Topical problems of hunter NLS diagnostics,metatron nls parts 4
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of the intestine wall circle. In the next investigation phase we estimated the
accuracy of the NLS method in defining the degree of the intestinal wall
invasion depending on the tumour location in the colon.
In 40 cases the tumour was localized in the rectum and in 21 cases in the
segmented intestine. The accuracy of diagnosing the phase of the tumoral
process in the colonic intestine is significantly higher, than at finding the
tumoral invasion depth with the neoplasms located in the rectum and
amounts to 71 and 62,5 % resppectively. This high result can be most likely
explained by the fact, that this department of colon contains a serous mem?
brane, which distinctly separates the muscular layer from the abenteric
organs and tissues. Also it is noted, that the serous membrane of the intestine
is less subjected to penetration of the inflammatory infiltration, than the
pararectal cellular tissue. The majority of mistakes falls on the cases of over?
estimated depth of the invasion at defining Phase Т2.
These researchers have noted, that accuracy of diagnosing the phase of
a tumoral process was higher in colonic intestine, than in rectum. The great?
est number of mistakes occures in Phase Т2, which is conditioned by the
presence of abscesses, inflammatory infiltraion or radial therapy in the neo?
plasm area. Damaged regional lymph glands are an important prognostic fac?
tor in diagnosing rectum cancer . To define the capabilities of the method in
diagnosing metastases in regional lymph glands, the results of the NLS
method were compared with those of the pathomorphologic essay. In the lat?
ter the malignant damage to the regional lymph glands was detected in 11
observations from 22 cases.
The analysis of the derrived data proved that the NLS essay had correct?
ly defined the pattern of damage to the lymph glands in 63.6 % of cases.
The metastatic pattern of damage to the lymph nodes was defined in
74.8% of cases, and in inflammatory changes the results of the ultrasonic
colonoscopy and those of the pathomorphologic essay coincided only in 45.5
% of observations. In 6 from 11 of cases the presence of metastasises in lymph
nodes was assumed (false?positive result). Such mistakes can be attributed to
oncologic vigilance of the researcher and complexity of differential diagnos?
tics of inflammatory and metastatically?altered lymph glands.
Conclusions
1. NLS diagnostics is a highly efficient method of diagnosing the neo?
plasms of the colon, allowing to diagnose neoplasms and regional lymph
glands.
2. The NLS method allows to detect the colon adenoma and cancer by
the presence or absence of the tumoral invasions in the intestinal wall.
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because NLS does not allow to provide a vessel’s image and hence to meas?
ure the vessel’s diameter. This kind of information may be acquired with the
help of Doppler systems with 2D?imaging, that offer duplex and triplex scan?
ning (the so?called Doppler chromatic charting).
The NLS?method was developed in the mid 90?s and played an essential
role in vascular pathology diagnosis. The main advantage of the NLS?method
was that it facilitated search and locating the vessels and allowed to very quick?
ly differentiate vessels from nonvascular structures, arteries from veins and
very accurately detect signs of disturbed vascular permeability caused by
stenosis or occlusion of the vessel lumen by an atherosclerotic patch or a
thrombus which are generally not visible at scanning in B?mode alone.
In addition the NLS?method allows to diagnose portal hypertension,
the extent of its intensity, and permeability of Porto systemic bypasses. NLS
is very sensitive in defining the extent of peripancreatic vessel involvement
with pancreas cancer which is essentially important for choosing the
approach for surgical treatment.
NLS allows to detect the damaged renal vessels (both veins and arteries),
which is very important for the correct choice of a hypotensive drug at arte?
rial hypertension.
Some effecient hypotensive drugs, i.e. inhibitors of angiotensin?convert?
ing enzyme (ACE) such as capoten, enalapril, berlipril, ect., became very
popular lately, but they have counter?indications at renal artery stenosis. So
physicians should bear in mind that checking for stenosis is a must before
prescribing this kind of medicine. The NLS?method is likely to be the choice
method in such cases.
The NLS?method is indispensable for differential diagnostics of benign
and malignant hepatic diseases. Its sensitivity is comparable with the poten?
tials of conventional or digital angiography and computer?assisted amplified
tomography. In addition, the NLS?method is much cheaper, simpler and
more intelligible. It can be employed directly at the patient’s bedside if
required. The NLS?method may be used in ophthalmology to check ocular
hemodynamics before or after surgical intervention, in obstetrics to detect
the disturbed blood current in umbilical cord arteries with a view to diagnose
a retarded fetus development and predict a negative perinatal produce.
Yet another potential of NLS method lies in cranial scanning which
allows to detect intracranial hematomas, aneurisms, cysts and tumors in the
encephalon.
These are far from all potentials of the NLS method.
Summing up, the NLS?method is one of the most dynamic techniques
and within the next few years it is bound to bring some new discoveries.
23
NLS — method in vascular pathology
diagnosis
S.M. Patrushev,
A.D. Sluzky, V.M. Vagulin
Today the world faces a constant trend of a growing rate of mortality
caused by occlusive vascular diseases, especially by cerebrovascular disorders
which are in the third place among death causes. On the one hand the trend
is caused by a growing number of elderly and aged patients. On the other
hand many men even already at 45 have atherosclerotic damage of main
head arteries, causing the need for a dispensary observation.
The most simple and at the same time informative method of noninvasive
diagnosis of occlusive damage of peripheral vessels appeared to be the NLS?
method which has been used in clinical practice not long since. The first NLS
devices equipped with analog trigger sensors, operating in 1.4 GHz frequency
mode and used in clinical practice since the late 90?s have not lost their impor?
tance yet. They can help determine the condition of certain sections of the
main vessels in the lower limbs and that of the brachiocephalic vessels.
Not only the condition of the vessels but also that of the valvular system
of deep veins can be studied. 102 patients were examined in 1997?1998 to
detect valvular insufficiency of deep veins affected by varicosis. The patients
were from 21 to 67 years old. The examined patients included 25 men
(24.5%) and 77 women (75.5%). The study was carried out by means of the
Oberon device using a 1.4GHz analog trigger sensor. In 32 patients a valvu?
lar insufficiency of the femoral vein was detected, in 44 patients failure of
both femoral and popliteal veins. NLS allows to assess the condition of the
valvular system of deep veins in low limbs on a noninvasive and objective basis
which is very important point for the surgery tactics to be selected, and can
be used as an alternative to phlebography analysis.
The NLS?signal spectral analysis method has no counterindications and
in terms of informational content is comparable to angiography. It can be
used to perform screening in the course of polyclinical examination with a
view to detect early or latent forms of vascular pathology and also as a pre?
liminary method for selecting patients for angiosurgical treatment, since
according to some angiologists, angiography should only be performed on
candidates for surgery picked out after a preliminary NLS investigation.
However, this method does not allow to assess bulk index of the bloodstream,
22
The chromogenic density of the lung tissue around the nidus was some?
what higher (due to infiltration), and the folia of the visceral and parietal
pleuras were blackened in the lower sections of the right lung.
The patient was offered a further therapy in a specialized surgical
department, which he turned down. 3 weeks later, after some anti?inflamma?
tory therapy a check NLS examination was performed. During the exami?
nation the patient complained of coughing with a profuse sputum discharge.
His temperature was normal, the clinical blood analysis indicated a leukocyte
count of 8.6×109, and the differential blood count was within the standard,
and ESR grew up to 37 mm/h. The NLS?investigation visualized a rounded
formation with even outlines, increased chromogenic density and heteroge?
neous internal structure sized 47×43. The chromogenic density of the lung
tissue around the perimeter decreased (because of reduced infiltration).
At the patient’s urgent appeal he was discharged from hospital for further
outpatient treatment. Later he underwent two check examinations conducted.
Patient M., aged 63, was examined by means of the NLS?method in
order to preclude a liver or gall bladder pathology.
An NLS?investigation of the lung and pleural cavities was carried out. In
the left lung and pleural cavities it found no signs of pathology in evidence.
In the right lung in the IX, X and XI hypochondria (from the paravertebral
line to the scapular one) it parietally visualized a formation having an
increased chromogenic density and sized 85×60 mm with uneven outlines
and heterogeneous structure (due to inclusions of a decreased chromogenic
density) sized 3?4 mm. The chromogenic density of the lung tissue was not
increased. NLS conclusion: signs of abscess in the right lung?
Radiological conclusion: abscess in the lower lobe of the right lung.
The patient had check NLS?investigations conducted against the back?
ground of anti?inflammatory therapy. With the NLS?investigation performed
10 days later the formation looked rounded, had even outlines, an increased
chromogenic density (4?5 spoints) and a heterogeneous internal structure.
