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DOPPLER ULTRASONOGRAPHY OF THE KIDNEYS IN UROLITHIASIS
Shakirova Nigina Sobirovna, Akhmedov Farkhod Khakimovich
Bukhara State Medical Institute named after Abu Ali Ibn Sino Department of Nuclear
Medicine and Medical Radiology.
Abstract.
Urolithiasis is one of the most pressing clinical problems in urology, as the
incidence of the disease increases annually, this disease is diagnosed in 12% of the world's
population, being the most common disease of the urinary tract. This increase can be
explained by many factors, including missed cases of small stones, sedentary lifestyle, high
BMI, lack of physical activity and poor nutrition. In addition, a significant contribution to
the formation of urolithiasis can be made by an increase in the incidence of comorbidities
such as diabetes, dyslipidemia, infections and multiple surgeries on the urinary tract. Kidney
stones have been shown to exhibit a “twinkle artifact” (TA) on color Doppler ultrasound.
Although this technique has better specificity than conventional B-mode imaging, it has
lower sensitivity. To improve the overall performance of TA as a diagnostic tool, the
Doppler output parameters were optimized in vitro . The data collected support the previous
hypothesis that TA is caused by random vibrations of micron-sized bubbles trapped in the
cracks and crevices of kidney stones. A set of optimized parameters was implemented such
that MI and TI remained within FDA-approved limits. Several clinical renal scans were
performed with the optimized settings and stones were detected with improved SNR
compared to the default settings.
Key words:
ultrasound, diplography, kidney stones, flicker artifact detection, optimization,
urolithiasis.
The aim
of this study was to conduct a comprehensive meta-analysis to evaluate the overall
diagnostic value of Doppler flickering for the diagnosis of urolithiasis.
Introduction.
Urolithiasis is a common problem in general practice. Prevalence rates range
from 7 to 13% in North America, 5 to 9% in Europe, and 1 to 5% in Asia. Nephrolithiasis is
influenced by many factors including genetic predisposition, age, gender, diet, occupation,
and lifestyle. Nephrolithiasis is more common in men than in women. Kidney stone
formation is a common urological problem with a lifetime prevalence of approximately 10%
in men and 6% in women, and its prevalence is increasing in many developed countries,
with a recurrence rate of almost 60% within 10 years of initial treatment.
Many diagnostic modalities are considered helpful in identifying urolithiasis, including plain
radiography, intravenous pyelourethrography, ultrasonography (US), and computed
tomography (CT). Non-contrast CT is widely considered the current gold standard for
diagnosing urolithiasis. Non-contrast CT is the most sensitive (up to 98%) and specific (96–
100%) method for detecting urinary stones. A history of nephrolithiasis with onset of flank
pain should prompt non-contrast CT of the abdomen and pelvis to evaluate for urinary
stones. Moreover, because of its ability to detect non-urologic causes of abdominal pain, CT
has become the primary imaging modality for confirming urinary stones. However, one of
the limitations of CT is that the associated radiation exposure is increasingly recognized as a
public health issue, as radiation exposure can damage the genetic material in cells and lead
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to radiation-induced cancers years later or to hereditary diseases in the offspring of exposed
individuals, and this can lead to various developmental outcomes under certain conditions.
In contrast, abdominal ultrasound does not involve radiation and has been shown to detect
urinary stones using the common criterion of seeing a hyperechoic lesion with posterior
acoustic shadowing. Hydroureteronephrosis also significantly improves the detection of
urinary stones using B -mode ultrasound imaging. However, this phenomenon used alone
has limited sensitivity, particularly for small stones (53% of stones are less than 5 mm in
size).
Ultrasound examination using Doppler flicker ( TA ) artifacts is considered an effective tool
for detecting urinary tract stones. The flicker artifact was first described by the French
radiologist Rahmouni and can be seen with color Doppler ultrasound, which appears as a
rapidly changing mixture of red and blue colors behind a rough interface object such as a
calcification [ 19 ]. Moreover, the chemical composition of the stone is related to the
creation of the artifact. It is found that calcium oxalate dihydrate and calcium phosphate
stones always give the TA sign , while stones composed of calcium oxalate monohydrate
and urate do not have the TA sign . The validity of TA as a diagnostic tool for the presence
of urolithiasis using a systematic review and meta-analysis. The TA sign may be useful as
an additional tool in the diagnostic work-up of patients with suspected urolithiasis.
Materials and methods.
Ultrasound is a widely used imaging method in the primary
diagnostics of the urinary tract in urolithiasis. This method has several advantages over other
diagnostic methods, such as noninvasiveness and absence of radiation exposure. Ultrasound
examination (ultrasound) is also used in the primary diagnostics of children and pregnant
women with suspected urolithiasis. Ultrasound allows diagnosing stones in the kidneys,
pelvic ureteral segment, and upper ureter. The limitations of the ultrasound method include
variability in sensitivity in detecting kidney stones within 12% to 93%, lack of reliable
assessment of the presence of some stones in the ureters, low (about 13%) sensitivity in
detecting stones less than 3 mm, and a tendency to overestimate the size of the stone. During
ultrasonography, a calculus is defined as a hyperechoic structure in the lumen of the ureter
giving an acoustic shadow. The ureter above the stone is dilated in most cases, its diameter
does not exceed the transverse size of the stone. Dilation of the ureter below the calculus
should suggest the presence of an additional cause of obstruction. Also, with Color Doppler
mapping in ultrasound, a "flickering" artifact appears: in the form of a linear strip of
inconsistent rapid color change to a highly reflective surface, this artifact is also known as a
"comet tail" artifact.
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A flickering artifact (FA) is a zone of rapid, random color change on an ultrasound image in
the Doppler mode. This artifact occurs when there are solid inclusions in the imaging area,
such as kidney stones and other concretions. The color range in the flickering mosaic spot
covers the entire palette of encoded blood flow velocities: from extremely high “positive”
ones, conventionally orange, to “negative” ones, conventionally violet. FA appears in those
areas of the image where blood movement is obviously absent. In the spectral mode, FA is
manifested by a wide “white” spectrum, often located vertical lines, and is audible as high-
intensity noise. The “gold standard” in the diagnosis of kidney stones is computed
tomography (CT), which has high
sensitivity (80–99%); however, it exposes
patients to ionizing radiation [1]. B-mode
ultrasound does not expose patients to
ionizing radiation, but imaging sensitivity
varies widely (19–93%) because accurate
stone detection is highly dependent on
operator skill and stone type.
The flickering artifact allows to detect 43–
96% of kidney stones [3–13] and can help
to differentiate kidney stones from
surrounding
tissues
(Fig.
1).
This
circumstance indicates the importance of
studying and using AM to improve
algorithms for ultrasound visualization of
stones.
Ultrasonography of the ureter can detect not only stones, but also salt conglomerates. The
latter look like elongated stones with a length-to-thickness ratio of more than 2:1. The
passage of salts along the ureter occurs quite quickly, sometimes the salt conglomerate
reaches the lower third of the ureter already 2–3 hours after the onset of renal colic. Such a
“stone”, clearly defined in the ureter during ultrasonography, seems to dissolve when it
enters the bladder, leaving behind only salts in laboratory urine tests. Ultrasound is also used
for dynamic monitoring, especially in patients with a history of renal colic and urolithiasis.
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Conclusion.
Doppler twinkling artifact has great diagnostic value for the diagnosis of
urolithiasis and should be used as an additional tool in the diagnosis of urolithiasis.
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