RU2759020C1 - Method for ultrasound diagnostics of duodenum and jejunum in dogs and cats - Google Patents

Abstract

FIELD: veterinary medicine.

SUBSTANCE: invention relates to veterinary medicine, namely to ultrasound diagnostics, and can be used when conducting a comprehensive ultrasound examination of the wall of the small intestine in dogs and cats. For this, a series of transverse, longitudinal and oblique scanning sections is carried out with visualization of the intestinal wall layers with measurement of the wall thickness on fixed images in the longitudinal and transverse planes. The index of echogenicity of the intestinal wall on the ultrasound image is determined. The two zones of each layer are compared. For the compared zone, the "deviation error in the compared zone" is additionally determined. Calculate the difference in deviations in the studied area and in the compared area. Provided that the layers are homoechogenic, the echogenicity index of the intestinal wall is calculated. In cats, with a thickness of the mucous layer of the duodenum from 57 to 63%, the thickness of the submucous layer of the duodenum from 15 to 19%, the thickness of the muscle layer from 11 to 14%, with a thickness of the mucous layer of the jejunum from 54 to 58%, thickness of the submucous layer of the jejunum from 15 to 19%, thickness of the muscle layer from 12 to 15% and the value of the echogenicity index of the wall of the duodenum and jejunum for the mucous layer from 25 to 30, submucosal layer from 50 to 62 and for the muscle layer from 38 to 46 - diagnose the echographic norm of the duodenum and jejunum. In dogs with a thickness of the mucous layer of the duodenum from 65 to 70%, the thickness of the submucous layer of the duodenum from 10 to 14%, the thickness of the muscle layer from 8 to 12%, the thickness of the mucous layer of the jejunum from 63 to 68%, the thickness of the submucous layer of the jejunum from 10 to 14%, thickness of the muscle layer from 8 to 12% and the value of the echogenicity index of the wall of the duodenum and jejunum for the mucous layer from 14 to 17, the submucous layer from 50 to 62 and for the muscle layer from 30 to 38 - diagnose the echographic norm of the duodenum and jejunum.

EFFECT: method improves the accuracy of diagnosing diseases of the digestive canal, expanding the diagnostic search, determining the tactics of further treatment, if necessary, as well as conducting morpho-ultrasonic correlation in the future due to the precise criteria for detecting the normal intestinal wall from the pathological one.

1 cl, 6 dwg, 6 ex

Description

The technical field to which the invention relates

The invention relates to veterinary medicine, in particular to a method for ultrasound diagnostics of the small intestine in animals, and finds application for a comprehensive analysis of the intestinal wall with the determination of the echogenicity of its layers in dogs and cats.

State of the art

There is a known method of threshold videodensitometry with a quantitative assessment of ultrasonographic images of organs and tissues (Patent RU No. 2082319 IPC А61В 8/08, publ. 06/27/97. Bull. 18), based on the calibration setting of the ultrasound scanner in terms of power to such a maximum value at which the blood in the lumen of the vessel still remains anechoic, that is, it has an amplitude of reflection on the "gray scale" equal to the 1st gradation. With the tuning parameters selected in this way at the focal depth, it becomes possible to estimate the average amplitude of the reflection of the tissue of the parenchymal organ and compare the values obtained in different patients. The disadvantage of this method is that it is unacceptable for digital ultrasound scanners with a high dynamic range and frame rate, which, in the context of optimizing presets, increases the amplitude of the signal reflection from the blood. As a result, the power of the emitted signal is not equal to the 1st gradation of the "gray scale", even at the minimum values.

There is a method for quantitative assessment of ultrasonographic images of parenchymal organs by means of amplitude histography and assessment of the obtained quantitative parameters (Patent RU No. 2270607MPK А61В 8/00 (2006.01), publ. 27.02.2006. Bull. 6). Prior to the study, to calibrate the ultrasound image on scanners with a digital principle, a preliminary calibration curve is constructed with an estimate of the average amplitude of the reflection of the background brightness of the screen at the focal depth with a stepwise increase in the power of the emitted signal. The initial amplitude of the screen luminescence is determined at the minimum power value for the given scanner and the calibration value of the average amplitude of blood reflection in the lumen of a large vessel in the area of interest is taken to be equal to the doubled value of the average reflection amplitude of the background brightness of the screen. The disadvantages of this method - the assessment of parenchymal organs in humans involves the use of low-frequency sensors, and the intestines in animals - high-frequency, while the ultrasound image of a large vessel can be accompanied by spontaneous echo contrast, which increases the echogenicity of this image and will certainly affect the calibration value.

