Aim. To study the fractional anisotropy of white and gray brain matter and its associations with clinical and instrumental data in acute ischemic stroke. Materials and methods. The parameters of fractional anisotropy of 10 areas of white and gray brain matter were analyzed in 30 acute ischemic stroke patients by diffusion-tensor imaging. The neurological (NIHSS), cognitive (MMSE), functional (Rivermead Mobility Index and Modified Rankin Scale) and some laboratory and instrumental data were assessed. Results. The fraction anisotropy was analyzed on the side of lesion and symmetrically. The decline of anisotropy was revealed in posterior limb of internal capsule on the side of stroke independently of the lesion location. Also the interactions between fraction anisotropy and stroke severity, global cognitive status and duration of hospital treatment were found. Conclusion. The obtained data may suggest that in acute period of stroke the neurodegeneration and neuroreparational ready start. It appears the changes of white and gray matter integrity. According to the concept “heart-vessels-brain” we received the data indicating the significance of vascular risk factors which lead to hypoperfusion and hypoxia in the development of microstructural changes. Some parameters of fractional anisotropy may predict clinical and functional outcome on discharge.

Aim. To evaluate the possibility of simultaneous magnetic resonance angiography of carotid arteries and contrast-enhanced magnetic resonance imaging of carotid atherosclerotic plaques. Material and methods. 24 persons entered in research: 16 (66.7%) patients with extensive atherosclerosis of aorta and large arteries and in 8 (33.3%) control persons. Using four-channel quadratur phase-array coil for head studies the brain MRI, MR-angiography of carotid arteries and MR-tomography of carotid atherosclerotic plaques were carried out using contrast enhancement with 0,5M cyclomang (Mn-diaminocyclohexanetetraacetate) solution. The angiography employed 3D GR FFE fast gradient echo protocol (TR/TE/FA/ST = 10 ms / 2.7ms / 20°/ 1.5 mm). MRI of carotid arteries used the T1-w.spin-echo scanning with TR = 500-700 ms, TE = 10 ms, with slices as thin as 1-3 mm, matrix 256 x 256, and voxel as small as 0.2 x x 0.2 x 2 mm. Results. The mean transit time for the paramagnetic contrast passage through brain haemispheres was in healthy control persons as short as MTT = 4.23 ± 0.14 s for the left and MTT = 4.27 ± 0.15 s for the right. The MTT in patients with single-side stenosis was on the involved side as long as 4.89 ± 0.23 s, whereas on the intact side 4.56 ± 0.19 s (p > 0.05). In bilateral stenosis the MTT was 4.98 ± 0.21 s and 5.01 ± 0.16 s (p > 0.05) for the left and right sides respectively. In all cases of aherosclerotic stenoses the contrast-enhanced MRA with cyclomang provided the correct diagnosis of both location and extent of the stenosis. The degree of stenosis calculated for the MR-angiography correlated significantly with the data of ultrasonic study calculated using ECST technique both for monolateral (r = 0.87, p < 0.05) and bilateral (r = 0. 85, p < 0.05) stenoses. High-risk inhomogenous plaques with high lipid content demonstrated high indices of enhancement on contrast-enhanced MRI scans: IE = 1.26 ± 0.07, whereas in dense fibrous avascular plaques IE = 1.09 ± 0.04 (p < 0.05), providing efficient detection of risk plaques. The entire time of the study did last for as long as 41 ± 5 min when including time-of-flight protocol of angiography and 29 ± 5 min without it. Conclusion. Thus the contrast-enhanced MRA and MRI of carotid plaques with manganese paramagnetic complex can be carried out simultaneously as a single study using four-channel quadratur phase-array coil for head studies.

Herpetic encephalitis is one of the most frequent and debilitating sporadic infections affecting CNS. According to WHO, it is the 2nd deadliest among viral infections. This article describes case of a healthy 27-year old woman with sudden onset of pronounced neurologic impairment. The patient was hospitalized by the ambulance crew with “acute stroke” as preliminary diagnosis. The definitive diagnosis was reached via comprehensive examination. Magnetic resonance imaging of the brain identified typical features of an encephalitis. The patient’s condition progressively deteriorated and despite treatment she fell into coma and died. Review of literature is also presented. Clinical and radiological features of atypical herpetic encephalitis are discussed along with treatment options.

Diffusion-weighted imaging (DWI) reflects Brownian motion of water molecules. DWI provides both qualitative and quantitative image analysis. In recent years, with technical advances, DWI has been increasingly applied to extracranial pathology, including liver diseases. In this article the basic principles of DWI, clinical application, studies of DWI in the differential diagnosis of focal liver lesions, evaluation of tumor response to chemotherapy and local treatment are discussed.

