% for the commonly used approach. In the 3rd part of the study, there were no significant differences in the ultrasound wave attenuation coefficient measured by specialists with various levels of experience according to the authors’ algorithm. The inter-rater correlation coefficient was 0.948 (95% confidence interval [0.914; 0.973], p 0.001), confirming the authors method's high reproducibility and consistency. Conclusion: We have proposed an operational procedure for ultrasound quantitative steatometry of the liver, based on determination of the attenuation coefficient of the ultrasound wave in tissues. The implementation of this algorithm by medical specialists irrespective of their working experience provides high reproducibility of the method, with maximal sensitivity (89%) and specificity (94%).

Shestakova D.Y., Borsukov A.V., Skutar A.I., Akhmedova A.R.

Aim. To evaluate the feasibility of using multiparametric liver ultrasound to determine the pathophysiological causes of increased stiffness in patients with cardio-metabolic risks.Material and methods. A study was conducted involving 104 cardiology patients, including 48 men (46,2%) and 56 women (53,8%), aged 49 to 73 years, of Caucasian ethnicity. Inclusion criteria included chronic heart failure stage IIB (II, III functional classes according to NYHA), main and additional criteria of metabolic syndrome containing cardiometabolic risks for the development of metabolically associated fatty liver disease. All patients were examined according to a unified diagnostic algorithm consisting of two stages: Stage 1 — clinical and laboratory assessment, Stage 2 — instrumental assessment using liver ultrasound methods (B-mode, color Doppler imaging, two-dimensional shear wave elastography, quantitative steatometry).Results. A scoring system has been proposed to assess the predominant contribution to liver fibrosis development based on data from multiparametric ultrasound examination of the liver. Total score 0-8: predominant liver involvement — in this case, characteristic signs of liver involvement, such as increased echogenicity and absence of significant venous vessel dilation, are observed. Total score 9-14: combined involvement — the signs include both liver-related changes (e.g., steatosis) and signs of venous congestion. Total score 15-16: predominant cardiovascular involvement — in this case, significant venous vessel dilation and other signs of congestive hepatopathy are the main features, indicating venous congestion as the primary cause of liver changes.Conclusion. Multiparametric ultrasound examination of the liver combined with the developed scoring system can be used to differentiate the causes of increased liver stiffness and the severity of liver steatosis in patients with cardiometabolic risks. Standardization of the ultrasound protocol improves the reproducibility of the method.

Borsukov A.V., Shestakova D.Y., Skutar’ A.I.

Objective. Study and comparison of the diagnostic performance of various ultrasound elastometry methods in detecting liver fibrosis in patients with heart failure.Materials and methods. The study was conducted from June 2022 to January 2024. 57 patients with heart failure and metabolic syndrome were examined, divided into three groups depending on the stage of the disease: stage I (n = 21), stage II (n = 24), stage III (n = 11), each of which was divided into subgroups depending on the severity of liver fibrosis (F0–F4). Standard parameters of sensitivity, specificity, and accuracy were used to compare the performance of transient elastometry, vibration-controlled transient elastometry, point elastometry, and two-dimensional shear wave elastometry. A complex of multislice computed tomography with color assessment of the liver structure, a biochemical blood test with the de Ritis coefficient and the FIB‑4 scale were used as a reference method.Results. In stage I heart failure, all four methods showed similar sensitivity, specificity and accuracy. At stage II, using transient elastometry, sensitivity was 59.4%, specificity — 68.2%, accuracy — 62.4%; visual transient elastometry — 72.8%, 87.2%, 79.4%, respectively; point elastometry — 68.6%, 83.7%, 77.4%, respectively; two-dimensional shear wave elastometry — 89.6%, 94.3%, 91.6%. At stage III, transient elastometry turned out to be uninformative; visual transient elastometry showed a sensitivity of 61.2%, specificity of 70.4%, accuracy of 64.6%; point elastometry — 48.6%, 60.1%, 52.3%, respectively; while two-dimensional shear wave elastometry showed a sensitivity of 85.6%, specificity of 92.5%, accuracy of 88.8%.Conclusions. For patients with stage I heart failure, the choice of a specific elastometry method is not of fundamental importance, since the indicators do not differ. However, in stages II and III, shear wave elastometry is the preferred method, especially in stage III, where it demonstrates higher diagnostic performance compared to point elastometry. Visual transient elastometry can be used additionally with the method of two-dimensional shear wave elastometry or in the case where two-dimensional shear wave elastometry is not possible. 

Leonov D., Nasibullina A., Grebennikova V., Vlasova O., Bulgakova Y., Belyakova E., Shestakova D., Costa-Júnior J.F., Omelianskaya O., Vasilev Y.

Thyroid cancer is one of the most common cancers worldwide, with ultrasound-guided biopsy being the method of choice for its early detection. The accuracy of diagnostics directly depends on the qualifications of the ultrasonographers, whose performance can be enhanced through training with phantoms. The aim of this study is to propose a reproducible methodology for designing a neck phantom for ultrasound training and research from widely available materials and to validate its applicability. The phantom was made using polyvinyl chloride mixed with additives to reproduce different levels of brightness on ultrasound screens. 3D printing and casting were used to create the neck model and various structures of the neck, including bones, cartilage, arteries, veins, lymph nodes, thyroid gland, and soft tissues. The small objects, such as tumor and lymph node models, were shaped manually. All the phantom’s materials were carefully selected to match the ultrasonic speed and attenuation values of real soft tissues and bones. The thyroid gland contains models of a cancerous and cystic nodule. In the neck, there are models of carotid arteries and jugular veins filled with ultrasound-transparent gel. Additionally, there are replicas of lymph nodes and bone structures such as hyoid bone, thyroid cartilage, trachea, and vertebrae. The resulting phantom covers the entire neck area and has been positively received by practicing ultrasound specialists. The proposed manufacturing technology offers a reliable and cost-effective approach to produce an anthropomorphic neck phantom for ultrasound diagnosis of the thyroid gland. The realistic simulation provided by the phantom enhances the quality and accuracy of ultrasound examinations, contributing to better training for medical professionals and improved patient care. Subsequent research efforts can concentrate on refining the fabrication process and exploring additional features to enhance the phantom’s capabilities.

Borsukov A.V., Venidiktova D.Y., Smirnova A.D., Yakusheva M.A.

Objective. Evaluation of a single vector of ultrasound assessment of changes in the liver parenchyma, taking into account the correct use of such physical concepts as stiffness, elasticity, elasticity, density.Material and methods. On the basis of the Problem Research Laboratory ‘Diagnostic Research and Minimally Invasive Technologies’ a study was conducted with the participation of 112 patients of a multidisciplinary hospital. Multiparametric ultrasound examination (B-mode, quantitative liver steatometry, 2D shear wave elastography, complex format ‘liver protocol’) was performed by ultrasound doctors (n = 24) of the following groups: half-a-year residents in the specialty ‘ultrasound diagnostics’ (n = 9; 37.6%), doctors working in a multidisciplinary hospital of a medical organization of the regional center with work experience up to 5 years (n = 4; 16.6%), 6–10 years (n = 4; 16.6%), 11–20 years old (n = 3; 12.6%), 21 years or more (n = 4; 16.6%), of which 1 (4.2%) professor, 1 (4.2%) doctor of medical sciences, 3 (12.5%) candidates of medical sciences. An analysis of the protocols of ultrasound examination was carried out.Results. The correct description of changes in the liver according to B-mode data, quantitative steatometry, 2D shear wave elastography and ‘liver protocol’ correct formulations were given by 9 (37.5%) specialists. In all cases, most of the correct protocols were provided by doctors from groups of 6–10 years of experience and 21 years of experience or more.Conclusions. In the community of specialists in ultrasound diagnostics there is no agreement on a correct and unified approach to the description of diffuse liver changes using multiparametric ultrasound. To increase the level of knowledge, complex multidisciplinary interaction is necessary in the format of scientific and educational programs organized jointly with specialists in the field of medical physics.

Borsukov A.V., Venidiktova D.Y., Skutar A.I., Ahmedova A.R.

