What is CDK in medicine? CDC is one of the methods of scanning vessels with ultrasonic waves

Modern technique CDC is a scanning of blood vessels with a digital image that allows one to distinguish the speed of blood flow in vessels of different diameters, study their shape and determine the degree of their deviation from the norm.

CDC is modern way vascular studies

It is a method of examining blood vessels and checking blood circulation in them.

It is based on converting the frequencies of wave oscillations, in the path of which obstacles arise in the form of the Doppler effect. Emitted sound vibrations reflected from moving objects.

On technical devices, signals are processed and a color image appears. As a result of the examination, the doctor is able to determine problems with blood flow in a specific area.

• Harmful, other diseases, pathologies carotid arteries.
• in vessels located deep and close to the skin.
• Vascular diseases in the extremities and abdominal cavity.
• Determination of the state of the brain in cases of suspected vascular disorders. Color flow and Doppler sonography allow you to determine the location of blockages in veins and arteries that cause problems in the functioning of the brain.
• You can examine both health and the placenta, the nature of blood flow to the fetus.
• and arteries in the spine.

There are two main areas of Dopplerography:

1. PSD or spectral dopplerography. This technique is used to analyze large veins, arteries and chambers of the heart. Taking into account the nature of the blood flow, a constant or pulsed scanning technique is used.
2. Power Doppler ultrasound imaging Current state all blood vessels located in the area under study. Even the smallest capillaries are taken into account here.

There are several main types of Doppler ultrasound:

1. Transcranial examination is used solely for the purpose of scanning blood vessels in the head
2. Duplex method combining conventional and scanning. The technology allows you to study the vessel of interest in as much detail as possible, determine the diameter of the lumen, and the condition of the artery walls in a certain area of ​​the blood flow.
3. Color Dopplerography refers to a duplex scanning technique. Essentially it's the same ultrasound examination, but with different markings of blood flow speed. In the image, vessels of different sizes have their own colors, showing the real state of the blood supply. It is this technique that requires specially adjusted ultrasound sensors, and also allows you to notice tumors in the initial stages.

When do doctors prescribe such examinations?

For migraines and fainting, you need to go through Doppler study vessels of the head and neck

If the attending physician, as a result of the examination, suspects the presence of some disorder associated with poor condition blood vessels, the patient is sent for an ultrasound examination. Therefore, there may be many reasons for performing Doppler sonography.

Often such an examination is prescribed for pregnant women to check the condition of the fetus, placenta and its blood supply.

If patients have leg pain, doctors evaluate the condition of the blood vessels using ultrasound devices.

Depending on the location of the vessels, indications for examination can be divided into several groups. For example, veins and arteries in the neck and head area should be scanned if the following symptoms are present:

• Migraine
• and dizziness
• Problems with sound perception
• Memory problems, absent-mindedness
• Extraneous noises in the ears
• Bad dream

In addition, CDK is prescribed to patients with head injuries. For prevention, such examinations are recommended smoking people, people with diabetes, and those with osteochondrosis.

• Poor sensitivity, numbness
• Skin changes color
• Pain in the limbs at rest or during movement

Renal vessels are examined in the following situations:

• Possible veins and arteries
• There is blood in the urine
• Kidney failure

If the doctor suspects that the patient has abdominal aorta, the disease is characterized by a pulsating formation in the abdominal cavity, the presence painful sensations behind the navel in the back and lower back.

Where is this scanning especially effective?

CDC allows you to determine the presence of blood clots in blood vessels

CDC makes it possible to determine the current state of blood vessels and the presence of blood clots, formations, aneurysm or painful transformation of veins and arteries.

Qualified specialists can identify and examine a previously diagnosed pathology, but also recognize benign or malignancy, as well as possible development trends.

For example, without such a scan it will not be possible to distinguish an ordinary stone formed in gallbladder, from a polyp. It is the vessels that are considered the main object of Doppler scanning. For this reason, there is little point in conducting any other examinations using such ultrasound devices.

Examination of the fetus using ultrasound and color circulation

Doppler sonography is used to determine the condition of the fetus during pregnancy.

Doppler scanning is widely used today in obstetrics to determine the condition of the fetus at various stages of pregnancy. It makes it possible to diagnose problems with the development of the unborn baby.

During pregnancy, it is advisable to undergo routine ultrasound examinations at least 3 times.

Acceptable pregnancy periods at which obstetricians can obtain important information, are 10-12, 20-24, 32-37 weeks.

When performing color Doppler ultrasound, the doctor can identify the following anomalies:

• "Cleft palate"
• Hypotrophy
• Amniotic fluid amount
• Placenta previa

In some situations, the study allows you to determine the likelihood of miscarriage. This makes it possible to provide timely the necessary conditions For inpatient treatment or premises “for safekeeping”, so that expectant mother could safely bear fruit.

It is difficult to manage without Dopplerography multiple pregnancy and identifying the placement of the fetus in the womb.

Indications for fetal Doppler examination

Poor blood supply during pregnancy increases the likelihood of problems with fetal development.

Dopplerography can be performed in the following situations:

• Too much fast maturation placenta
• Characteristic oligohydramnios or polyhydramnios
• Problems with the location of the umbilical cord
• Manifestation of Rh conflict
• Preeclampsia
• Kidney problems, diabetes, hypertension
• Presence of chromosomal pathology
• Dropsy
• Uneven growth of embryos during multiple pregnancies

Doppler ultrasound in combination with CTG is performed in a situation where the fetus has heart problems.

