Contrast enhanced ultrasound examination (SonoVue, Bracco, Italy) was done to 66 patients (2380 years old) with thyroid nodular lesions. Morphological study confirmed malignant thyroid lesions in 26 patients, benign - in 40 patients. Benign thyroid nodules were characterized by following qualitative signs: homogeneous enhancement (78.37%), well-defined margins (72.97%), and “wash-in” pattern which was compared with surrounding parenchyma (70.27%). Quantitative parameters (M ± σ) of contrast enhancement for benign thyroid nodules were as follows: time to peak - 23.47 ± 3.89 sec, peak intensity - 33.95 ± 3.31 dB, descending time / 2 - 80.52 ± 13.58 sec, time to peak index - 1.064 ± 0.118, peak intensity index - 0.985 ± 0.051, and descending time / 2 index - 0.971 ± 0.065. Malignant thyroid nodules were characterized by following qualitative signs: heterogeneous enhancement (65.38%), poorly-defined margins (65.38%), fast “wash-in” in arterial phase (61.53%), and fast “wash-out” in venous phase (65.38%). Quantitative parameters (M ± σ) of contrast enhancement for malignant thyroid nodules were as follows: time to peak - 18.50 ± 3.68 sec, peak intensity - 29.13 ± 4.50 dB, descending time / 2 - 68.77 ± 15.52 sec, time to peak index - 1.173 ± 0.244, peak intensity index - 1.073 ± 0.159, and descending time / 2 index - 1.136 ± 0.134. ROC-analysis revealed the best criterion in malignant thyroid tumors diagnosis - descending time / 2 index > 1.03 (sensitivity - 91.9%, specificity - 84.6%).

16 patients with the normal thyroid (32 lobes) and 11 patients with the focal lesions (15 colloid nodules) were examined. Intra- and interobserver reproducibility of the shear wave elastography was assessed. Young’s modulus (kPa) (Emax and Emean) was measured by using Aixplorer scanner (Supersonic Imagine, France) with linear probe (4-15 MHz). All measurements were acquired by two operators with the same experience in ultrasound. Interobserver reproducibility in assessment of Emean for normal thyroid parenchyma was as follows: intraclass correlation coefficient - 0.85 (0.63-0.95) (95% confidence interval), Spearman rank correlation coefficient - 0.84 (P = 0.0001) and kappa - 0.58 (0.41-0.74); intraobserver reproducibility - 0.95 (0.86-0.98), 0.94 (P < 0.0001) and 0.73 (0.63-0.82), respectively. Inter- and intraobserver reproducibility of Emax for normal thyroid parenchyma - 0. 81 (0.53-0.93), 0.85 (P < 0.0001) and 0.54 (0.41-0.74); 0.95 (0.85-0.98), 0.89 (P < 0.0001) and 0. 61 (0.45-0.78), respectively. Interobserver reproducibility in assessment of Emean for colloid nodules - 0.93 (0.84-0.97), 0.85 (P < 0.0001) and 0.62 (0.47-0.77); Emax - 0.90 (0.77-0.96), 0.79 (P < 0.0001) and 0.55 (0.38-0.72), respectively. Study results show high reproducibility and agree ment in Young’s modulus measurements. Intraobserver reproducibility of Young’s modulus measurements for normal thyroid parenchyma and colloid lesions was higher than interobserver reproducibility. Inter- and intraobserver reproducibility of Emean measurements was higher comparing with Emax. All reproducibility results for normal thyroid parenchyma and nodules assessment gave comparable results.

72 women aged from 24 up to 76 years old with unilateral and bilateral ovarian lesions (with size more than 30 mm) were examined. B-mode and Doppler ultrasound data was assessed according to the score system. Cut-off value for ovarian cancer diagnosis was equal to score 8. CA125, HE4, and ROMA (Risk of Ovarian Malignancy Algorithm) were assessed before the surgery. Malignant lesions were revealed in 23 (33.3%) patients, benign - in 48 (66.4%). The only ultrasound value was higher (sensitivity - 89%, specificity - 89%, accuracy - 89%) then other diagnostic modalities in postmenopausal patients. Ultrasound was sufficient for malignant lesion diagnosis in postmenopausal period. Ultrasound and ROMA at the first step and only HE4 assessment at the second step were recommended in premenopausal patients. It increased sensitivity and specificity up to 100% in our study. Positive result of ultrasound was sufficient for malignant lesions diagnosis without considering the ROMA results. HE4 tumor marker was assessed at second step if ultrasound result was negative and ROMA result positive. Positive result of HE4 was used as the marker of malignant lesion. Lesion was considered as a benign in cases of negative HE4. Malignant lesions were excluded if ultrasound and ROMA results were negative. This algorithm should be studied more precisely. More data is needed.

Clinical case of the congenital high airway obstruction syndrome in 19 weeks old fetus is presented. In literature review classification, pathophysiology, prenatal diagnosis, and treatment of the congenital high airway obstruction syndrome are shown. Main echography signs of the abnormality includes: bilateral enlargement of the lung size, increased lung echogenicity, dilated trachea with hypoechoic fluid, and protrusion of the diaphragm in to the abdomen. There is a high likelihood of the ascites due to compression of the great vessels and polyhydramnios due to esophagus compression. It is noted that prognosis for the newborn in the presence of this defect is unfavorable.

Prenatal diagnosis of suprarenal abdominal aortic aneurism is described. Aneurism was diagnosed at 31 week of gestation. Verification of diagnosis was done at neonatal period by CT-angiography. One year old child was successfully operated on. In literature review classifications, etiology, pathomorphology, and treatment of abdominal aortic aneurisms are discussed. 16 cases of abdominal aortic aneurism diagnostics (except this case) at antenatal, neonatal, and infant period are presented (7 cases among 16 were at 21-34 weeks of gestation).

110 ulnar nerves were examined in 88 patients with ulnar neuropathology at the elbow. Cross-section area was assessed at different levels of the ulnar nerve. 141 ulnar nerves were examined in 91 patients of the control group. There were following injury degrees according to the electroneuromyography: mild (n = 23), moderate (n = 37), severe (n = 27), and extreme (n = 23). In patients of the control group (n = 141) nerve conduction was normal. Cross-section area was measured at antebrachium (S1), at the level of cubital tunnel (S2), at the level of condylar groove (S3), just proximal to the medial humeral epicondyle (S4), at middle part of brachium (S5). Good correlation was established between severity of neuropathy and cross-section area measured at S2, S3, and S4 levels (r = 0.58, 0.68, and 0.64 respectively, P < 0.05). The highest correlation was obtained for maximum cross-section area value at S2-S4 segment (r = 0.76, P < 0.05). A negative correlation was revealed between cross-section area and motor nerve conduction velocity at ulnar nerve segment (r = -0.74, P < 0.05). The cut-off value of cross-section area at S2-S4 segment was 12 mm² (normal value - ≤12 mm², pathology - >12 mm²; sensitivity - 84%, specificity - 95%, accuracy - 90%, AUC - 0.928). The cut-off value equal to 18 mm² was assessed to differentiate the injury type (demyelinating nerve lesion - ≤18 mm², axonal involvement - >18 mm²; sensitivity - 60%, specificity - 86%, accuracy - 74%, AUC - 0.779).

Two rare cases of central nervous system pathology are described. Fetal arachnoid cysts were revealed during the first trimester screening at 12 and 13 week of gestation, accordingly. In literature review pathomorphology and ultrasound diagnostic strategy are discussed and few clinical observations of successful arachnoid cysts diagnosis in the first trimester of pregnancy are shown.