Purpose: To evaluate the dynamics of the opinions of world experts on the materials of world recommendations on ultrasound elastography and liver steatometry from the standpoint of the domestic level of development of ultrasound diagnostics and on the basis of our own data.Material and methods: 16 main provisions of the World Guidelines for Liver Elastography in 2018 were reviewed and comments were made, differences from the European Guidelines of 2017 and the first World Guidelines of 2015 were noted. We reviewed and commented on the 2020 SRU comments. The final scientific publication of a large group of world experts in 2022 is analyzed in detail, where for the first time the norms and threshold values between benign and malignant neoplasms of a large number of human organs and tissues are given.Results: From 2006 to the present, more than 45,000 ultrasound studies have been carried out on our own material (n=15627), some differences in approaches to liver elastometry are given, and approaches to the use of ultrasound steatometry are considered.Conclusion: Threshold development vectors are shown, techniques to avoid artifacts and reduce the risk of obtaining false negative and false positive elastometry results are proposed. There is caution of the expert community in the review of the method of quantitative steatometry based on the measurement of the attenuation coefficient of the ultrasound wave.

Venidiktova D.Y., Borsukov A.V.

Taking into account the lack of consensus between different scientific groups on the nature and unity of the pathomorphological substrate of non-alcoholic and metabolically associated fatty liver diseases, there is a need to find new instrumental methods for their differential diagnosis in order to develop the correct treatment and monitoring tactics.Aim: To assess the possibilities of using the complex application of instrumental diagnostic methods for the differential diagnosis of metabolically associated and non-alcoholic fatty liver disease.Methodology and Methods. The study involved 94 patients of a multidisciplinary hospital with a combination of ultrasound signs of liver steatosis according to the B-mode. As part of the two stages of the diagnostic examination, clinical, laboratory and instrumental methods were used, including a block of ultrasound diagnostics (assessment of the thickness of visceral fat, quantitative liver steatometry, two-dimensional elastography of shear waves of the liver), dual-energy X-ray absorptiometry in the “Whole body” mode. The control group included 78 patients without signs of hepatic steatosis according to B-mode ultrasound.Results. All patients were divided into groups according to signs of metabolic syndrome, with subsequent distribution into conditional groups of patients with non-alcoholic and metabolically associated fatty liver disease, highlighting the main signs of both diseases. Metabolic syndrome was detected in 24 women (29.27%), 18 men (21.95%). In 53 patients (64.63%), the presence of hepatic steatosis was quantitatively confirmed, of which 39 patients were found to be overweight or obese (47.56%).Conclusion. Indicators of the instrumental assessment of the metabolic status and a complex diagnostic algorithm were determined, allowing for differential diagnosis between non-alcoholic and metabolically associated fatty liver disease with a quantitative assessment of liver steatosis.

Venidiktova D.Y., Borsukov A.V.

Objective. To demonstrate the possibilities of using dual-energy X-ray absorptiometry in the ‘Whole-Body’ mode in the algorithm for diagnosing and monitoring metabolically associated fatty liver disease in patients with metabolic syndrome.Material and methods. All patients were examined according to a single diagnostic algorithm, consisting of a physical examination with anthropometry, dual-energy X-ray absorptiometry in the ‘Whole-Body’ mode and quantitative ultrasound steatometry. In addition to the main study group (n = 118), two control groups were recruited: the first with an increased body mass index, but without signs of metabolically associated fatty liver disease (n = 101), the second with a normal body mass index, without signs of liver damage (n = 84).Results. In a larger number of patients with confirmed metabolically associated fatty liver disease, according to clinical, laboratory and instrumental data, a predominance of visceral adipose tissue over subcutaneous adipose tissue was observed (compared to patients without confirmed metabolically associated fatty liver disease). At the same time, the percentage of fat in patients of the main study group and control group No. 1 is within the normal range of age intervals. Quantitative ultrasound steatometry data have a high correlation with data describing the components of the metabolic syndrome according to dual-energy X-ray absorptiometry in the ‘Whole-Body’ mode with a direct relationship.Conclusion. Dual-energy X-ray absorptiometry in the ‘Whole-Body’ mode can be used both for screening and for diagnosing the components of the metabolic syndrome due to high information content and minimal radiation exposure. Patients in whom visceral subcutaneous tissue predominates over subcutaneous adipose tissue are at greater risk of developing metabolically associated fatty liver disease. Quantitative ultrasound steatometry complements the picture of diffuse liver changes in patients with metabolic syndrome.

Leonov D., Venidiktova D., Costa-Júnior J.F., Nasibullina A., Tarasova O., Pashinceva K., Vetsheva N., Bulgakova J., Kulberg N., Borsukov A., Saikia M.J.

The WHO reported an increasing trend in the number of new cases of breast cancer, making it the most prevalent cancer in the world. This fact necessitates the availability of highly qualified ultrasonographers, which can be achieved by the widespread implementation of training phantoms. The goal of the present work is to develop and test an inexpensive, accessible, and reproducible technology for creating an anatomical breast phantom for practicing ultrasound diagnostic skills in grayscale and elastography imaging, as well as ultrasound-guided biopsy sampling. We used FDM 3D printer and PLA plastic for printing an anatomical breast mold. We made a phantom using a mixture of polyvinyl chloride plastisol, graphite powder, and metallic glitter to simulate soft tissues and lesions. Various degrees of elasticity were imparted using plastisols of stiffness ranging from 3 to 17 on the Shore scale. The lesions were shaped by hand. The materials and methods used are easily accessible and reproducible. Using the proposed technology, we have developed and tested a basic, differential, and elastographic versions of the breast phantom. The three versions of the phantom are anatomical and intended for use in medical education: the basic version is for practicing primary hand–eye coordination skills; the differential one is for practicing the differential diagnosis skills; the elastographic version helps developing the skills needed for assessing the stiffness of tissues. The proposed technology allows the creation of breast phantoms for practicing hand–eye coordination and develop the critical skills for navigation and assessment of the shape, margins, and size of the lesion, as well as performing an ultrasound-guided biopsy. It is cost-effective, reproducible, and easily implementable, and could be instrumental in generating ultrasonographers with crucial skills for accurate diagnosis of breast cancer, especially in low-resource settings.

Venidiktova D.Y., Borsukov A.V.

The aim of the work was to evaluate the possibility of replacing liver biopsy with other methods of examination in patients with metabolically associated fatty liver disease. All patients were examined according to a single diagnostic algorithm consisting of four stages: physical, laboratory, instrumental (using non-invasive bioimpedansometry, multiparametric ultrasound examination, dual-energy X-ray absorptiometry in the "Whole body" mode, computer and magnetic resonance imaging), histological (evaluation of liver micropreparations on the SAF scale). the patients were divided into three groups, taking into account the results of histological examination of biopsies on the SAF scale: group 1 – patients with hepatic steatosis without signs of inflammation, fibrosis (n = 56, 53.9%); group 2 – patients with steatohepatitis and clinically insignificant hepatic fibrosis F0-F1 (n = 30, 28.8%); group 3 – patients with steatohepatitis and clinically significant liver fibrosis F2-F3 (n = 16, 15.4%). the correlation of findings obtained by the histological examination of liver biopsies and the data of ultrasound quantitative liver steatometry is high – r = 0.95 (for liver steatosis S1), r = 0.84 (for liver steatosis S2), r = 0.91 (for liver steatosis S3); ultrasonic shear wave elastography – r = 0.84 (for clinically insignificant liver fibrosis F0-F1), r = 0.88 (for clinically significant liver fibrosis F2-F3). the data obtained using dual-energy X-ray absorptiometry in the "Whole Body" mode quantitatively reflect the state of the patient's metabolic status, they can be evaluated in dynamics due to low radiation load. Thus, the diagnostic complex consisting of assessing the level of hepatic transaminases, multiparametric ultrasound examination and dual-energy X-ray absorptiometry in the "Whole body" mode is optimal to examine the patients who have contraindications to liver biopsy or completely refuse to pass this study. in case of the patient's consent, absence of contraindications, as well as in the presence of a number of diffuse liver diseases, histological examination is recommended to identify and to assess in detail the dystrophic, inflammatory, sclerotic, regenerative processes.

Borsukov A.V., Gorbatenko O.A., Venidiktova D.Y., Tagil A.O., Borsukov S.A., Kruglova A.A., Kurchenkova V.S., Ahmedova A.R.

Gorbatenko O.A., Venidiktova D.Y., Borsukov A.V.