Around the perimeter of the nidus the lung tissue had an increased chro?
mogenic density (3?4 points) because of infiltration. The formation meas?
ured 73x50x60 mm. The NLS?investigation 2 weeks later did not detect any
positive dynamics from the administered anti?inflammatory therapy.
The submitted clinical observations once again confirm that the NLS?
investigation with lung diseases is not used in clinical practice as often as it
deserves.
Besides, the dynamic NLS?observation of the patients affected by lung
diseases allows to assess the efficiency of the employed therapy and reduce
the radiation load both on patients and on the medical personnel.
25
NLS?diagnostics of lung abscess
S.N. Makarova
A screening NLS?investigation detected two cases of lung abscess in
feverish patients who were complaining of pain in the right hypochondriac
region. The patients were subjected to echography in order to preclude an
abdominal cavity pathology.
The NLS examination was conducted by means of “Oberon?4009”
device equipped with a digital trigger sensor. (1,4GHz).
Patient N., aged 57, was admitted to the therapeutic department. He was
complaining of a week?long fever with a temperature of up to 40?C, a mod?
erate non?productive cough and pain in the right hypochondriac region as a
result of catching a cold. He came to see a doctor ten days after falling ill. The
anamnesis read a bilateral pneumonia 14 years before. The clinical blood
analysis indicated an increased leukocyte content ? up to 18.7 x 109 with a
flush left leukogram. The common urinalysis showed no deviations. Physical
examination: vesicular pulmonary respiration, weakened in the lower sec?
tions on the right with no rhonchi.
Tongue dry, white furred. Belly soft, with frank painfulness in the right
hypochondriac region. No symptoms of peritoneum irritation in evidence.
Pasternatski symptom negative on the right and left.
The NLS?investigation of the abdominal cavity did not detect any signs
of pathology in the liver, gall bladder or pancreas. On the right there are visu?
alized blackenings in the diaphragmatic pleura (4?5 points according to
Flandler’s scale) and an image of voluminous formation in the right lung was
acquired (5?6 points). On the dorsal thoracic wall there was an image of a
enhanced chromogenic formation (6 points) of a heterogeneous internal
structure, sized 80x65x54 cm. The lung tissue around the nidus had a higher
chromogenic density (4?5 points) on account of infiltration. A spectral simi?
larity to the “lung abscess” reference standard (D=0.312) was detected. The
investigation of the left lung and pleural cavities did not detect any structur?
al changes. NLS conclusion: certain signs of developing abscess in the right
lung.
The check radiological investigation arrived at the conclusion: an
abscess in the lower lobe of the right lung in progress.
A repeated NLS examination was conducted 10 days later. It visualized
a rounded hyporchromogenic formation with uneven outlines with some
hyporchromogenic zones inside, sized 81x60x51 mm.
24
did not show any changes. According to some literary evidence, in this phase
the histology detects a substitution of the fat bone marrow for the red bone
marrow often accompanied by enlarged trabeculae. This phase generally pre?
cedes an osteochondrosis development which can be diagnosed a little while
later by conventional radiographs.
The spectral similarity to the reference standard “intervertebral osteo?
chondrosis” was frank (D 0.246 to 0.360).
Degree 3, a frank hyperchromous response (6 points), which corre?
sponds to a far advanced vertebral body sclerosis, was detected in 312
patients. Some secondary symptoms, like local bulging and vertebral asteo?
phytes, were detected with a far advanced degenerative lesion of the disks and
a substantial similarity to the reference standard “osteochondrosis” (D from
0.152 to 0.218). NLS allows to differentiate between a protrusion and pro?
lapse of the disk and existence of rupture of the fibrotic ring and the condi?
tion of longitudinal and other ligaments.
A protrusion is defined as a bulging of the disk tissue beyond the poste?
rior outline of the vertebral body into the spinal canal. The fibrotic ring tissue
endures though becomes very thin and NLS only reveals a zone of slight
destructive change in the structure (3?4 points). The pulpous nucleus shifts
dorsally much farther in the disk. The protrusion has a wide base and can
spread as far as intervertebral foramina with the inferior part of the foramina
filled with disk tissue. The compression of the intraforaminal structures can
cause irritation of the nerve root. Normally, the nerve root uninvolved in the
process gives a moderate response (3?4 points). With compression it gives an
acutely frank hyperchromous response (6 points).
Protrusion may be accompanied by a slight caudal shift which is quite
often defined by means of the NLS?method at L5?S1 intervertebral disk level.
NLS detected protrusion in 729 patients.
The rupture of the fibrotic ring fibers results in the prolapse of the
pulpous nucleus on a subligamentary level and the ligament rupture results in
the prolapse inside the cerebrospinal canal. As can be seen from NLS, the
longitudinal ligaments look well delimited and are represented as hyperchro?
mous band?like structures (5?6 points) which adjoin the bones and the fibrot?
ic ring. The extraligamentary prolapse can shift either in a caudal or a cranial
direction. The extraligamentary prolapses of the disk that lost contact with
the host disk become sequesters. Occasionally, we observed some very small
extraligamentary sequesters which shifted far into the cerebrospinal canal,
which made it hard to detect them.
The NLS?investigation detected prolapse in 445 patients. In 68% of cases
the hernia of intervertebral disk was combined with other degenerative dystroph?
27
NLS?diagnostics of degenerative
changes in the spine
A.G. Brusova, P.A. Manokhin,
T.K. Puzanovskaya, T.A. Shyshkovets
Computer Nonlinear Diagnostics (NLS) is a new highly informative
method provided to examine the spine and spinal marrow. The NLS advan?
tages are noninvasiveness, scalability of the image field, a capability to obtain
sections of any orientation and virtual imaging of radicular canals and par?
avertebral zone. Undoubtedly the use of NLS in diagnostics of degenerative
spine diseases has apparent prospects.
Subject and methods
The investigation was conducted by means of “Oberon 4009” metatron
equipped with a 1.5 GHz digital trigger sensor. 1217 patients affected by
degenerative changes in the lumbar region of the spine were investigated. The
NLS of the spine and spinal marrow was performed for all patients, 112
patients had NLS and CT, and myelography was performed for 10 patients.
Analysis of results
In 87% of cases in the examinee group we found disks affected by
degenerative changes. The earliest degenerative change in intervertebral disks
(ID) was a hyperchromous lesion (6 points on Flandler’s scale) in zone
between the pulpous nucleus and the fibrous annulus. Along with the degen?
erative changes NLS has detected an increased chromogenic density of the
signal from the bone marrow in the adjacent regions of the vertebral bodies
(4?5 points according to Flandler’s scale). 3 degrees of degenerative changes
could be distinguished depending on the process intensity.
Degree 1, a hyperchromous zone appraised at 4?5 points on Flandler’s
scale, was detected in 90 patients. Conventional radiographs did not display
any changes. Formation of fibrovascular tissue followed by its penetration
into the bone marrow is believed to underlie the changes. Some authors relate
these changes to the lack of stability in this segment.
The histograms displayed a spectral similarity to the reference standard
“intervertebral osteochondrosis” (D 0.396 to 0.425)
Degree 2, a hyperchromous responce in the affected zone at 5?6 points
on Flandler’s scale was detected in 215 patients. Conventional radiographs
26
NLS ?diagnostics of diffuse
infiltrative lung diseases
V.I. Nesterova,
T.G. Kuznetsova,
N.L.Ogluzdina
Among different kinds of lung disorders special attention has been paid
over the last years to diffuse infiltrative lung diseases (DILD), which is large?
ly accounted for by some problems in their timely diagnostics and treatment.
Most diffuse lung diseases involve in the pathological process both the
interstitial tissue and the respiratory tract and alveola. In this connection this
type of pathological processes should be defined rather as diffuse infiltrative
than as interstitial diseases. Despite of the polymorphism of clinicomorpho?
logical manifestations of DILD, most of them start off with productive alve?
olitis (in contrast to the exudative alveolitis in the case of a pneumonia) with
fairly stereotyped changes in the lung interstice in the form of inflammatory
infiltration with different degrees of intensity. Subsequently a fibrosis devel?
ops that can have different rates of progression. A ‘cellular lung’ pattern is the
final phase of the development. It should be noted, that some infectious dis?
eases of certain etiology (like tuberculosis, histoplasmosis, etc.) and particu?
lar malignant tumors (lymphogenous carcinomatosis, bronchioloalveolar
cancer) do not directly belong to interstitial lung diseases but are similar to
them in terms of manifestation.
The clinical evaluation of patients with a suspected DILD is a complex
problem. Nonspecific symptoms and in some cases signs detected during
chest examination may be characteristic of a multitude of acute or chronic
lung diseases that involve the interstitial tissue, respiratory tract or alveola.
