What is CDC in medicine. Color Doppler is one of the ways to scan blood vessels with ultrasonic waves.

Modern technique Color Doppler is a scanning of blood vessels with a digital image that allows you to distinguish between the blood flow velocity 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 the frequency conversion of wave oscillations, on the way of which there are obstacles in the form of the Doppler effect. emitted sound vibrations reflected from moving objects.

On technical devices, signal processing is performed and a color image appears. As a result of the examination, the doctor can determine the problems with blood flow in a particular area.

Harmful, other diseases, pathologies carotid arteries.
in vessels located deep and close to the skin.
Diseases of the vessels in the extremities and abdominal cavity.
Determining the state of the brain in case of suspected vascular disorders. Color Doppler and Doppler ultrasound can determine the location of the blockage of veins and arteries that cause problems in the brain.
You can examine both health and the placenta, the nature of the blood flow to the fetus.
and arteries in the spine.

There are two main areas of dopplerography:

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

There are several main types of dopplerography:

A transcranial examination is used solely for the purpose of scanning blood vessels in the head.
Duplex mode combining normal and scan. The technology makes it possible to study the vessel of interest in as much detail as possible, to determine the diameter of the lumen, the condition of the walls of the artery in a certain area of the blood flow.
Color Doppler refers to a duplex scanning technique. Essentially, it's the same ultrasound examination, but with different labeling of blood flow velocity. On the image, the vessels differing in size have their own colors, the real state of the blood supply is displayed. It is this technique that requires specially adjusted ultrasound sensors, and also allows you to notice neoplasms in the initial stages.

When do doctors prescribe such examinations?

For migraine and fainting, it is necessary to pass 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 bad condition blood vessels, the patient is sent for an ultrasound examination. Therefore, there can be a lot of reasons for performing Doppler ultrasound.

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

If patients have pain in their legs, 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 should be scanned if the following symptoms are present:

Migraine
and dizziness
Problems with and sound perception
Memory problems, distraction
Extraneous noises in the ears
bad dream

In addition, CDC is prescribed for patients with head injuries. For prevention, such examinations are recommended smoking people, suffering from diabetes, owners and osteochondrosis.

Poor sensation, numbness
The skin changes color
Pain in limbs at rest or on movement

Renal vessels are examined in such situations:

Possible veins and arteries
Urine contains blood
kidney failure

If the doctor suspects that the patient has a doppleroscopy abdominal aorta, the disease is characterized by a pulsating formation in the abdominal cavity, the presence of pain behind the navel in the back and lumbar region.

Where is such a scan most effective?

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

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

Qualified specialists can identify and examine a pre-diagnosed pathology, but also recognize a benign or malignancy and 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 scanning by Doppler sonography. For this reason, it makes little sense to conduct any other examinations using such ultrasonic devices.

Fetal examination using ultrasound and color doppler

Doppler ultrasound 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 a routine ultrasound examination at least 3 times.

Acceptable terms of pregnancy at which obstetricians can receive 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
Amount of amniotic fluid
placenta previa

In some situations, the study allows you to determine the likelihood of a miscarriage. This makes it possible to provide timely the necessary conditions for inpatient treatment or premises "for preservation" in order to future mother could safely bear fruit.

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

Indications for a fetal doppler study

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

Dopplerography can be performed in such situations:

Too much rapid maturation placenta
Characteristic oligohydramnios or polyhydramnios
Problems with the location of the umbilical cord
Manifestation of Rhesus conflict
Preeclampsia
Kidney problems, diabetes, hypertension
The presence of a chromosomal pathology
Dropsy
Uneven growth of embryos in multiple pregnancy

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

Contraindications

TsDK is undesirable to carry out with burns on the skin

Consider the main list of contraindications:

Research is undesirable 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, for small anal fissures and various types diseases in which it is not recommended to insert sensors into the rectum or it is difficult to tightly press the sensor to the intestine.
Transvaginal dopplerography of the pelvis is undesirable after surgery, as well as for virgins.
Transabnomal dopplerography when bladder must be filled, undesirable 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 a state of health or insufficient information content of the study.

Is preparation required before scanning?

