According to the World Health Organization, uterine tumours rank second in the structure of oncological morbidity in women. Epithelial tumours account for 95% of all genital tumours and only 5% are mesenchymal tumours. Malignant mesenchymal tumours include uterine sarcomas. Annually, 10 cases of uterine sarcomas are diagnosed in 1 million women worldwide. The problems of early diagnosis and screening of malignant uterine mesenchymal tumours (sarcomas) have not yet been solved. Due to the fact that this disease is rare and the treatment of uterine sarcomas remains a pressing problem.
The goal of assessing tumour response on imaging is to identify patients who are likely to benefit — or not — from anticancer treatment, especially in relation to survival. The World Health Organization was the first to develop assessment criteria. This early score, which assessed tumour burden by standardising lesion size measurements, laid the groundwork for many of the criteria that followed. This was then improved by the Response Evaluation Criteria in Solid Tumours (RECIST) which was quickly adopted by the oncology community. At the same time, many interventional oncology treatments were developed to target specific features of liver tumours that result in significant changes in tumours but have little effect on tumour size. New criteria focusing on the viable part of tumours were therefore designed to provide more appropriate feedback to guide patient management. Targeted therapy has resulted in a breakthrough that challenges conventional response criteria due to the non-linear relationship between response and tumour size, requiring the development of methods that emphasize the appearance of tumours. More recently, research into functional and quantitative imaging has created new opportunities in liver imaging. These results have suggested that certain parameters could serve as early predictors of response or could predict later tumour response at baseline. These approaches have now been extended by machine learning and deep learning. This clinical review focuses on the progress made in the evaluation of liver tumours on imaging, discussing the rationale for this approach, addressing challenges and controversies in the field, and suggesting possible future developments.
We studied the echographic and elastographic parameters and features of hemodynamics in the uterine vessels at 79 women, including 59 women by cesarean section and 20 women after vaginal birth. In the case of complications with endometritis after cesarean section, an increase in uterine body volume by 25.5%, an increase in the rate of end diastolic blood flow in the arch arteries of the uterine body was found. Symptoms of the inflammatory process in the myometrium were combined with the manifestation of its anatomical inconsistency, which was manifested by the formation of a wall defect in the form of an irregular triangular “thorn” by the uterine cavity and a clear thinning. its distal part. On day 3 after cesarean delivery, the myometrium in the uterine scar area had a higher index of elasticity than the control.
A special place in the problem of abnormal uterine bleeding is occupied by the issues of qualitative diagnosis of patients with abnormal uterine bleeding, the cause of which is pathomorphological changes in the endomyometrium, such as: endometrial hyperplasia, uterine myoma, adenomyosis, a combination of fibroids and endometrial hyperplasia, a combination of adenomyosis and endometrial hyperplasia. Abnormal uterine bleeding is observed in 10-30% of women of reproductive age, in perimenopause - their frequency increases to 50%.
Uterine fibroids and adenomyosis are an urgent problem in modern gynecology. In recent years, there has been an increase in the combined form of uterine fibroids and adenomyosis. Improvement of non-invasive methods of ultrasound diagnostics with color Doppler hysterosonography and magnetic resonance imaging (MRI) can improve the accuracy of diagnosing the combined pathology of uterine fibroids and adenomyosis. The effectiveness of treatment of patients with a combined form of uterine fibroids and adenomyosis depends on determining the severity of a particular disease.
Relevance of the problem. The difficulties of diagnostics of orbital diseases are well known. Especially difficult is intraspecies differentiation among the multitude of tumour, pseudotumour, inflammatory, vascular, endocrine and other diseases occurring here, manifested by the symptom complex of unilateral exophthalmos [Beradze I.N., 1978; Brovkina A.F., 1993].
Malignant intraocular neoplasms are the main cause of death of patients with diseases of the organ of vision, with 45-48% of patients dying from metastases in the first 5 years after enucleation [Alekseeva I.B., 1990, Barkhash S.A.1978, Brovkina A.F..1991, 1997; Keizer R.W.. Viclvoyc G.L.,1986],
Retinoblastoma is the most frequent malignant neoplasm in children. According to different authors, the frequency of its occurrence is 1 case per 14000 - 35000 newborns. [Bobrova N.F. and Vit V.V., 1993; Brovkina A.F., 1997; Provenzale J.M., et al., 1995; Skulski M., et al., 1997; Weber A.L., Mafee M.F, 1992; Wilms G., et al., 1989]. The frequency of patients with the most malignant intraocular tumour in adults - uveal melanoma has recently reached 7-9 people per 1 million population [Brovkina A.F., 1997; Kotslyansky E.O., 1989; Yushko N.A., Peskova L.I., Kalenich L.A., 1989; Peyster R.G., Augsburger J..I., Shields J.A., 1988; Romani A.. Baldeschi L., ct al 1998; Scott I.U., 1998].