DILD are represented by an extremely heterogeneous group of diseases. The
DILDs have been described in over a hundred possible versions, however in
clinical practice only about 10 or 15 conditions are most common and it
should be noted that sarcoidosis and various cases of lung fibrosis occur in
clinical practice in 35?50% of all DILDs. Besides, acute diffuse lung process?
es in patients with reduced immunity (also in combination with HIV?infec?
tion) are likely to have a great number of infectious and non?infectious vari?
eties, which X?ray evaluation is found to be difficult.
Unfortunately, the capabilities of conventional roentgenography for
patients with a suspected DILD appear to be limited for the sensitivity and
29
ic spinal changes on this level. The hernia of the intervertebral disk was detected
at L4?5 level in 83%, at L5?S1 level in 15% and at L3?4 level in 2% of cases. A
lesion of several disks was found in 50 patients. 196 patients underwent surgery,
among them 114 had lateral hernia, 76 patients had median lateral hernia and 6
had median hernia. 5 patients had surgery for hernia recurrence. The NLS diag?
nosed extraligamentary sequestrated hernia in 38 patients, and intradural hernia
was diagnosed in 3 persons. Multiple sequesters were detected in 5 patients.
The clinical symptomatology for the prolapse of intervertebral disks was vari?
able and did not always depend on their size. In some cases we observed median
protrusions which did not result in any clinical implications. The clinical sympto?
matology for small sequestrated hernia was no less than for large sequesters.
In evaluating the NLS data not only the size of hernia but also the reserve area
of the cerebrospinal canal and their prepositions should be taken into account.
With a suspected hernia the NLS?investigation should be performed at
least in two planes, sagittal and paraxial, i. e., parallel to the disk plane, and
the sagittal investigation in T1w?SE can be combined with other sequences.
The median prolapses of intervertebral disks in sagittal shots could be
seen quite clearly. The signal content of the hernia predominantly corre?
sponded to the NLS signal content of the pulpous nucleus. The external part
of the fibrotic ring, posterior longitudinal ligament and the dura matter give
a frank hyperchromous response and do not differentiate from one another.
Thus, the NLS?method sometimes fails to present a direct proof of a rupture
in the external part of the fibrotic ring.
It is largely a lesion of the pulpous nucleus on the side of the back edge
of the vertebral body that speaks in favor of the protrusion in axial shots.
Displacement and compression of the spinal marrow can well be seen in both
sagittal and axial projections.
Sagittal shots have an advantage in deciding on the disk prolapse, the size of
intervertebral foramina and the condition of the cerebrospinal canal and bones.
These shots are not significant for detecting an intradural process with the cone
especially poorly visible in them. Frontal shots have drawbacks in determining the
condition of the pulpous nucleus and fibrotic ring. To that end paraxial virtual mod?
els are used, for they allow to differentiate the process between the pulpous nucleus
and the fibrotic ring and sometimes make it possible to differentiate between the
fibrotic ring rupture and the protrusion free of the rupture. Thanks to virtual dimen?
sional scaling sagittal shots allow to well delimit the subarachnoid space.
28
row transplant and clinical symptoms of fever of obscure genesis. The authors
demonstrated high reliability of the NLS in determining fungal infection in
20 of 24 cases. Besides, the fact that no changes were detected during NLS
lung examination allows to assume that the the fever was caused by bacterial
or fungal infection of extra pulmonary genesis.
It is also a proven fact that the sensitivity with NLS is higher than with
standard computer tomography. We examined 150 patients. Using conven?
tional CT (10 mm collimation) and NLS we found that NLS had a higher
sensitivity in recognizing pathological changes in the lung tissue.
Due to its high sensitivity, NLS should be used to define lung diseases in
patients with a normal or obscure aspect of disease who have a pulmonary
disturbance or symptoms that suggest an acute or chronic diffuse lung dis?
ease.
Even with certain clinical signs in evidence the diagnostic accuracy of
classic radiography in patients affected by DILD appears to be limited. The
reason is both superposition of the image in the radiograph and low contrast
of minute lung structures. NLS is free of these aspects, which is why it is
reputed to be a more efficient method for recognizing diffuse lesions of lung
tissue as compared to both radiographic survey and conventional computer
tomography.
Besides, having a higher sensitivity, specificity and diagnostic accuracy,
the NLS method can become a determining factor in evaluating the activity
of a pathological process in patients affected by DILD. In certain cases NLS
can be used not only to define the presence or absence of a pathological
process or the extent to which it has spread, but also to collect information
about the reversibility of changes (in an acute or active phase) as compared to
irreversible (fibrotic) changes in the lung tissue. Moreover, since NLS can
accurately identify the imponderable activity of a pathological process in the
lungs, it can be employed to evaluate the efficiently of the treatment given to
the patients.
The conventional methods for evaluating disease activity, such as trans?
bronchial lung biopsy (TBLB), bronchoalveolar lavage (BAL), chest radiog?
raphy, gallium lung scanning and functional lung tests are insufficiently reli?
able in evaluating the activity and in terms of prognostication. So the open
lung biopsy (OLB) is still the choice method for both diagnosing and evalu?
ating the process activity. We were able to prove, that signs detected in
patients by means of NLS can provide some valuable information and be sig?
nificantly important in defining the activity of a pathological process.
In terms of its prognostic value NLS is now advancing to the foreground
leaving behind some functional lung tests, BAL and even OLB, because it
31
specificity of the method prove to be insufficient. The data on 458 patients
with a histologically confirmed DILD were studied. The chest radiographs
for 10% of the cases turned out to be normal. Among 86 patients affected by
DILD no pathological change was detected in 50% of the patients with his?
tologically proven bronchiectasia and in over 20% of the patients with
emphysema shown on X?ray shots. Radiography may equally show false pos?
itive results of the investigation. We have discovered that in 10?20% of the
patients with the x?ray?confirmed signs of DILD no changes were detected
during the lung biopsy.
The computer nonlinear diagnostixs (NLS) is one of the promising
methods of diagnosing lung diseases of today. NLS appreciably improves the
communication of the fine morphological elements in the lung tissue and
opens up new opportunities for recognizing interstitial diseases of the bron?
choalveolar system. NLS has a high sensitivity in detecting fine interstitial
lesions of the parenchyma and small nodules.
The results of the investigations prove that NLS has a better sensitivity in
detecting both acute and chronic diffuse lung diseases. The sensitivity of the
NLS diagnosis in detecting lung diseases makes 85% as compared to 70% in
chest radiography.
The accumulated experience too, gives additional grounds to assert that
NLS is a highly efficient method for diagnosing a wide range of various dif?
fuse lung diseases, DILD included, and excels the ‘classic’ chest radiography
by sensitivity.
It should be noted that the high sensitivity of the NLS?method is
achieved without sacrifising the specificity and diagnostic accuracy of the
method. In patients affected by DILD the NLS specificity amounted to 86%
as opposed to 76% in radiography. In particular, the high sensitivity (87?88%)
and specificity (83?89%) of NLS were demonstrated in bronchiectasia diag?
nostics.
Although NLS is a more sensitive method as compared to chest radiog?
raphy, its sensitivity in lung disease diagnostics is not absolute and the fact
that no radiological changes were detected by NLS may lead to precluding
lung disease in patients who actually suffer from DILD. 100 patients were
examined by means of the NLS with 86 of them affected by DILD and 14
having no pathological change in the lungs.
Despite a high value of NLS sensitivity and specificity, for 4% of the
patients with biopsy?detected lung diseases the results were interpreted as
being normal. On the other hand, the NLS was proven to be a high?accura?
cy technique for precluding acute lung diseases in patients with immunode?
ficiency. Some examination data were studied for patients with a bone mar?
30
Conclusion. Radiography still remains the most accessible method for
diagnosing DILD yet its informational content appears to be not sufficient.
Making a correct diagnosis necessitates a combination of laboratory,
functional and radiological investigations as well as some invasive methods ,
each of them having its own substantial limitations.
NLS?diagnostics is a method that greatly improves identification of dif?
fuse infiltrative lung diseases and as such it should become a part and parcel
of an integrated investigation.
33
allows to assess a lesion of actually the whole lung parenchyma as compared
to a separate biopsy sample. Moreover, NLS can become an accurate nonin?
vasive method for evaluating the efficiency of the administered treatment.
Sarcoidosis is one of the most common interstitial lung diseases of
unknown etiology. In typical cases granulomas are formed in fine lymph ves?
sels or beside them, afterwards the granulomas self organize which causes
lung tissue fibrosis.
A number of researchers considered the NLS potentials in defining the
process activity in patients affected by sarcoidosis. The main activity indica?
tor is the presence of small nodules and to a lesser degree their distribution
and occurence in the lung tissue. Unfortunately, despite the difference
between reversible and irreversible changes detected by NLS for patients hav?
ing sarcoidosis, the potentials of NLS in assessing the process activity have
not been studied well enough.
