Aim: to estimated the efficiency of complex elastography in patients with the liver and pancreas diseases. Materials and methods. It is surveyed 153 main with various clinical forms of diffuse liver diseases (DLD) (1^st group): 75 (49%) men and 78 (51%) women. 2ndgroup:165 main with pancreas diseases (113 (68.4%) men and 52 (31.5%) women). For complex elastography were used transient elastography, compression elastography: transabdominal and in endosonography, elastography shear waves. Results. Statistical anlysis of the results showed that in a comparative analysis of all groups of data complex elastography of the liver, compression elastography of the pancreas, its histological materials, it confirms the hupothesis of the existence of similarity groups of elastography and histological material (p > 0.05). The study received: the complex elastography of the liver and pancreas allows to specify the diagnosis, to solve the question of holding or exclude any method of inspection elastography. Conclusions. The complex elastography in DLD - AUC = 0.909 with 95% confidence interval [0.893-0.997]; biopsy of the liver - AUC-0.901 with 95% confidence interval [0.897-0.991]; compression elastography of the pancreas in endosonography: AUC-0.895 with 95% confidence interval [0,864-0,975]; histological materialof the pancreas - AUC-0.995 with 95% confidence interval [0,893-0,998].

Purpose. Clarifying indications to the type of portosystemic shunt by improving the visualization methods of portal vascular system in children with portal hypertension. Materials and methods. 157 children with portal hypertension syndrome on the background of cavernous transformation of the portal vein were examined and treated. Investigations were carried out on the US-scaner SonoScape 5000 (China), on the 256-slice CT scanner Brilliance i-CT and 3 Tesla MR scanner Achiva TX Philips with intravenous bolus administration of water-soluble nonionic contrast agent. Results. The average speed of blood flow in the modified portal vein V@mean = 18.43 ± 1.05 (p ≤ 0.05), blood flow in different directions. The spleen was enlarged in 70 (90%) patients, the surface is S = 82.1 ± 9.4 cm². The main CT and MRI features of extrahepatic portal hypertension were: the presence of the block with the formation of cavernoma in the projection of a would portal vein, increasing the diameter of the splenic vein, the presence of varicose veins in cardioesophageal transition, splenomegaly, increased portosystemic collaterals. Conclusions. On preoperative stage Doppler ultrasound techniques, MDCT and MRI angiography allow a detailed assessment of the topography of the pathologically developed portal vein, reveal the presence of natural portosystemic shunts, and subsequently accurately assess the functional state of formed portosystemic shunts.

Computed tomography (CT) can be used to accurately determine bone density in Hounsfield units (HU), the use of CT as a predictive tool has not been conclusively demonstrated in relation to low energy vertebra compression fracture (VCF). The objective: to define the prognostic value of bone density measured during CT investigation in relation to VCF. Materials and methods. One hundred consecutive patients undergoing CT scans were enrolled in this study. Bone density measurements were obtained at the level L_II or L_III from the cancellous portion of the vertebral body in the mid-sagittal, mid-coronal and axial planes. The presence of a single-level or multi-level VCF was identified by CT. Multilevel degenerative changes were characterized and recorded. Logistic regression was utilized to assess the relationship between the variables of bone density in HU, single - or multi-level VCF and the presence of degenerative changes. Results. HU were found to have a strong correlation to the risk of VCF. HU of less than 101 were associated with a significant increase in the rate of VCF, whereas HU of less than 82 were associated with a significant increase in the rate of multi-level VCF. Hypertrophic degenerative changes were found to be associated with a decreased rate of VCF. Conclusion. CT data can accurately define the risk of VCF and therefore presents a useful clinical tool to support the need for prophylactic medical therapies for osteoporosis or to provide information useful in counseling patients at risk for VCF.

The success and the diagnostic value of multidetector CT angiography (MDCT angiography) are directly dependent on the correct execution of scanning techniques. There are some ways to optimize protocols MDCT with intravenous contrast bolus, which aim to achieve the best arterial or parenchymal enhancement, with the use of minimum (to the extent possible to solve the diagnostic problem) volume of contrast agent, because it is known that the majority of adverse reactions to contrast agent depend on the total iodine dose.