CFM does not require special training before the study

How should one prepare for a CFM scan, provided additional application devices? In most cases, when the doctor manages to do dopplerography different ways, no preparatory procedures are required.

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

How the scan is done

Color dopplerography is performed in the same way as conventional ultrasound. In accordance with the instructions of the doctor, 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 driven over the skin.

results

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

What indicators are important for assessing blood flow

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

Doppler is deciphered according to several indicators that can be assessed in the arteries or veins. After that, comparisons are made with the standards for this vessel.

The attending physician in most cases knows how this or that vessel looks in normal condition, where it has curves, where it passes into more large vein or an artery. The location and shape of the arteries in patients is always compared to a known normal state.

The following parameters are subject to evaluation by doctors:

The rate of blood flow for certain types vessels
The ratio of the lowest to the highest blood flow rate
Pulse index - the difference between the lowest and highest speed is divided by the average speed in the vessel
The thickness of the tissues of the vessels in most examples is from 0.9 to 1.1 mm.

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

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

Watch a video about what Dopplerography is:

The CDI technique is considered one of the most advanced in medicine, it allows you to scan in detail internal organs, alert the presence all kinds of diseases or detect them at an early stage.

Ultrasound with CDC - what is it? This question is of interest to many when such a record as an ultrasound scan of the CDC is found in a doctor's prescription. This means that the specialist has appointed the story ultrasound diagnostics with a study of the movement of blood through the vessels using the Doppler method.

Most often, this procedure is carried out during the bearing of a child, in order to evaluate the work of the placenta, which ensures the life of the baby.

In some cases, women carry out such a diagnosis in order to find out in which pelvic organ a violation has occurred, and blood does not enter it.

This procedure is absolutely no different from a simple ultrasound examination. So you shouldn't be afraid of it.

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 to the vessels, and in response they receive a feedback signal, to which the sensor reacts.

The measuring device records the frequency of oscillations, as well as the difference between the initial and subsequent value. During diagnostics, you can not only measure the speed of blood flow, but also determine its direction, see 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 carried out several times, depending on the need.

To date, this method allows you to objectively assess the situation: to see the state of vascular connections in the body, to establish the cause of a particular disease. 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.

Approximately for a period of 30-34 weeks, all pregnant women undergo an ultrasound scan. 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, then it is possible that the baby will lag behind in development or premature birth will begin.

Ultrasound with CDC is a completely standard procedure that you should not be afraid of.

Purpose of diagnostics

Despite the fact that during pregnancy, the passage of such a study is mandatory for everyone on last term, sometimes the specialist makes the appointment earlier or spends it several times.

Such a study can be prescribed if a person has certain problems with blood vessels or has diseases associated with the vascular system of the body. The presence of such problems is revealed from a number of symptoms and complaints. Often women are prescribed such a diagnosis of the thyroid gland or breast.

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

So, Doppler studies are prescribed in the following cases:

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

This diagnosis is carried out starting from the 23rd week of pregnancy. Previously, it does not represent any informative character. The study will help to clearly clarify the picture of hypoxia. If hypoxia occurs, then in this case, a study of the cause of such a deviation is assigned. Studies make it clear where the obstruction occurred and for what reason.

After that, a specialist develops a special scheme for managing pregnancy.

Often there is an ultrasound with CDI, which is prescribed for 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 wound healing.

Often, with the help of such a diagnosis, they examine abdominal cavity, thoracic region, neck, head. The study can be scheduled and urgent. It all depends on the complaints and the condition of the patient.

A little about the method

CDI can be considered a variation of classical ultrasound. It is based on the Doppler research method. This is the aggregate conventional ultrasound in black and white with color highlighting of a particular area. Color allows you to assess the blood flow and the state of the vascular system.