Among different indications in favor of NLS application, the use of this
method in lung biopsy is probaly the most important one. Biopsy is a very
essential diagnostics technique which allows to define the nosology of a lung
disease, its activity level and phase. The diagnostic value of biopsy to a cer?
tain degree depends on its method and the type of DILD. The authors proved
that TBLB was diagnostically informative for only 20 patients of 53 (38%)
who had DILD in evidence; in 33 such patients (62%) TBLB displayed nor?
mal lung tissue or nonspecific changes.
At the same time OLB made a specific diagnosis of DILD in 92% of
cases. In DILD?affected patients TBLB proved to be most informative for
patients having sarcoidosis or lymphogenous carcinomatosis, because these
lesions have largely peribronchial tissue involved and are therefore most
accessible to TBLB. Diagnostically OLB appears to be more accurate, but it
also has certain complexities because lung tissue is sampled from a small sec?
tor of the lung which might not reflect the changes occurring in the rest of the
lung tissue. Many diffuse diseases affect lung tissue irregularly so the patho?
logically altered parts of lung parenchyma may be located among normal
lung tissue. Besides, the same lung may contain both active manifestations of
the disease and fibrotic changes of long standing. For an accurate diagnosis
and assessment of the clinical progress of the disease the right choice of a
biopsy sample is very important. During biopsy NLS helps to collect more
accurate data indicating active areas of a pathological process. By using NLS,
the areas affected by lung fibrosis in its final phase, with ‘honeycomb lung
formed, could be skipped during biopsy sampling. In addition, NLS may
prove to be vitally important for choosing the most effective technique
(TBLB, BAL or OLB) for making a histological diagnosis.
32
1) Anterior fibro muscular stoma (AFS).
2) Unstriated muscular fibers of the urethra (UMFU).
3) Preprostatic sphincter (PPS), which is an extension of the muscula?
ture of the inferior part of the urcter and prevents inverse emission of seminal
fluid.
4) Postprostatic sphincter (PPS), which is responsible for retaining
urine in the bladder and blocks incontinent micturition.
The gland can be conventionally subdivided into 2 parts:
— external part consisting of CZ, PZ, TZ and
— internal part comprising AFS, PPS and PoPS.
According to NLS?investigation, the external part looks like a structure
of normal chromogenic density (2?3 points on Flandler’s scale), and the
internal one is hypochromogenic (1?2 points). The two parts are divided by a
fibro muscular layer, the so called surgical capsule, along which an incision is
made during surgical intervention, and calcium salts deposit (calcium incrus?
tation of the gland). In the NLS investigation those formations can well be
seen as fairly hypochromogenic structures (3?4 points) of different size.
The analysis of the prostatic gland image on the NLS virtual model is
made according to the following quantity and quality characteristics:
1. Size: front to back — 2?2.5 cm, across — 3?4.5 cm, from top to bot?
tom — 2.5?4 cm;
2. Volume: up to 20 cm 3 ;
3. Symmetry. The urethra is the reference point.
If any pathological changes are detected in the NLS?graph it is recomm?
nded to:
— specify their exact location,
— perform histography of the pathological area and area of the tissue
with a normal structure.
It will be helpful for the case follow?ups. At a benign hyperplasia NLS
allows to detect the direction of the principal germination. In case of hyper?
trophic transitory zones the gland proliferates inwards. Though darkened lat?
eral zones are formed ( 4?5 points on Flandler’s scale), the nodes can still be
always visualized. The trans?rectal NLS offers the most detailed and authen?
tic information.
Enlarged lateral lobes squeeze PZ and CZ causing their atrophy. With
proliferation of the paraurethral zones a massive fibro muscular PPS layer
restricts their hyperplasia, so with this kind of pathology the gland prolifer?
ates along the urethra forming a middle darkened zone pushing back the
bladder wall. Virtual scanning makes this pathology clearly visible in longitu?
dinal sections. At the beginning of the proliferation a relationship between
35
NLS?diagnostics of prostate diseases
V.A. Toropova,
S.N. Petrenko
An ever growing number of physicians enjoy an opportunity of a screen?
ing NLS diacrisis of prostate gland and urinary bladder. This aricle attempts
to consider some particulars of morphological changes occuring in a prostate
affected by pathology, based on the results of NLS?investigations.
In the West prostate cancer makes 20% of the total cancer diseases and
ranks second to lung tumors as a death cause.
According to some autopsy findings with a histological investigation of
the prostate, 12?47% of men aged over 50 appeared to have cancerous nidi.
Clinically, cancer is diagnosed more rarely because a high percentage of that
number corresponds to ‘minor forms’ of cancer that have low invasiveness, so
the patients suffering from it die of another kind of pathology.
To enhance the quality of prostate diseases diagnostics it is important to
comprehend the specifics of topographic and zonal anatomy of a particular
organ.
The prostate gland is located in the small pelvis between the bladder and
anterior abdominal wall, anterior rectum wall and secondary urogenital
diaphragm. The gland has a chestnut shape and tightly envelops the bladder
cervix and prostatic urethra. The gland base is tightly connected with the
bladder into a coherent mass. Its anterior surface is directed to the symphysis,
and the posterior one ? to the rectum ampulla. The posterior surface of the
gland has an expressed sulcus, which allows to conventionally subdivide the
gland into the left and right lobes. Besides, there is a protruding middle
cone?shaped lobe confined anteriorly by the prostatic urethra and by the
spermatic ducts posteriorly.
According to zonal anatomy theory usually 4 glandular zones are distin?
guished in the prostate. The correct interpretation of NLS data largely
depends on the knowledge of their topical pattern. 20% of the glandular tis?
sue correspond to the central zone (CZ). The peripheral zone (PZ) occupies
75%. The intermediate (transitory) zones (TZ) make up 5% of the total
amount of the glandular tissue.
Perurethral glands (PUG) take a relatively small amount of the tissue,
however exactly this area of the gland is very important for explaining the
changes at a benign hyperplasia. Apart from the glandular area, 4 fibro mus?
cular zones can be discriminated:
34
With an oncological pathology, analysis of the gland picture helps local?
ize the process in different projections and assess the extent of prevalence and
involvement of adjacent organs. The minimum size of tumor determinable by
means of NLS?investigation is about 8?10 mm. 80% of the tumorous nodes
are represented by markedly hyperchromogenic structures (6 points on
Flandler’s scale).
Analysis of histograms of the nidi helps differentiate an oncoprocess.
The method’s sensitivity becomes higher with both ‘elimination’ and ‘NLS?
analysis’ modes in use. Peripheral zones have first place as far as cancer inci?
dence rate is concerned. Their share makes 70?80% of cases. Transitory zones
(TZ) are affected in 10?20% and CZ in less than 5% of cases. In transitory
zones a tumorous nidus should be looked for within 3?4 mm from the cap?
sule. In case of an oncological alertness the symmetry in the lobe affection is
assessed w.r.t. the sagittal axis and intensity of the black patch (4?5 points on
Flandler’s scale), in the adjacent organs, especially seminal vesicles and blad?
der because in 25% of cases metastizing occures through the gland apex and
seminiferous tracts. Considering the fact that cancer often develops with
some diffuse changes occuring on the background, for example, with chron?
ic prostatitis or adenomatosis, it is not always possible to visualize newly
formed cancerous areas. In such cases the results of PSA level definition and
digital rectal examination should be considered. The PSA level is defined
considering the patient’s age and gland volume.
Conclusions:
1. NLS?method allows to diagnose most prostate diseases and being a
screening diagnostics method, it should be supplemented by biopsy, should
any pathological changes be detected.
2. The final diagnosis should be made on the basis of the clinic lab data
and the results of digital rectal examination in combination with biopsy only.
37
the internal and external glandular parts is disturbed. Apart from some dis?
tinctions in the zones of principal proliferation, the clinical signs will be dif?
ferent as well. In the case where a globe?shaped gland is formed (TZ prolif?
eration) the gland is chiefly hyperchromogenic and the dysuric
manifestations are minimal while with a ‘middle zone’ formed the gland is
slightly darkened and dysuria appears to be frank. Sphincter decompensation
leads to the development of urinary incontinence and dilatation of the upper
urinary tract followed by the atrophy of the cortical layer of kidneys, which
gradually adds to frequent urination, nycturia, reduced pressure of the urine
or slowed?down urination occuring in the initial phase of the disease.
In case of a squeezed cervix of the bladder an NLS?graph allows to visu?
alize signs of an infravesical obstruction, that causes some morphological
and functional changes in the lower and upper urinary tracts. Specifically, in
the initial phases of benign hyperplasia a darkened wall in the bladder can be
observed. Dark patches result from compensatory hypertrophy of the detru?
sor.