The fundamental difference in treatment tactics, depending on the stage of development, size and topography of the tumour, as well as the seriousness of the prognosis in retinoblastomas and melanomas sharply increase the requirements for the accuracy of their differential diagnosis. At the same time, the number of diagnostic errors in ocular tumours continues to be 10-30% even when complex clinical and instrumental examination is applied in specialised ophthalmological centres [Ternovoy S.K., Panfilova G.V., Rogozhin V.A., 1979; Friedman F.E., Malyuta G.D., Kodzov M.V., 1995; Song G.X., 1991].
Widely used in ophthalmological practice traditional diagnostic methods (ophthalmoscopy, gonioscopy, diaphanoscopy, fluorescence angiography, laboratory tests) are insufficient to obtain comprehensive information about the localisation, nature of growth and prevalence of volumetric pathological formations of the eye and orbit. This circumstance and not quite satisfactory results of surgical treatment are the causes of high mortality of patients [Muratova T.T., Nigmanova N.H., Kozlovskaya G.M.. 1989, Naches A.I., 1980; Cheremisin V.M., Trufanov G.E., Kholin A.V., 1991]. Untimely or erroneous recognition of pathological processes of the orbit leads to a sharp deterioration of visual functions, up to blindness, and in some cases to the death of the patient [Yuzhakov A.M., Travkin A.G., Kiseleva O.A., 1991]. All this determines the importance of timely and accurate diagnosis of diseases of the orbit, on the one hand, and the difficulty of such diagnosis - on the other [Gabunia R.I., Kolesnikova E.K., Tumanov L.B., 1982].
The fact that the orbit is closed from direct inspection and palpation by bone walls and the eyeball, indicates the advantage of radial diagnostics in comparison with other methods of examination. In the arsenal of clinicians there is a great variety of methods of clinical-radial diagnostics of orbital pathology, however, at present the information in the literature about their resolving capabilities and significance in comparative aspect is incomplete and not fully studied. The priority of using one or another instrumental investigation, their sequence and expedient combination have not been determined yet. This makes it difficult to choose the optimal standardised approach for diagnosis and adequate treatment [Cheremisin V.M., Trufanov G.E., 1993, Weber A.L., Sabates N.R., 1996; Wenig V.M., Mafee M.F., 1998].
Thus, the study of these and other questions, contributing to the improvement of diagnostics and treatment of patients with neoplasms of the eye and ocular cavity, should be recognised as urgent urgent.
Purpose of the study. Comparative evaluation of magnetic resonance tomography capabilities and development of algorithms for complex radial diagnostics of volumetric formations of the visual organ. To solve this goal we set the following tasks.
1. To study the normal picture of the magnetic resonance image of the visual organ in comparison with other methods of visualisation.
2. To find out the possibilities of magnetic resonance tomography, ultrasound and computed tomography in detection and evaluation of intraocular neoplasms.
3. To determine the role and place of magnetic resonance tomography in differential diagnostics of volumetric pathological formations of the eye cavity in comparison with other radial methods of research.
4. To determine the indications and to develop an algorithm for the complex application of radiography, ultrasound, computer and magnetic resonance tomography for diagnostics of volumetric formations of the eye organ.
Scientific novelty.
The present work is the first to give a detailed and detailed description of the complex clinical and radiation examination, with generalisation and standardisation of magnetic resonance, computer and ultrasound semiotics of volumetric pathological formations of the eye and eye cavity. The conducted clinical and instrumental investigations allowed to determine the diagnostic value and resolving capabilities of each of the applied methods. The ultrasound, CT and MRI signs of volumetric formations of the eye organ were studied, clarified and supplemented taking into account the use of low-field magnetic field and general-purpose ultrasound apparatus. The developed standardised diagnostic algorithm of examination of patients with this pathology is new, thanks to which the pre-oppositional diagnosis of tumour and other diseases of the visual organ is improved and the total radiation load on the patient is reduced.