Postoperative biliary complications with the rate of 15-20% of cases remain the important problem in patients after liver transplantation. The presented brief review is an attempt to summarize the data of literature regarding to the main types of strictures, their causes, and their adequate detection by magnetic resonance imaging. The key moments of the use of magnetic resonance cholangiography in patients after liver transplantationare described. Detailed attention have been done to the indications and diagnostic value of the method in this group of patients.

Objective. To assess the prognostic value of the collateral flow through abdominal inconstant arterial collateral pathways of persistent primary origin, as defined with MSCT angiography (MSCTA), in terms of its providing one of the criteria for resectability of pancreas cancer. Material and methods. Both retrospective and prospective analyses of the diagnostic and treatment outcomes data from 837 patients who had presented to Vishnevsky Surgery Institute between 2008 and 2013 were conducted with evaluation of diagnostic accuracy of MSCT. 627 (74.9%) out of them made up the screening group (controls), the group of operated subjects comprised 85 (10.2%) patients who had undergone different types of radical pancreatic surgery with resection of the great arteries. A group of 98 (11.7%) patients had pancreatic tumors deemed unresectable by MSCT. There were also 27 (3.2%) cases of nontumor-related celiac artery stenosis. Intravenous boluscontrast-enhanced MSCT with post-processing of MSCTA data was performed on a Brilliance 64-Slice CT scanner or a Brilliance iCT 256-Slice CT system (Phillips, Cleveland, OH, USA) using a bolus-tracking technique: 2D multiplanar and 3D MSCTA reconstructions were generated with the Brilliance Workspace Portal (Philips Medical Systems), ARIS MultiVox version 5 (the Medical Computer Systems Laboratory at the Lomonosov Moscow State University’s Skobeltsyn Institute of Nuclear Physics). Results. In our unresectable pancreatic cancer patients 1. aberrant arterial anatomy was 2-2.5 times more commonly found and 2. follow-up MSCT showed the pattern of the celiac-mesenteric arterial vasculature to be changed by the presence of pancreatic tumor in such a way where the variant artery acted as a collateral. Not a single collateral artery was encountered in 20.4% of our cases of non-resectable pancreatic cancer. In most of the unresectable pancreatic cancer patients, no fewer than 2-3 collateral channels were seen. The occurrence of the left type collateral arcades was demonstrated to be 60.2% in the group of unresectable tumors. The MSCT achieved an accuracy of 100% in correctly identifying the celiac-mesenteric arterial vasculature type. There were no discrepancies between the imaging and intraoperative findings. Conclusions. In the setting of tumor involvement of the celiac-mesenteric territories’ major arteries, the accessoryhepatic arteries serve as collaterals routes. Functional inconstant preexisting abdominal arterial collaterals as depicted by MSCTA are a sign of invasion of the wall of a great vessel, evidence of their recruitment is highly indicative of pancreatic cancer unresectability. Altered Michels’ type of the celiac-mesenteric arterial architecture in non-resectable pancreas cancer suggests that the type of the celiac-mesenteric arterial anatomy cannot be presumed consistent at all times. Its estimation only holds true at the time of scanning. Detection of the left type collateral arcades significantly reduces the chance of pancreatic tumor resection.

A lot of opportunities for application of methods and ways of rational use of them have opened after licence to use the ultrasound contrast agents in Russia. Purpose: rate possibility contrast-enhanced ultrasound in the diagnosis of pancreatic diseases. Materials and methods. In our study we presented the first experience of contrast-enhanced ultrasound for 10 patients with diseases of the pancreas. All researches were done transabdominal and intraoperatively. All patients were operated on, education morphologically verified. Results. We have developed criteria for the selection of patients with pancreatic diseases for contrast-enhanced ultrasound and have identified the most difficult diagnostic areas, where the use of contrast agents could improve the diagnostic accuracy of method. Conclusion. Contrast-enhanced ultrasound (CEUS) allows to evaluate the vascular architecture of focal changes of pancreas both preoperatively and intraoperatively, that is a promising method of modern diagnostics. CEUS helps to carry out a localization diagnosis of masses, differential diagnosis of tumors and inflammatory changes, and allows to assess the prevalence of malignancy in detail.