There is a known method for assessing volumetric intraocular formations from their ultrasound image, including pointing the sensor at an object, obtaining its image, delineating the zone of interest and constructing an amplitude histogram under conditions of constant standard device settings, with the exception of the G (Gain) parameter, characterized in that it additionally determines homogeneity index IH = M / Tx100 and echogenicity index IE = L / G, where T is the total number of elements in the delineated area of any shade of gray, L is the level of the gray scale shade that occurs most often in the delineated area, M is the number of elements most of a frequently occurring shade of gray in the outlined area, G is the degree of amplification of the reflected signal, determined by the scale of the gain regulator of the device, and the value of the obtained indices is used to judge the presence of choroidal melanoma or pseudotumorous formations. (Patent RU No. 2180800 IPC А61В 8/10 (2006.01), publ. 03/27/2002. Bul. 9). Disadvantages of the method - the level of the gray scale shade is used out of 64 possible, and not out of 256, which reduces the sensitivity of the method for characterizing the echogenicity of small-sized structures, in addition, this method depends on the degree of amplification of the reflected signal, determined by the scale of the gain control of the device.

It is known to determine the echo density of the myometrium during transabdominal and transvaginal ultrasound (Makukhina T.B., Pomortsev A.V. The use of histograms of the echo density of myometrium in the ultrasound diagnosis of adenomyosis. Materials of the 4th Congress of RASUDM. Moscow, 2003), the purpose of which is to develop echographic criteria for adenomyosis using mathematical methods. The authors, using the brightness histograms in the B-mode, calculated the standard deviation of the echo density of the myometrium. Disadvantages of the method: in the course of this study, the indicators characterizing the state of the myometrium in different patients are compared with each other, i.e. obtained with different tuning parameters of the scanner presets, there is no comparative analysis of the echogenicity of the myometrium during one study.

The prototype is the method for determining the echo uniformity and the degree of echogenicity of the ultrasound image (Patent RU No. 2398513, MPK51 A61B 8/00 A61B 8/14 (2006.01) Method for determining the echo uniformity and the degree of echogenicity of the ultrasound image / Silina T.L., Golubkov S.S. - No. 2008149311/14; declared 12/16/2008; publ. 09/10/2010, bull. explore and the area to be compared. The ultrasound image is analyzed in a graphical editor in black and white mode, for which, after turning on the histogram function, the investigated zone and the background zone are selected. In this case, the numerical values of the parameters "mean value" and "deviation" are displayed automatically in the histogram window. For the background zone, the "deviation error in the background zone" is additionally determined, for which the background zone is divided into several sections, determining the deviation value in each section of the background zone, the maximum deviation and the minimum deviation in the background zone or its sections were selected. Next, the deviation error in the background zone is calculated using the formula:

P _Off2 = Off _addmax - Off _addmin , where

P _Off2 - deviation error in the compared zone;

Off _addmax - the maximum deviation value in the compared zone itself or its sections;

Off _addmin - the minimum deviation value in the compared zone itself or in its parts.

Then the difference between the deviations in the studied area and in the background area is calculated using the formula:

ΔOff = Off ₁ - Off ₂ , where

ΔOf - the difference in deviations in the investigated and compared areas;

Off ₁ - deviation in the studied area;

Off ₂ - deviation in the compared zone.

Comparison of the deviation error in the background zone with the difference in deviations in the investigated and the background zone is made according to the formula:

KEO = P _Off2 - ΔOf, where

KEO - criterion of echo uniformity of the investigated area;

P _Off2 - deviation error in the compared zone;

ΔOf - the difference between deviations in the studied and compared areas.

