The aim of the study was to compare the accuracy of shear wave elastography performed by ultrasonic scanners from different manufacturers and to develop the conversion coefficients to recalculate the stiffness values obtained with different instruments using a calibrated phantom. Materials and Methods. A comparative analysis of the accuracy of stiffness measurements by shear wave point elastography was performed using three commercial ultrasonic scanners: Aixplorer (Supersonic Imagine, France), Acuson S2000 (Siemens, Germany), LOGIQ E9 (GE, USA), and the acoustic system Verasonics (Verasonics Inc., USA). The measurements were carried out using the calibrated phantom CIRS Model 049 Elasticity QA Phantom Spherical (Computerized Imaging Reference Systems Company, USA) that contained spherical inclusions of different stiffness. Results. With all tested scanners, comparable stiffness values with deviations within the measurement error were obtained. For the less stiff spheres of type I and type II, the obtained values were consistent with to the phantom calibration. For the medium-stiff phantom matrix, the measured values were at the lower limit of the calibration range. With the stiff spheres of type III, we found values lower than those predicted by calibration; the deviation was less pronounced in the linear sensor of the LOGIQ E9 scanner. In all sensors, this discrepancy increased along with increasing stiffness of the object. We developed formulas for recalculating the stiffness values for all tested scanners grouped by pairs. For example, for the pair of linear sensors Acuson S2000-Aixplorer, the conversion formulas of the Young's modulus E and the shear wave velocity V are as follows: E(Aixplorer, kPa)=3.11•V 2.06 (Acuson S2000, m/s) and V(Acuson S2000, m/s)=0.58•E 0.48 (Aixplorer, kPa). Conclusion. All tested sensors and scanners have a comparable high accuracy of shear wave point elastography. The tested instruments are more accurate when measuring objects with low stiffness; as the stiffness increases, the deviations from the standard values become greater. The formulas proposed for recalculating the stiffness indices allow an accurate comparison between the shear wave elastography results obtained with different scanners. When used with the same object, the measured stiffness values increase in the row: Acuson S2000 → Aixplorer → LOGIQ E9.

Цель. Повышение эффективности лечения больных распространенным альвеококкозом печени применением современных хирургических технологий, включая трансплантационные. Материал и методы. Проведен анализ хирургического лечения 25 больных с распространенным альвеококкозом печени с 2008 по 2014 г. Операции выполнены 21 больному. Метастазы (отсевы) в легких диагностированы у 2. Длительная механическая желтуха была у 5 пациентов, портальная гипертензия-у 2. У 1 пациентки сопутствующий гепатит В привел к циррозу печени. Результаты. Хирургические вмешательства отличались большим объемом и включали резекцию печени in situ в 16 наблюдениях, ex situ-в 1, ортотопическую трансплантацию печени-в 3. При резекции печени врастание в нижнюю полую вену выявлено в 9 наблюдениях: 6 больным протезировали нижнюю полую вену армированными протезами из политетрафторэтилена, в 1 наблюдении-с пластикой устья левой печеночной вены, в 3с краевой резекцией. Резекция и реконструкция воротной вены выполнены 6 больным. В 9 наблюдениях выполнена резекция внепеченочных желчных протоков. Резекция правого купола диафрагмы выполнена 4 больным. Одному пациенту выполнена диагностическая лапаротомия. Всем больным после операции проводят противопаразитарную терапию. Отмечен 1 летальный исход, наступивший в послеоперационном периоде от полиорганной недостаточности. В течение 7 лет наблюдения рецидива заболевания не выявлено. Противопаразитарная терапия после трансплантации печени не потребовала коррекции иммуносупрессивной терапии. Заключение. Операции при альвеококкозе отличаются большим объемом в сочетании с реконструктивно-пластическими вмешательствами на магистральных сосудах и желчных протоках. Максимальное стремление к резекционной хирургии связано с потенциальной опасностью иммуносупрессивной терапии после трансплантации печени для прогрессирования заболевания, что оправдывает сложные резекции ex situ.

4-6 баллов, в 21 (30 %) -7-9, в 32 (45 %) -10-12. Средний диаметр опухолей -4,4 (1,5-10,0)

Aim. Analysis of the techniques of advanced liver resections involving transplantation technologies which affect the results of surgery for advanced liver alveococcosis.Material and methods. There were 65 patients with massive complicated liver alveococcosis for the period from 2008 to 2018. Radical procedures were applied in 82% of cases (n = 53). Mechanical jaundice was observed in 45% ofpatients, portal hypertension — in 25%. Previous palliative surgery was applied in 58% of patients. Thirty-three patients (50.8%) had advanced parasitic lesion with involvement of afferent and (or) efferent vascular structures. Distant metastases were detected in 6 patients: metastatic lung lesions occurred in 5 of them, simultaneous injury of brain and lungs — in 1 case.Results. There were 47 RO-resections with application of transplantation technologies including 4 extracorporeal resections and 6 orthotropic liver transplantations. Reconstruction of great afferent and efferent vascular structures was performed in 47% of cases: IVC repair — 25 cases, PV repair — 25 cases. Resection of extrahepatic bile ducts was made in 33 cases. Postoperative complications occurred in 26 cases: Clavien-Dindo type II — 5, IIIb — 13, IVb — 2, V — 6. Bile leakage ISGLS class B occurred in 6 cases, class C — in 11 cases.Conclusion. Transplantation technologies for advanced liver resections and liver or its segment transplantation allow to achieve radical surgery in 82% of patients. Advanced operations are indicated for advanced liver alveococcosis due to good outcomes. There are various technical aspects of such operations which are useful to avoid most of complications.

The common algorithm of shear waves excitation for diagnostical ultrasonic devices was modified for measurements in muscles. We measured the speed of shear waves, excited by a focused ultrasound at a frequency of 5 MHz in the muscles of the volunteers. Siemens Acuson S2000 was used for in vivo measurements. The suggested algorithm was tested on the muscle mimicking phantoms. The values of shear wave velocities in the same areas of studied phantoms at the same angles measured with Siemens Acuson S2000 system corresponded to the values obtained by Verasonics, where the region of shear wave excitation had a form of “blade” of thickness less than 0.5 mm, length and width of 1.5-2 mm. Due to this form of the region, the excited shear wave has propagated codirectional with the long side of the ultrasonic medical probe. Thus, the direction of propagation of the shear wave with respect to the phantom fibers, became dependent on the position of the probe. [The reported study was funded by RFBR and Moscow city Government according to the research project № 15-32-70016 «mol_а_mos», by RFBR according to the research project № 16-02-00719 а, and by Program for Sponsorship of Leading Scientific Schools (Grant NSh-7062.2016.2).]