Contraindications

It is not advisable to perform CDK if there are burns on the skin.

Let's consider the main list of contraindications:

• It is not advisable to conduct research when skin in the projection of the scanned organ there are inflammatory processes, burns, dermatological diseases, due to which it will not be possible to achieve a sufficiently tight fit of the sensor to the body. Since the position of the sensor is adjustable, such contraindications are rarely relevant in practice.
• Transrectal prostate scanning is not recommended after surgical procedures intestines, elimination hemorrhoids, with small anal fissures And various types diseases in which it is not recommended to insert sensors into the rectum or it is difficult to press the sensor tightly to the intestine.
• Transvaginal Dopplerography of the pelvis is not advisable to perform after surgery, or for virgins.
• Transabnominal Dopplerography, when bladder must be filled, not recommended for urinary incontinence and after surgical intervention. In addition, this scanning technique is not informative enough.

Most of the contraindications are due to possible risk for health conditions or insufficient information content of the study.

Is preparation required before scanning?

CDC does not require special training before the study

How should you prepare for scanning the color flow center, provided additional use devices? In most cases, when the doctor manages to perform a Doppler ultrasound different ways, no preparatory procedures are required.

The only nuance that needs to be taken into account is the influence of various nutrients on blood circulation in the vessels of the mother and fetus. For this reason, it is advisable to begin the examination only a few hours after eating.

How is the scan performed?

Color Doppler sonography is performed similarly to conventional ultrasound. In accordance with the doctor's instructions, you need to take a certain position and not move. After applying a special lubricant to the skin over the area under study, the sensor is moved over the skin.

results

As the examination progresses, it will be possible to identify various anomalies and problems in great detail, and then prescribe The right way treatment. When receiving the results of a Doppler ultrasound, you do not need to try to figure it out yourself and engage in diagnostics. All necessary instructions will only be stated by the attending physician or specialist who recently performed the examination.

What indicators are important for assessing blood flow

CDC allows you to painlessly determine the condition of arteries and veins in the human body

Doppler sonography is interpreted using several indicators that can be assessed in arteries or veins. After this, comparisons are made with the standards for a given vessel.

In most cases, the attending physician knows what a particular vessel looks like in in good condition, where it has bends, where it turns into more large vein or artery. The location and shape of the arteries in patients is always compared with the known normal state.

The following parameters are subject to assessment by doctors:

• Blood flow rate for individual species vessels
• The ratio of the lowest and highest blood flow rates
• Pulsation index - the difference between the lowest and highest speed divided by the average speed in the vessel
• The thickness of the vascular tissues in most examples ranges from 0.9 to 1.1 mm.

The cost is determined by which veins or arteries are scanned.

The advantages of this technique include the possibility of safe, painless examination blood flows and the condition of veins and arteries in different parts bodies. There is no radiation exposure and no direct contraindications to the use of this examination technique.

Watch a video about what Doppler sonography is:

The CDC technique is considered one of the most progressive in medicine; it allows detailed scanning internal organs, notify availability all kinds of diseases or detect them at an early stage.

Ultrasound with color circulation - what is it? This question interests many when a doctor’s prescription contains such an entry as an ultrasound of the central circulation. This means that the specialist has assigned a story ultrasound diagnostics with the study of blood movement through the vessels using the Doppler method.

Most often, this procedure is carried out during pregnancy in order to evaluate the functioning of the placenta, which provides vital functions to the baby.

In some cases, women undergo such diagnostics in order to find out in which pelvic organ the disorder has occurred and blood is not flowing into it.

This procedure is absolutely no different from a simple ultrasound examination. So there is no need to be afraid of her.

This diagnostic method is used to accurately describe the movement of blood flow, its pressure and speed, as well as to assess the degree of vascular patency. The procedure is carried out using ultrasound, which is sent into the vessels, and in response they receive a return signal, to which the sensor reacts.

The measuring device records the oscillation frequency, as well as the difference between the initial and subsequent values. During diagnostics, you can not only measure the speed of blood flow, but also determine its direction, look at the structure of the area under study and the patency of blood vessels. For each vessel, a certain oscillation frequency is selected.

This is the safest and completely painless research method. The procedure can be performed several times, depending on the need.

Today, this method allows you to objectively assess the situation: look at the state of vascular connections in the body, establish the cause of a particular ailment. For example, due to insufficient blood circulation, the fetus may suffer during pregnancy. And such a study will help identify this and prescribe measures to eliminate the problem.

At approximately 30-34 weeks, all pregnant women undergo a routine ultrasound. It is during this period that it is very important to understand how the placenta copes with its functions. If there are any disturbances in the blood flow, it is possible that the baby will lag behind in development or premature birth will begin.

Ultrasound with color circulation is a completely standard procedure that should not be feared.

Purpose of diagnosis

Despite the fact that during pregnancy, undergoing such a study is mandatory for everyone last date, sometimes the specialist makes an appointment earlier or carries it out several times.

Such a study may be prescribed if a person has certain problems with blood vessels or has diseases associated with the body’s vascular system. The presence of such problems is determined by a number of symptoms and complaints. Often women are prescribed such a diagnosis of the thyroid gland or mammary gland.

The specialist has to find out which vessel failed. And an ultrasound makes it clear how events will develop further, how the disease will progress and whether it will worsen general state patient.