Next, the difference between the arithmetic mean values of the brightness of the investigated and background zones is calculated, according to the formula:

ΔСр _bright = _{Ср bright1} - _{Ср bright2} , where

ΔСр _bright - the difference between the average values of the brightness;

_{Ср bright1} - average value of brightness in the investigated area;

Average _luminance2 is the average value of the brightness in the background zone.

Then, the modulus of the difference between the mean value of the brightness of the echo-uniform test area and the mean value of the brightness of the background area with the deviation in the background area is compared according to the formula:

, где

, where

KIZ - criterion of isoechogenicity of the investigated area;

- модуль разницы средних значений яркости;

- the modulus of the difference between the average values of the brightness;

Off ₂ - deviation in the compared zone.

As a result of these calculations, the degree of echo uniformity of the structure is determined. Provided that the structure under study is homoechogenic, its echogenicity is determined. The investigated area is defined as heteroechoic if the EEC <0; isoechoic, if 0 ≤ KEO, KIZ ≤ 0; hypoechoic, if 0 ≤ KEO, 0 <KIZ, ΔСр _bright <0; hyperechoic, if 0 ≤ KEO, 0 <KIZ, 0 <ΔСр _bright .

Disadvantage: due to the fact that this method allows one to compare indicators characterizing the state of tissues and organs only in a particular patient during one ultrasound examination, and is not applicable for comparing different patients during different examinations. The method is not applicable if, even during one examination, the ultrasound screen is divided into a so-called double image, then the histograms of the same type of images (left and right) will differ in their echographic characteristics.

Disclosure of invention

The objective of the present invention is to provide an informative method for diagnosing the small intestine in dogs and cats, based on a quantitative analysis of the obtained ultrasound image.

The technical result of the invention is the possibility of determining the ratio of individual layers to the wall thickness of the duodenum and jejunum, obtaining a universal index of echogenicity of the intestinal wall in dogs and cats, providing detection of a normal wall from a pathological one, the ability to assess the course of a disease of the digestive tract and the effectiveness of treatment through dynamic studies, as well as improving the accuracy of diagnosing diseases of the digestive canal, expanding the diagnostic search, determining the tactics of further treatment if necessary, as well as conducting morpho-ultrasound correlation in the future.

The technical result is achieved using a method of ultrasound diagnostics of the duodenum and jejunum, including ultrasound examination of the duodenum and jejunum using a multi-frequency linear transducer from 7.5 to 12.5 MHz with the calibration setting of the ultrasound scanner on the scale of the instrument gain regulator equal to 255, through the front and the lateral abdominal wall with a series of transverse, longitudinal and oblique scanning sections with visualization of the intestinal wall layers, with measurement of the wall thickness on fixed images in the longitudinal and transverse planes, by placing the cursor on the outer border of the serous membrane and on the inner border of the mucous membrane perpendicular to the longitudinal axis, measurement of the muscle, submucosal, mucous layers and the echographic layer corresponding to the outer part of the intestinal cavity and the border of the cavity with the mucosa, followed by the determination of the echogenicity index of the intestinal wall on the digital ultrasound image of the intestine. th threefold scale on a computer in a graphic editor in black and white mode, by comparing two zones of each layer - investigated and compared, for which the investigated zone and the compared zone are outlined, the histogram function is turned on, while the numerical values of the parameters "mean value" and "deviation" are automatically displayed in the histogram window of the graphical editor, for the compared zone the "deviation error in the compared zone" is additionally determined, for which this zone is divided into several sections, the deviation value in each section of this zone is determined, the maximum deviation and the minimum deviation in the compared zone or its areas, then the deviation error in the compared zone is calculated using the formula:

P _Off2 = Off _addmax - Off _addmin , where

P _Off2 - deviation error in the compared zone;

Off _addmax - the maximum deviation value in the areas of the compared zone;

Off _addmin - the minimum deviation value in the areas of the compared zone,

then the difference in deviations in the investigated area and in the compared area is calculated using the formula:

ΔOff = Off ₁ - Off ₂ , where

ΔOf - the difference in deviations in the investigated and compared areas;

Off ₁ - deviation in the studied area;

Off ₂ - deviation in the compared zone,

then the deviation error in the compared zone is compared with the difference in deviations in the investigated and compared zone according to the formula:

KEO = P _Off2 - ΔOf, where

KEO - criterion of echo uniformity of the investigated area;

P _Off2 - deviation error in the compared zone;

ΔDev is the difference in deviations in the investigated and compared zones,

under the condition of homoechogenicity of the layers, where CEO> 0, the index of echogenicity of the intestinal wall is calculated, for which the fraction of echogenicity of each layer of the intestinal wall is determined as the ratio of the average brightness of the studied layer (Cp _bright ) for each of the mucous, submucosal, muscle layers of the jejunum wall in percentage to the maximum echo signal reflection, expressed in the maximum value of the brightness of the pixels of an 8-bit image equal to 256 according to the formula:

DES = (Wed _bright × 100) / 256, where

DES - the proportion of echogenicity of a separate layer (mucous, submucous, muscular) in percentage;

Ср _bright - the average value of the brightness of the studied layer;

256 - the maximum value of the brightness of the pixels of an 8-bit image, as a result, the index of echogenicity of the wall of the jejunum IEc is obtained:

IETc = DES _s / DES _{p / s} / DES _m , where

IE mk - the index of echogenicity of the wall of the jejunum;

DES _with - the proportion of echogenicity of the mucous layer;

DES _{p / s} - the proportion of echogenicity of the submucosal layer;

DES _m - the proportion of echogenicity of the muscle layer

and in the presence of five clearly demarcated echographic layers of the internal hyperechoic - corresponding to the outer part of the lumen and the border of the lumen with the mucosa, hypoechoic - corresponding to the mucosa, hyperechoic - corresponding to the submucosa, hypoechoic - corresponding to the muscular, external hyperechoic - corresponding to the serous membrane, in the presence of peristaltic contractions, no expansion of the small intestine cavity more than three values of the wall thickness, with the thickness of the echographic layer corresponding to the outer part of the intestinal cavity and the border of the cavity with the mucosa no more than 0.5 mm, in cats with the thickness of the mucous layer of the duodenum, determined by the ratio of the thickness of the mucous layer to the thickness of the entire intestinal duodenal wall, constituting from 57 to 63%, the thickness of the submucosal layer of the duodenum, determined by the ratio of the thickness of the submucosa to the thickness of the entire intestinal wall constituting from 15 to 19%, the thickness of the mouse thick layer, determined by the ratio of the thickness of the muscle layer to the thickness of the entire intestinal wall constituting from 11 to 14%, with the thickness of the mucous layer of the jejunum, determined by the ratio of the thickness of the mucous layer to the thickness of the entire wall of the jejunum, constituting from 54 to 58%, the thickness of the submucosa layer of the jejunum, determined by the ratio of the thickness of the submucosal layer to the thickness of the entire intestinal wall constituting from 15 to 19%, the thickness of the muscle layer, determined by the ratio of the thickness of the muscle layer to the thickness of the entire wall of the jejunum, which is from 12 to 15% and the value of the echogenicity index of the duodenal wall and the jejunum for the mucous layer from 25 to 30, the submucous layer from 50 to 62 and for the muscle layer from 38 to 46, in dogs with the thickness of the mucous layer of the duodenum, determined by the ratio of the thickness of the mucous layer to the thickness of the entire intestinal wall of the duodenum, constituting from 65 to 70%, the thickness of the submucous layer of the duodenum, determined by the ratio of the thickness of the submucosal layer to the thickness of the entire intestinal wall constituting from 10 to 14%, the thickness of the muscle layer, determined by the ratio of the thickness of the muscle layer to the thickness of the entire intestinal wall, constituting from 8 to 12%, with the thickness of the mucous layer of the jejunum, determined by the ratio of the thickness of the mucous layer to the thickness of the entire wall of the jejunum, ranging from 63 to 68%, the thickness of the submucosal layer of the jejunum, determined by the ratio of the thickness of the submucosal layer to the thickness of the entire intestinal wall constituting from 10 to 14%, the thickness of the muscle layer, determined by the ratio of the thickness of the muscle layer to the thickness of the entire wall of the jejunum constituting from 8 to 12% and the value of the echogenicity index of the wall of the duodenum and jejunum for the mucous layer from 14 to 17, the submucous layer from 50 to 62 and for the muscle layer from 30 to 38, diagnose the echographic norm of the duodenum and jejunum ...