These 3 phases of benign hyperplasia of the prostate can be distinguished
depending on the intensity of the changes:
1. hyperchromogenic density of the gland with no residual urine;
2. residual urine present;
3. all of the above?mentioned plus dilatation of the upper urinary tract
with the cortical layer of kidneys involved in the process.
Diagnosis of acute prostatitis is made on the basis of histograms (simi?
larity to the reference standard process “prostatitis” D<0.425).
Diagnostication should be done in combination with dactylar rectal exami?
nation (painfulness during palpation) with clinic lab data taken into account.
In the case of abscessed lesion a still higher hyperchromous area (6
points) is visible against the general dark patch (4?5 points according to
Flandler’s scale). Areas of frank blackening correspond to necrotic changes.
With an abscess in progress one can notice a reduced infiltration of the tissue
around the cavity with the dark patch gradually getting lighter in the course
of dynamic observation (up to 3?4 points). With adequate therapy employed
the postinflammatory cyst may fall into regression.
As can be seen from NLS?investigation, chronic prostatitis does not give
a common characteristic picture, however the morphological processes in
different phases of the disease are reflected in histograms. With a long?lasting
disease the chromogenic density tends to rise due to a postinflammatory sub?
stitution for the glandular component and in histograms, in the
‘organopreparations’ mode destructuring of the fibrous component starts to
predominate.
36
these days makes the NLS investigation even more important. Our own prac?
tical experience can confirm that. Patient B., 63 years old was admitted to the
clinic with regard to right mammary gland cancer in its early phase IIa after
an ischemic stroke in combination with ischemic heart disease and hyper?
tension III. Palpation did not detect any lymph node enlargement. The NLS
investigation did not detect metastasis?affected lymph nodes which allowed a
tumorectomy for this patient at a low hazard to life.
Thus, the NLS investigation of regional lymph nodes with mammary
gland cancer may become a sufficiently reliable method for assessing their
metastatic affection which allows to pick out the most efficient tactics in
treating patients with this kind of pathology.
39
NLS diagnostics of affected regional lymph
nodes at a mammary gland cancer
O.P. Dergatch, Y.A. Somov,
M.A. Kolesnikov, L.V. Chernyshov
Mammary gland cancer is one of the most common women’s oncologic
diseases. Its annual growth rate in the developed countries is about 3%. In
addition, this pathology proves to be the primary cause of mortality among
females affected by oncologic diseases. The tactics of treatment and disease
prognosis largely depend on the presence or absence of any regional metas?
tases. In this connection the problem of competent diagnosis of affected
regional lymph nodes becomes especially pertinent. With that end in view a
number of methods have been used, from physical to hardware?based exam?
inations. However, in 40% of the patients metastatic lesion of the lymph
nodes in the axillary area is not determined clinically and false positive data
were observed in 25% of cases. Instrumental diagnosis methods do not have
a rich informational content either. The NLS investigation of regional lymph
nodes has been more extensively used lately.
Subject and methods of investigation
We have examined regional lymph nodes by means of the Oberon device
using a 4.9 GHz nonlinear trigger sensor in 25 patients affected by mamma?
ry gland cancer in Phases I?III. The obtained data were compared with the
results of histological investigation of the macropreparations removed during
surgery.
Investigation results
According to the NLS investigation results, of 25 patients examined
prior to surgery as many as 1?3 affected lymph nodes were detected in 20
patients. The derrived results were practically fully confirmed by histological
investigation of the macropreparations removed during surgery. Only in one
case NLS?graphy did not detect affected nodes which we account for their
small size.
During the NLS investigation the metastatic lymph nodes were found to
have pathological changes with quite a high degree of intensity. Flandler’s
scale indicated 5?6 points in 80% of cases. The fact that organosaving surgery
and in some cases tumorectomy are being more and more extensively used
38
ed in virtual shots in sagittal planes above and below the kneecap and along the pos?
terior surface of the joint. Frontal planes along the lateral surfaces of the joint were
used to define the exact condition of menisci, articular cartilages and changes in the
synovium.
It is traditioanally believed that in the articular cartilage degenerative
changes start off with a rupture of the articular matrix and degeneration of
chondrosites. Therefore during the NLS examination special attention was
paid to changes in the articular cartilage. In the examinees of the test group
the articular cartilage looked like a hyperchromous strip (1?2 points accord?
ing to the Flandler’s scale). Two patients were found to have an articular car?
tilage of a heterogeneous chromogenic pattern, 3?5 points, in the initial
phase of the disease with small hyperchromogenic nidi (1?2 points) present.
No radiological changes in the joints were detected for this group of patients.
In 14 (28.0%) patients in the second clinical phase of the disease the
chromostructure of the cartilage was heterogeneous and some high hyper?
chromogenic structures (4?5 points) were detected as well as hyperchro?
mogenic inclusions (1?3 points) of a small diameter.
In 21 (42%) examinees in the third phase of the disease the hyaline car?
tilage looked as a hyperchromogenic strip (5?6 points).
In 10 (20.0%) patients in the same clinical phase of the disease the articu?
lar cartilage was visualized as a distinctly hyperchromogenic linear structure (6
points) with vertical fissures present (4?5 points). In three patients the higher
line cartilage was not visualized mostly in the middle departments of the joint.
Depending on the phase and duration of the disease a spectral similari?
ty (D 0.189 to 0.621) could be visualized to the reference standard process
‘osteoarthritisdeformans’.
The X?ray pictures detected a moderate constriction and deformity of
the joint space as a primary sign of the articular cartilage distraction in 22
patients and considerable constriction in 12 patients. Subcartilaginous osteo?
phyte was very important for osteoarthritis patagenesis. Formation of subcar?
tilaginous and epiphyseal sycts started off already in the initial phases of the
disease (71.0% of the patients). According to NLS?investigation, the cysts
were located subcartilaginously in the lateral regions of the bone, 1.0?3.0 mm
deep and were as many as 4 to 12?15. Standard X?ray pictures of knee joints
displayed some changes in the subcartilaginousregions of the bone, like cysts
and fibrosis, only in the second phase of the disease.
A very important role in the osteoarthrosis deformans development was
attributed to the condition of the synovium and articular capsule. With the
progress of the disease and changes in its phases, a cartilaginous detritus with
antigenicity was formed on the articular surfaces. That often led to the
41
NLS?investigation in evaluating
the condition of knee?joint affected
by osteoarthritis deformans
M.S. Petrov, L.A. Voroshilova,
V.M. Kartuzov, A.Y. Vesnin,
G.V. Derevyanko, A.P. Guglya
Introduction
Primary osteoarthritis deformans of the knee?joint is one of the most
pertinent problems in modern medicine due to its prelevance, great loss of
working time and treatment expenses. In addition, in many cases an early or
differential diagnosis of the knee?joint lesion is impeded, which complicates
selecting the most efficient therapeutical and rehabilitation measures and
evaluating the patient’s disability.
Today diagnostics of knee?joint disorders comprises conventional radiogra?
phy as well as sonographic evaluation of the joints, used to examine soft tissues of
the locomotorium. The existing techniques used to examine the knee?joint allow
to determine dominance of pathological process in the joint, including degenera?
tive ones. However, the relationship between the intensity of pathomorphological
changes and the severity and dynamics of the process have not been studied yet.
This article aims to demonstrate the efficiency of the NLS?investigation
in diagnosing osteoarthritis deformans, especially in the early (subclinical)
phase of the disease.
Subjects and methods
To define a normal relationship of the knee?joint anatomical structures
10 healthy persons aged from 25 to 55 (test group) were examined. The main
group consisted of 50 patients with clinical implications of osteoarthritis
deformans of knee joints in different phases. The average duration of the dis?
ease was 7.0±3.0 years. All patients were routinely radiologically examined in
two interperpendicular planes.
The X?ray pattern analysis took into account the joint space amount of
narrowing, existence of marginal osteophytes and deformation of osseous
structures with cysts and fibrosis areas present in the subcartilaginous bone
department. The NLS investigation was carried out using “Oberon” device
equipped with a 1.5 GHz trigger sensor. Changes in the joint capsule were evaluat?
40
Potentials of NLS?investigation
in the presurgical evaluation
of intramural invasion of gastric cancer
K.P. Vasov, S.D. Setkin,
S.A. Skvortsova, G.F. Maretskaya
Gastric cancer in Russia as well as in some other countries all over the
world reamains one of the most acute medical problems. Most researchers
engaged in the diagnostics and treatment of gastric cancer have concluded
that a timely and early diagnosis can promote cancer treatment and improve
prognostication for the patients.