Objective: to develop and introduce a modern system of quality management in radiology. Materials and methods. The base of system there was a comprehensive quality management program by J. Juran (1989). For the purpose of development of the system of quality, questioning of 1837 patients of hospital and 421 Moscow general practitioners was carried out. The standard tools of quality management were used: questionnaires, macro- and micro-flowcharts, diagrams of cause and effect, Pareto technique. Results. Using the questionnaire results of 1837 patients and 421 of general practice doctors, quality criteria have been determined: the divergence of diagnoses in cross-and external control, the cost of diagnosis ascertainment, period of diagnosis, the waiting time of the study, the radiation dose of the patient at diagnosis, the rate of complications during the diagnostic procedures, frequency of high-tech methods using, undue repeated diagnostic procedures, the patient waiting time of the study. Comparing these figures with data from other medical facilities, “critical” values of quality criteria have been identified. During a comparison of the quality criteria of the radiology departments, Main clinical hospital of the Ministry of internal Affairs of Russia “critical” quality indicators weak points were identified: the divergence of diagnoses in crosscontrol studies was 0.09% (vs. 0.06% “critical” value) and the cost of diagnosis - 12876 rubles (vs. 5201 rubles). To eliminate these disadvantages standardized protocols examination for the major pathological conditions have been developed, the introduction of which resulted in a decrease of the divergence of diagnoses during cross control to 0.03% and reduce the cost of diagnosis until 5257 rubles. Conclusion. Implementation of the quality management system demonstrate a high practical efficiency, wich expresses in increasing diagnostic confidence and reducing the cost of the survey.

The aim: goal was to evaluate the possibility of magnetic resonance imaging (MRI), including contrast-enhanced (СЕ) in the diagnosis of lesions of the spinal cord neural structures in gunshot wounds of the spine, at the stage of specialized medical care. Materials and methods. The analysis of 22 patients with gunshot wounds to the spine. Patients were examined on multyslise (64 slice) computer tomograph Toshiba Aquilion 64, as well as by MRI Picker Eclipseand Toshiba Atlas with the induction of the magnetic field 1 and 1.5 Tesla. Results. MRI provides the best visualization of the spinal cord and its membranes and radicles, identification of damadged areas, to determine the level of neurological disorders and the extent of the blockade subarachnoid spaces. MRI with СЕ most informative method for studying the damage of neural structures in gunshot wounds of the spine, as reveals inflammatory changes such as postranevoy scar-adhesive epidurit, discitis and spondylitis, follow the dynamics of their authorization. The absence of radiation exposure allows dynamic observation without harm to the patient. Conclusion. Patients with gunshot wounds to the spine in need of a comprehensive high-tech ray studies to fully assess the damage to both bone and neural structures and to select the optimal strategy of surgical and conservative treatment, thereby greatly increasing the effectiveness of treatment and reduce the risk of serious consequences.

The purpose: to develop the algorithm of differential diagnosis of simple and proliferating uterine fibroids subserous localization by ultrasound. Materials and methods. Based on the study results of the histological structure of tumors obtained in the surgical treatment of 103 patients of reproductive age operated on for uterine fibroids subserous localization, was a retrospective analysis of complex echographic studies. Objective 2 groups were formed: group 1 - 73 (70.9%) patients with simple fibroids; group 2 - 30 (29.1%) patients with proliferating myoma. Results. The sonographic parameters with the greatest diagnostic and prognostic value in the differential diagnosis of simple and proliferating fibroids: the type of histogram, the type of vascularization, the coefficient of homogeneity, the increase in maximum node dynamic observation in mm number of color pixels in 1 cm2 area of the myoma node, resistance index, maximum systolic blood flow velocity, the maximum venous blood flow in the vessels of myoma nodes. On the basis of the obtained data was evaluated information weight and practical significance of each of the parameters, the mathematical model used to predict the morphological type subserous uterine fibroids. Diagnostic efficiency of the resulting model is tested in a prospective study on separately recruited a group of 86 patients with uterine myoma subserous localization. Received high performance diagnostic test. The computer program “Probability Proliferation” to facilitate the use of the algorithm in practice. Conclusion. We have developed an integrated algorithm of differential diagnosis with evaluation of the informative value of the parameters with high accuracy to predict the morphological type of fibroids subserous localization in patients of reproductive age, that was previously unavailable when using a separate ultrasonic criteria.