Brief description of drawings and their materials

FIG. 1 shows the designation of the studied zone 2 and the compared zone 1 of the mucous layer of the jejunum of the dog on the digital sonogram.

FIG. 2 shows the selection on the sonogram of the investigated zone of the layers of the wall of the jejunum of the dog in a graphical editor with the display of the data "mean value" or Cp _bright and "deviation" in the histogram window.

FIG. 3 shows the quantitative indicators of the echogenicity of the wall of the structures of the digestive canal of dogs.

FIG. 4 shows the proportion of echogenicity of the mucous, submucosal and muscle layers of the wall of the small intestine as a percentage of the maximum possible value of the reflected echo signal in healthy dogs.

FIG. 5 shows the quantitative indicators of the echogenicity of the wall of the structures of the digestive canal of cats.

FIG. 6 shows the proportion of echogenicity of the mucous, submucosal and muscle layers of the wall of the small intestine as a percentage of the maximum possible value of the reflected echo signal in healthy cats.

Implementation of the invention

Examples of specific implementation of the method for ultrasound diagnostics of the duodenum and jejunum in dogs and cats.

Example # 1.

A three-year-old female French Bulldog dog without clinical symptoms of diseases of the digestive system undergoes an ultrasound examination of the digestive canal using a multifrequency linear transducer with a frequency of 7.5 - 12.5 MHz, in B-mode with the calibration setting of the ultrasound scanner on the scale of the gain regulator of the device ( Gain) equal to 255. Measurement of the thickness and echogenicity of the layers of the duodenal wall is examined in the descending part, behind the cranial bend. Five clearly demarcated echographic layers of the wall of the duodenum and jejunum are recorded, internal hyperechoic - corresponding to the outer part of the lumen and the border of the lumen with the mucosa, hypoechoic - corresponding to the mucosa, hyperechoic - corresponding to the submucosa, hypoechoic - corresponding to the muscular, external hyperechoic - corresponding to the serous membrane, , lack of expansion of the cavity of the small intestine. Measure the wall thickness on fixed images in the longitudinal and transverse planes by placing the cursor on the outer border of the serous membrane and on the inner border of the mucous membrane perpendicular to the longitudinal axis, by measuring the muscle, submucosal, mucous layers and the echographic layer corresponding to the outer part of the intestinal cavity and the border of the cavity from the mucous membrane. The thickness of the duodenal wall is obtained 4.5 mm, the thickness of the mucous layer is 3.05 mm, the thickness of the submucosal layer is 0.54 mm, the thickness of the muscle layer is 0.46 mm, the thickness of the echographic layer corresponding to the outer part of the intestinal cavity and the border of the cavity with the mucous membrane is 0, 4 mm. The ratio of the thickness of the mucous, submucosal and muscle layers to the entire intestinal wall is 67.8%, 12% and 10.2%, respectively. On a threefold enlarged digital image of a longitudinal scan of the duodenum in a graphics editor in black and white mode, two zones in each layer of the mucous, submucous and muscle fragments of the duodenum are compared (Fig. 1). The zone to be examined (zone 2 in Fig. 1) and the compared zone (zone 1 in Fig. 1) are outlined, while the numerical values of the parameters "mean value" and "deviation" are displayed automatically in the histogram window (Fig. 2). Average or Sryark is a weighted average of image pixel brightness that the computer automatically calculates by multiplying each brightness level by the number of pixels at that level, and then dividing by the total number of brightness levels. For the studied zone of the mucous layer, Cp _bright1 is 37.01 with a deviation Off ₁ = 4.73, and for the compared zone, Cp _bright2 is 34.05 with a deviation Off ₂ = 5.36.