Relevance. Currently, metabolic syndrome (MS) occurs in 20–30% of the population. The main age of patients is 20–65 years. The study of this syndrome is genetically determined, which indicates that insulin resistance is genetically determined. The obtained facts allowed us to consider MS as the principle of primary prevention of type 2 diabetes and its complications. MTS affects such vital organs as kidneys, pancreas, etc. Since the topic of the development of CKD in patients with metabolic syndrome is acute, a qualitative diagnosis of this complication is necessary. To date, such a method is non-ionizing contrast-enhanced ultrasound, which is not nephrotoxic and hepatotoxic and can be used in patients with reduced renal function.Objective. Evaluation of the effectiveness of the multimodal approach in the algorithm of instrumental diagnostics of examination of patients with metabolic syndrome on the background of type 2 diabetes mellitus.Materials and methods. A study of patients with metabolic syndrome (n = 240) was conducted in 2020–2022. When collecting and analyzing clinical and laboratory data, (n = 67) had metabolically associated fatty liver disease: 22 of them were women (32.8%), 45 men (67.2%), average age 51.0 ± 4.2. All patients were examined according to a single diagnostic algorithm, which included four stages. Stage 1. Examination of patients by specialists, including clinical and laboratory data, with the resolution of the conclusion (n = 67). Stage 2. Ultrasound of the liver with quantitative ultrasound steatometry with determination of the level of the attenuation coeffcient of the ultrasonic wave (n = 67). Stage 3. Conducting dualenergy X-ray absorptiometry (DXA) in the ‘Whole body’ mode (with an assessment of the percentage of adipose tissue, abdominal obesity index) (n = 67). Stage 4. Conducting multiparametric ultrasound of the kidneys in B-mode and colour Doppler mapping (CDC) mode in patients with CKD, followed by contrast-enhanced ultrasound (n = 14). The criteria for inclusion in the study are age over 18 years, metabolic syndrome.Conclusions. 1. The algorithm of examination of patients with metabolically associated fatty liver disease may include extended ultrasound examination of the kidneys, including contrast-enhanced ultrasound examination of the kidneys as a safe and effective method of assessing chronic kidney disease. 2. Two-energy X-ray absorptiometry in the ‘Whole body’ mode is a highly sensitive method in determining and monitoring the components of the metabolic syndrome. 3. A multimodal instrumental study of patients with metabolic syndrome and type 2 diabetes mellitus makes it possible to identify possible complications at an early stage.

Borsukov A., Venidiktova D., Borsukov S.

Introduction. The article presents an overview of novel complex algorithm based on methods of ultrasound steatometry, combined elastography and dual-energy X-ray absorbtiometry in “Whole body” mode in diagnostic and monitoring of metabolically associated fatty liver disease.The purpose of the study: to assess the possibility of quantitative ultrasound steatometry using in the detection and monitoring of metabolically associated fatty liver disease.Material and methods. 157 patients were examined. The main group consisted of 47 patients with liver steatosis; 45 patients with steatohepatitis and clinically insignificant liver fibrosis (F0-F1); 32 patients with steatohepatitis and clinically significant liver fibrosis (F2-F3); 33 patients with focal hepatic steatosis. We used complex algorithm based on methods of questionnaires, laboratory tests, ultrasound steatometry, combined elastography and dual-energy x-ray absorbtiometry in “Whole body” mode, liver biopsy. to determine the severity of steatosis, a scale was used: S0 – no steatosis; 2.9 dB/cm.Results and conclusion. It is possible to use quantitative ultrasound steatometry for metabolically associated fatty liver disease, as a reference method both for the initial detection of the disease and for monitoring non-drug treatment (sensitivity 90.7%, specificity 92.4%). The optimal complex for the diagnosis and monitoring of non-drug treatment of metabolically associated fatty liver disease includes an assessment of the level of compliance, the use of quantitative ultrasound steatometry and dual-energy X-ray absorptiometry in the «Whole body» mode (sensitivity 92.8%, specificity 92.3%).

Borsukov A.V., Gorbatenko O.A., Venidiktova D.Y., Tikhankova A.V., Pulatova I.Z., Tagil A.O., Bezmenova T.S., Ahmedova A.R.

Purpose: To assess the effectiveness of a new method of contrast-enhanced ultrasound examination (CEUS) for determining the duration of the arterial phase of contrasting liver, kidney and spleen.Material and methods: We examined 37 patients with a verified diagnosis of viral alcoholic hepatitis with splenomegaly syndrome (n = 11), chronic hepatitis B (n = 14) and diabetic nephropathy against the background of type 2 diabetes (n = 12). The age of the examined patients was 39–56 years. Patients with diabetic nephropathy underwent complex diagnostics, including ultrasound examination of internal organs in B-mode with further Doppler assessment of the hemodynamics in the vessels of the kidneys. Patients with chronic viral hepatitis B and alcoholic hepatitis underwent a multiparametric ultrasound complex of examination, supplemented by strain elastography (SE). Further, a contrast-enhanced ultrasound examination (CEUS) of the kidneys was carried out using an echocontrast agent SonoVue in doses recommended for each organ, followed by an assessment of the arterial phase according to the standard and proposed method.Results: While interpreting the data of the liver study in patients with chronic viral hepatitis B according to the standard method, quantitative data were obtained for the duration of the arterial phase of 16.4 ± 15.7 sec, and according to the proposed method, 12.1 ± 8.3 sec. In patients with alcoholic hepatitis with splenomegaly syndrome, the CEUS values are 21.8 ± 16.9, 17.3 ± 12.8 sec, in patients with diabetic nephropathy, — 13.5 ± 9.5 and 10.5 ± 5.9 sec accordingly. The results obtained, together with clinical and laboratory indicators can be interpreted in favor of improving the dynamics. Knowing the approximate data on the duration of the arterial phase during for the liver (from 8–14 to 40 sec), for the kidney (10–20 to 25–35 sec), for the spleen (8–60 sec), it can be concluded that the proposed method for determining the time of the onset of the arterial phase during CEUS is more accurate, since it allows one to determine the presence of diffuse pathology of organs at the microcirculatory level.Conclusion: 1. The exact values of the onset of the arterial phase of contrasting were determined, thereby increasing the importance of CEUS in the diagnosis of diffuse pathology of the liver, kidneys and spleen. 2. The proposed method for determining the flow time of the arterial phase of echocontrast agent allows monitoring the effectiveness of treatment of diffuse pathology of the kidneys, spleen and liver (Patent RU No. 2744825). 

Venidiktova D.Y., Borsukov A.V.

Aldehani W., Jawali A., Savaridas S.L., Huang Z., Manfredi L.

Breast ultrasound elastography phantoms are valued for their ability to mimic human tissue, enabling calibration for quality assurance and testing of imaging systems. Phantoms may facilitate the development and evaluation of ultrasound techniques by accurately simulating the properties of breasts. However, selecting appropriate tissue-mimicking materials for realistic and accurate ultrasound exams is crucial to ensure the ultrasound system responds similarly to real breast tissue. We conducted a systematic review of the PubMed, Scopes, Embase, and Web of Sciences databases, identifying 928 articles in the initial search, of which 19 were selected for further evaluation based on our inclusion criteria. The chosen article focused on tissue-mimicking materials in breast ultrasound elastography phantom fabrication, providing detailed information on the fabrication process, the materials used, and ultrasound and elastography validation of phantoms. The phantoms fabricated from Polyvinyl Chloride Plastisol, silicon, and paraffin were best suited for mimicking breast, fatty, glandular, and parenchyma tissues. Adding scatterers to these materials facilitates accurate fatty and glandular breast tissue simulations, making them ideal for ultrasound quality assurance and elastography training. Future research should focus on developing more realistic phantoms for advanced medical training, improving the practice of difficult procedures, enhancing breast cancer detection research, and providing tailored tissue characteristics.

Hariyanto A.P., Mugni F.F., Khumaira L., Sensusiati A.D., Nursela A.L., Suprijanto, Ng K.H., Haryanto F., Endarko

Shestakova D.Y., Borsukov A.V.