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

Catad_tema Functional and laboratory methods diagnostics - articles

Color Doppler imaging in the diagnosis of uterine tumors

The article discusses the possibilities of color Doppler imaging (CDM) 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 color flow diagnostics in the diagnosis of tumor processes are the visualization and evaluation of the blood flow of newly formed tumor vessels, which have their own characteristics. characteristics. The system of tumor vascularization, as a rule, is represented by many small, very thin, abnormal in shape and location vessels, randomly scattered within the tumor tissues. The blood flow in these vessels is characterized by extremely low vascular resistance, high speed and varied direction. The color flow method has high sensitivity, specificity and accuracy of the forecast in early diagnosis tumors and their differentiation according to the degree of malignancy. In addition, the level of vascularization estimated using color Doppler mapping makes it possible to predict the growth rate of the identified formation. I.S. Sidorova, I.N. Kapustina, S.A. Levakov, A.N. Sarantsev
Department of Obstetrics and Gynecology of the Faculty of Postgraduate Education vocational education(Head of the Department - Prof. I.S. Sidorova) of the Moscow medical academy them. THEM. Sechenov,
Urban clinical Hospital N 40 (chief doctor - honored doctor of the Russian Federation M.I. Fedorova), Moscow.

The diagnostic value of color Doppler mapping (CDM) cannot be overestimated. 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 characteristics, allows us to consider this method important in the differential diagnosis of benign and malignant tumors uterus.

Color Doppler allows you to evaluate three parameters of blood flow simultaneously: direction, speed and character (homogeneity and turbulence). Due to the high resolution of the currently used equipment, visualization and identification are possible. smallest vessels up to the microcirculatory system, invisible on B-mode scans.

The system of tumor vascularization, as a rule, is represented by many small, very thin, abnormal in shape and location vessels, randomly scattered within the tumor tissues. The blood flow in these vessels is characterized by extremely low vascular resistance, high speed and diverse direction. The image of the blood flow in this case is characterized by a pronounced brightness of the color signal, and the "color" 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 a large number arteriovenous anastomoses among newly formed vessels, which provide high kinetic energy of the blood flow and explain the wide variability of its direction.

The CDI method has high sensitivity, specificity and accuracy in early diagnosis. neoplastic diseases internal genital organs and their differentiation according to the degree of malignancy. The level of vascularization assessed by means of color doppler analysis makes it possible to predict the rate of growth of the identified formation.

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

An analysis of the curves of blood flow velocities in uterine myoma made it possible to establish the following features. All patients showed a decrease in resistance in both uterine arteries. Diastolic blood flow has always been found in the main arteries supplying 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 than on its localization. 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 myoma (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 the myomatous nodes is carried out from the vessels, which 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 CDC, 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 vascular density depends on histological structure node and its location. Large quantity arteries are noted but on the periphery of the node, since they are a continuation of the arcuate vessels of the uterus. In the central part, the vessels are visualized in a very small amount. In these cases, necrotic, degenerative and inflammatory changes in the myomatous node are noted during morphological examination.

The frequency of visualization of intratumoral blood vessels, but data various authors, is characterized by a large spread (54-100%). This is due to the use of various accesses (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 their localization.

According to F. Aleem and M. Predanic, subserous myoma nodes are the most vascularized. When studying the parameters of blood flow in these nodes, the lowest numerical values of the resistance index (IR 0.43) were noted, 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 pulsation index are proportional to the size of the uterus. However, they did not reveal the dependence of the pulsation index on cell proliferation and angiogenesis.

Taking into account the significant scatter of the numerical values of the resistance index in different areas 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, as a rule, are located in the center of the tumor node.

Color Doppler imaging is used by many researchers to evaluate the effectiveness conservative treatment patients with uterine myoma. After 4 months of taking analogues of gonadotropic releasing hormone (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 index of resistance of the uterine arteries before treatment averaged 0.52, in 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 therapy with AGTRH 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 frequent clinical manifestation endometrial cancer - the appearance of bloody abnormal secretions from the genital tract, which undoubtedly belong to late manifestations this pathology.

Numerous studies indicate that the main attention in the diagnosis of endometrial cancer is given to 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 survey to clarify the diagnosis (separate diagnostic curettage).

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

Heterogeneity internal structure education;
- uneven contours;
- higher echogenicity compared to the uterine muscle;
- big sizes formations that make up half the thickness of the uterus or more;
- increased sound conductivity;
- the presence of liquid inclusions irregular shape and various sizes;
- a noticeable increase in the size of formations with dynamic observation;
- lack of a clear image of the contours of the uterus due to the 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. Saveliev 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 on the background of neuroendocrine disorders. Other types of endometrial pathology turn into cancer extremely rarely.