For many decades radiology and endoscopy remained the principal
methods for diagnosing gastric cancer. The main shortcoming of these meth?
ods of investigation is their inability to obtain a picture of the thick layers of
the stomach wall and hence a more exact data about the extent of tumor inva?
sion into the stomach wall, i. e., the phase of the tumor process in the presur?
gical period. The first attempts to establish phase gradation in stomach tumor
were made when such investigation methods as computer tomography (CT),
transabdominal ultrasound scanning (US) and the most recent NLS investi?
gation were put into clinical practice. In today’s medicine the NLS investiga?
tion may become an essential method for diagnosing abdominal cavity dis?
ease because of its extreme simplicity, accessibility and non?invasiveness.
However, in view of the fact that this investigation method has been used in
medical practice since the late 90s, the amount of the published literature
dealing with potentials of the NLS in diagnosing parenchymal organs is still
insufficient.
Rather explicit methods of NLS stomach investigation have been
already developed and some NLS signs of cancer, benign and malignant gas?
tric ulcers have been described (V.I. Nesterova et al., 2002). An attempt was
made to establish phase gradation of gastric cancer by means of NLS investi?
gation which resulted in a fairly high accuracy (75.8%) of the diagnosis most?
ly due to diagnosing much earlier phases of the tumor process. According to
some authors, NLS offers some incontestable opportunities in defining phas?
es of gastric tumor mostly located in distal regions of stomach.
Yet, according to most researchers, until recently the NLS had been
largely used as a method for specifying the extent of cancer proliferation, for
defining metastases and malignant invasions beyond the stomach, in other
43
inflammation of the synovium and its fibrosis. As a result, the synovium pro?
duced an inadequate fluid, which in turn impaired the cartilagan nutrition
with its ensuing degeneration.
The synovium in healthy persons (test group) was visualized as a hyper?
chromogenic linear structure (1?2 points). The first and second phases of the
disease saw a steady rise in its chromogenic pattern in 14 (28%) patients (3?
4 points). In 32 (62%) patients in the third phase of the disease the chro?
mogenic density of the membrane reached 4?5 points throughout the phase
with at most 3 or 6 hyperchromogenic inclusions. In three patients with an
aggravated form of the osteoarthrosis deformans (the forth clinical phase) the
synovium looked like a distinctly hyperchromogenic structure (4 points) with
areas of a reduced entropic density (3?4 points).
Changes in the membrane structure were always concomitant with syn?
ovitis with a limited amount (mostly in the upper enstrophe in 28.0% of the
patients) or a great amount (in all regions of the joint ? in 68% of the patients)
of fluid free of sediment and additional inclusions.
Depending on the phase and extent of pathological changes in the joint
affected by osteoarthrosis a change in the joint capsule structure also took place.
Only in the first phase of the disease did the joint capsule structure remain normal.
In the second phase of the disease, especially with synovitis in evidence,
the chromostructure was assessed at 4?5 points in 14 (28%) patients and in
the third and forth phases of the disease ? up to 6 points in 34 (68%) patients.
Roentgenographic evidences of synovitis and changes in the paraarticular soft
tissues were detected in some patients only in the third and forth phases of the disease.
Thus, the analysis showed that the NLS?investigation had an advantage
over conventional roentgenologic methods in terms of early detection of
degenerative changes in the articular cartilage.
On the whole, the NLS?method sensitivity in the early phase of the dis?
ease amounted to 82%, specificity to 85% and accuracy to 86%. The sensi?
tivity of standard radiography in two projections was 68%, specificity 54%
and accuracy 78%.
Conclusion
The extensive use of NLS?investigation of knee?joints in everyday clini?
cal practice allows to diagnose osteoarthrosis deformans in its early phases.
42
patients’ posture in the course of scanning allowed to visualize all the regions
of the stomach very well. The location of the tumorous infiltrate as to the
stomach wall layers was assumed as a principal criterion whose analysis
allowed to suggest the extent of the intramural invasion of the gastric cancer
during NLS?investigation, while in computer tomography the main point
was to define the thickness and elasticity of the stomach wall at the lesion
spot.
The point is that NLS?investigation allowed to differentiate tumor quite
clearly w.r.t. the layers of the stomach wall, while in computer tomography
the most diagnostically important factor was the degree of the stomach wall
thickening at the lesion spot with respect to the neighboring unaffected areas
(thickening ratio) along with some other sings (rigidity, roughness, uneven?
ness). Based on the analysis of the results of the surgical intervention and
morphological investigation of post surgical material as well as their compar?
ison with NLS and CT data the following conclusions were reached: both
methods are quite potent in presurgical determination of the extent of intra?
mural invasion of gastric cancer, however the NLS investigation demon?
strates a higher specificity as compared to computer tomography in detecting
early phases of gastric cancer due to visualization of lesion zones in the stom?
ach wall.
The analysis of the the performed investigations allowed to discriminate
the NLS?signs that allowed to define the extent of intramural invasion of gas?
tric cancer:
1. T1 phase: presence of tumorous infiltrate within the first layer of the
stomach wall, which is accompanied by hyperchromogenic density of the
wall at the lesion spot lesion spot (5, less often 6 points on Flandler’s color
scale).
2. T2 phase: tumorous infiltrate within the first and second layers of the
stomach wall accompanied by hyperchromogenic density of the first two lay?
ers (5?6 points at the lesion spot).
3. T3 phase: a frank chromogeneity of the inner layers of the stomach
wall (6 points) except for the serous layer, which is evaluated at 4 or more
often 5 points.
4. T4 phase: lesion of all layers of the stomach wall accompanied by
chromogeneity of the serous membrane (6 points) and signs of tumorous
invasions into the neighboring anatomical structures accompanied by a frank
chromogeneity (4?5 points) of the adjacent organs.
Detection of some affected peregastric (regional) lymph nodes and dis?
tant metastases in the course of investigation allowed to analyze the N and M
criterion as well.
45
words, the NLS investigation method allows to diagnose stomach tumors
even in early phases of the disease.
Most literature dealing with the use of radiological computer tomogra?
phy to diagnose stomach tumors provides a proof that this method can poten?
tiality be used to diagnose gastric cancer, especially its endophytic forms.
However, most authors still believe that the principal role of this method lies
in acquisition of certain very important information about the extent of stom?
ach lesion and spread of the process to some adjacent organs. According to
different researchers, the early gastric cancer, that only affects the mucosa
and submucous layer can not be detected on the computer tomograms. In the
authors’ opinion, this is beyond ‘the resolution capabilities’ of this investiga?
tion method.
This work attempted to evaluate the potentials of the noninvasive radia?
tion methods of investigation (trans?abdominal ultrasound scanning and
radiological computer tomography) in detecting intramural invasion of gas?
tric cancer, and to draw their comparison characteristics.
The analyse included 72 cases of gastric cancer. All the cases were com?
pared with the surgical intervention data and the morphological studies of
post surgical evidence. According to the latest gastroenterological TNM clas?
sification of tumors (1997), the group of gastric cancer carriers in phase T1
made 9 (12.5%) cases, T2 8 (11.1%) cases, T3 22 (30.6%) cases and T4 33
(45.8%) cases. Computer nonlinear diagnostics (NLS) and radiological
computer tomography (CT) of the stomach were performed as supplemen?
tary investigation methods deliberately after a preliminary integrated
radioendoscopic investigation.
Computer tomography of the stomach was done after expanding the
stomach walls with a gas (pneumoscanning) in standard projections (lying on
the back and belly); the transabdominal NLS?investigation of the stomach
was performed using the standard procedure.
In order to more clearly comprehend the NLS and CT signs underlay?
ing the presurgical diagnosis of the T?phase of gastric cancer (i.e., invasion
degree) one needs to have a clear idea of the image of a ‘normal’ stomach wall
visualized by means of the investigation method.
Thus, in CT investigation the stomach walls (adequately expanded) were
at most 0.3 cm thick in normal conditions (test group of 50 persons) in all
regions with few exceptions in cardiac and prepiloric regions where the walls
were 0.4 cm thick, whereas at an intramural tumorous effect the stomach wall
authentically thickened over 0.6 cm (p < 0.01). In most cases it proved to be
impossible to differentiate the lamellar structure of the stomach wall by com?
puter tomography. Changing the section thickness, pitch of the table and the
44
So, an integrated approach to the use of NLS investigation and radio?
logical computer tomography has proved to be more preferable for more
accurate presurgical diagnostics of intramural invasion of gastric cancer,
however the order of priority and efficiency in their use somewhat depend on
the results of primary radioendoscopic investigation of the stomach. In addi?
tion it should be noted, that contradistinction of these methods of investiga?
tion in diagnosing and phasing of gastric cancer against each other would be
a mistake and delusion.
In conclusion, it should be emphasized that despite their subordinate
use with reference to radiological and endoscopic methods of gastric cancer
investigation, the NLS investigation and radiological computer tomography
should be brought into line with primary methods of stomach investigation.