Rationale: Due to rising prevalence of metabolic syndrome, obesity and type 2 diabetes mellitus, the prevalence of metabolic-associated hepatic steatosis has amounted to 38–42% worldwide. The burden of its dangerous complications, such as steatohepatitis, liver fibrosis and cirrhosis, hepatocellular carcinoma, make the search for effective diagnostic methods of liver steatosis a priority. However, lack standardization of assessments reduces the accuracy and reproducibility of their results and requires elaboration of unified protocols for such assessments. Aim: To develop a unified algorithm for quantitative ultrasound steatometry of the liver and to evaluate its diagnostic accuracy (sensitivity, specificity, and reproducibility). Methods: This was a three step study, with its 1st part including 34 specialists on echography diagnostics aged 28 to 64 years with varying levels of experience (1 to 3 years, n = 5, 15.6%; 4 to 10 years, n = 18, 50%; 11 to 20 years, n = 8, 25%; ≥ 21 years: n = 3, 9.4%). The accuracy of quantitative ultrasound steatometry procedure evaluated with a test questionnaire, by analysis of archived echograms (340 clinical cases), and real-time ultrasound steatometry performed in 102 patients under the direct or remote supervision of the authors. In the 2nd part of the study we examined 173 patients with liver steatosis confirmed by multiparametric echography, comprehensive clinical and biochemical SteatoTest, magnetic resonance spectroscopy, multiaxial computed tomography with color mapping, dual-energy X-ray absorptiometry in the "whole body" mode, and histological examination of liver biopsy samples. In the 3rd part of the study we assessed the reproducibility of the quantitative ultrasound steatometry algorithm proposed by the authors, 12 ultrasound diagnostic physicians with varying levels of experience were involved (1 to 3 years: n = 3; 4 to 10 years: n = 3; 11 to 20 years: n = 3; more than 21 years: n = 3). Each physician examined 20 patients (5 patients in groups with no steatosis and with histologically confirmed steatosis of grades 1 to 3). Results: In the 1st part of the study, we identified the main patterns of quantitative ultrasound steatometry of the liver by specialists in the ultrasound diagnostics. Based on the international and Russian guidelines, as well as our own research, we proposed standardized operational procedure for quantitative ultrasound steatometry. The comparative analysis in the 2nd part of the study showed that the implementation of the operational procedure proposed by the author was associated with more narrow intervals for the ultrasound wave attenuation coefficient and better reproducibility, compared to the most common “rules” used by specialists in the ultrasound diagnostics. There were significant differences in the diagnosis of moderate and maximal steatosis with these two approaches (p 0.05). The sensitivity and specificity of the operational procedure proposed by the authors were 89% and 94%, respectively, compared to 75% and 79% for the commonly used approach. In the 3rd part of the study, there were no significant differences in the ultrasound wave attenuation coefficient measured by specialists with various levels of experience according to the authors’ algorithm. The inter-rater correlation coefficient was 0.948 (95% confidence interval [0.914; 0.973], p 0.001), confirming the authors method's high reproducibility and consistency. Conclusion: We have proposed an operational procedure for ultrasound quantitative steatometry of the liver, based on determination of the attenuation coefficient of the ultrasound wave in tissues. The implementation of this algorithm by medical specialists irrespective of their working experience provides high reproducibility of the method, with maximal sensitivity (89%) and specificity (94%).

Shestakova D.Y., Borsukov A.V., Skutar A.I., Akhmedova A.R.

Aim. To evaluate the feasibility of using multiparametric liver ultrasound to determine the pathophysiological causes of increased stiffness in patients with cardio-metabolic risks.Material and methods. A study was conducted involving 104 cardiology patients, including 48 men (46,2%) and 56 women (53,8%), aged 49 to 73 years, of Caucasian ethnicity. Inclusion criteria included chronic heart failure stage IIB (II, III functional classes according to NYHA), main and additional criteria of metabolic syndrome containing cardiometabolic risks for the development of metabolically associated fatty liver disease. All patients were examined according to a unified diagnostic algorithm consisting of two stages: Stage 1 — clinical and laboratory assessment, Stage 2 — instrumental assessment using liver ultrasound methods (B-mode, color Doppler imaging, two-dimensional shear wave elastography, quantitative steatometry).Results. A scoring system has been proposed to assess the predominant contribution to liver fibrosis development based on data from multiparametric ultrasound examination of the liver. Total score 0-8: predominant liver involvement — in this case, characteristic signs of liver involvement, such as increased echogenicity and absence of significant venous vessel dilation, are observed. Total score 9-14: combined involvement — the signs include both liver-related changes (e.g., steatosis) and signs of venous congestion. Total score 15-16: predominant cardiovascular involvement — in this case, significant venous vessel dilation and other signs of congestive hepatopathy are the main features, indicating venous congestion as the primary cause of liver changes.Conclusion. Multiparametric ultrasound examination of the liver combined with the developed scoring system can be used to differentiate the causes of increased liver stiffness and the severity of liver steatosis in patients with cardiometabolic risks. Standardization of the ultrasound protocol improves the reproducibility of the method.

Leonov D.V.

Ultrasound imaging is routinely used to diagnose and monitor the progression of kidney disease. It supports evaluation of the presence of abnormal formations such as stones, cysts, and tumors, and also the performance of various manipulations under ultrasound guidance. However, the effectiveness of an investigation depends largely on the qualifications of the sonologist. Training using phantoms increases qualifications. This article discusses the creation of a kidney phantom which can be used as a standalone training tool or as part of a more complex phantom, such as a torso model. This phantom is made of a durable material which is not susceptible to drying out or bacteria. It consists of models of the pelvis with Malpighian pyramids and cortex and contains kidney stones and focal formations. The acoustic characteristics of the phantom tissue are in the range of values characteristic of human tissues, namely, the speed of sound and the attenuation coefficient in the cortical layer model are 1530 m/sec and 0.35 dB/cm/MHz. The phantom supports development of skills in assessing the size, shape, and structure of the kidney and those of diagnosing stones and focal formations, and will be useful in advanced training courses for ultrasound diagnostic doctors.

Kozubova K.V., Busko E.A., Bagnenko S.S., Balahnin P.V., Shmelev A.S., Goncharova A.B., Kostromina E.V., Kadyrleev R.A., Lyubimskaya E.S., Burovik I.A.

INTRODUCTION: Determining the nature of focal liver pathology is an important issue, especially in oncological practice. Imaging methods with contrast enhancement are the main methods for diagnosing pathology of the hepatobiliary tract, however, there are limitations in the use of computed tomography, magnetic resonance imaging, and contrast-enhanced ultrasound. In recent years, acoustic radiation force impulse elastography has become a widely used method in assessing changes in the liver. This technique has been successfully used to quantify diffuse disease in the liver, and scientific research is currently being actively conducted to determine the threshold values of the stiffness of various liver lesions.OBJECTIVE: To determine the possibility of an alternative method for differential diagnosis of solid liver lesions from pseudofocal lesions using the acoustic radiation force impulse elastography technique in the context of multiparametric ultrasound examination. MATERIALS AND METHODS: The study included 64 patients with a history of cancer. In all cases, contrast-enhanced computed tomography and multiparametric ultrasound using acoustic radiation force impulse elastography technology were performed to assess quantitative indicators of lesion stiffness in the non-cirrhotic liver. The minimum, average and maximum stiffness of the lesion was assessed, expressed in m/s based on the results of 10 measurements. The results obtained were compared with accepted standards for the stiffness of the liver parenchyma for assessing diffuse changes, recommended by EFSUMB. RESULTS: In accordance with the final clinical diagnosis, the studies included focal liver lesions: hemangioma (n=16; 25.0%), focal steatosis (n=19; 29.7%), metastases (n=29; 45.3%). We assessed three subgroups of values: the minimum value, the maximum and the average. The most important parameter used for further interpretation of the data is the average stiffness value based on the results of all measurements. When assessing this indicator for hemangioma, the median was 1.63 m/s, the standard deviation was 0.36, and the range was 1.02 m/s. For these focal lesions the 25th percentile is 1.47 m/s, the 75th percentile is 2.01 m/s. For metastatic lesions, the median was 1.83 m/s. When determining the standard deviation, this indicator was 0.34 m/s, and the range was 1.58 m/s. Also, the values of the 25th percentile were 1.68 m/s, and the 75th were 2.08 m/s. When analyzing these indicators of stiffness in focal steatosis, the following values were obtained: median — 1.09 m/s; range — 0.21 m/s and standard deviation — 0.06 m/s. The 25th percentile values were 1.025 m/s, the 75th percentile — 1.105 m/s. DISCUSSION: Based on the presented data, solid lesions, such as hemangioma and metastasis, had significantly high stiffness values in comparison with unchanged liver parenchyma. Our results are close to the values described in a number of large studies, but at the moment there is no consensus regarding the threshold values, as well as the methodology for performing the study and determining the zone for assessing stiffness in the lesion, which makes this technique promising for further study. CONCLUSION: Performing a multiparametric ultrasound examination using the technique of acoustic radiation force impulse elastography to assess quantitative indicators of stiffness in the lesion makes it possible to identify changes in the liver at the screening stage, conduct constant non-invasive monitoring of cancer patients, and determine further tactics for patient management. This technique is a promising, easily accessible, economical and, most importantly, dose-free diagnostic tool for detecting and characterizing liver lesion, allowing to reduce the time of differential diagnosis at the initial stage and reduce the costs of further research.

Leonov D.V.

