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RU-2861635-C1 - METHOD FOR DIFFERENTIAL DIAGNOSIS OF SOFT TISSUE SARCOMA RECURRENCES AND POSTOPERATIVE CHANGES

RU2861635C1RU 2861635 C1RU2861635 C1RU 2861635C1RU-2861635-C1

Abstract

FIELD: medicine. SUBSTANCE: invention relates to radiation diagnostics, and can be used for differential diagnosis of soft tissue sarcoma recurrences and postoperative changes. After ultrasound examination, a comprehensive analysis of contrast enhancement patterns is performed based on intensity relative to the surrounding tissue and the nature of contrast distribution, distinguishing five patterns: non-contrast; heterogeneous hypoenhancing; heterogeneous hypoenhancing with peripheral enhancement; heterogeneous hyperenhancing; heterogeneous hyperenhancing with peripheral enhancement. At the same time, kinetic perfusion parameters are analysed: absence of contrast enhancement, type II and type III. Postoperative changes are diagnosed when the 1st or 2nd pattern is combined with the absence of a curve or type II kinetics, and soft tissue sarcoma recurrence is diagnosed when the 3rd, 4th or 5th pattern is combined with type II or III kinetics. EFFECT: method increases the diagnostic accuracy, allows early detection of recurrences, safe monitoring of postoperative patients and reduces the need for invasive interventions due to a comprehensive analysis of qualitative and quantitative indicators in contrast-enhanced ultrasound. 1 cl, 12 dwg, 1 tbl, 5 ex

Inventors

  • Lyubimskaya Elvira Sergeevna
  • Busko Ekaterina Aleksandrovna
  • Kozubova Kseniya Vyacheslavovna
  • Kadyrleev Roman Andreevich
  • Zinovev Grigorij Vladimirovich
  • Burovik Ilya Aleksandrovich
  • Bagnenko Sergej Sergeevich

Dates

Publication Date
20260506
Application Date
20250722

Claims (9)

  1. A method for differential diagnosis of soft tissue sarcoma recurrences and postoperative changes using contrast-enhanced ultrasound with perfusion parameter assessment, characterized in that the ultrasound examination is followed by a comprehensive analysis of contrast patterns; the diagnostic pattern is determined by two parameters: the intensity of contrast enhancement in the study area compared to the surrounding tissue and the nature of contrast distribution within the study area; the following patterns are determined:
  2. the first is a non-contrast pattern, characterized by the absence of accumulation of contrast agent,
  3. the second is heterogeneous, hypocontrast, manifested by a non-intense and uneven enhancement, corresponding to the course of vascular structures in granulomatous inflammation against the background of changes,
  4. the third is heterogeneous with peripheral enhancement, hypocontrast with low-intensity, predominantly peripheral uneven contrasting,
  5. the fourth is heterogeneous, hypercontrast with intense, chaotic distribution of contrast throughout the entire volume of the formation,
  6. fifth - heterogeneous with peripheral enhancement, hypercontrast, demonstrating pronounced peripheral enhancement with a central acontrast zone;
  7. At the same time, the kinetic parameters of perfusion are analyzed, where the absence of significant contrast excludes the construction of a curve, type II is characterized by an increase in intensity followed by a plateau, and type III is characterized by rapid accumulation with early washout,
  8. when the first or second patterns are combined with the absence of a curve or type II kinetics, postoperative changes are diagnosed,
  9. When the third or fourth or fifth pathological patterns are combined with kinetics of types II or III, a relapse of soft tissue sarcoma is diagnosed.