For the compared zone (zone 1 in Fig. 1), the "deviation error in the compared zone" is additionally determined, for which this zone is divided into several sections, determining the value of the "deviation" in each section of this zone, choosing the maximum (Off _addmax = 4.7 ) deviation and minimum deviation (Off _addmin = 3.93). Calculate the deviation error in the compared zone P _Off2 = Off _addmax - Off _addmin (4.7 - 3.93 = 0.77) and calculate the difference in deviations in the studied area and in the compared zone: ΔOff = Off ₁ - Off ₂ (4, 73 - 5.36 = -0.63). Next, the deviation error in the compared zone is compared with the difference in deviations in the investigated and compared zones and the criterion of echo uniformity of the investigated zone is determined: KEO = P _Off2 - ΔOf (0.77 - (-0.63) = 1.4), while it is established, that the investigated area is echo-homogeneous, since the EEC exceeds "0". Next, the share of echogenicity of each layer (DES) of the duodenal wall is determined as the ratio of the obtained result Cp _bright for the mucous, submucosal and muscle layers as a percentage of the maximum echo signal reflection, expressed in the maximum value of pixel brightness equal to 256. DES _c = 14.5%, DES _{p / s} = 57.4%, DES _m = 31.4%.

As a result, the index of echogenicity of the duodenal wall is obtained IEdpk 14.5 / 57.4 / 31.4 mucous, submucous, muscle layers, respectively.

Example # 2.

Determine the echogenicity of the wall of the jejunum in a dog without clinical symptoms of diseases of the digestive system according to the method taken as a prototype (Patent RU No. 2398513, MPK51 А61В 8/00 А61В 8/14 (2006.01) publ. 09/10/2010, bull. 4), but the examination is carried out at various calibration settings of the ultrasound scanner on the scale of the instrument gain control (Gain). The actual value of the echogenicity of the layers of the wall of the jejunum, expressed in quantitative terms Cp _bright, representing the weighted average brightness levels of the pixels of the ultrasound image of the layers, is obtained. These values vary depending on the set value of the scale of the gain control of the device, and therefore, when determining the echogenicity index of the layers, the ratio of these indicators changes with each new examination. In addition, this index is obtained without taking into account the share of echogenicity of each layer of the intestine, in relation to the maximum reflection of the echo signal, expressed in the maximum value of the brightness of the image pixels, which reduces the objectivity of the results obtained.

Example No. 3.

Determination of the echogenicity of the walls of the duodenum and jejunum in 86 healthy dogs is carried out similarly to example 1. The following average percentage of the layers of the duodenum and jejunum to the thickness of the entire intestinal wall is obtained: mucous 67.63 and 67.23%, submucosa 12.46 and 12.62 %, muscle 10.24 and 10.66%, respectively. The thickness of the echographic layer corresponding to the outer part of the intestinal cavity and the border of the cavity with the mucous membrane is on average 0.46 mm. The following average quantitative indices Cp _bright (Fig. 3) and average indices of the echogenicity index are obtained: for the duodenum IE _dpk = 15.51 / 56.44 / 33.76, for the jejunum IE _mk = 15.45 / 55.82 / 34.94 (Fig. 4).

Example No. 4.

The echogenicity of the walls of the duodenum and jejunum of 37 healthy cats is determined similarly to example 1. The following average percentage of the layers of the duodenum and jejunum to the thickness of the entire intestinal wall is obtained: mucous 59.42 and 56.23%, submucous 17.39 and 16.98% , muscle 12.68 and 13.58%, respectively. The thickness of the echographic layer corresponding to the outer part of the intestinal cavity and the border of the cavity with the mucosa is on average 0.39 mm. The following average quantitative indices Cp _bright (Fig. 5) and average indices of the echogenicity index are obtained: for the duodenum IE _dpk = 28.8 / 56.9 / 42.2, for the jejunum IE _mk = 27.9 / 56.3 / 42.9 (Fig. 6).

Example No. 5.