So, Doppler studies are prescribed in the following cases:

1. 1. If during pregnancy there is diabetes, high blood pressure, VSD.
2. 2. Delayed development of the fetus in the womb.
3. 3. Rhesus conflict between mother and child.
4. 4. Multiple pregnancy.
5. 5. Transverse position of the baby in the womb.
6. 6. Entwining.
7. 7. Problem with amniotic fluid.
8. 8. Preeclampsia.
9. 9. Development of intrauterine pathologies.

This diagnosis is carried out starting from the 23rd week of pregnancy. Previously, it does not represent any informational character. The study will help clearly clarify the picture of hypoxia. If hypoxia occurs, then a study of the cause of such deviation is prescribed. Research makes it clear where the obstruction occurred and for what reason.

After this, the specialist develops a special pregnancy management plan.

Ultrasound with color circulation is often found, which is prescribed to patients with vegetative-vascular dystonia. It is prescribed in cases where the patient has complaints such as:

• changes in the veins in the legs;
• swelling of the legs;
• change in skin color;
• pain when walking;
• tingling;
• constantly cold extremities;
• long healing of wounds.

Often, with the help of such diagnostics, they examine abdominal cavity, thoracic region, neck, head. The study can be carried out planned or urgently. Everything depends only on the complaints and the patient’s condition.

A little about the method

CDC can be considered a type of classical ultrasound. It is based on the Doppler research method. This is the totality regular ultrasound in black and white with the use of colored highlighting of a particular area. Color allows you to assess blood flow and the state of the vascular system.

The black and white image has color inclusions, which precisely indicate the speed and direction of blood flow in all vessels.

Catad_tema Functional and laboratory methods diagnostics - articles

Color Doppler mapping in the diagnosis of uterine tumors

The article discusses the possibilities of color Doppler mapping (CDC) in the differential diagnosis of uterine tumors. The essence of the method is the ability to visualize all moving body fluids in real time and analyze their movement. The main achievements of CDK in the diagnosis of tumor processes are visualization and assessment of the blood flow of newly formed tumor vessels, which have their own characteristics. The tumor vascularization system, as a rule, is represented by many small, very thin, abnormal in shape and location of vessels, randomly scattered within the tumor tissue. The blood flow in these vessels is characterized by extremely low vascular resistance, high speed and a varied direction. The CDC method has high sensitivity, specificity and accuracy of prognosis in early diagnosis tumors and their differentiation according to the degree of malignancy. In addition, the level of vascularization assessed using color Doppler mapping allows one to predict the rate of growth of the identified formation. I.S. Sidorova, I.N. Kapustina, S.A. Levakov, A.N. Sarantsev
Department of Obstetrics and Gynecology, Faculty of Postgraduate Studies vocational education(Head of the department - Prof. I.S. Sidorova) Moscow medical academy them. THEM. Sechenov,
Urban clinical Hospital N 40 (chief physician - Honored Doctor of the Russian Federation M.I. Fedorova), Moscow.

The diagnostic value of color Doppler mapping (CDC) is difficult to overestimate. The essence of this method is the ability to visualize all moving body fluids in real time and analyze their movement. The study of blood flow in the vessels of neoplasms, which have their own characteristic features, allows us to consider this method important in the differential diagnosis of benign and malignant tumors uterus

CDC allows you to evaluate three parameters of blood flow simultaneously: direction, speed and character (homogeneity and turbulence). Due to the high resolution of the equipment currently used, visualization and identification of the smallest vessels up to the microvasculature system, invisible when scanning in B-mode.

The tumor vascularization system, as a rule, is represented by many small, very thin, abnormal in shape and location of vessels, randomly scattered within the tumor tissue. The blood flow in these vessels is characterized by extremely low vascular resistance, high speed and varied direction. The image of the blood flow is distinguished by the pronounced brightness of the color signal, and the “coloring” of tumor tissues can be dominated by both primary colors and the “mosaic” form of mapping. These features of blood flow are due to the presence large quantity arteriovenous anastomoses among newly formed vessels, which provide high kinetic energy of blood flow and explain the wide variability of its direction.

The CDC method has high sensitivity, specificity and accuracy in early diagnosis tumor diseases internal genital organs and their differentiation according to the degree of malignancy. The level of vascularization assessed using CDK allows one to predict the rate of growth of the identified formation.

Uterine fibroids. Studies performed by A. Kuljak and I. Zalud showed that out of 291 observations of benign uterine cancers, in 157 (54%) cases there were signs of tumor vascularization, as evidenced by the detection of color signals in the neoplasm tissue. Of 17 cases of malignant uterine tumors, intense vascularization was detected in 16 (94%) cases, which was confirmed by subsequent morphological studies.

Analysis of blood flow velocity curves in uterine fibroids allowed us to establish following features. All patients showed a decrease in resistance in both uterine arteries. Diastolic blood flow was always found in the main arteries supplying blood to the myomatous nodes. The average value of the resistance index at the level of myometrial blood flow was 0.54. The degree of vascularization depended more on the size of the tumor rather than on its location. The numerical values ​​of the resistance index in the uterine arteries averaged 0.74+/-0.09 for vascularized nodes and 0.80+/-0.10 for avascularized uterine fibroids (control 0.84+/-0.09).