Purpose. Echographic imaging efficiency evaluation in detection of urgent conditions in maxillofacial area (MFA). Materials and methods. Echographic examination was performed on a total number of 169 patients (age 18 to 70) with suspected various urgent conditions with MFA soft tissue pathology. Examination was carried out using the iU-22 ultrasound system (Philips, Germany), with the L 15-17 io (dedicated compact pen-transducer with 15 to 7 MHz operating frequency range) and the L 9-3 linear array transducers. B-mode and color Doppler flow mapping were applied. Results. 35 (20.7%) patients were diagnosed with sialolithiasis, 32 (18.9%) of them had “salivary colic”. 3 (1.8%) patients had acute sialolithiasis complication in the form of abscessing gland. Acute major salivary gland sialadenitis was found in 35 (20.7%) cases, of which 20 (11.8%) had serous inflammation and 15 (8.9%) - the purulent one. 39 (23.0%) patients were diagnosed with acute lymphadenitis, 20 (11.8%) of them had serous inflammation, 11 (6.5%) were in periadenitis stage, 8 (4.7%) had lymph node abscess. Acute extraorganal MFA soft tissue inflammation (n = 32 (18.9%): abscess was found in 25 (14.8%) cases, phlegmon - in 7 (4.1%) cases. Lateral (n = 16 (9.4%) and median (n = 9 (5.3%) cyst festering was identified. 3 (1.7%) patients had MFA soft tissue foreign body. Primary diagnostics and dynamic observation were performed in 100% cases. All results had clinical confirmation. B-mode echography allowed for the affected area characterization, location, size, pathological process depth of occurrence and expansion, surrounding structures condition. Duplex scanning allowed for vascularization evaluation. Conclusion. Echography is a highly-informative method of urgent conditions detection for patients with MFA diseases, usage of which on early stages of examination influences further treatment tactics.

Objective: to provide echographic assessment of the cervix in pregnant women at term 16-24 weeks for the prediction of preterm delivery using functional tests. Materials and methods. 61 pregnant during the period from 16 to 24 weeks of gestation with the diagnosis “threat of interruption of pregnancy” we prospectively examined. In addition to standard measurement study involved functional tests. The study, 3 (7.5%) patients in the initial examination was revealed cervical incompetence (CIN). Two clinical groups were distinguished from other 58 pregnant women: group I of 26 patients (44.8%) with existence of risk factors of CIN which the cervical stressful test were not performed and group II of 32 (55.2%) patients to whom test with change of position of a body was carried out. In group II allocated two subgroups: IIA - 11(34.4%) pregnant women without risk factors of CIN; IIb - 21 (65.6%) the pregnant woman with risk factors. Results. At the II group after carrying out functional test with change of position of a body in 9 (28.1%) of 32 patients the cervical stressful test was positive, in 23 (71.9%) - negative. In IIA group shortening of length of the cervix and/or an expansion of the internal os was in 3 (27.3%) patients of 11, from IIb group in 6 (28.6%) of 21. When comparing outcomes of pregnancies it is possible to note that in group I the number of premature birth was higher, than in the II group, besides in the I group there was a late spontaneous abortion. It was succeeded to distinguish group of risk of premature birth for further monitoring and correction among pregnant of group IIa pregnant women without risk factors of CIN by means cervical stressful test. Conclusion. Thus, reducing the length of the cervix and / or increasing the diameter of the internal os, changing its shape are important in predicting preterm labor. Conducting cervical stress test allows you to select a risk group for the development of CIN and preterm birth, including among pregnant women without risk factors for CIN, that allows to carry out in due time keeping therapy and to receive more safe ends of pregnancy.