The conclusion is based on the facts that unlike some conventional radi?
ological and endoscopic methods of investigation they allow to evaluate the
internal structure of the stomach wall, which is a master factor in the presur?
gical detection of intramural invasion.
This allows to work out the proper approach for treating patients affect?
ed by gastric cancer, and based on the well?founded data reject the explo?
rative laparatomy in case of a frank process. Considering general accessibili?
ty, lack of radiation exposure and application simplicity it appears more
apropriate to use NLS investigation as the most preferable of the above?men?
tioned methods.
47
With respect to the potentials of computer tomography in presurgical
determination of the extent of intramural invasion of gastric cancer, it should
be admitted that it had a less specific pattern and was essentially based on the
extent of the stomach wall thickening at the lesion spot.
Thus, since the CT signs are indicative of one or another degree of gas?
tric cancer invasion, they could be conditionally classified in the following
manner:
• It proved practically impossible to distinguish between tumors in T1
and T2 phases. So their diagnostics was based on the analyses of non?multi?
ple stomach wall thickenings from 0.3 to 05 cm, with the external outlines
being clear and smooth.
• The T?3 phase typically had integer multiple thickenings of the stom?
ach wall over 0.5cm not accomapanied by deformed external outlines of the
stomach wall and with no signs of the tumor spreading beyond the stomach
wall ,
• The T4?phase had multiple thickenings of the stomach wall (two,
three or more times as thick) over 0.1cm with a disturbed integrity of the
external outlines of the stomach wall at the lesion spot and with some signs
of tumorous invasion into the adjacent anatomical structures.
According to our information, the NLS?investigation proved to be the
most accurate and specific method of investigation in presurgical diagnosis of
gastric cancer in its early phases (T?1, T?2) while CT results appeared to be
more convincing in detecting later phases of tumorous lesion (T?3, T?4). It
should be noted, that, in our opinion NLS is the most accurate method of
investigation in detecting remote metastases (p > 0.05). Based on the statis?
tical analyses, the specificity of the NLS method of the investigation in
detecting the T?phase of gastric cancer (with calculations made with refer?
ence to T?1, T?1 phases) amounted to 76%, sensitivity to 74.3% and accura?
cy to 78.2%, w.r.t the computer topography the specificity, sensitivity and
accuracy were 70% each (in this case calculations were made w.r.t. T4?phase
of gastric cancer, because differentiating the lamellar structure of the stom?
ach wall was found impossible in CT investigation).
Thus, as compared to computer tomography, the NLS investigation
proved to be a more specific method for diagnosing gastric cancer in its early
phases although in a number of cases it was found difficult to differentiate
between T1?T3 phases of a tumorous lesion. In CT investigation T1?T2 phas?
es were defined conventionally based on the degree of stomach wall thicken?
ing at the lesion spot. NLS did not succeed in imaging anatomical structures
beyond the stomach wall as distinctly as CT investigation did, but NLS was
more efficient in evaluating such characteristics as M and N.
46
important, for example, for differential diagnostics. As a result of using high
frequency sensors in combination with virtual imaging equipment, a high
spatial resolution is provided which is very important for patient examina?
tion.
According to the analysis of our observations, the correct diagnosis was
made for 22 patients of 23 (95.6%). In one female patient with Itzenko?
Kusching syndrome in clinical evidence the NLS?scopy detected in the supe?
rior pole area of the right kidney a small (30?35 mm) hyperchromous growth
which had a monochromous internal structure and a spectral similarity to the
‘adrenal adenoma’ reference standard (d=0.217) and was regarded as a
benign adrenal tumor. Because of typical clinical presentation of Itzenko?
Kusching syndrome and concomitant changes in blood and urine in clinical
and lab evidence, computer tomography was not performed. The surgery
detected a focal macronodal hyperplasia of the adrenal, which was confirmed
by the histological investigation of the removed growth.
Generally a distinction is made between the diffuse and focal hyperpla?
sia. Focal hyperplasia can be subdivided into micro? and macronodal hyper?
plasia. As a matter of fact, focal hyperplasia can not be easily discriminated
from adrenal tumors by means of NLS evidence, so in this partcular case our
conclusion cannot be considered to be diagnostically wrong.
Of 23 cases computer tomography was done for 17 with its data match?
ing the NLS?investigation results. 9 patients of 23 underwent surgery to have
an adrenal tumor removed, and the NLS data were confirmed by surgery and
histological investigation results.
The size of detected tumors varied in diameter from 6 to 10 cm. All of
them had a capsule, smooth surface and rounded or oval shape. Small tumors
had a monochrome structure and in 4 cases with the tumor size over 8 cm,
the internal structure was represented by an irregular alternation of areas
having different color saturation on account of necrotic zones, degenerative
changes and decalcification, which was confirmed by a histological investi?
gation of the removed tumors.
According to the literature and our information the differential diagnos?
tication of benign and malignant adrenal tumors is an extremely difficult
process. A malignant pattern of the detected growth can be suspected only in
the presence of an irregular internal structure of the growth, restricted kidney
mobility at forced breathing, enlarged regional lymph nodes and metastases
in other organs.
Thus, diagnosis of adrenal tumors is complicated because of diverse
clinical implications in place. The potentials of the NLS?diagnostics could
scarcely be overestimated, for the simplicity of the investigation procedure,
49
Potentials of NLS?scopy
in adrenal tumor diagnostics
B.I. Lukashenko,
T.B. Georgadze
Adrenal tumors do not occur very often still they are known to be most
often hormon?active and even if small sized cause various glandular disor?
ders. However, practice knows adrenal tumors, which clinically develop with
no symptoms in evidence or are accompanied by vague complains.
Both documentary evidence and our experience show that from 6
months to two years may elapse from primary disease manifestations to form?
ing a diagnosis. Early detection of adrenal tumors has become an important
clinical problem, which is now conventionally solved by means of ultrasound
investigations (US) along with computer tomography (CT), magnetic reso?
nance tomography (MRT) and angiography (AG).
Today NLS?scopy is one of the most advanced informative hardware?
based methods of diagnostication. The NLS method will allow to substan?
tially increase the percentages of early and accurate diagnostication of adre?
nal tumors. The implementation of the latest devices equipped with digital
trigger sensors made it possible to detect any growth sized around 1 cm in
adrenals, which is comparable to computer tomography in terms of diagnos?
tical accuracy.
This our research aimed to study the NLS?scopy potentials in adrenal
tumor diagnostics and to provide an evidence that with a proper procedural
approach and advanced equipment in place, bulky growths could be diag?
nosed as successfully as if by using computer?aided and magnetic resonance
tomography.
Subject and methods
Clinical data: from June 2000 through May 2001 23 patients aged 25?64
were examined who were suspected to have developed adrenal tumors based
on careful complaint analysis and clinical and lab data. For all the patients
kidney and adrenal investigation was conducted under a regular procedure by
means of the Oberon metatron equipped with a 4.9 GHz digital sensor and
developed at the Institute of Practical Phychophysics. The device has an
automatic focusing, that can self adjust both when emitting and receiving
echo signals, and it ensures high definition of the spectrogram, which is very
48
Diagnosing rare instances of mammary gland
diseases using NLS?investigation
S.N.Okunev,
K.S. Kogan
This article deals with some clinical observations of rare cases of mam?
mary gland diseases detected by means of nonlinear diagnostics method
(NLS) during clinical diagnostic prophylactic investigations performed in
October 2001 with the purpose of an early diagnostics. In the course of the
activity the examined patients were found to have different diffuse or nodal
mammary gland diseases among which of particular interest are some rare
diseases like liposarcoma (1 case), colloidal cancer (1 case), phyllode cys?
tosarcoma (1 case), phyllode fibroadenoma (2 cases), hemangioma (1 case)
and Mondore’s syndrome (1 case).
According to some literary evidence, colloidal cancer and liposarcoma
do not occur very often among malignant tumors: colloidal cancer in 2,4%
and liposarcoma in 0.001? 0.03% of cases respectively. Among benign tumors
hemangioma occurs in 0.12%, phyllode fibroadenoma in 5.4% and phyllode
cystosarcoma in 2.5?5.4% of cases. The investigation was done using series
4011 Oberon device with a 4.9 Ghz nonlinear sensor under the program of
virtual tissular representation of panoramic scanning (Panoramic NLS
Imaging).
Mammary gland liposarcoma
Patient G., aged 28, was admitted having complaints of a nodal forma?
tion in her left mammary gland. During the examination an umbilication
symptom in the upper outside guardant of the left mammary gland was dis?
covered. The palpation detected a small?sized painless sluggish node of a
dense elastic consistency, that had a doled structure and adhered to the skin.