It has been established that the growth of myomatous nodes directly depends on the increase in blood flow in vascular system uterus. The blood supply to myomatous nodes is carried out from vessels that are branches of the terminal sections of the uterine artery. Myomatous nodes grow due to the proliferation of smooth muscle cells and fibrous connective tissue, forming a pseudocansula. Therefore, with CDK, vessels located on the periphery of the myomatous node are more often visible. Dilated vessels visible in the outer third of the myomatous node are most often represented by dilated veins and arteries. The density of blood vessels depends on histological structure node and its location. Large quantity arteries are noted at the periphery of the node, since they are a continuation of the arcuate vessels of the uterus. In the central part, vessels are visualized in very small numbers. In these cases, morphological examination reveals necrotic, degenerative and inflammatory changes in the myomatous node.

Frequency of visualization of vessels of intratumoral blood flow, but data various authors, is characterized by a large scatter (54-100%). This is due to the use of different approaches (transvaginal and transabdominal scanning). It has been established that the degree of vascularization of myomatous nodes depends not only on their size, but also on location.

According to F. Aleem and M. Predanic, subserous myomatous nodes are the most vascularized. When studying blood flow indicators in these nodes, the lowest numerical values ​​of the resistance index were noted (IR 0.43), which apparently depends on the large cross-section of the artery passing through the pedicle of the subserous myomatous node. Interstitial and submucosal myomatous nodes are characterized by higher vascular resistance (IR 0.59 and 50, respectively).

There is also a decrease in vascular resistance in the uterine arteries and arteries of the unchanged myometrium.

According to S.E. Huang, intratumoral values ​​of the pulsatility index are proportional to the size of the uterus. However, they did not reveal the dependence of the pulsatility index on cell proliferation and angiogenesis.

Taking into account the significant scatter in the numerical values ​​of the resistance index in different zones of the myomatous node, the authors recommend recording intratumoral blood flow velocity curves in at least 3 areas of the node. Measurements are taken in suspicious areas of the node (areas of reduced echogenicity, cystic cavities), which are usually located in the center of the tumor node.

Color Doppler mapping is used by many researchers to evaluate effectiveness conservative treatment patients with uterine fibroids. After 4 months of taking gonadotropin releasing hormone analogues (AGTRH), there is a significant increase in vascular resistance of the uterus. The index of resistance of the uterine arteries and large arteries of myomatous nodes was used as a criterion. The resistance index of the uterine arteries before treatment averaged 0.52, in the large arteries of myomatous nodes - 0.48, and after treatment - 0.92 and 0.91, respectively. The authors concluded that the decrease in uterine volume during AGTRH therapy is due to a decrease in uterine vascularization.

Endometrial carcinoma. Endometrial cancer is a fairly common pathology and ranks second among all malignant diseases female genital organs. Statistical data recent years indicate a significant increase in the incidence of endometrial cancer. In our country it increases annually by approximately 6%.

Most common clinical manifestation endometrial cancer - the appearance of bloody abnormal discharge from the genital tract, which undoubtedly belongs to late manifestations this pathology.

Numerous studies indicate that the main focus in diagnosing endometrial cancer is on determining the thickness of the M-echo. In menopause, this indicator, exceeding 5 mm, is considered as the leading echographic sign of this pathology, which requires comprehensive examination to clarify the diagnosis (separate diagnostic curettage).

From the point of view of V.N. Demidov, most characteristic features Endometrial cancers are as follows:

Heterogeneity internal structure education;
- uneven contours;
- higher echogenicity compared to the uterine muscle;
- big sizes formations that are half the thickness of the uterus or more;
- increased sound conductivity;
- presence of liquid inclusions irregular shape and of various sizes;
- noticeable increase in the size of formations with dynamic observation;
- lack of a clear image of the contours of the uterus due to transition tumor process to adjacent organs.

It is now known that in most cases, endometrial cancer occurs against the background of precancerous diseases. G.M. Savelyev and V.N. Serov observed the transition of benign neoplastic processes to cancer in 79% of patients. TO precancerous diseases include atypical hyperplasia, adenomatous polyps, glandular cystic hyperplasia in menopause (especially recurrent) or developing against the background of neuroendocrine disorders. Other types of endometrial pathology turn into cancer extremely rarely.

From data by V.N. Demidov and S.P. Krasikova follows that the use of echography in women and timely detection and the elimination of a benign neoplastic process made it possible to reduce the incidence of endometrial cancer by 6.2 times. Thus, before the use of echography, stage I cancer was diagnosed in 50% of patients, stage II - in 32%, Stage III- in 4% and stage IV - in 8%. In the last 5 years of using echography, these figures were 75, 20, 5 and 0%, respectively.

However, the use of color flow with analysis of blood flow velocity curves is more precise method diagnosis of endometrial carcinoma, since in the vast majority of cases of the disease there are pathological curves of blood flow velocity, characteristic of vessels with reduced resistance.

In a study conducted in 35 postmenopausal women with endometrial carcinoma, it was found that endometrial blood flow was recorded in 91% of cases: intratumoral - in 29%, peritumoral - in 45%, their combinations - in 26%. The resistance index (RI) for endometrial carcinoma was 0.42+/-0.02; normally, in atrophic endometrium and in most cases of hyperplasia, endometrial blood flow was not visualized. Newly formed vessels in the intratumor type are viewed in color Doppler mode inside the M-echo, and in the peri-tumor type - directly along the outer border of the M-echo. The resistance index for intratumoral blood flow is 0.39, for peritumoral blood flow - 0.43, which is significantly lower than in the group of patients with endometrial hyperplasia - 0.65.