Liver cancer is the sixth most common and fourth most fatal of all types of cancer. Interstitial thermal ablation, performed under ultrasound control, provides an effective method of treating it. This method involves introduction of electrodes into the area of metastases for destruction of diseased tissue. To train for this procedure, an anatomically accurate liver phantom containing multiple metastatic lesions, some located close to vessels, was developed. A computed tomography study was used as the basis for creating an anatomically accurate shape for the phantom. The phantom is made of durable, wear-resistant material and allows repeated insertion of electrodes. The speed of sound, the attenuation coefficient, and tissue stiffness in the phantom were 1564 m/sec, 0.32 dB/cm, and 3 Shore units respectively, which are close to the values of the human liver. This phantom may be of interest to educational organizations involved in training ultrasound diagnostic doctors with a focus on oncology.

Belyakova E.D., Nasibullina A.A., Bulgakova J.V., Vlasova O.V., Grebennikova V.V., Omelyanskaya O.V., Petraikin A.V., Leonov D.V.

BACKGROUND: The knee joint is a frequently visualized anatomical region in clinical practice. Accurate interpretation of CT scans necessitates a comprehensive understanding of anatomy and a sound grasp of fundamental technical principles and imaging protocols. To safeguard the patient's well-being, it is of paramount importance to prevent erroneous studies resulting from suboptimal equipment quality, setup issues, and patient positioning. These difficulties can be circumvented by the use of phantoms to pre-adjust the equipment and the provision of training to medical staff in scanning techniques. AIM: The aim of the study was to develop a technique for creating an anthropomorphic medical phantom of the knee joint that would accurately reflect the X-ray density of the corresponding human tissues, thus enabling the use of computed tomography studies. MATERIALS AND METHODS: The knee joint phantom comprises a series of models representing the femur, tibia, fibula, patella, collateral ligaments, lateral and medial menisci, tendon of the quadriceps femoris muscle, anterior and posterior cruciate ligaments, and patellar ligament. Ligament models were 3D-printed from resin, bones were cast from silicone, soft tissues were modeled with a homogeneous structure of silicone-like materials and made by casting into silicone molds. The skin was similarly modeled. In the study, the anode voltage range of the CT scanner varied from 80 to 140 kV, and the slice thickness was equal to 1.25 mm. RESULTS: The developed anthropomorphic knee joint phantom demonstrated the X-ray density of the modeled anatomical structures, with ligaments exhibiting a range of 80–120 units on the Hausfield scale, bones exhibiting a range of 320–370 units, and soft tissues and skin exhibiting a range of 20–60 units. The use of additive technologies made it possible to achieve a high degree of similarity between the phantom forms and the knee joint. Further research may be directed towards the creation of a more complex model of bone tissue, comprising a separate cortical layer and spongy substance. CONCLUSIONS: The use of an anthropomorphic knee phantom allows for the acquisition of high-quality CT images without the need for prior scanning of patients.

Borsukov A.V., Shestakova D.Y., Skutar’ A.I.

Objective. Study and comparison of the diagnostic performance of various ultrasound elastometry methods in detecting liver fibrosis in patients with heart failure.Materials and methods. The study was conducted from June 2022 to January 2024. 57 patients with heart failure and metabolic syndrome were examined, divided into three groups depending on the stage of the disease: stage I (n = 21), stage II (n = 24), stage III (n = 11), each of which was divided into subgroups depending on the severity of liver fibrosis (F0–F4). Standard parameters of sensitivity, specificity, and accuracy were used to compare the performance of transient elastometry, vibration-controlled transient elastometry, point elastometry, and two-dimensional shear wave elastometry. A complex of multislice computed tomography with color assessment of the liver structure, a biochemical blood test with the de Ritis coefficient and the FIB‑4 scale were used as a reference method.Results. In stage I heart failure, all four methods showed similar sensitivity, specificity and accuracy. At stage II, using transient elastometry, sensitivity was 59.4%, specificity — 68.2%, accuracy — 62.4%; visual transient elastometry — 72.8%, 87.2%, 79.4%, respectively; point elastometry — 68.6%, 83.7%, 77.4%, respectively; two-dimensional shear wave elastometry — 89.6%, 94.3%, 91.6%. At stage III, transient elastometry turned out to be uninformative; visual transient elastometry showed a sensitivity of 61.2%, specificity of 70.4%, accuracy of 64.6%; point elastometry — 48.6%, 60.1%, 52.3%, respectively; while two-dimensional shear wave elastometry showed a sensitivity of 85.6%, specificity of 92.5%, accuracy of 88.8%.Conclusions. For patients with stage I heart failure, the choice of a specific elastometry method is not of fundamental importance, since the indicators do not differ. However, in stages II and III, shear wave elastometry is the preferred method, especially in stage III, where it demonstrates higher diagnostic performance compared to point elastometry. Visual transient elastometry can be used additionally with the method of two-dimensional shear wave elastometry or in the case where two-dimensional shear wave elastometry is not possible. 

Leonov D., Nasibullina A., Grebennikova V., Vlasova O., Bulgakova Y., Belyakova E., Shestakova D., Costa-Júnior J.F., Omelianskaya O., Vasilev Y.

Thyroid cancer is one of the most common cancers worldwide, with ultrasound-guided biopsy being the method of choice for its early detection. The accuracy of diagnostics directly depends on the qualifications of the ultrasonographers, whose performance can be enhanced through training with phantoms. The aim of this study is to propose a reproducible methodology for designing a neck phantom for ultrasound training and research from widely available materials and to validate its applicability. The phantom was made using polyvinyl chloride mixed with additives to reproduce different levels of brightness on ultrasound screens. 3D printing and casting were used to create the neck model and various structures of the neck, including bones, cartilage, arteries, veins, lymph nodes, thyroid gland, and soft tissues. The small objects, such as tumor and lymph node models, were shaped manually. All the phantom’s materials were carefully selected to match the ultrasonic speed and attenuation values of real soft tissues and bones. The thyroid gland contains models of a cancerous and cystic nodule. In the neck, there are models of carotid arteries and jugular veins filled with ultrasound-transparent gel. Additionally, there are replicas of lymph nodes and bone structures such as hyoid bone, thyroid cartilage, trachea, and vertebrae. The resulting phantom covers the entire neck area and has been positively received by practicing ultrasound specialists. The proposed manufacturing technology offers a reliable and cost-effective approach to produce an anthropomorphic neck phantom for ultrasound diagnosis of the thyroid gland. The realistic simulation provided by the phantom enhances the quality and accuracy of ultrasound examinations, contributing to better training for medical professionals and improved patient care. Subsequent research efforts can concentrate on refining the fabrication process and exploring additional features to enhance the phantom’s capabilities.

Cherkasskaya M.V., Petraikin A.V., Omelyanskaya O.V., Leonov D.V., Vasilev Y.A.

The use of computed tomography during diagnostic examinations makes it a source of additional radiation exposure to patients. In this regard, the development of test objects (phantoms) that simulate the X-ray properties of tissues, including for preliminary assessment of the ionizing radiation distribution, becomes relevant. These test objects play an important role in quality control and the development of new medical imaging methods in conditions where test scans of patients are not possible. Although a range of ready-made solutions is available on the market, there is a lack of prototypes with a certain set of properties to test scientific and practical hypotheses in solving specific clinical and technical problems. Finding materials for a fast and inexpensive production process and studying their properties could provide insight into the effectiveness of their use in making phantoms. The purpose of the work is to search and analyze materials for creating phantoms used in computed tomography. The article discusses materials for the production of non-anthropomorphic and anthropomorphic phantoms, including those printed on a 3D printer. The development of three-dimensional printing has facilitated the transition from simple test objects to high-precision anthropomorphic phantoms made from tissue-mimicking materials that have equivalent signals on computer tomograms. Plastics, silicones, polyvinyl chloride, resins, liquids are used for visualizations identical to soft tissues; plastics, gypsum, photopolymers, potassium hydrogen orthophosphate, calcium hydroxyapatite, plexiglass — for hard tissues. Commercial phantoms are made from materials with reproducible, stable properties, but these same materials must be retested to create test objects specific to a particular clinical task.

Vasilev Y.A., Omelyanskaya O.V., Nasibullina A.A., Leonov D.V., Bulgakova J.V., Akhmedzyanova D.A., Shumskaya Y.F., Reshetnikov R.V.