The aim: to assess functional parameters of the left ventricle (LV) in patients with coronary heart disease (CHD) using Velocity Vector Imaging before and early after surgical revascularisation. Materials and methods. The analysis of the strain (S) and strain rate (SR) of longitudinal, circular and radial fibers in 216 segments of the left ventricle before and on the 12th day after surgery. Results. The impact of CHD on the LV segments is expressed not only in the reduction or compensatory increase S and SR, but also a variety of options associated with the change mainly the strain or strain rate. Along with this marked change in the direction of motion of the LV myocardial fibers. After revascularization, the normalization of the deformation properties of the longitudinal and radial fibers occurred in 51 (24%) and 139 (64%) segments, respectively. Significant improvement in the function of circular fibers in the early stages is not registered. Low indices S and SR longitudinal, radial and circular fibers registered in 55 (25%), 15 (7%) and 167 (77%) LV segments. Conclusion. All segments with a change of direction of motion after revascularization regained its function, however, the deformation indicators remained low.

Purpose: to evaluate parameters of ocular blood flow in subclinical atherosclerosis. Materials and methods. We observed 45 patients aged from 40 to 65 years. The methods of investigation of the blood flow in orbital vessels and carotid arteries included duplex ultrasonography, Color Doppler Imaging and spectral Doppler analysis. Retinal vascular caliber was measured by using digital retinal photographs. Results. Color Doppler Imaging and spectral Doppler analysis of ocular blood flow showed significant increase of vascular resistance in central retinal artery and short posterior ciliary arteries, dilatation of retinal venular caliber in cases of subclinical atherosclerosis. Retinal venular caliber was significantly larger in individuals with subclinical atherosclerosis. Conclusion. Ultrasound methods of investigation of ocular blood flow and measurement of retinal vessel caliber showed the changes of choroidal and retinal circulation in patients with subclinical atherosclerosis.

Aim. Comparative evaluation between segmental anatomy of the circle of Willis and brain CT-perfusion parameters, in group of patient with widespread atherosclerosis and unilateral brachiocephalic artery occlusion. Materials and methods. 24 patient, who underwent native brain CT, brain CT-perfusion and CT-angiography were included in our study. All patients had unilateral atherosclerotic occlusion one of the main brachiocephalic artery. Basic group of patients was carried out by subgroups, depending on the anatomical structure of the circle of Willis. CT-perfusion changes were compared between subgroups. Presence of post-ischemic changes and severity of atherosclerotic lesions on the contrary side were described. Results. More than half of patients (66.7%) had unilateral carotid artery occlusion, combined with contralateral carotid stenosis, which includes 6 cases of critical stenosis. In 59% of cases different steno-occlusive lesions of vertebrobasilar arteries was found. Inter-emispheric cerebral perfusion differences were significant between the ipsilateral and contrary side in a ROI of arteria cerebri media (ACM). Also, significant ratio between the value of inter-hemispheric difference and anatomic variations of the circle of Willis were found. No relation was found between inter-hemispheric perfusion difference and presence of post-ischemic changes or severity of the contralateral stenosis. Conclusion. Between different, heterogeneous subgroups with different variations of the circle of Willis, significant difference in inter-hemispheric cerebral perfusion was present.