7. Bourne et al. when examining 223 postmenopausal women (endometrial atrophy - 199, endometrial carcinoma - 24), they found that with adenocarcinoma, the thickness of the endometrium averaged 20.2 mm, while with atrophy -1.35 mm. The pulsatility index (PI) of the uterine arteries is significantly lower in cancer than in atrophy (1.0 and 3.8, respectively). According to other authors, in women and postmenopausal women with the presence of bloody discharge from the genital tract prognostic value positive result color Doppler mapping was 94%, negative - 91%.

However, it is more justified to evaluate blood flow velocity curves in specific vessels (intra- and peritumoral). The pulsatility index is a less sensitive criterion than the vascular resistance index.

P. Sladkevicius and L. Valeiitin (cited from V.K. Mitkov et al.) examined 138 postmenopausal women no more than 8 days before the planned operation. After surgery, 114 women had benign endometrial changes and 24 had malignant changes. The thickness of the endometrium in benign processes was 5.5 mm (individual fluctuations from 1 to 44 mm), in malignant processes it was 24 mm (from 7 to 56 mm). Blood flow studies were carried out in the uterine arteries, as well as in intra- and peritumoral vessels. The number of cases of detection of signals in the color flow mode was significantly higher in endometrial cancer than in its benign changes, both in the study of endometrial vessels (87 and 34%) and around it (91 and 58%). The pulsation index in the uterine arteries was significantly lower in malignant endometrial processes. At the same time, PIs in intra- and periendometrial arteries in malignant and benign processes did not differ from each other. Application of CDC for differential diagnosis benign and malignant changes in the endometrium allows you to use only such an indicator as endometrial thickness.

S. Rakits et al. conducted a prospective analysis of 64 cases of endometrial pathology using the classical gray scale in combination with color Doppler mapping for the diagnosis of endometrial cancer. Pathological blood flow and neovascularization were characterized by the presence of “hot spots” in the endometrium. The "hot spots" were noticeably different from the surrounding blood vessels. "Hot spots" are a sequence of newly formed chaotic shunts and alternative changes in blood flow. Resistance and pulsation indices were measured in separate blood vessels, which made it possible to prove the absence of the muscular membrane in the wall of arterial vessels in the neovascularization basin. In the case of pathology, diastolic blood flow was accelerated, but the indices remained low. The volume limits for IR 0.4 and PI 1 in the study did not differ from the generally accepted ones.

Endometrial cancer was detected in 12 cases, benign pathology in 52 cases. Lack of blood flow was detected in 48 patients with benign and 4 malignant changes in the endometrium.

In the presence of pathological blood flow, “hot spots” were visualized in 8 cases of malignant and 4 cases of benign changes (specificity 92%, positive predictive value 67%, predictive value negative result test 92.3%). However, their studies did not reveal differences in blood flow velocity levels in primary and secondary blood vessels, but showed a difference between the two groups of patients for IR and IS. Both indices have a high correlation and specificity of 92%. The predictive value is unsatisfactory: for PI - 46% and IR - 56%. This can be explained in the following way: Small and tortuous endometrial vessels align the angle of Doppler sound reflection, which leads to error due to low blood flow velocity. The authors concluded that the combination of the two ultrasound modalities is valuable for screening for endometrial cancer.

L.E. Teregulova, examining 218 patients with histologically confirmed endometrial cancer, came to the conclusion that ultrasonography makes it possible to determine the degree of development of endometrial cancer, the depth of invasion and the prevalence of the process, since with the growth of endometrial adenocarcinoma, venous and then arterial vessels with characteristic of malignant tumors low index resistance: IR<0,42.

Sarcoma of the uterus. One of the difficult issues of ultrasound examination for uterine fibroids is the differential diagnosis of sarcoma. Uterine sarcoma is quite rare, accounting for 1-3% of all malignant tumors of the uterus. Sarcoma is not characterized by pronounced clinical symptoms, although in most cases irregular bleeding and rapid growth of the uterus are noted. Most researchers point to the almost complete identity of the echographic images of sarcoma and uterine fibroids.

So, V.I. Demidov and B.I. Zykin, having conducted a retrospective analysis of case histories of 9 patients with a morphologically confirmed diagnosis of sarcoma, did not reveal clear echographic signs of this tumor. According to the authors, indirect signs that allow one to suspect sarcoma are the presence in the myomatous uterus of a zone of reduced echogenicity without signs of acoustic enhancement, the appearance of cystic degeneration of the tumor and its increase in the menopausal period. However, a similar picture can be observed with pronounced secondary changes in myomatous nodes.

Additional echographic criteria for uterine sarcoma include the presence of large, predominantly solid tumors of the uterus, which either have a lobulated structure or do not have the characteristic signs of mature, long-standing fibroids, as well as the absence of images of the uterine cavity and endometrium. It was found that in all 8 patients with uterine sarcoma, intratumoral blood flow was well visualized. The resistance index is 0.37+/-0.03 (for fibroids 0.59+/-0.08, normal 0.90+/-0.02). The differential diagnostic criterion between sarcoma and uterine fibroids in the Color Doppler mode is the visualization of irregular, thin, chaotically scattered signals from vessels with indicators of low resistance both inside and around the tumor.