Phantoms are used to validate diagnostic imaging methods or develop skills of medical professionals. For instance, they allow conducting an unlimited number of imaging studies during medical training, assessing the image quality, optimizing the radiation dose, and testing novel techniques and equipment. Researchers in breast imaging utilize anthropomorphic models to validate, assess, and optimize new methods for diagnosing breast diseases. Such models also facilitate control over the quality of diagnostic systems, help to optimize clinical protocols and improve image reconstruction algorithms. Realistic simulation of organ tissue is essential for addressing these challenges in breast phantoms. The goal of this review is to describe what breast phantoms for diagnostic imaging are currently available on the market and how they are fabricated.Building an accurate breast model with X-ray imaging requires detailed knowledge of its anatomy and radiological features. The breast has a heterogeneous structure composed of glandular and adipose tissues, skin, and appendages, as well as other structures such as vessels and ligaments. In this literature review, we screened PubMed and Google Scholar for the relevant articles. 72 articles and 13 conference papers were included.There are two major types of breast phantoms: computational and physical. Specifically, the computational phantoms are classified into sub-groups depending on what data they use. These include mathematical models, tissue samples, and medical images of the breast. The physical phantoms, on the other hand, are classified based on their composition: molds, 3D printed, or paper-based with contrast inclusions. The main advantage of computational phantoms is the ability to generate large amounts of virtual data, while physical phantoms allow to perform an unlimited number of radiological studies.

Kuznetsova A.S., Dolgushina A.I., Smagina N.V., Lebedev E.V., Genkel V.V.

The prevalence of non-alcoholic fatty liver disease, according to various estimates, affects a quarter of the world population. Significant interest in this pathology is due to the high frequency of adverse liver (steatohepatitis, liver fibrosis and cirrhosis) and extrahepatic (association with cardiovascular disease) outcomes. One of the key areas is the timely diagnosis of liver steatosis. Reference diagnostic methods, which include liver biopsy and magnetic resonance imaging with assessment of liver fat proportion weighted by proton density, have objective practical and financial limitations for their routine use in detection and quantitative assessment of liver steatosis. Therefore, one of the current trends in hepatology is the development of inexpensive, widely applicable, and reliable noninvasive diagnostic tools. The aim of the present review is a comparative analysis of various ultrasound methods of liver steatosis diagnostics: qualitative, semi-quantitative and quantitative (estimation of hepatorenal index, controlled attenuation parameter). The presented publication reviews the currently available methods of detection and assessment of severity of liver steatosis based on ultrasound examination, including their classification, methodology and comparison of diagnostic efficiency with analysis of intra- and inter-operator reproducibility, sensitivity and specificity.

Venidiktova D.Y., Borsukov A.V.

Objective. To demonstrate the possibilities of using dual-energy X-ray absorptiometry in the ‘Whole-Body’ mode in the algorithm for diagnosing and monitoring metabolically associated fatty liver disease in patients with metabolic syndrome.Material and methods. All patients were examined according to a single diagnostic algorithm, consisting of a physical examination with anthropometry, dual-energy X-ray absorptiometry in the ‘Whole-Body’ mode and quantitative ultrasound steatometry. In addition to the main study group (n = 118), two control groups were recruited: the first with an increased body mass index, but without signs of metabolically associated fatty liver disease (n = 101), the second with a normal body mass index, without signs of liver damage (n = 84).Results. In a larger number of patients with confirmed metabolically associated fatty liver disease, according to clinical, laboratory and instrumental data, a predominance of visceral adipose tissue over subcutaneous adipose tissue was observed (compared to patients without confirmed metabolically associated fatty liver disease). At the same time, the percentage of fat in patients of the main study group and control group No. 1 is within the normal range of age intervals. Quantitative ultrasound steatometry data have a high correlation with data describing the components of the metabolic syndrome according to dual-energy X-ray absorptiometry in the ‘Whole-Body’ mode with a direct relationship.Conclusion. Dual-energy X-ray absorptiometry in the ‘Whole-Body’ mode can be used both for screening and for diagnosing the components of the metabolic syndrome due to high information content and minimal radiation exposure. Patients in whom visceral subcutaneous tissue predominates over subcutaneous adipose tissue are at greater risk of developing metabolically associated fatty liver disease. Quantitative ultrasound steatometry complements the picture of diffuse liver changes in patients with metabolic syndrome.

Borsukov A., Venidiktova D., Borsukov S.

Introduction. The article presents an overview of novel complex algorithm based on methods of ultrasound steatometry, combined elastography and dual-energy X-ray absorbtiometry in “Whole body” mode in diagnostic and monitoring of metabolically associated fatty liver disease.The purpose of the study: to assess the possibility of quantitative ultrasound steatometry using in the detection and monitoring of metabolically associated fatty liver disease.Material and methods. 157 patients were examined. The main group consisted of 47 patients with liver steatosis; 45 patients with steatohepatitis and clinically insignificant liver fibrosis (F0-F1); 32 patients with steatohepatitis and clinically significant liver fibrosis (F2-F3); 33 patients with focal hepatic steatosis. We used complex algorithm based on methods of questionnaires, laboratory tests, ultrasound steatometry, combined elastography and dual-energy x-ray absorbtiometry in “Whole body” mode, liver biopsy. to determine the severity of steatosis, a scale was used: S0 – no steatosis; 2.9 dB/cm.Results and conclusion. It is possible to use quantitative ultrasound steatometry for metabolically associated fatty liver disease, as a reference method both for the initial detection of the disease and for monitoring non-drug treatment (sensitivity 90.7%, specificity 92.4%). The optimal complex for the diagnosis and monitoring of non-drug treatment of metabolically associated fatty liver disease includes an assessment of the level of compliance, the use of quantitative ultrasound steatometry and dual-energy X-ray absorptiometry in the «Whole body» mode (sensitivity 92.8%, specificity 92.3%).

Ferraioli G., Barr R.G., Berzigotti A., Sporea I., Wong V.W., Reiberger T., Karlas T., Thiele M., Cardoso A.C., Ayonrinde O.T., Castera L., Dietrich C.F., Iijima H., Lee D.H., Kemp W., et. al.

The World Federation for Ultrasound in Medicine and Biology (WFUMB) endorsed the development of this document on multiparametric ultrasound. Part 1 is an update to the WFUMB Liver Elastography Guidelines Update released in 2018 and provides new evidence on the role of ultrasound elastography in chronic liver disease. The recommendations in this update were made and graded using the Oxford classification, including level of evidence (LoE), grade of recommendation (GoR) and proportion of agreement (Oxford Centre for Evidence-Based Medicine [OCEBM] 2009). The guidelines are clinically oriented, and the role of shear wave elastography in both fibrosis staging and prognostication in different etiologies of liver disease is discussed, highlighting advantages and limitations. A comprehensive section is devoted to the assessment of portal hypertension, with specific recommendations for the interpretation of liver and spleen stiffness measurements in this setting.

Ferraioli G., Barr R.G., Berzigotti A., Sporea I., Wong V.W., Reiberger T., Karlas T., Thiele M., Cardoso A.C., Ayonrinde O.T., Castera L., Dietrich C.F., Iijima H., Lee D.H., Kemp W., et. al.

Abstract The World Federation for Ultrasound in Medicine and Biology (WFUMB) has promoted the development of this document on multiparametric ultrasound. Part 2 is a guidance on the use of the available tools for the quantification of liver fat content with ultrasound. These are attenuation coefficient, backscatter coefficient, and speed of sound. All of them use the raw data of the ultrasound beam to estimate liver fat content. This guidance has the aim of helping the reader in understanding how they work and interpret the results. Confounding factors are discussed and a standardized protocol for measurement acquisition is suggested to mitigate them. The recommendations were based on published studies and experts' opinion but were not formally graded because the body of evidence remained low at the time of drafting this document.

Westcott F., Dearlove D.J., Hodson L.

The prevalence of metabolic diseases, including type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing. Although invariably associated with obesity, the importance of fat deposition in non-adipose tissue organs has yet to be fully explored. Pathological ectopic fat deposition within the liver (known as (MASLD)) has been suggested to underlie the development of T2DM and is now emerging as an independent risk factor for cardiovascular disease (CVD). The process of hepatic de novo lipogenesis (DNL), that is the synthesis of fatty acids from non-lipid precursors (e.g. glucose), has received much attention as it sits at the intersect of hepatic glucose and fatty acid handling. An upregulation of the DNL pathway has been suggested to be central in the development of metabolic diseases (including MASLD, insulin resistance, and T2DM). Here we review the evidence to determine if hepatic DNL may play a role in the development of MASLD and T2DM and therefore underlie an increased risk of CVD.

Borsukov A.V., Shestakova D.Y., Skutar’ A.I.