Conclusions
1. MPT will provide an opportunity to study the weight of the soft tissue and anatomical components of the ocular cavity, up to the optic nerve sheath and perineural liquor space, the orbital apex and chiasmal-sellar region, as well as to assess the condition of adjacent structures of the brain and facial skull. The method is limited in the evaluation of changes in the bony walls of the orbital cavity.
2. MRI is inferior in detecting characteristic signs of retinoblastoma (presence of calcification). The sensitivity of MRI was 66.6%, while for ultrasound and CT these values were 96.1 and 100%, respectively. But when the tumour spreads rstrobulbarly outside the eyeball (at 3-4 stages) the informativeness of MRI increases significantly. In uveal melanoma the sensitivity and specificity of MRI reaches 100%.
3. Both MRI and CT have a high detection rate (98.1% and 95.8% respectively) of benign orbital tumours of both primary and secondary origin. However, MRI is the preferred method of investigation. MRI is especially informative when a cranioorbital tumour and pseudotumour are suspected. The sensitivity of the method is 90.9% and 91.6%, respectively
4. In some cases ultrasound can be used to differentiate between encapsulated and diffuse neoplasms, which facilitates the diagnosis. However, when the pathological process is localised near the orbital apex, the diagnostic value of ultrasound decreases. In such cases it is advisable to use MRI.
5. In detection of primary and secondary malignant tumours of the orbital cavity both MRI and CT are quite informative (sensitivity 97,2% and 95,4% respectively), but the most comprehensive information about the state of bone walls will be provided by CT. When the process spreads intracranially, the value of MRI increases significantly, especially with the use of contrast enhancement.
6. The developed algorithm of complex clinical and radiation examination of patients with the use of ultrasound, CT and MRI is the most effective in the diagnosis of volumetric pathological formations of the eye and eye cavity, allowing to reduce to an adequate minimum the total radiation load on the patient and diagnostic period, excluding duplication of research techniques and choosing the most informative in each case, which in turn allows to develop appropriate treatment tactics and reduce the level of disability of the patient.
The aim of the study was to study the immunological cytokine status in women with combined forms of fibroids and adenomyosis to determine their role in the course of the disease. Methods. A total of 165 women with uterine myoma and / or adenomyosis were examined and the patients were divided into 3 groups. The research methods were dynamic study of blood flow of nodes by ultrasound with Doppler and immunological blood tests. Results: determination of the level of proinflammatory cytokines in patients before treatment showed the following results: the level of IL-1, IL-6 and TNF-α was higher in all three groups than in the control group. IL-6 and TNF-α, as well as VEGF, which proved the effectiveness of therapy. Discussion: an increase in the level of cytokines in the blood is most pronounced in combined forms of fibroids and adenomyosis compared with isolated forms of fibroids and adenomyosis. This indicates the participation of the immune system in the development and progression of such hyperplastic processes of the uterus as myoma and adenomyosis.
In gynecological practice, fibroids and adenomyosis are among the most common diseases among women of reproductive age, since these diseases are often the cause of radical operations. Ultrasound examinations are used in the world as screening for the detection of fibroids and adenomyosis. Conducting ultrasound on expert-class devices with blood flow Dopplerometry allows you to differentiate the type of myomatous node, determine the degree of adenomyosis and offer a comprehensive treatment depending on the activity of the process.
The problem of the development of polyhydramnios is relevant in connection with the complications of pregnancy and childbirth, both for the mother and for the fetus. One of the most dangerous complications is hypotonic bleeding in the postpartum period, which leads to an increase in maternal morbidity and mortality. Among the causes of bleeding, polyhydramnios, the frequency of which reaches 1–8% of the total pool of pregnant women, occupies one of the leading positions. The aim of the study was to study the features of the clinic and the morphological structure of the uterine wall in polyhydramnios of varying severity. All this dictates the need to improve ways to prevent hypotonic postpartum bleeding in women with polyhydramnios.
The morphological study to activities of proliferative cellular endometrial element under uterine of miami has shown that viral
infection aggravates the development an mioma’s process and brings about widespread proliferation process both histiotitar, and muscular of the hutches with appearance new miomatosis centre