Purpose. To analyze published data concerning the usage of CT perfusion in pancreatic tumors and to compare them with the results of our own research. Materials and methods. 64 articles were found in the well-known database PubMed by keyword “CT perfusion of pancreatic tumors”. From January 2014 to January 2015 at the A.V. Vishnevsky Institute of Surgery 19 patients with cystic and solid tumors of the pancreas underwent CT-perfusion study using a low-dose protocol (80 kV. 100-200 mAs). Post-processing techniques were performed by the model of maximum slope and the curves density/time. Results. CT-perfusion characteristics of the healthy pancreatic parenchyma were - blood flow (BF) - 69.7 ml/100g/min, the blood volume (BV) - 25.6 ml/100 g. For pancreatic cancer (ductal adenocarcinoma) - BF - 15 ml/100g/min, BV - 3 ml/100 g. For neuroendocrine tumors - BF - 202 ml/100g/min, BV - 24 ml/100 g. For microcystic adenomas BF - 56 ml/100g/min, BV - 30 ml/100 g. Time to peak (TTP) for the healthy pancreatic parenchyma was 12 sec. In case of pancreatic cancer and cystic tumors this parameter significantly increases. And in case of neuroendocrine (hypervascular) tumors it conversely decreases (TTP is reduced to 4-8 seconds). Conclusions. CT perfusion can be used for the differential diagnosis of pancreatic tumors, however, the lack of a single protocol scanning and many mathematical models of calculation do not allow to distinguish standardized criteria. Perfusion settings remain approximate data. That’s why it is necessary to use CT perfusion in a large cohort of patients with larger number of investigators.

Communication haematocele and pyocele in newborns, despite the casuistic rarity, are manifestations of life-threatening conditions: damage to the abdominal organs, and inflammatory changes in the last generalized. These changes are clinically characterized by edema syndrome of scrotum (SES) and integrate a large number of clinical entities. Ultrasonography (US) is the only safe, non-invasive and highly effectiveness diagnostic method in the SES in newborns. Purpose. Determination of the diagnostic value of ultrasound examination and improvement of the algorithm examination in the communication haematocele and pyocele in newborns. Materials and methods. 244 male newborns admitted to neonatal surgery department with the preliminary diagnosis of SES were treated in the St. Vladimir Moscow clinical municipal children hospital in the period from 2002 to 2014. To accomplish this goal were selected and analyzed the results of ultrasonography performed at admission and in dynamics during the treatment (surgical and conservative) neonates with communication haematocele and pyocele, extravaginal deep hematomas (14 (5.7%) patients). Communication pyocele found in 3 patients (with perforated peritonitis on the background of necrotizing enterocolitis); communicative haematocele occurred in 8 cases (rupture of the liver - 5, if damaged umbilical vein - 1 at postoperative hemoperitoneum - 2); extravaginal deep hematomas - 3 cases at break adrenal gland. Results. Based on the analysis of own observations the most representative sonographic manifestations of communication haematocele and pyocele are highlighted. Conclusions. Communication haematocele and pyocele not accompanied by structural changes in the testis and epididymis, do not lead to disruption of blood flow in the data structures in the newborn. Given the mechanism of development, communication haematocele and pyocele may be bilateral as opposed to unilateral obligate extravaginal deep hematomas. Sonographic characteristics of pathological changes in communication haematocele and pyocele is not specific, therefore, these states can not be differentiated with absolute certanly by US, in this connection, emphasizes the need to expand areas of research in the identification of these symptoms.

Hypoxia is a leading etiological factor of most of the fetal brain damages and neurological disorders in the postnatal period. The evaluation of fetal brain blood flow can be considered crucial because deficits in the perfusion of this area may lead to inadequate development of the central nervous system and are associated with adverse perinatal outcomes, including perinatal death. With the advent of fetal Doppler velocimetry it became possible to study fetal circulatory safely and non-invasively. Assessment of the fetal circulation is essential in better understanding of the pathophysiology of a wide range of pathological pregnancies and their clinical management.