Objective. Study and comparison of the diagnostic performance of various ultrasound elastometry methods in detecting liver fibrosis in patients with heart failure.Materials and methods. The study was conducted from June 2022 to January 2024. 57 patients with heart failure and metabolic syndrome were examined, divided into three groups depending on the stage of the disease: stage I (n = 21), stage II (n = 24), stage III (n = 11), each of which was divided into subgroups depending on the severity of liver fibrosis (F0–F4). Standard parameters of sensitivity, specificity, and accuracy were used to compare the performance of transient elastometry, vibration-controlled transient elastometry, point elastometry, and two-dimensional shear wave elastometry. A complex of multislice computed tomography with color assessment of the liver structure, a biochemical blood test with the de Ritis coefficient and the FIB‑4 scale were used as a reference method.Results. In stage I heart failure, all four methods showed similar sensitivity, specificity and accuracy. At stage II, using transient elastometry, sensitivity was 59.4%, specificity — 68.2%, accuracy — 62.4%; visual transient elastometry — 72.8%, 87.2%, 79.4%, respectively; point elastometry — 68.6%, 83.7%, 77.4%, respectively; two-dimensional shear wave elastometry — 89.6%, 94.3%, 91.6%. At stage III, transient elastometry turned out to be uninformative; visual transient elastometry showed a sensitivity of 61.2%, specificity of 70.4%, accuracy of 64.6%; point elastometry — 48.6%, 60.1%, 52.3%, respectively; while two-dimensional shear wave elastometry showed a sensitivity of 85.6%, specificity of 92.5%, accuracy of 88.8%.Conclusions. For patients with stage I heart failure, the choice of a specific elastometry method is not of fundamental importance, since the indicators do not differ. However, in stages II and III, shear wave elastometry is the preferred method, especially in stage III, where it demonstrates higher diagnostic performance compared to point elastometry. Visual transient elastometry can be used additionally with the method of two-dimensional shear wave elastometry or in the case where two-dimensional shear wave elastometry is not possible. 

Holzhey M., Petroff D., Wirkner K., Engel C., Baber R., Tönjes A., Zeynalova S., Yahiaoui-Doktor M., Berg T., Karlas T., Wiegand J.

Introduction Guidelines increasingly recommend the use of glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose co-transporter-2 inhibitors (SGLT2i) to prevent cardiovascular and cardiorenal endpoints. Both drugs also show beneficial effects in nonalcoholic fatty liver disease (NAFLD). Preexisting GLP-1 RA and SGLT2i therapies are frequently defined as exclusion criterion in clinical studies to avoid confounding effects. We therefore investigated how this might limit recruitment and design of NAFLD studies. Methods GLP-1 RA and SGLT2i prescriptions were analyzed in NAFLD patients with diabetes mellitus recruited at a tertiary referral center and from the population-based LIFE-Adult-Study. Individuals were stratified according to noninvasive parameters of liver fibrosis based on vibration-controlled transient elastography (VCTE). Results 97 individuals were recruited at tertiary care and 473 from the LIFE-Adult-Study. VCTE was available in 97/97 and 147/473 cases. GLP-1 RA or SGLT2i were used in 11.9% of the population-based cohort (LSM < 8 kPa), but in 32.0% with LSM ≥ 8 kPa. In the tertiary clinic, it was 30.9% overall, independent of LSM, and 36.8% in patients with medium and high risk for fibrotic NASH (FAST score > 0.35). At baseline, 3.1% of the patients in tertiary care were taking GLP-1 RA and 4.1% SGLT2i. Four years later, the numbers had increased to 15.5% and 21.6%. Conclusion GLP-1 RA and SGLT2i are frequently and increasingly prescribed. In candidates for liver biopsy for NASH studies (VCTE ≥ 8 kPa) the use of them exceeds 30%, which needs careful consideration when designing NASH trials.

Boers T., Brink W., Bianchi L., Saccomandi P., van Hespen J., Wennemars G., Braak S., Versluis M., Manohar S.

AbstractBackgroundNeedle‐based procedures, such as fine needle aspiration and thermal ablation, are often applied for thyroid nodule diagnosis and therapeutic purposes, respectively. With blood vessels and nerves nearby, these procedures can pose risks in damaging surrounding critical structures.PurposeThe development and validation of innovative strategies to manage these risks require a test object with well‐characterized physical properties. For this work, we focus on the application of ultrasound‐guided thermal radiofrequency ablation.MethodsWe have developed a single‐use anthropomorphic phantom mimicking the thyroid and surrounding anatomical and physiological structures that are relevant to ultrasound‐guided thermal ablation. The phantom was composed of a mixture of polyacrylamide, water, and egg white extract and was cast using molds in multiple steps. The thermal, acoustical, and electrical characteristics were experimentally validated. The ablation zones were analyzed via non‐destructive T2‐weighted magnetic resonance imaging scans utilizing the relaxometry changes of coagulated egg albumen, and the temperature distribution was monitored using an array of fiber Bragg grating sensors.ResultsThe physical properties of the phantom were verified both on ultrasound as well as in terms of the phantom response to thermal ablation. The final temperature achieved (92°C), the median percentage of the nodule ablated (82.1%), the median volume ablated outside the nodule (0.8 mL), and the median number of critical structures affected (0) were quantified.ConclusionAn anthropomorphic phantom that can provide a realistic model for development and training in ultrasound‐guided needle‐based thermal interventions for thyroid nodules has been presented.

Borsukov A.V., Venidiktova D.Y., Smirnova A.D., Yakusheva M.A.

Objective. Evaluation of a single vector of ultrasound assessment of changes in the liver parenchyma, taking into account the correct use of such physical concepts as stiffness, elasticity, elasticity, density.Material and methods. On the basis of the Problem Research Laboratory ‘Diagnostic Research and Minimally Invasive Technologies’ a study was conducted with the participation of 112 patients of a multidisciplinary hospital. Multiparametric ultrasound examination (B-mode, quantitative liver steatometry, 2D shear wave elastography, complex format ‘liver protocol’) was performed by ultrasound doctors (n = 24) of the following groups: half-a-year residents in the specialty ‘ultrasound diagnostics’ (n = 9; 37.6%), doctors working in a multidisciplinary hospital of a medical organization of the regional center with work experience up to 5 years (n = 4; 16.6%), 6–10 years (n = 4; 16.6%), 11–20 years old (n = 3; 12.6%), 21 years or more (n = 4; 16.6%), of which 1 (4.2%) professor, 1 (4.2%) doctor of medical sciences, 3 (12.5%) candidates of medical sciences. An analysis of the protocols of ultrasound examination was carried out.Results. The correct description of changes in the liver according to B-mode data, quantitative steatometry, 2D shear wave elastography and ‘liver protocol’ correct formulations were given by 9 (37.5%) specialists. In all cases, most of the correct protocols were provided by doctors from groups of 6–10 years of experience and 21 years of experience or more.Conclusions. In the community of specialists in ultrasound diagnostics there is no agreement on a correct and unified approach to the description of diffuse liver changes using multiparametric ultrasound. To increase the level of knowledge, complex multidisciplinary interaction is necessary in the format of scientific and educational programs organized jointly with specialists in the field of medical physics.

Nagao K., Maruichi‐Kawakami S., Aida K., Matsuto K., Imamoto K., Yukawa H., Kanazawa T., Kobayashi Y., Takahashi N., Ito H., Hayashi F., Inada T.

Background Peripheral venous pressure (PVP) has been shown to be a reliable surrogate for right atrial pressure in assessing congestion in patients with heart failure (HF). Liver fibrosis markers and scores can be useful in assessing organ injury in patients with acute HF. This study aimed to investigate the association of liver fibrosis markers and scores with PVP in patients with acute HF. Methods and Results The 7S domain of the collagen type IV N‐terminal propeptide (P4NP 7S), aspartate aminotransferase‐to‐platelet ratio index, fibrosis‐4, and nonalcoholic fatty liver disease fibrosis score were determined along with PVP measurements before discharge in 229 patients with acute HF. The strongest correlation with PVP was found for P4NP 7S (Pearson r =0.40). Patients with high P4NP 7S levels (≥median [6.2 ng/mL]) had an increased risk of cardiovascular death or HF hospitalization (adjusted hazard ratio [HR], 1.80 [95% CI, 1.09–3.04], P =0.02). The concomitant high PVP (≥mean [8 mm Hg])/high P4NP 7S group, in contrast to the high PVP/low P4NP 7S or low PVP/high P4NP 7S group, had a significant risk relative to the low PVP/low P4NP 7S group for cardiovascular death or HF hospitalization (adjusted HR, 2.63 [95% CI, 1.43–5.05], P =0.002). A sustained elevation in PVP for 1 month postdischarge was associated with a persistent increase in P4NP 7S. Conclusions The study demonstrated the relationship between the liver fibrosis marker P4NP 7S and congestion. PVP and P4NP 7S could be useful for assessing congestion‐related organ injury and predicting prognosis in patients with acute HF.