Cervical carcinoma. V. Breyer et al. found that in cervical cancer there is a significant decrease in the resistance index and pulsation index in the branch of the uterine artery. Although CDC cannot serve as a screening test for diagnosing cervical cancer, this method is suitable for dynamic monitoring of patients during conservative treatment using radiation and chemotherapy. In patients with cervical cancer, the resistance index was significantly reduced (0.57+/-0.14) compared to the control group (0.87+/-0.12). CDC may be useful in patients with suspected cervical cancer.

Trophoblastic tumors of the uterus. Trophoblast tumors are a serious disease in women of childbearing age. Over the past decades, there has been an increase in the incidence of trophoblastic disease by 1.54 times, and malignancy of hydatidiform mole occurs in 3-5% of patients; There is certainly a risk of increased incidence of choriocarcinoma. Diagnosis of hydatidiform mole during ultrasound examination is quite simple: the uterus is enlarged, the contours are smooth, the structure of the myometrium is heterogeneous due to diffusely dilated vessels, the cavity is expanded evenly, the border with the myometrium is clearly defined, in the cavity there are multiple small (4-6 mm) cellular structures in the background reflections of increased intensity. If a living fetus is detected in the uterine cavity and at the same time in one of the areas of the placenta, cellular structures should be assumed to be partial hydatidiform mole.

The predominance in the structure of a hydatidiform mole of a solid component with reflections of increased intensity and cellular structures of smaller sizes (up to 4 mm) indicates a more pronounced proliferation of the chorionic epithelium. A characteristic feature of hydatidiform mole is the detection of thin-walled multiseptal cystic formations of the ovaries; in most cases they are bilateral (theca lutein).

Trophoblastic tumors are characterized by high vascularity. In this case, the tumor vessels have an irregular shape and different caliber; with destructive tumor growth with damage to the vessel walls, arteriovenous shunts are observed. For many years, pelvic angiography has been used to diagnose trophoblastic disease, based on identifying changes in both existing pelvic vessels and new pathological vessels. Detection of trophoblastic disease using color Doppler is based on the detection of impaired vascularization and typical turbulent blood flow in tumor vessels. According to F. Flam et al. , a comparative study of PDC and pelvic angiography data obtained in 10 patients with trophoblastic disease showed complete agreement of the results, while the real-time study in 3 cases did not allow an accurate diagnosis to be established.

K. Shimamoto et al. reported 100% sensitivity of CDK in diagnosing trophoblastic disease. The results of R. Matijevic's studies showed that in trophoblastic disease, in 100% of cases it is possible to clearly visualize the uterine, arcuate, radial and spiral arteries in the Color Doppler mode. The numerical values ​​of IR and PI in this disease in the vessels under consideration are significantly lower than similar indicators in normal pregnancy. The resistance index in the uterine arteries in trophoblastic disease averages 0.74+/-0.08. After curettage, the resistance index increases after 4 weeks to 0.84+/-0.07. It is of interest to use CDC for dynamic monitoring to assess the effectiveness of chemotherapy in trophoblastic disease. During treatment, there is a decrease in vascularization, expressed in an increase in the resistance index, in choriocarcinoma during chemotherapy.

Thus, there are conflicting opinions about the dependence of intratumoral blood flow on cell proliferation and angiogenesis in benign and malignant uterine tumors. Further study of the dependence of blood flow velocity curves on the histological structure and degree of differentiation of tumors is required.

As a result, it should be noted that although most of the studies conducted have found encouraging data, more research is needed.

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Sometimes a standard ultrasound examination (ultrasound) is not enough to establish an accurate diagnosis, since it is not the structure of the organ itself that is disrupted, but the blood circulation in it. Then color Doppler mapping (CDC) comes to the rescue. A study such as ultrasound with color flow is a reliable method for diagnosing blood flow disorders in organs. The method is used if thrombosis, blockage of a vessel, or cardiac dysfunction is suspected.

Ultrasound with Color Doppler is based on the Doppler Effect - the ability of an ultrasonic wave to change frequency as it approaches or moves away from the ultrasound sensor. That is why the examination is important for assessing the characteristics of the blood supply to organs and tissues. In this case, the objects whose approach or distance is determined by ultrasound are red blood cells. The scanner of an ultrasound machine simultaneously generates and receives ultrasonic waves.

When performing an ultrasound in color Doppler mode, a red-blue image is displayed on the screen. Blood flow towards the scanner is coded in red, and away from it in blue. Hence the name of the method – CDK. A standard ultrasound examination shows an accurate black and white image of the structure of the organ. Thus, conventional ultrasound in combination with color Dopplerography helps to obtain complete information about the processes that occur in the area of ​​interest in the body.

What to look for and when to prescribe

The color flow mode on an ultrasound machine allows you to see the following changes in the vessels:

• blood clots and foreign bodies;
• atherosclerotic plaques;
• incorrect direction of blood flow;
• change in blood flow speed;
• narrowing or expansion of the lumen of blood vessels (arteries and veins);
• aneurysms;
• poor circulation inside the heart cavity, improper functioning of valve structures;
• the presence or absence of blood flow in organs or neoplasms.

The main situations when CDK diagnostics are prescribed:

• painful and uncomfortable sensations in the limbs, neck and head, in the abdomen and chest;
• headaches, dizziness, episodes of loss of consciousness;
• swelling in the legs;
• visual expansion of the saphenous veins of any area;
• cramps, heaviness, pain in the lower extremities;
• coldness of the extremities with a change in their color;
• long-term non-healing wounds, ulcers on the legs;
• the presence of a space-occupying formation of an unspecified nature of any location (pelvic and abdominal organs, genitourinary system, mammary glands, thyroid gland);
• suspicion of impaired blood flow in the mother-fetus system during pregnancy.