The aim: to explore the possibilities of complex ultrasonic diagnostics in detection of hydrosalpinx in tubal-peritoneal infertility before the IVF procedure. Materials and methods. A comprehensive clinical and instrumental examination of 687 women of reproductive age was conducted and 587 (85.5%) patients aged 22 to 45 years old were diagnosed with primary and secondary infertility. While checking up, infertility caused by endocrine factor was detected in 302 (51.4%) of women. Tubal factor of infertility was diagnosed in 164 (27.9%) women (study group), congenital abnormalities in 14 (2.4%), internal endometriosis in 38 (6.5%). During the study, we found that infertility caused by tubal factor was in 164 (27.9%) women (basic group of our study). The remaining causes of infertility were: endocrine factors in 302 (51.4%), congenital abnormalities in 14 (2.4%), internal endometriosis in 38 (6.5%), focal hyperplastic process (endometrial polyp) - in 69 (11.8%). The control group consisted of 100 women of similar age without gynecological diseases, with regular menstrual cycles with childbirth without complications in anamnesis. Comprehensive examination included: clinical, laboratory and ultrasound studies (transabdominal, transvaginal sonography, duplex scanning) of all patients and instrumental (hysteroscopy, hysterosalpingography) methods as indicated. Results. Comprehensive ultrasound examination revealed abdominal formation faf round or irregular elongated shape) in the projection of the fallopian tubes in 48 (29.2%) out of 164 patients with tubal - peritoneal infertility. The formations were with homogeneous anechogenic content and with clear welldefined contours. Vascularization in the wall of the formations was absent. The formations were unilateral at 29 (60.4%) and bilateral at 19 (39.6%) patients; multilocular - at 36 (75.0%) patients, unilocular - at 12 (25.0%). Hysterosalpingography allowed to confirm the presence of hydrosalpinx, in all 48 (100%) of the patients. Moreover in 19 (39.6%) of all examined patients after passing through the tube, the contrast substance was not detected in the abdominal cavity, which indicated both tubal obstruction. After a comprehensive survey of 164 patients with tubal factor of infertility, 142 (86.6%) patients in vitro fertilization was implemented. Conclusion. Our research has shown that the complex ultrasound examination including transabdominal, transvaginal, duplex scanning in the diagnosis of hydrosalpinx with tubal - peritoneal infertility requires no special training and is carried out fairly quick, painless and does not cause complications with its high information content. Integrated ultrasound diagnosis plays a leading role in the choosing of tactics further diagnosis and management of patients before the procedure of in vitro fertilization (IVF).

The goal: to analysis of ultrasound diagnostics to identify hereditary and congenital abnormalities of the fetus, as well as gynecological diseases in the private clinic Medical Centre Lotos. Material and methods. A retrospective analysis of surveys 11645 female-patients aged 18 to 45 years divided into 3 groups. The first group (n = 3046) consisted of patients who underwent screening ultrasound examinations on the 11-14 weeks of pregnancy, 18-21 weeks and 32-34 which let reveal congenital malformations of the fetus. On the terms of gestation of 11-14 and 18-21 markers of chromosomal fetal malfunctions were estimated, that gave the second group of patients (n = 3840). The third group (n = 3772) - patients who had ultrasound to reveal pathologies of small pelvis organs. Examinations were carried out with Ultrasound Scanners Voluson 6 Expert (General Electric The UK), convex transducer 2-5 MHz and transvaginal transducer 4-9 MHz with 3D scanning technologies. The obtained data were compared with the ultrasound department results of inter district centre of prenatal diagnostics Chelyabinsk city. Comparison of the efficiency of research was carried on the basis of one-factor dispersive analysis. Results. 85 fetuses with congenital malformations were revealed in the first group (2.8% from the amount of patients), that suits common data. In the second group the carrying out of ultrasound and biochemical screening revealed 18 patients with the high risks of fetal malformations. To prove fetal chromosomal anomalies in this group prenatal karyotyping was performed. Some gene mutations were revealed: autosomal in the form of trisomy (2 cases of Down's syndrome) and X-Chromosome monosomy (1 case of Turner's syndrome). In the third group in 71.1% examinations gynecological pathology with the biggest unit weight of womb mioma, endometriosis, ovarian cysts and tumors were revealed. Conclusions. MC “Lotos” doesn't yield a 2nd level medical organization - inter district centre of prenatal diagnostics in Chelyabinsk city according to the structure of revealed pathology in obstetrical and gynecological and can be included in territorial programme of state guarantees of free medical service on the basis of private - state partnership.