Keywords:
Extremities, Musculoskeletal bone, Paediatric, Ultrasound, Ultrasound-Colour Doppler, Ultrasound-Spectral Doppler, Statistics, Diagnostic procedure, Arterial access, Haemodynamics / Flow dynamics, Cancer, Image registration
Authors:
I. Begun; Minsk Region/BY
DOI:
10.1594/ecr2013/C-2663
Results
There was the predominance of the size of the affected area of malignant neoplasms compared with benign.
The average volume of of malignant neoplasms was 252±240cm³. The soft-tissue component of bone sarcomas was presented as heterogeneous echostructure (Fig.
1).
In most cases it was tumor outgoing from the bone.
And bone was with altered in varying degrees of cortical integrity tissue (Fig.
2,
3). Thus,
common features of malignant bone tumors in most cases: irregular shape,
fuzzy contours,
low acoustic density,
heterogenity of echostructure.
In 32% of patients were determined ultrasound signs of X-ray analogues periosteal reaction.
In 80% - the degree of tumor vascularization was high and average (Fig.
4).
In system "organism- malignancy tumor" were noted the change in cardiac output with increasing tumor volume (r = 0,42; p<0,05),
so-called "systemic effects of the malignancies" on the background of the interdependence of volume blood flow in the main artery of the affected and healthy limbs (r = 0,69; p<0,05).
Herewith a negative correlation between index value of %Q and blood flow to the healthy limb - Q (r =-0,41; p<0,05), are confirmation, that one of component of the hemodynamic changes there is redistributive blood flow. Was established the correlation volume of malignancies and %RI,
%PI (r = 0,35-0,38; p <0,05) too.
That is,
there has been a decrease in regional vascular tone in affected limbs with growth of the tumors.
Cited symptoms above are allowed help to establish qualitatively differentiate between benign and malignant neoplasms.
The efficiency of diagnosis has been increased with the use of quantitative data of triplex ultrasound scanning.
Consistent with the above an increase in the volume velocity of blood flow in CFA for the affected limb and a decrease in RI and PI for CFA compared with the contralateral side (p <0.01) could indicate a decrease in resistance for the distal circulatory bed on the side of the tumor.
Analysis of quantitative data showed that the sensitivity and specificity in the differential diagnosis of sarcomas and benign tumors of bone of the lower limbs by criterion of reducing PI%,
RI% and increasing of Q% (at threshold values - 23%,
10% and 15% respectively) were 79-96% (Fig 5).
For studying event-free survival the cut-off value of predictor PI% were selected that so information content of data analysis was maximal.
For patients of all groups (OS,
SE,
OS+SE) best statistical representativeness of forecast EFS five-year for PI% were obtained when it’s a threshold value there was 33%.
Percentages of values deviation (downward) of PI for the affected limb were associated with 100% EFS in the event of occurrence in the range 33% and less,
or with the EFS of 26±5% in case of entry into a range of more than 33% (p<0,01) - Fig 6.