The echogenicity of the jejunal wall is determined in 16 dogs with a laboratory-confirmed diagnosis of parvovirus enteritis similarly to example 1. The following average percentage of the layers of the jejunum to the thickness of the entire intestinal wall is obtained: mucous 31.3%, submucosal 18.42%, muscular 14.74% accordingly, which indicates a decrease in the thickness of the mucous layer by more than 2 times. The thickness of the echographic layer corresponding to the outer part of the intestinal cavity and the border of the cavity with the mucous membrane is obtained on average 0.87 mm, which exceeds the value obtained in the study of healthy dogs by 1.8 times. The following indicators Cp _{bright are} obtained: 100.8 for the mucous membrane, 157.6 for the submucosa, and 116.6 for the muscle layers. The EEC for all layers is less than "0", i.e. the layers are homoechoic. The echogenicity index of the intestinal wall is IE _mc = 39.4 / 61.6 / 45.6. This result compared to the index of healthy dogs (EI _mk = 15.45 / 55.82 / 34.94) differs significantly increasing echogenicity absolute layers intestine. The most increased echogenicity of the mucous layer, more than 2.5 times. Microscopically, the most pronounced destructive changes are found in this layer.

Example No. 6.

The echogenicity of the jejunal wall is determined in 12 cats with a microscopically confirmed diagnosis of alimentary lymphoma similarly to example 1. The following average percentage of the layers of the jejunum to the thickness of the entire intestinal wall is obtained: mucous 21.23%, submucous 7.11%, muscular 58.16% respectively, which indicates an increase in the thickness of the muscle layer by more than 4.5 times. The thickness of the echographic layer corresponding to the outer part of the intestinal cavity and the border of the cavity with the mucosa is on average 0.37 mm. The following indicators Cp _{bright are} obtained: 68.1 for the mucous membrane, 124.3 for the submucosal and 50.7 for the muscle layers. The EEC for all layers is less than "0", i.e. the layers are homoechoic. The echogenicity index of the intestinal wall is IE _mk = 26.6 / 48.5 / 19.8. The result obtained in comparison with a similar index in healthy cats (IE _mk = 27.9 / 56.3 / 42.9) significantly differs in the decrease in the absolute echogenicity of the intestinal layers in cats with alimentary lymphoma. The echogenicity of the muscle layer is most reduced, more than 2.1 times. Microscopically, it is in this layer that pronounced infiltration by cells of the lymphoid series is found.

The presented invention has advantages over the prototype and other technical solutions, which consist in an easy-to-use method for determining the ratio of different layers to the wall thickness of the duodenum and jejunum and the distribution of echogenicity in the wall to the maximum echo signal, allowing to differentiate the normal wall of the duodenum and jejunum from the pathological ...

Claims (31)

A method for ultrasound diagnostics of the duodenum and jejunum in dogs and cats, including ultrasound examination of the duodenum and jejunum through the anterior and lateral abdominal wall using a multifrequency linear transducer from 7.5 to 12.5 MHz, while conducting a series of transverse, longitudinal and oblique scanning sections with visualization of the intestinal wall layers with measurement of the wall thickness on fixed images in the longitudinal and transverse planes, by placing the cursor on the outer border of the serous membrane and on the inner border of the mucous membrane perpendicular to the longitudinal axis, measuring the muscle, submucosal, mucous layers and the echographic layer corresponding the outer part of the intestinal cavity and the border of the cavity with the mucosa, characterized in that the ultrasound image is obtained with the calibration setting of the ultrasound scanner on the scale of the instrument gain regulator equal to 255, the determination of the echogenicity index of the intestinal wall is carried out on the ultrasound image to intestine in a graphical editor in black and white on a threefold magnified scale, compare two zones of each layer - the investigated and compared, for which the investigated zone and the compared zone are outlined, the "histogram" function is turned on, while the numerical values of the parameters "mean value" and " deviation ”are automatically displayed in the histogram window of the graphical editor; for the compared zone, the "deviation error in the compared zone" is additionally determined, for which this zone is divided into several sections, the deviation value in each section of this zone is determined, the maximum deviation and the minimum deviation in the compared zone or its sections are selected, then the deviation error in the compared zone according to the formula:

P _Off2 - deviation error in the compared zone, Off _addmax - the maximum deviation value in the areas of the compared zone, Off _addmin - the minimum deviation value in the areas of the compared zone; then the difference in deviations in the investigated area and in the compared area is calculated using the formula:

ΔDev is the difference in deviations in the investigated and compared zones, Off ₁ - deviation in the studied area, Off ₂ - deviation in the compared zone; then the deviation error in the compared zone is compared with the difference in deviations in the investigated and compared zone according to the formula:

KEO - criterion of echo uniformity of the investigated area, P _dev2 - deviation error in the compared zone, ΔOf - the difference in deviations in the investigated and compared areas; under the condition of homoechogenicity of the layers, where CEO> 0, the index of echogenicity of the intestinal wall is calculated, for which the fraction of echogenicity of each layer of the intestinal wall is determined as the ratio of the average brightness of the studied layer (Cp _bright ) for each of the mucous, submucosal, muscle layers of the jejunum wall in percentage to the maximum echo signal reflection, expressed in the maximum value of the brightness of the pixels of an 8-bit image, equal to 256, according to the formula:

DES - the share of echogenicity of a separate layer - mucous, submucous, muscle, in percentage, Ср _bright - the average value of the brightness of the layer under study, 256 - the maximum value of the brightness of the pixels in an 8-bit image; get an index of echogenicity of the wall of the jejunum IEtk:

IETc - the index of echogenicity of the wall of the jejunum, DES _C - the proportion of echogenicity of the mucous layer, DES _{p / s} - the proportion of echogenicity of the submucosal layer, DES _m - the proportion of echogenicity of the muscle layer; and in the presence of five clearly demarcated echographic layers of the internal hyperechoic - corresponding to the outer part of the lumen and the border of the lumen with the mucosa, hypoechoic - corresponding to the mucosa, hyperechoic - corresponding to the submucosa, hypoechoic - corresponding to the muscular, external hyperechoic - corresponding to the serous membrane, in the presence of peristaltic contractions, no expansion the cavity of the small intestine is more than three values of the wall thickness, with the thickness of the echographic layer corresponding to the outer part of the intestinal cavity and the border of the cavity with the mucosa not more than 0.5 mm; in cats with the thickness of the mucous layer of the duodenum, determined by the ratio of the thickness of the mucous layer to the thickness of the entire intestinal wall of the duodenum, constituting from 57 to 63%, the thickness of the submucosal layer of the duodenum, determined by the ratio of the thickness of the submucosa to the thickness of the entire intestinal wall, constituting 15 to 19%, the thickness of the muscle layer, determined by the ratio of the thickness of the muscle layer to the thickness of the entire intestinal wall, ranging from 11 to 14%, with the thickness of the mucous layer of the jejunum, determined by the ratio of the thickness of the mucous layer to the thickness of the entire wall of the jejunum, ranging from 54 to 58%, the thickness of the submucosal layer of the jejunum, determined by the ratio of the thickness of the submucosal layer to the thickness of the entire intestinal wall, ranging from 15 to 19%, the thickness of the muscle layer, determined by the ratio of the thickness of the muscle layer to the thickness of the entire wall of the jejunum, ranging from 12 up to 15%, and the value of the echogenicity index of the duodenal wall th and jejunum for the mucous layer from 25 to 30, the submucosal layer from 50 to 62 and for the muscle layer from 38 to 46; in dogs with the thickness of the mucous layer of the duodenum, determined by the ratio of the thickness of the mucous layer to the thickness of the entire intestinal wall of the duodenum, ranging from 65 to 70%, the thickness of the submucosal layer of the duodenum, determined by the ratio of the thickness of the submucosa to the thickness of the entire intestinal wall, constituting from 10 to 14%, the thickness of the muscle layer, determined by the ratio of the thickness of the muscle layer to the thickness of the entire intestinal wall, ranging from 8 to 12%, with the thickness of the mucous layer of the jejunum, determined by the ratio of the thickness of the mucous layer to the thickness of the entire wall of the jejunum, ranging from 63 to 68%, the thickness of the submucosal layer of the jejunum, determined by the ratio of the thickness of the submucosal layer to the thickness of the entire intestinal wall, ranging from 10 to 14%, the thickness of the muscle layer, determined by the ratio of the thickness of the muscle layer to the thickness of the entire wall of the jejunum, ranging from 8 up to 12%, and the value of the echogenicity index of the duodenal wall and the jejunum for the mucous layer from 14 to 17, the submucosal layer from 50 to 62 and for the muscle layer from 30 to 38; diagnose the echographic norm of the duodenum and jejunum.

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