From the data of V.N. Demidov and S.P. Krasikova it 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. So, 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 analysis with the analysis of blood flow velocity curves is more exact method diagnosis of endometrial carcinoma, since in the vast majority of cases of the disease, pathological curves of blood flow velocity are observed, 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) in endometrial carcinoma was 0.42+/-0.02, in normal cases with atrophic endometrium and in most cases of hyperplasia, endometrial blood flow was not visualized. Newly formed vessels in the intratumoral type are viewed in the color Doppler mode inside the M-echo, and in the peritumoral type - directly along the outer border of the M-echo. The resistance index for intratumoral blood flow is 0.39, for peritumoral - 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), it was found that with adenocarcinoma, the thickness of the endometrium averaged 20.2 mm, while with atrophy - 1.35 mm. The pulsation 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 spotting from genital tract predictive value positive result color Doppler mapping was 94%, negative - 91%.

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

P. Sladkevicius and L. Valeiitin (quoted by V.K. Mitkov et al.) examined 138 postmenopausal women no more than 8 days before the planned operation. In 114 women, benign changes in the endometrium were found after surgery, and in 24 - malignant changes. The thickness of the endometrium in benign processes was 5.5 mm (individual fluctuations from 1 to 44 mm), in malignant - 24 mm (from 7 to 56 mm). The study of blood flow was performed 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 processes of the endometrium. At the same time, PIs in intra- and periendometrial arteries in malignant and benign processes did not differ from each other. The use of color flow for differential diagnosis benign and malignant changes in the endometrium allows using only such an indicator as endometrial thickness.

S. Rakits et al. conducted a prospective analysis of 64 cases of endometrial pathology using classical gray scale in combination with color Doppler mapping for the diagnosis of endometrial cancer. Pathological blood flow, neovascularization were characterized by the presence of "hot spots" in the endometrium. "Hot spots" were markedly 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 area of neovascularization. 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. The absence 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 benign changes (specificity 92%, predictive value of a positive test result 67%, predictive value negative result test 92.3%). However, their studies did not reveal differences in the levels of blood flow velocity in primary and secondary blood vessels, but showed a difference between the two groups of patients for IR and IS. Both indices are highly correlated and have a 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 vessels of the endometrium align the angle of Doppler sound reflection, which leads to an error due to low blood flow velocity. The authors concluded that the combination of the two ultrasound methods is of value for screening for endometrial cancer.

L.E. Teregulova, examining 218 patients with histologically confirmed endometrial cancer, came to the conclusion that ultrasound procedure allows you 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 characteristic of malignant tumors low index resistance: IR<0,42.

Sarcoma of the uterus. One of the complex issues of ultrasound examination in uterine myoma is the differential diagnosis of sarcoma. Uterine sarcoma is quite rare, accounting for 1-3% of all malignant tumors of the uterus. For sarcoma, severe clinical symptoms are not typical, although in most cases irregular spotting and rapid growth of the uterus are noted. Most researchers point to the almost complete identity of the echographic image of sarcoma and uterine fibroids.

So, V.I. Demidov and B.I. Zykin, after a retrospective analysis of the 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 of a zone of reduced echogenicity in the myomatous uterus without signs of acoustic amplification, 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 uterine tumors, which either have a lobular structure or do not have the characteristic signs of a mature, long-term fibroid, as well as the absence of an image 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 (with myoma 0.59+/-0.08, normally 0.90+/-0.02). The differential diagnostic criterion between sarcoma and uterine myoma in the CDI mode is the visualization of irregular, thin, randomly scattered signals from vessels with low resistance indicators 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 the diagnosis of cervical cancer, this method is suitable for the dynamic observation of patients on the background of conservative treatment using radiation and chemotherapy. In patients with cervical cancer, the resistance index was significantly reduced (0.57+/-0.14) compared with 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 the most serious disease of women of childbearing age. Over the past decades, an increase in the incidence of trophoblastic disease by 1.54 times has been noted, and malignancy of hydatidiform mole occurs in 3-5% of patients; certainly, there is a risk of increased incidence of choriocarcinoma. Diagnosis of hydatidiform drift during ultrasound is quite simple: the uterus is enlarged, the contours are even, the structure of the myometrium is heterogeneous due to diffusely dilated vessels, the cavity is evenly expanded, the border with the myometrium is clearly defined, in the cavity there are multiple small (4-6 mm) cellular structures against the background high-intensity reflections. If a live fetus is found in the uterine cavity and at the same time cellular structures in one of the placental areas, a partial cystic mole should be assumed.