For pregnant women, ultrasound with colorectal dosage is prescribed in the following cases:

• the presence of unfavorable background diseases (diabetes mellitus, neurocirculatory dystonia, hypertension);
• Rhesus conflict;
• umbilical cord entanglement;
• changes in the properties of amniotic fluid in the uterine cavity;
• multiple pregnancy;
• incorrect presentation of the fetus;
• gestosis;
• intrauterine growth retardation;
• large fruit;
• child development abnormalities;
• sudden deterioration in the condition of a pregnant woman.

Are there possible contraindications?

There are no absolute contraindications for ultrasound with colorectal dosage. This research method is safe for health, so it is often prescribed several times - over time - to correct the treatment. For example, with thrombosis, vascular aneurysms, during pregnancy.

There may be situations where ultrasound and Doppler examination are difficult. These are relative contraindications:

• skin diseases or mechanical damage, skin burns in the area that needs to be examined;
• the general serious condition of the patient, if he is unconscious, cannot move independently, or follow the doctor’s commands;
• a recent diagnostic FGDS or colonoscopy, after which gases accumulate in the intestines, making visualization difficult. This is a relative contraindication for CDK in diseases of the abdominal and pelvic organs.

Ultrasound of a fetus with colorectal dysplasia is not performed until the 23rd week of pregnancy, since the procedure in the early stages will still not provide the necessary information.

Decoding and norms

Decoding the CDC indicators is complex and requires special training of a specialist who knows the methods of conventional ultrasound diagnostics. Therefore, you will not be able to independently identify any pathology by looking at the ultrasound examination protocol with color circulation. When performing color Doppler, a functional diagnostics doctor evaluates the following parameters:

• linear speed of blood flow;
• direction of blood flow;
• vascular pulsation;
• width of the vessel lumen;
• the presence of thrombus formation, foreign bodies in the lumen of the vessel;
• resistance index - vascular wall density;
• the presence or absence of blood flow in a given area;
• the presence of aneurysms, abnormalities in the structure of the vessel;
• blood circulation directly inside the heart cavity.

Acceleration of blood flow through the central circulation may be a sign of vessel narrowing. Slowdown is possible due to insufficient contractility of the vessel wall or heart, which cannot push blood through with the proper force. Vessel narrowing is observed with atherosclerosis, thrombosis, compression by a foreign body; expansion - with varicose veins, the presence of an obstruction to blood flow.

Determining the direction of blood flow using ultrasound with color flow is especially important for heart defects, when it is diagnosed whether there is a reverse flow of blood from one chamber to another (regurgitation), or whether there is a mixing of arterial and venous blood. In particular, this is how indications for surgical treatment are determined.

Sometimes it is important to determine whether there is blood flow in an organ at all - a sharp decrease in it leads to the death of a section of tissue and the development of complications. It is also important to understand whether the mass is supplied with blood, especially if it is planned to be surgically removed. This is how the risk of bleeding is predicted.

Preparation and execution

Special preparation for an ultrasound scan with colorectal dosage is not always required. For example, if you have been prescribed an examination of the vessels of the limbs, neck, thyroid gland, placental blood flow, then the main preparation is to remember to bring a sheet and wet wipes with you to remove the gel; you don’t need to do anything else.

If you are going to have a color circulation of the abdominal organs, pelvis, or kidneys, then it is important to follow the following instructions:

• 3 days before the procedure, avoid foods that cause flatulence - such as cabbage, legumes, and baked goods.
• Do not eat any food for about 8 hours before the start of the study; you are only allowed to drink still water.
• In some cases, 6-7 hours before an ultrasound with CDK, it is recommended to take Espumisan, activated carbon or other sorbents so that the gas formed in the intestines has time to dissolve.

The procedure itself is usually performed with the patient in a horizontal position; sometimes the doctor asks you to tilt your head back, bend your knees, turn to the side, etc. This is necessary for ease of installation of the sensor and gaining access to deep vessels, the visualization of which may be difficult. A hypoallergenic transparent gel is applied to the area being examined to eliminate any air gap that reduces image clarity.

The blood supply zones will be displayed on the monitor screen in red and blue; the numbers show all the characteristics of blood flow through the vessels. The doctor enters the results of the CDC into the ultrasound protocol, as a rule, immediately during the examination. The procedure time usually varies from 15 to 30 minutes depending on the area being examined. After its completion, do not forget to wipe the gel off the skin and wait for the result.

Where to do it and how much it costs

The study is carried out, if indicated, free of charge under the compulsory medical insurance policy in many hospitals and city clinics, subject to the availability of the necessary equipment and trained specialists. If desired, an ultrasound scan with the CDC mode can be performed for a fee or under a VHI policy in private medical centers engaged in functional diagnostics. The price of the procedure depends on the area of ​​study, the cost of the ultrasound machine, and the qualifications of the doctor. The average price for CDK is from 1000 to 4000 rubles.

Color Doppler mapping is an informative technique that allows you to identify problems with blood flow in various organs and tissues, as well as see over time how effective the treatment is. In combination with a classic ultrasound examination, colorectal dosage can provide complete information about the condition of the organ and how impaired blood supply affects its functioning.

