Methodology for Determination of the Arterial Phase During Contrast-Enhanced Ultrasound Examination of the Liver, Kidneys and Spleen

Purpose: To assess the effectiveness of a new method of contrast-enhanced ultrasound examination (CEUS) for determining the duration of the arterial phase of contrasting liver, kidney and spleen.

Material and methods: We examined 37 patients with a verified diagnosis of viral alcoholic hepatitis with splenomegaly syndrome (n = 11), chronic hepatitis B (n = 14) and diabetic nephropathy against the background of type 2 diabetes (n = 12). The age of the examined patients was 39–56 years. Patients with diabetic nephropathy underwent complex diagnostics, including ultrasound examination of internal organs in B-mode with further Doppler assessment of the hemodynamics in the vessels of the kidneys. Patients with chronic viral hepatitis B and alcoholic hepatitis underwent a multiparametric ultrasound complex of examination, supplemented by strain elastography (SE). Further, a contrast-enhanced ultrasound examination (CEUS) of the kidneys was carried out using an echocontrast agent SonoVue in doses recommended for each organ, followed by an assessment of the arterial phase according to the standard and proposed method.

Results: While interpreting the data of the liver study in patients with chronic viral hepatitis B according to the standard method, quantitative data were obtained for the duration of the arterial phase of 16.4 ± 15.7 sec, and according to the proposed method, 12.1 ± 8.3 sec. In patients with alcoholic hepatitis with splenomegaly syndrome, the CEUS values are 21.8 ± 16.9, 17.3 ± 12.8 sec, in patients with diabetic nephropathy, — 13.5 ± 9.5 and 10.5 ± 5.9 sec accordingly. The results obtained, together with clinical and laboratory indicators can be interpreted in favor of improving the dynamics. Knowing the approximate data on the duration of the arterial phase during for the liver (from 8–14 to 40 sec), for the kidney (10–20 to 25–35 sec), for the spleen (8–60 sec), it can be concluded that the proposed method for determining the time of the onset of the arterial phase during CEUS is more accurate, since it allows one to determine the presence of diffuse pathology of organs at the microcirculatory level.

Conclusion: 1. The exact values of the onset of the arterial phase of contrasting were determined, thereby increasing the importance of CEUS in the diagnosis of diffuse pathology of the liver, kidneys and spleen. 2. The proposed method for determining the flow time of the arterial phase of echocontrast agent allows monitoring the effectiveness of treatment of diffuse pathology of the kidneys, spleen and liver (Patent RU No. 2744825). 

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