Purpose. To assess the diagnostic efficacy of diffusion kurtosis inaging in grading of brain gliomas. Material and methods. Absolute and normalized to the contralateral normal appearing white matter values of diffusion tensor parameters (mean, axial and radial diffusivities, fractional and relative anisotropies) and diffusion kurtosis parameters (mean, axial and radial kurtosis, kurtosis anisotropy) of tumors were compared in the most malignant solid parts of 27 (44%) low grade gliomas, 14 (23%) grade-III and 20 (33%) grade-IV gliomas (p < 0.05 significance level, Kolmogorov-Smirnov test). Results. Absolute and normalized values of all diffusion parameters (except of absolute fractional and relative anisotropies) were significantly different between high and low grade gliomas, and maximal sensitivity and specificity were found for normalized values of mean kurtosis (85,19% and 85,29%) and radial kurtosis (85,19% and 85,29%). Absolute and normalized values of all diffusion parameters (except of absolute and normalized values of fractional and relative anisotropies) differed significantly among grade-III and grade-IV gliomas, and maximal sensitivity and specificity were found for absolute mean kurtosis (92.86% and 90.00%). Only normalized values of mean, axial and radial kurtosis were significantly different between low grade and grade-III gliomas, and maximal sensitivity and specificity were found for normalized values of mean kurtosis (77.78% and 78.57%) and axial kurtosis (77.78% and 78.57%). Conclusion. Diffusion kurtosis imaging demonstrated a promising potential to differentiate among glioma grades. Kurtosis parameters better differed between gliomas grades compared with diffusion tensor parameters.

Aim: to study the clinical and sonographic characteristics of inflammation of the meibomian glands - dialazion to determine the tactics of treatment. Materials and methods. 24 patients (26 eyes) with dialazion aged from 25 to 66 years were examined using complex ultrasound examination with multifunctional ultrasonic diagnostic system Voluson 730 (GE Healthcare) and a linear probe Sp 10-16 MHz. In addition, ultrasound biomicroscopy (UBM) of eyelids was performed using 48 MHz probe Accutome UBM Plus. The removal of inflammatory structures was performed outside of exacerbation period using radio wave apparatus Surgitron (USA) or traditional surgery under regional anesthesia. Surgical removals of masses were histologically verified. Results. Chalazion was diagnosed in 23 (96%) patients (25 eyes); adenocarcinoma of the meibomian gland was determined in 1 case. Ultrasound and UBM echographic images of dialazion depended on the size, degree of manifestation inflammation, the presence of the capsule. Color Doppler Imaging did not show any vascular structures in the pathological focus. Preoperative conservative therapy was performed in cases of inflammatory. In one recurrent case was revealed adenocarcinoma of the meibomian gland. Conclusion. Complex ultrasound with UBM of eyelids and periorbital area allows us to determine the character of the pathology, the localization and relationship with the surrounding tissues, degree of inflammation that helps to diagnose and determine the tactics of treatment of dialazion.

The extent of locally advanced tongue cancer and the presence of metastases need to be determined for adequate treatment planning. The standard diagnostic process for these patients include CT and MRI. Purpose. The aim of the investigation was to determine the possibilities of ultrasound examination in patients with carcinoma of the tongue and of the floor of the mouth. Material and methods. 128 patients were examined, 92 (71.2%) male and (28.8%) female. Median age was 55 years. All patients in this group had a primary tumor size more than 15 mm in greatest dimension and the tumor was well differentiated on ultrasound examination. All patients underwent ultrasound examination in outpatient clinic in order to determine the primary tumor extent. The results of ultrasound examination were compared with MRI, morphological examination of the tumor. The majority of patients (124 (96.9%) had squamous cell carcinoma of tongueor floor of the mouth at morphology. Results. Ultrasound examination allow effective tumor determination in all patients, evaluate the extent of primary tumor to the lingual artery, sublingual artery, extent over the midline to the counterlateral part of the tongue in case of unilateral lesion. While comparing the US and MRI data of tumor size assessment a correlation was found, the correlation coefficient was 0.68. The information about the tumor extent gives an opportunity to perform more organ preserving surgery. Conclusion. Ultrasound examination assists in visualization of tongue and floor of the mouth tumors, determination of local extent, planning of surgical procedure.

The article contains a review of publications over the last 10 years dedicated to the venous pool of superior vena cava, in particular, the azygos and hemiazygos veins in portal hypertension. Attention is drawn to the fact that the role of the azygos vein in the pathogenesis of esophageal varices and stomach and bleedings from them in the syndrome of portal hypertension has not been studied. Insufficiently studied issues such as the status change of azygos at portal hypertension how a change in blood flow in the azygos vein as these changes are associated with the severity of varicose veins of the esophagus and stomach. The lack of dedicated work on this encourages a more detailed study of the role of the azygos vein in portal hypertension.