By means of a detailed imaging the investigation ascertained a node of 15?20
mm in diameter and detected its spectral similarity to the reference standard
‘mammary gland liposarcoma’ (D=0.204). The investigation of the regional
lymph nodes did not detect any metastatic lesion.
Based on the NLS?investigation data a surgery (radical mastectomy
according to Maden’s method) was performed. The histological diagnosis
was liposarcoma.
51
its harmlessness and rich informational content allowed us to make a correct
and promt diagnosis in 78% of cases. The conducted investigation showed
that NLS?scopy may become as efficient method of adrenal tumor examina?
tion as computer tomography and US. Patients having complaints typical for
adrenal tumors should be examined by means of the NLS?method the first.
Patients with symptoms indicative of adrenal tumor should be referred to spe?
cialized endocrine surgery departments where they would be thoroughly
investigated using US, CT and MRT which will allow to substantially reduce
the investigation time and timely provide a correct treatment.
50
were performed. The histological diagnosis was phyllode fibroadenoma.
After the plastic surgery (one month later) a repeated NLS?investigation
was carried out.
Mammary gland hemangioma
Patient C. aged 42 was admitted as having complaints of a large size
node in the right mammary gland.
During the examination it was found out that the skin over the node had
a cyanotic cast. On the border between the upper quadrants a mobile forma?
tion with a soft consistency was palpated. The graph analysis detected a sim?
ilarity to the reference standard ‘hemangioma’ (D=0.414).
The patient underwent surgery, i.e., a sectoral resection was performed.
The histological diagnosis was cavernous hemangioma.
The presented clinical observations showed that the continuous
improvement of NLS?systems and the modern technologies made it possible
to introduce a morphological picture of the neoplasm which helps devise the
optimal tactics of surgery with further morphological verification of the der?
rived results.
53
Colloidal mammary gland cancer
Patient K. aged 49 was admitted as having complaints of a node in the
left mammary gland.
The examination did not produce any visible evidence of changes in the
mammary glands. A sluggish roundish formation with a diverse consistency
and vague outlines was palpated on the border between the upper quadrants
of the left mammary gland.
The NLS?investigation detected a roundish formation (6 points accord?
ing to Flandler’s scale). The graph examination showed spectral similarity to
the reference standard ‘solid cancer’.
The patient underwent surgery; a radical mastectomy was performed
according to Moden’s technique. The histological conclusion was colloidal
cancer.
Phyllode mammary gland cystosarcoma
Patient G. aged 46 was admitted as having complaints of a slow growth
dense node in the right mammary gland.
Palpation detected in the upper outside guardant of the right mammary
gland a painless motionless formation with a diverse density and heteroge?
neous surface, that adhered to the skin.
The NLS?investigation detected an irregular 3x6x4 cm formation. A
spectral similarity to the reference standard ‘mammary gland sarcoma’
(D=0.412) was found. Its small size allowed to completely visualize the
involvement of lymph nodes.
The patient underwent surgery ? radical mastectomy according to
Moden’s techique. The histological diagnosis was phyllode cystosarcoma.
Phyllode mammary gland fibroadenoma
Patient Z. aged 43 was admitted as having complaints of a large node in
the right mammary gland.
The examination showed asymmetry of the mammary glands.
On the border between the outside quadrants of the right mammary
gland a mobile node of a large node with distinct outlines and smooth surface
and tight elastic consistency was palpated. The skin above the tumor was very
thin.
The NLS?investigation detected some hyperchromous structures corre?
sponding to intranodal vessels. The analysis of the graphs detected a similar?
ity to the reference standard ‘fibroadenoma’ (d=0.384).
On the strength of the NLS?investigation subcutaneous amputation of
the right mammary gland and omentomammoplaty on a vascular pedicle
52
with granulomatous fields which are small ? 2.0 cm or less in diameter. On
NLS image these formations look like hyperchromatic areas (6 points on
Flandler’s scale) with the central necrosis zone in ring?shaped structures
being visible as an area of lower chromogenic density (4?5 points).
Hemorrhage areas of small size are quite typical. The above?mentioned
changes are localized peri?and paraventriculary, often in the region of bor?
dering corticomedullary structures as well as in the region of basal ganglia.
Clinical observation
Patient K., born in 1974. The preliminary diagnosis when admitted into
the neurological department was acute cerebral circulation disturbance in the
spinal artery basin.
The patient complained of weakness in left limbs, speech impediment,
asthenia and loose cough. Accourding to her wording she fell ill (Feb. 06.01)
when she stopped talking, developed weakness in left limbs, diplopia and dis?
turbed swallowing. The anamnesis read a developed right?side hemiparesis,
that passed off by itself within two weeks.
The patient is in grave condition. Neurological status: conscious, under?
stands when she hears people speaking to her, but doesn’t speak. Cranial
nerves: equal palpebral fissures, nystagmus not present, the right nasolabial
fold smoothed out. Slight deviation of the tongue to the right. High tendon
and periosteal extremity reflexes, weakness in right limbs. Reduced pharyn?
geal reflex on both sides. Rigidity of occipital muscle is moderately frank.
Kering’s symptom on both sides. Babinski’s reflex on the left.
Laboratory investigation:
Clinical blood analysis: erythrocytes — 3.96×10.12/1; hemoglobin — 127
g/1; ?0.9; L — 5.6×10.9/1, ESR — 32 mm/g, — 1; — 74; — 21; — 2; — 2.
Biochemical blood test: glucose — 4.6 mm/1; urine — 6.6 mm 1/1,
bilirubin — 13.38; — 5.5; — 7.85 mmo1/1; creatinine — 0.066 mmo1/1, total
protein — 70.0m g/1; albumin — 5.5; globulins — 44.8; L2 — 4.8; L2 — 7.7,
B — 11.8; J — 20.5; — 1.24; — 0.29 mmo1/1; — 0.31 mmo1/1.
Test for toxoplasmosis detected antibodies with rising antibody titer in
dynamics (1:21 — 1:400).
Cerebrospinal — 2.5 mmo1/1; chlorides — 1.24 mmo1/1, protein —
0.2 g/1; sugar — 4.1 mmo1/1. Cellular composition: cytosis — 213, L — 1?2;
erythrocytes — 4?5.
MRT?investigation of the encephalon (of 16 Feb. 01) in T?2 picture on
both sides, detected paraventriculary and subcortically multiple unequal?
sized roundish nodi (from 0.5 to 2.0 cm) producing an unevenly increased
55
Diagnostics of toxoplasmosis (serologic
examination, CT, MRT and NLS)
T.I. Pankova,
A.S. Sosnovskaya
Toxoplasmosis is a parasitic disease whose causative agent is toxoplasma
(Tixoplasma gondii Nicolle et Manceaux), which belongs to protosa. The
disease typically has a chronic course, nervous system lesion, limphadenopa?
thy and enlarged liver and spleen. Quite often myocardium, muscles and eyes
are affected.
The infection is mostly transmitted through the alimentary tract. Yet
there are some instances recorded where contagion occurred through the
injured skin and mucous membranes. Toxoplasma is apt to form cysts in tis?
sues causing a latent infection condition. The parasite becomes active in the
conditions adverse to the macroorganism and with its immune responsive?
ness going down. In the pathogenesis of the toxoplasmodial lesion of the cen?
tral nervous system of importance are local inflammatory occurrences, dis?
circulatory disturbances related to vasculitis and blocked liquor tracts leading
to hydro? or microcephaly.
Clinically, the lesion of the central nervous system manifests itself as
meningitis, encephalitis, meningoenciphalitis and encephalomyelitis.
The most typical form of toxoplasmosis of the central nervous system is
meningoenciphalitis, which clinical picture contains general cerebral and
meningeal symptoms, paresis and limb paralyses, tonic and clonic spasms,
opticokinetic?(diplopia) and coordination disturbances. The blood test
reveals a left?shiifted leukocytosis and increased ESR; the cerebrospinal fluid
contains lymphocytic pleocytosis and a moderately increased protein con?
tent.
In diagnosing toxoplasmosis of importance are cranial radiography,
serological investigation, pneumoencephalography, CT and MRT. However,
it is the NLS?investigation of cerebral structures that plays the most impor?
tant part in the diagnosis. Of great diagnostic importance is a substantially
increased spectral similarity to the reference standard ‘toxoplasma gondii’ (D
< 0.425). The toxoplasmosis should be discriminated from viral encephalitis,
encephalomyelitis and meningitis.
In the MRT?investigations toxoplasmosis is manifested by a progressive
multifocal encephalopathy. With toxoplasmosis the typical cases have to do
54
Nonlinear diagnostics
of thyroid gland pathology
K.M. Beznogov,
L.V.Kondratyev,
S.N. Pauli
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