The predominance of a solid component with reflections of increased intensity and cellular structures of smaller sizes (up to 4 mm) in the structure of cystic drift indicates a more pronounced proliferation of the chorionic epithelium. For cystic drift, a characteristic feature is the detection of thin-walled multi-septal cystic ovarian formations, in most cases they are bilateral (tecalutein).

Trophoblastic tumors are characterized by high vascularization. At the same time, the vessels of the tumor have an irregular shape and different caliber, with destructive growth of the tumor with damage to the walls of the vessels, arteriovenous shunts are observed. For many years, pelvic angiography has been used to diagnose trophoblastic disease, based on the detection of 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 the MPC 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. report a 100% sensitivity of CDI in the diagnosis of trophoblastic disease. The results of research by R. Matijevic showed that in 100% of cases with trophoblastic disease it is possible to clearly visualize the uterine, arcuate, radial and spiral arteries in the CFM mode. The numerical values of IR and PI in this disease in the considered vessels are significantly lower than those 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. Of interest is the use of color doppler for dynamic monitoring of the evaluation of the effectiveness of chemotherapy in trophoblastic disease. In the course of treatment, there is a decrease in vascularization, expressed in an increase in the resistance index, with choriocarcinoma against the background of chemotherapy.

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

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

LITERATURE

1. Demidov V.N., Zykin B.I. Ultrasonic diagnostics in gynecology M.: Medicine, 1990. S. 100-102.
2. Demidov V.N., Krasikova S.P. // Ultrasound: Clinical lectures on ultrasound diagnostics in obstetrics, gynecology and perinatology. M., 1994. S. 66-78.
3. Zykin B.I. Ultrasound diagnostics in gynecology: Atlas. M.: Vidar, 1994. S. 29.
4. Miitkov V.V., Bulanov M.N., Zykin B.I. // Medical imaging. 1997. N1. pp. 8-13.
5. Mitkov V.V., Medvedev M.V. Clinical guide to ultrasound diagnostics. M.: Vidar, 1997. T. 111. S. 30-38.
6. Rakitz S. // Sonoace international. 1996. N1. Russian version. pp. 35-38.
7. Savelyeva G.M., Serov V.N. Precancer of the endometrium. M., 1980. S. 8-16.
8. Strizhakov A.N., Davydov A.I. Clinical transvaginal echography. M., 1994. S. 184.
9. Teregulova L.E. // Ultrasound diagnostics. 1996. N4. pp. 21-23.
10. Kharchenko N.V. Possibilities of echography in the primary and clarifying diagnosis of endometrial cancer: Abstract of the thesis. diss... cand. honey. Sciences. M., 1996. 21 p.
11. Chekalova M.A., Kozachenko V.P., Lazareva N.I. // Ultrasound diagnostics. 1997. N1. pp. 26-34.
12. Meem F., Predanic M. Uterine Leiomyoma: transvaginal color Doppler studies and new aspects of management // Ultrasound and the uterus: The Parthenon Publ. Gr.:N.Y. 1995. P. 61-70.
13. Bourne T.N., Cnyfwd T., Hanclp SMJ. // Ultrasound Obstet. Gynec. 1992 Vol. 2. Supply. 1. P. 75.
14. Breyer B., Despot A., Predanic M. // Ultrasound Obstet. Gynec. 1993 Vol. 3.N4. P. 268-270.
15. Flam F., Lindholm H., Bui T.N. // Ultrasound Obstet. Gynec. 1991 Vol. 1. No. 5. P. 349-352.
16. Hata T., Hata K. // J. Ultrasound Med. 1989 Vol. 8. P. 309-314.
17. Huang S.E. // J. Obstet. Gynec. 1996 Vol. 87. N6. P. 1019-1024.
18. Kuljak A., Zolud I. // Ultrasound Obstet. Gynec. 1991 Vol. 1.N1. P. 50-52.
19. Kurjak A., Kupesic-Urek S., Mine D. // Ultrasound Med. Biol. 1992 Vol. 18. P. 645-649.
20. Kwjah A., Shalan H., Kupesw S., et al. // Ultrasound Obstet. Gynec. 1993 Vol. 3. N2. P. 137-154.
21. Shimamoto K., Sakuma S., Ishidaki T. //Radiology. 1987 Vol. 165. P. 683-685.