Description

The invention relates to medicine, namely to radiation diagnostics, and can be used for differential diagnosis of recurrent soft tissue sarcomas and postoperative changes. Soft tissue sarcomas (STS), despite their rarity (≤1% of all tumors), are characterized by an aggressive course and a high recurrence rate after treatment (6.5-25%) ([1]-Italiano, A 2014;[2]-Gamboa, A.S, 2020; [3]-Siegel R.L). (often clinically asymptomatic) and postoperative changes (scar tissue, granulomas. The main diagnostic problem is the difficulty of distinguishing early tumor recurrence, seroma), especially against the background of post-radiation fibrosis, which leads to false-negative results or, conversely, to unjustified repeat biopsies. Ultrasound (US) has traditionally been used to monitor patients after STS resection due to its availability and non-invasiveness. Significant advances in the effectiveness of ultrasound have been achieved with the introduction of microbubble echocontrast agents, which allow visualization of the vascular network with a diameter of up to 40-100 μm, opening up new opportunities for the early detection of STS recurrence by detecting pathological vascularization ([3] - Bus'ko E.A., 2024; [4] - Fischer S., 2020; [5] - Zaitsev A.N., 2023). A special contribution to the development of diagnostic criteria for contrast-enhanced ultrasound (CEUS) was made by Loizides et al. (2012), who proposed 4 perfusion patterns (P1-P4) for the differential diagnosis of benign and malignant soft tissue formations: P1: no contrast, P2: peripheral enhancement, P3: heterogeneous diffuse enhancement, P4: homogeneous enhancement ([6] - Loizides, A., 2012). This method is the closest analogue. Another close analogue is the method for differential diagnosis of breast and soft tissue formations proposed in patent RU 2 634 783 C1, using a combination of kinetic curve data: -Type I: Gradual linear increase (benign processes), -Type II: Linear increase + plateau phase (border formations), -Type III: Rapid rise/fall (malignant tumors) and contrast patterns (ring-shaped, ring-shaped with a parietal component, tree-shaped - benign, and spiculated, spiral-shaped - malignant) ([7] - Busko E. A, 2017). The key drawback of existing models is their lack of specificity in assessing postoperative soft tissue changes, as they were developed for a wide range of pathologies and general differential diagnosis of benign and malignant tumors. The technical result of the invention is the development of a refined classification for contrast-enhanced ultrasound (CEUS) focused specifically on the postoperative context, with optimization of contrast enhancement patterns and consideration of quantitative parameters (time-enhancement curves); the possibility of early diagnosis of soft tissue sarcoma recurrences, safe monitoring of postoperative patients, informed clinical decision-making, a reduction in the need for additional invasive interventions, and an increase in the accuracy and differential diagnosis to 92%. The specified technical result is achieved in the method of differential diagnosis of relapses of soft tissue sarcomas and postoperative changes using the method of contrast-ultrasound examination with assessment of perfusion parameters, characterized in that after the ultrasound examination, a comprehensive analysis of contrast patterns is additionally carried out; the diagnostic pattern is determined by two parameters: the intensity of contrast in the examination area in comparison with the surrounding tissue and the nature of the distribution of contrast in the study area; define the following types of patterns: - the first is a non-contrast pattern, characterized by the absence of accumulation of contrast agent, - the second is heterogeneous, hypocontrast, manifested by a non-intensive and uneven enhancement, corresponding to the course of vascular structures in granulomatous inflammation against the background of changes, - the third is heterogeneous with peripheral enhancement, hypocontrast with non-intensive, predominantly peripheral uneven contrasting, - the fourth is heterogeneous, hypercontrast with intense, chaotic distribution of contrast throughout the entire volume of the formation, - the fifth - heterogeneous with peripheral enhancement, hypercontrast, demonstrating pronounced peripheral enhancement with a central acontrast zone; At the same time, the kinetic parameters of perfusion are analyzed, where the absence of significant contrast excludes the construction of a curve, type II is characterized by an increase in intensity followed by a plateau, and type III is characterized by rapid accumulation with early washout, - when the first or second patterns are combined with the absence of a curve or type II kinetics, postoperative changes are diagnosed, - when the third or fourth or fifth pathological patterns are combined with kinetics of types II or III, a relapse of soft tissue sarcoma is diagnosed. The diagnostic pattern