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Доплеровский артефакт мерцания: физические механизмы и место в диагностической практике. Современное состояние вопроса

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Введение. Артефакт мерцания известен специалистам ультразвуковой диагностики с 1996 г. Однако до настоящего времени нет однозначного понимания как физических основ его появления, так и областей ультразвуковой диагностики, где выявление его несет реальную диагностическую информацию.Материал и методы. В электронных базах данных (PubMed, E-library, Web of Science) был проведен поиск опубликованных исследований по ключевым словам “twinkling artifact”, “мерцающий артефакт”, “артефакт мерцания”. Систематизирована и проанализирована имеющаяся научная литература, посвященная доплеровскому артефакту мерцания с момента первых публикаций о его существовании. Отмечены собственные разработки на эту тему. Определены современные взгляды на данное явление и его место в ультразвуковой диагностике. Представлена основная на настоящий момент версия о причинах возникновения данного явления.Результаты. Сформулированы рекомендации для практических врачей по изменению настроек ультразвукового сканера с целью повышения выявляемости артефакта мерцания. Определены направления использования артефакта для получения дополнительных диагностических признаков патологических изменений, к которым в настоящее время относят диагностику нефро-, уретеро- и холедохолитиаза.Заключение. Отмечена высокая эффективность использования артефакта мерцания для диагностики мелких камней почек, сопоставимая с возможностями компьютерной томографии. Показана низкая результативность использования артефакта для выявления микрокальцинатов молочной железы и обызвествлений других анатомических структур.

Ключевые слова:
ультразвуковые артефакты, артефакт мерцания, мерцающий артефакт, ultrasonic artifact, twinkling artifact

Литература:
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Doppler twinkling artifact: physical mechanisms and place in diagnostic practice. State of the art

The twinkling artifact has been known to specialists in ultrasound diagnostics since 1996. However, until now there is no understanding of the reasons for its appearance, and the place of its application in diagnostics.Material and methods. Electronic databases (PubMed, E-library, Web of Science) were searched studies using the keyword – “twinkling artifact”. The scientific publications on the Doppler twinkling artifact from the moment of the first reports about its existence is systematized and analyzed. The authors' own developments on this topic are presented. Modern views on this phenomenon and its place in ultrasound diagnostics are described. An explanation of the physical mechanisms of this phenomenon is given.Results. Recommendations are formulated for practitioners on changing the settings of an ultrasound scanner in order to increase twinkling artifact detectability. The directions of using the artifact to obtain additional diagnostic signs of pathological changes, which currently include the diagnosis of nephro-, uretero- and choledocholithiasis, are determined.Conclusions. The high efficiency of the use of the twinkling artifact for the diagnosis of small kidney stones, comparable with the capabilities of computed tomography, has been shown.  

Keywords:
ультразвуковые артефакты, артефакт мерцания, мерцающий артефакт, ultrasonic artifact, twinkling artifact