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 disturbed, 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 for suspected thrombosis, occlusion of the vessel and dysfunction of the heart.

Ultrasound with color flow is based on the Doppler Effect - the ability of an ultrasonic wave to change frequency as it approaches or moves away from an ultrasonic transducer. That is why the examination is relevant for assessing the characteristics of the blood supply to organs and tissues. In this case, the objects, the approach or removal of which is determined by ultrasound, are erythrocytes. The scanner of the ultrasound machine simultaneously generates and perceives ultrasonic waves.

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

What they watch and when they prescribe

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

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

The main situations when CDC 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;
convulsions, heaviness, pain in the lower extremities;
cold extremities with a change in their color;
long-term non-healing wounds, leg ulcers;
the presence of a volumetric formation of an unspecified nature of any localization (organs of the small pelvis and abdominal cavity, genitourinary system, mammary glands, thyroid gland);
suspicion of impaired blood flow in the mother-fetus system during pregnancy.

Pregnant women with ultrasound with CDC are prescribed in the following cases:

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

Are there possible contraindications

There are no absolute contraindications for ultrasound with CFD. This research method is safe for health, so it is often prescribed several times - in dynamics - to correct the ongoing treatment. For example, with thrombosis, vascular aneurysms, during childbearing.

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

skin diseases or mechanical damage, skin burns in the area, the study of which is necessary;
the general serious condition of the patient, if he is unconscious, cannot move independently, follow the doctor's commands;
a recent diagnostic EGD or colonoscopy, after which gases accumulate in the intestine, making it difficult to visualize. This is a relative contraindication for CDI in diseases of the abdominal cavity and small pelvis.

Ultrasound of the fetus with CDC is not done until the 23rd week of pregnancy, since at an early stage the procedure will still not provide the necessary information.

Decoding and norms

Deciphering the CDI indicators is complex and requires special training for a specialist who knows the technique of conventional ultrasound diagnostics. Therefore, you will not be able to identify any pathology on your own by looking at the protocol for examining an ultrasound scan with color doppler. When conducting color Doppler, the doctor of functional diagnostics evaluates the following parameters:

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

Accelerated blood flow through the CDC may be a sign of vasoconstriction. Slowdown is possible with insufficient contractility of the wall of the vessel or heart, which cannot push the blood with due force. Narrowing of the vessel is observed in atherosclerosis, thrombosis, compression by a foreign body; expansion - with varicose veins, the presence of an obstruction to blood flow.

It is especially important to determine the direction of blood flow by ultrasound with CDC in case of heart defects, when it is diagnosed whether there is a backflow of blood from one chamber to another (regurgitation), whether there is a mixture 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 the organ at all - its sharp decrease leads to the death of a tissue area 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 predicts the risk of bleeding.

Preparation and holding

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

If there is a CDI of the abdominal organs, small pelvis, kidneys, then it is important to follow the following instructions:

3 days before the procedure, refuse products that cause flatulence - such as cabbage, legumes, pastries.
Do not take any food for about 8 hours before the start of the study, it is only allowed to drink non-carbonated water.
In some cases, it is recommended to take Espumizan, activated charcoal, or other sorbents 6-7 hours before an ultrasound with a CDI, so that the gas formed in the intestine has time to resolve.

The procedure itself is usually performed in the horizontal position of the patient, sometimes the doctor asks to throw back the head, bend the knees, turn to the side, etc. This is necessary for the convenience of installing the sensor and gaining access to deep vessels, the visualization of which can be difficult. A hypoallergenic transparent gel is applied to the area under study to eliminate the air gap that reduces image clarity.