Aspromonte N., Fumarulo I., Petrucci L., Biferali B., Liguori A., Gasbarrini A., Massetti M., Miele L.

Heart failure (HF) is a clinical syndrome due to heart dysfunction, but in which other organs are also involved, resulting in a complex multisystemic disease, burdened with high mortality and morbidity. This article focuses on the mutual relationship between the heart and liver in HF patients. Any cause of right heart failure can cause hepatic congestion, with important prognostic significance. We have analyzed the pathophysiology underlying this double interaction. Moreover, we have explored several biomarkers and non-invasive tests (i.e., liver stiffness measurement, LSM) potentially able to provide important support in the management of this complex disease. Cardiac biomarkers have been studied extensively in cardiology as a non-invasive diagnostic and monitoring tool for HF. However, their usefulness in assessing liver congestion in HF patients is still being researched. On the other hand, several prognostic scores based on liver biomarkers in patients with HF have been proposed in recent years, recognizing the important burden that liver involvement has in HF. We also discuss the usefulness of a liver stiffness measurement (LSM), which has been recently proposed as a reliable and non-invasive method for assessing liver congestion in HF patients, with therapeutic and prognostic intentions. Lastly, the relationship between LSM and biomarkers of liver congestion is not clearly defined; more research is necessary to establish the clinical value of biomarkers in assessing liver congestion in HF patients and their relationship with LSM.

Borsukov A.V., Venidiktova D.Y., Skutar A.I., Ahmedova A.R.

Purpose: To evaluate the dynamics of the opinions of world experts on the materials of world recommendations on ultrasound elastography and liver steatometry from the standpoint of the domestic level of development of ultrasound diagnostics and on the basis of our own data.Material and methods: 16 main provisions of the World Guidelines for Liver Elastography in 2018 were reviewed and comments were made, differences from the European Guidelines of 2017 and the first World Guidelines of 2015 were noted. We reviewed and commented on the 2020 SRU comments. The final scientific publication of a large group of world experts in 2022 is analyzed in detail, where for the first time the norms and threshold values between benign and malignant neoplasms of a large number of human organs and tissues are given.Results: From 2006 to the present, more than 45,000 ultrasound studies have been carried out on our own material (n=15627), some differences in approaches to liver elastometry are given, and approaches to the use of ultrasound steatometry are considered.Conclusion: Threshold development vectors are shown, techniques to avoid artifacts and reduce the risk of obtaining false negative and false positive elastometry results are proposed. There is caution of the expert community in the review of the method of quantitative steatometry based on the measurement of the attenuation coefficient of the ultrasound wave.

Chan W., Chuah K., Rajaram R.B., Lim L., Ratnasingam J., Vethakkan S.R.

Ciardullo S., Carbone M., Invernizzi P., Perseghin G.

AbstractBackground and ObjectiveThe aim of the present study is to explore the epidemiologic impact of the definition of steatotic liver disease (SLD) proposed by a multi‐society (American Association for the Study of the Liver‐the European Association for the Study of Liver Diseases‐Asociación Latinoamericana para el Estudio del Hígado) Delphi consensus statement.MethodsThis is a cross‐sectional study of US adults participating in the 2017–2020 cycles of the National Health and Nutrition Examination Survey who were evaluated by vibration‐controlled transient elastography. Hepatic steatosis and fibrosis were diagnosed by the median value of controlled attenuation parameter and liver stiffness measurement using cut‐offs of 274 dB/m and 8.0 kPa, respectively. Recently proposed criteria for metabolic dysfunction‐associated steatotic liver disease (MASLD), MetALD (MASLD + significant alcohol consumption), MASLD‐Viral hepatitis and cryptogenic SLD were applied.ResultsSLD was present in 42.1% (95% CI: 40.3–43.9) of the 3173 included participants. Among patients with SLD, 99.4% met the metabolic dysfunction definition. Moreover, 89.4%, 7.7%, 2.4%, 0.4% and 0.1% were defined as MASLD, MetALD, MASLD‐Viral, alcoholic liver disease (ALD) (significant alcohol consumption without metabolic dysfunction) and cryptogenic, respectively. No patients without metabolic dysfunction had significant liver fibrosis, which was present in 15.2%, 9.5% and 19.5% of patients with MASLD, MetALD and MASLD‐viral, respectively. Approximately, 90% of the overall adult US population could be diagnosed with metabolic dysfunction according to the consensus criteria. A high degree of concordance was found between MASLD and the previously proposed metabolic dysfunction‐associated fatty liver disease definition.ConclusionsMetabolic dysfunction is present in almost all patients with SLD in the United States. The new change in diagnostic criteria did not significantly impact disease prevalence.

Venidiktova D.Y., Borsukov A.V.

Taking into account the lack of consensus between different scientific groups on the nature and unity of the pathomorphological substrate of non-alcoholic and metabolically associated fatty liver diseases, there is a need to find new instrumental methods for their differential diagnosis in order to develop the correct treatment and monitoring tactics.Aim: To assess the possibilities of using the complex application of instrumental diagnostic methods for the differential diagnosis of metabolically associated and non-alcoholic fatty liver disease.Methodology and Methods. The study involved 94 patients of a multidisciplinary hospital with a combination of ultrasound signs of liver steatosis according to the B-mode. As part of the two stages of the diagnostic examination, clinical, laboratory and instrumental methods were used, including a block of ultrasound diagnostics (assessment of the thickness of visceral fat, quantitative liver steatometry, two-dimensional elastography of shear waves of the liver), dual-energy X-ray absorptiometry in the “Whole body” mode. The control group included 78 patients without signs of hepatic steatosis according to B-mode ultrasound.Results. All patients were divided into groups according to signs of metabolic syndrome, with subsequent distribution into conditional groups of patients with non-alcoholic and metabolically associated fatty liver disease, highlighting the main signs of both diseases. Metabolic syndrome was detected in 24 women (29.27%), 18 men (21.95%). In 53 patients (64.63%), the presence of hepatic steatosis was quantitatively confirmed, of which 39 patients were found to be overweight or obese (47.56%).Conclusion. Indicators of the instrumental assessment of the metabolic status and a complex diagnostic algorithm were determined, allowing for differential diagnosis between non-alcoholic and metabolically associated fatty liver disease with a quantitative assessment of liver steatosis.

Ferraioli G., Raimondi A., Maiocchi L., De Silvestri A., Poma G., Kumar V., Barr R.G.

Leonov D., Venidiktova D., Costa-Júnior J.F., Nasibullina A., Tarasova O., Pashinceva K., Vetsheva N., Bulgakova J., Kulberg N., Borsukov A., Saikia M.J.

The WHO reported an increasing trend in the number of new cases of breast cancer, making it the most prevalent cancer in the world. This fact necessitates the availability of highly qualified ultrasonographers, which can be achieved by the widespread implementation of training phantoms. The goal of the present work is to develop and test an inexpensive, accessible, and reproducible technology for creating an anatomical breast phantom for practicing ultrasound diagnostic skills in grayscale and elastography imaging, as well as ultrasound-guided biopsy sampling. We used FDM 3D printer and PLA plastic for printing an anatomical breast mold. We made a phantom using a mixture of polyvinyl chloride plastisol, graphite powder, and metallic glitter to simulate soft tissues and lesions. Various degrees of elasticity were imparted using plastisols of stiffness ranging from 3 to 17 on the Shore scale. The lesions were shaped by hand. The materials and methods used are easily accessible and reproducible. Using the proposed technology, we have developed and tested a basic, differential, and elastographic versions of the breast phantom. The three versions of the phantom are anatomical and intended for use in medical education: the basic version is for practicing primary hand–eye coordination skills; the differential one is for practicing the differential diagnosis skills; the elastographic version helps developing the skills needed for assessing the stiffness of tissues. The proposed technology allows the creation of breast phantoms for practicing hand–eye coordination and develop the critical skills for navigation and assessment of the shape, margins, and size of the lesion, as well as performing an ultrasound-guided biopsy. It is cost-effective, reproducible, and easily implementable, and could be instrumental in generating ultrasonographers with crucial skills for accurate diagnosis of breast cancer, especially in low-resource settings.