Doppler is an ultrasound method based on the Doppler effect. The effect is to change the frequency of ultrasonic waves when they are reflected from moving bodies. The method is widely used in the study of the vascular bed. Here, blood cells (erythrocytes, platelets, leukocytes) act as moving bodies. Color Doppler mapping (CDC) is also used. The essence of the method is to record blood flow velocities, coded in different colors. The resulting color picture is superimposed on a two-dimensional image. Such images are called a cartogram.

In Dopplerography, the moving elements are red blood cells, which make it possible to see the diagram and indicators of the vascular bed

What organs are being examined?

The vascular bed of the pelvis is included in the list of anatomical formations diagnosed using ultrasound. Let us recall the boundaries of the small pelvis: in front - the pubic symphysis, in the back - the sacrum, on the sides - the pelvic bones. The pelvic organs include:

1. bladder and ureters;
2. rectum;
3. male genital organs - prostate, spermatic cords and seminal vesicles;
4. female genital organs - uterus, ovaries, vagina.

Most diseases of the pelvic organs are accompanied by impaired arterial and venous circulation. The optimal period for Doppler examination of women is the first or second period of the menstrual cycle: on days 5-7.

Affected arteries in pathologies of the reproductive system organs:

1. uterine veins and arteries (in women);
2. inferior vesical arteries supplying blood to the prostate gland (in men);
3. prostate veins;
4. veins of seminiferous tubules;
5. vessels of the penis.

General indications for the pelvic ultrasound procedure:

• pain in the pubic area of ​​various types (in men and women);
• suspicion of varicose veins of the small pelvis;
• suspicion of vascular neoplasms;
• thrombosis of the veins and arteries of the pelvic organs;
• compression of arteries by neoplasm;
• congenital anomalies of the development of veins and arteries of the pelvis.

Indications for the ultrasound procedure of the genitourinary system in women:

• diagnostic search for tumors of the uterus and ovaries;
• determining the cause of miscarriages;
• assessment of the nature of the blood supply to uterine fibroids;
• monitoring the course of pregnancy;
• searching for the reason for the ineffectiveness of in vitro fertilization.

Monitoring the progress of pregnancy is one of the main reasons for prescribing Doppler ultrasound of the uterine vessels

Doppler research capabilities:

1. detailed examination of the uterine and ovarian arteries;
2. diagnosis of blood flow in the endometrium;
3. study of the blood supply to ovarian tissue.

Description of the technique

To perform colorectal dosage, as in the case of conventional two-dimensional ultrasound, no preparation is required. This procedure, like all ultrasound methods, does not cause pain and is absolutely safe. Position of the subject: lying on his back.

A layer of special gel is applied to the area of ​​the patient's skin to be examined. Its main property is to improve the transmission of ultrasound, as it prevents air from entering between the sensor and the skin. Next, the doctor presses the sensor tightly against the patient’s skin and begins the procedure.

During the CDC, the patient is prohibited from moving. This is because movements make it difficult for ultrasonic waves to pass through. Thus, the quality of the results may deteriorate sharply. The doctor also often asks you to hold your breath for a couple of seconds to improve the quality of the image.

The Doppler examination procedure does not bring any unpleasant sensations to the patient. At the end of the CDC, the patient removes the remaining gel from the skin with a napkin. During the study, an image indicating the parameters of interest is displayed on the screen. This allows the doctor to make a conclusion already during the diagnostic process.

Research Opportunities

Using color circulation, you can assess the speed and quality of blood circulation in the vessels. Based on the results of the study, information about the vessels is obtained in real time.

The advantage of Doppler is the availability of mobile ultrasound machines that allow examining the patient at his bedside. Also, the advantages are the low cost of the study and harmlessness, which allows it to be used for examining pregnant women.

Ultrasound provides accurate information about changes in blood flow in the vessels. Using a Doppler study with color flow, vascular patency is assessed based on data on the speed and direction of blood flow.

Simple Doppler sonography, unlike duplex scanning, cannot visualize the vessel. Thus, identifying pathology in the structure of the vessel with Doppler ultrasound is impossible. At the same time, Doppler ultrasound is an important component in the diagnosis of inflammatory and tumor processes in the reproductive organs.

Doppler ultrasound allows you to diagnose the following pathological conditions:

1. congenital defects of the uterus and fallopian tubes;
2. inflammation in the uterus and ovaries;
3. adhesive process in the lumen of the fallopian tubes;
4. myomatous nodes;
5. neoplasms of the uterus and ovaries;
6. prostate neoplasms;
7. purulent process in the prostate gland;
8. varicose veins of the spermatic cord;
9. deformation of the penis.

Doppler ultrasound in women can easily detect inflammation of the uterus and ovaries

Dopplerography of pelvic vessels during pregnancy

Color Doppler measurements are often performed on pregnant women. Doctors perform this procedure at 23-24 weeks of pregnancy. Using the study, an ultrasound picture of blood flow in the organs of the pregnant woman and the fetus is obtained. The technique is completely safe for pregnant women and their unborn children.

Doppler testing during gestation is similar to a simple ultrasound examination. The difference is that the scan is performed with a Doppler sensor. With its help, the speed of blood flow in the uterine vessels and umbilical cord is determined, and the following conditions are excluded:

1. abruption of the maternal part of the placenta;
2. entwining the unborn child with the umbilical cord;
3. pathology of placental blood flow;
4. congenital malformations of the child's heart.

Based on the above, we can conclude that this method is more informative than other ultrasound methods. This non-invasive technique gives a complete picture of the course of the pathological process, in which it is not inferior to invasive methods.