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

Where to do it and how much does it cost

The study is carried out if there are indications 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, ultrasound with the CDI regimen can be paid or under the VHI policy in private medical centers involved 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 a CDC is from 1,000 to 4,000 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 to see in dynamics how effective the treatment is. In combination with the classic ultrasound examination, the CFM allows you to get complete information about the state of the organ and how impaired blood supply affects its work.

Doppler is a method of ultrasound examination 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, in the role of moving bodies, blood cells (erythrocytes, platelets, leukocytes) act. Color Doppler imaging (CDC) is also used. The essence of the method is to register blood flow velocities coded in different colors. The resulting color picture is superimposed on a two-dimensional image. Such images are called cartograms.

In Doppler sonography, erythrocytes act as moving elements, allowing you to see the scheme and indicators of the vascular bed.

What organs are being examined?

The vascular bed of the small pelvis is included in the list of anatomical formations diagnosed using ultrasound. Recall the boundaries of the small pelvis: in front - the pubic joint, behind - the sacrum, on the sides - the pelvic bones. The pelvic organs include:

bladder and ureters;
rectum;
the genital organs of men - the prostate, spermatic cords and seminal vesicles;
female reproductive 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: 5-7 days.

Affected arteries in the pathology of the organs of the reproductive system:

uterine veins and arteries (in women);
lower vesical arteries supplying the prostate gland (in men);
prostate veins;
veins of the seminiferous tubules;
vessels of the penis.

General indications for a pelvic ultrasound procedure:

pain in the pubic region of a different nature (in men and women);
suspicion of varicose veins of the small pelvis;
suspicion of vascular neoplasms;
thrombosis of veins and arteries of the pelvic organs;
compression of the arteries by a neoplasm;
congenital malformations of the veins and arteries of the small pelvis.

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

diagnostic search for neoplasms 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;
search for the cause of the ineffectiveness of in vitro fertilization.

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

Doppler research capabilities:

detailed examination of the uterine, ovarian arteries;
diagnosis of blood flow in the endometrium;
study of the blood supply to the ovarian tissue.

Description of the technique

To conduct color flow, 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. Subject position: supine.

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

During the CDC, the patient is forbidden to move. This is due to the fact that the movements impede the passage of ultrasonic waves. Thus, the quality of the results may deteriorate drastically. Also, the doctor often asks to hold your breath for a couple of seconds to improve the quality of the image.

The Doppler examination procedure does not bring discomfort to the patient. At the end of the TsDK, the patient removes the remnants of the gel from the skin with a napkin. During the study, an image is displayed on the screen indicating the parameters of interest. This allows the doctor to make a conclusion already in the process of diagnosis.

Research Opportunities

With the help of color doppler, you can evaluate 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 dopplerometry is the availability of mobile ultrasound machines that allow you to examine the patient at his bedside. Also, the advantages are the low price of the study and harmlessness, which allows it to be used for examination of 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, unlike duplex scanning, cannot visualize a vessel. Thus, the detection of pathology in the structure of the vessel with dopplerometry is impossible. At the same time, dopplerometry is an important component in the diagnosis of inflammatory and tumor processes in the reproductive organs.

Dopplerometry allows you to diagnose the following pathological conditions:

congenital malformations of the uterus and fallopian tubes;
inflammation in the uterus and ovaries;
adhesive process in the lumen of the fallopian tubes;
myoma nodes;
neoplasms of the uterus and ovaries;
neoplasms of the prostate;
purulent process in the prostate gland;
varicose veins of the spermatic cord;
deformation of the penis.

On dopplerometry in women, inflammation of the uterus and ovaries is easily determined.

Dopplerography of the pelvic vessels during pregnancy

Often dopplerometry is performed on pregnant women. Doctors perform this procedure at 23-24 weeks of pregnancy. With the help of the study, an ultrasound picture of the 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.

Conducting dopplerometry during gestation is similar to a simple ultrasound examination. The difference lies in the fact that the scan is carried out with a Doppler transducer. With its help, the speed of blood flow in the uterine vessels, umbilical cord is determined, and the following conditions are excluded:

detachment of the maternal part of the placenta;
entwining the unborn child with the umbilical cord;
pathology of placental blood flow;
congenital malformations of the child's heart.

Based on the foregoing, we can conclude that this method is the most informative than other ultrasonic 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.