Primary multiple tumors are an independent emergence and development two or more neoplasms in one patient. Thus can be the struck not only different bodies of various systems, but pair bodies (mammary glands, lungs, etc.) also, and one body with multicentric defeat. Primary multiple tumors can be synchronous and metachronous. The increase in frequency of multiple neoplasms is noted in recent years. The factors influencing growth of incidence of malignant primary multiple tumors are: increase in average duration of life as in general, and after successful treatment of oncological diseases; increase of intensity of cancerogenic influences, urbanization, accumulation of a hereditary burdeness, improvement of diagnosis of oncological diseases. Insufficient knowledge of doctors of possibility of multiple tumoral defeat, often, is the reason of that after detection of one malignant tumor possibility of existence of other tumors isn't taken into account and therefore purposeful research of other parts of body in which the tumor, and also other bodies developed in certain cases isn't made. Also, considering the opportunity of development of metachronous tumors, postoperative monitoring of the patient condition has to become an important aspect of tactics of treatment of the patients with this pathology.

Abdominal pseudomyxoma is a rare condition without any specific symptoms. Abdominal pain, nausea or ascites often can be the only symptoms of abdominal pseudomyxoma for a long time after the disease onset. In the majority of cases when patients present with unspecific abdominal symptoms, ultrasound and endoscopy are performed. However, these diagnostic procedures have low sensivity for detection of abdominal pseudomyxoma, which results in late diagnosis and unfavourable prognosis. In the given clinical case importance of CT in patients with abdomianl pain and ascites in the absence of other known cause is emphasized.

The problem of early detection of breast cancer (breast), an accurate assessment of the extent and stage of the process remains one of the most important in modern oncology. Breast cancer (BC) in Russia takes first place in the structure of oncological diseases of the female population - 19.5% and first place in mortality (over 8000 women). The annual growth of 1.5-2.0% (more than 15 thousand new cases). Purpose. Analysis of the possibilities of standard and optional procedures RMG (radiograph in mediolateral projection, aksillografiya, aiming X-ray region of interest with maximum local compression, microfocus X-ray with an increase of 1.8) in early breast cancer diagnostics complex, determining predictors of use of noninvasive and invasive diagnostic methods of research according to RMG. Materials and methods. 2680 women are examined. These standard MMG in 11.8% of cases may not accurately characterize the visualized lesions, are sure to appreciate that they belong to a certain category of classification, require the use of diagnostic ultrasound and MMG. The results of the standard and diagnostic RMG, and ultrasound in 423 patients with the non-palpable breast masse syndrome (NPBM). Additional projections for diagnosis NPBm applied at 10.5% of the cases both individually and in combination. RMG in lateral projection (n = 398 (6.2%)) contributed to the exclusion of processes, “mimicking” pathological changes in: layering summation structures, simulating mass lesion or a portion of the restructuring of the 32 cases, and demonstrated stability skialogicheskoy picture. Aksillografiya (1.5%) was performed 98 patients to clarify the characteristics of the axillary LU collector, but only 2 cases, changes in the LU had metastatic origin. RMG with maximum compression (n = 76 (1.2%)) and microfocus sighting mammograms with an increase of 1.8 times (n = 101 (1.8%)), particularly in identifying structures of small size (less than 5 mm), and the restructuring of the MCC without displaying ultrasound, allow confidence to visualize the morphological characteristics, categorize the pathological changes, avoid unwarranted biopsies. Results. The use of non-invasive radiological techniques RMG diagnostic algorithm research at non-palpable breast masse syndrome increases the information content of the standard RMG 5%, which is comparable with the results of the application of techniques tomosynthesis (but not type IV radiographic density of breast tissue on the ACR). Studies in additional projections allow confidently identify characteristics shadow pattern defining malignancies. Qualitative characteristics of visible changes associated with histological type of cancer. Conclusions. Using an arsenal of available imaging techniques, standardization and uniform interpretation of the revealed changes formed the basis of the diagnostic algorithm non-palpable formations breast to determine the optimal route survey, strategy and tactics of the patients that we believe will help to reduce the number of unwarranted biopsies, optimizing the timing of examination of patients, improve efficiency diagnostic in identifying non-palpable breast masse syndrome.

The purpose: the development and implementation of Digital X-ray diagnostics Low dose of innovative techniques. Materials and methods. Work carried out in the City Mariinsky hospital on 3 digital X-ray machines companies “Electron” (Russia). We use technology Digital X-ray diagnostics, modification which makes them low-doze. These were pulsed fluoroscopy with digital radiography for contrast studies of the stomach; Digital contrast barium enema for colon cancer research; digital chest X-ray with “virtual raster”; digital chest X-ray tough shooting mode. The study included 420 people. For the analysis of doses received by patients as a result of the screening of stomach and colon, were taken from 2 groups of 30 people surveyed according to the procedures developed and 2 control groups of 30 persons, in which the study was conducted by doctors-radiologists of the hospital, not performing accurately implemented the methodology, complementing her own unfounded techniques. Make digital radiography chest without raster 50 people, and digital chest X-ray by shooting rigid beams at a voltage of 120 kV - 100 people. We analyzed the dose control patients (50 people), which was carried out with X-rays chest raster and digital chest X-ray (100 people) was performed at a voltage of 100 kV Computer processing X-ray images included software features automated workstation (AWS), a physician, developed by the “Elektron”. Results. Developed innovative methods of x-ray examination of the stomach and the large intestine was more than 2 times of a low-dose, by reducing the number of images and fluoroscopy frames. Radiography OGK without raster and by hard shooting is possible to significantly reduce the radiation dose to the patient. Conclusions. 1. Continuous fluoroscopy as by high-technique, should be excluded from the practice of diagnostic studies. The rate pulsed fluoroscopy is selected depending on the purpose of the study. 2. The proposed innovative methods CR study of the stomach and colon, allowing patients to reduce the dose of 2.5 and 4 times, respectively. 3. Digital Radiography chest raster without patient exposure is reduced by 3.5 times. 4. In order to reduce patient dose digital chest X-ray screening recommended tough shooting mode. 5. In order to reduce the number of repeat shots and improve the accuracy of the digital radiography is necessary to use the entire arsenal of digital post-processing provided in AWS radiologist.

Purpose. To develop the reference range length of the fetal corpus callosum in 18-27 weeks of gestation. Materials and methods. Fetal brain was evaluated in 292 normal fetuses at 18-27 weeks of gestation. The multiplanar mode to obtain the mid-sagittal plane and measured length of the fetal corpus callosum. The length of the corpus callosum was measured from the most anterior aspect of the genu to the most posterior aspect of the splenium. Results. In 98% satisfactory visualization and measurements of the corpus callosum were obtained. Length of the corpus callosum is increasing during the second trimester of pregnancy. Normal range plotted on the reference range (mean, 5^th and 95^th percentiles) of length of the corpus callosum. Conclusion. Measurement of the length of the corpus callosum may be useful for assessment development of the corpus callosum in cases of suspicion on cerebral anomalies like hypoplasia, partial agenesis of the corpus callosum.

One of the actual problems of modern obstetrics is the obstetric bleedings at the postnatal period. The abnormal attachment of placenta is the most significant reason for postnatal bleedings, making 36% of cases of maternal mortality of blood loss. Clinical case of pregnant P, 37 years old, with the verified case of placenta increta is presented. Opportunities of the set of radiological methods of diagnostic (US and MRI) for searching of abnormal attachment of placenta are shown. Ultrasound findings: the placenta is on the front wall of a uterus, completely blocks the area of internal os with transition to a back wall of a uterus, on some sites lack of the border between miometry and placentary tissue is seen on imaging. Color Doppler shows multiple lacunas with a turbulent blood flow. MRI data (T1, T2 (FASE), T2 SSFP): the placenta is located on the front, back and right side of uterus walls, going down to internal os, completely blocking it. In the area of a postsurgical scar throughout 35 mm, the heterogeneity of miometry due to existence of the expanded spiral vessel visually not separating from a back wall of a bladder is noted. Cesarean delivery was carried out at 35 weeks according to vital indications.. During the operation there was revealed an extensive germination of placenta into the lower segment of the uterus which demanded the metroplastic by Petrovsky.

The aim: to assess the impact of surgical and interventional revascularization on parameters of deformation (S) and strain rate (SR) longitudinal, circular and radial fibers of the LV myocardium. Materials and methods. The analysis of the S and SR of longitudinal, circular and radial fibers 216 and 234 in the LV segments before and after surgical and interventional revascularization. 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. Surgical revascularization has a negative impact in the early stages on a circular fiber, since in most (167 (77%) segments noted a decrease S and SR. The impact of interventional revascularization in the early period showed the positive dynamics of the deformation properties of all Lv myocardial fibers. Positive dynamics is observed in longitudinal SR (171 (73%) and circular (124 (52.9%) fibers. Normal S and increased SR observed in radial fibers (187 (80%). All segments with the change of direction its motion regained its function. Conclusion. Technology Velocity Vector Imaging to conduct a detailed analysis of L_V segments and to estimate the dynamics of the deformation properties of longitudinal, circular and radial fibers after revascularization.

Lipoid pneumonia is an infiltration of the lung parenchyma with subsequent fibrous induration as a result of lipoid substances inhalation or due to accumulation of endogenous lipid material in lungs. In this article literature data are analyzed, and own clinical observations on lipoid pneumonia are provided since it was suspected by computed tomography fulfilled to the patients with neoplastic lesions of the upper respiratory tract who use oily products for tracheostoma’s toilet. Risk factors, mechanism of development, clinical features, as well as X-ray description of the disease are provided.