Hypertrophic cardiomyopathy is characterized by primary hypertrophy of myocardium without another cause such as arterial hypertension. We present a rare case of apical hypertrophic cardiomyopathy in 7-year-old girl with minimal nonspecific clinical manifestation (headache after loading). At planned examination typically ECG changes - pronounced repolarization changes and deep (about 10 mm) inverted T waves in precordial leads - were discovered. Transthoracic echocardiography detected local symmetric hypertrophy of left ventricular apex with reduced contractility of this area and intraventricular obstruction with pressure gradient between apical and middle parts of left ventricle 30 mm Hg. This findings were confirmed by ventriculograhy and myocardial scintigraphy. Cardiac magnetic resonance imaging determined marked fibrotic transformation of left ventricular apex. The features of this case are: the young age of the patient and combination of apical hypertrophy with intraventricular obstruction.

According to the current guidelines the left main disease with stenosis >50% by coronary angiography (CAG) is the indication for revascularization. However, the limitations of CAG in estimation of left main coronary artery lesions are well known. Purpose. To compare the results of CAG and intravascular ultrasound (IVUS) in patients with angiographically intermediate left main coronary artery lesions (<50%). Material and methods. IVUS was performed in 8 patients with left main coronary artery stenoses <50% by CAG. The measure of agreement of IVUS and CAG was assessed by Cohen's kappa coefficient. Results. The value of Cohen's kappa coefficient was 0.6 (CI -0.072 - 1.272; p = 0.064), which is showing that the results of IVUS and CAG has no agreement in making decision about surgery of left main coronary artery intermediate lesions. Conclusion. In patients with intermediate left main coronary artery lesions decision about coronary stenting should be made only on IVUS data.

Tuberculosis of the spine - an infectious disease caused by Mycobacterium tuberculosis. Tuberculous spondylitis is 50-60% of cases of all forms of osteoarticular tuberculosis. The diagnosis in this group of patients is based primarily on determining whether exposure to TB patients, trauma and other predisposing factors. Leading role in the diagnosis of bone destructive changes in tuberculous lesions of the spine play ray examination methods. Radiation pattern of tuberculous spondylitis depends on the duration of the process. Each of the methods of beam diagnostics has its own advantages and disadvantages when examining patients at different phases of the disease (prespondilitis, spondilitis, postspondilitis). To date, the presence of extensive hardware base, requires a clear approach in the diagnosis of tuberculous lesions of the spine. In this connection, an analysis of literature, which showed that, despite the fairly large number of studies on tuberculosis of the spine, it is necessary to conduct a study that would have been implemented comprehensive clinical and diagnostic approach, which would allow the algorithm to develop a rational examination of patients with suspected tuberculous lesions of the spine, improve the quality of diagnosis and optimized treatment strategy.

Pigmented villonodular synovitis (PVNS) is a rare disease that affects the synovial membrane of joints, mucous bursa, tendon sheaths, combining features of both inflammatory and neoplastic process. Given the lack of specific clinical symptoms, radiographic, US and CT findings it takes several months from the onset of symptoms to definitive diagnosis. MRI can not only detect and characterize the changes in detail in the joint and to differentiate them from other illnesses by its intrinsic possibility to identifying hemosiderosis which is typical for PVNS, but also to evaluate the extent of lesions, including extraarticular, facilitating selection of the optimal treatment strategy.

Purpose: assessrnent of^99mTc-MIBI SPECT and SPECT/ CT capabilities in diagnoses of sternurn osteornyelitis in patients after sternotorny. Material and methods. 28 patients with (suspected postsurgical sternurn osteornyelitis (n = 21, 75.0%) and patients with neoplastic, inflarnrnatory or other diseases of lungs or rnediastinurn without sternurn involved (n = 7, 25.0%) were undergone^99mTc-MIBI SPECT and SPECT/CT Results. Scintigraphic sign of sternurn osteornyelitis was pathological intraosseous accurnulation^99mTc-MIBI in sternurn. On basis of this sign sensitivity, specificity, positive and negative predictive values, accuracy of^99mTc-MIBI SPECT were 88.9%, 100.0%, 100.0%, 83.3% and 92.9%, respectively; sensitivity, specificity, positive and negative predictive values, accuracy of SPECT/CT were 94.4, 100.0, 100.0, 90.9 and 96.4%, respectively. Cause of the false-negative results of^99mTc-MIBI SPECT were connective tissue growth in chronic inflarnrnation’s area, and incorrect congruence also between focus of rnarker hyperfixation and soft tissue of anterior chest wall due wide sternurn diastasis in patient with fixation sternurn failure. Through the use of SPECT/CT second false-negative result was avoided. Conclusion.^99mTc-MIBI SPECT and SPECT/CT are perspective and available tools for indication of sternurn osteornyelitis in patients after sternotorny. But sensitivity of SPECT/CT is higher than^99mTc-MIBI SPECT due better spatial congruence between inflarnrnatory focuses and anatomical structures.

Sclerosing adenosis is a benign breast disease, clinically and radiologically simulate breast cancer. Using a standard set of clinical workup (clinical examination, mammography, cytology examination of fine needle biopsy) impossible to answer an opinion about benign nature of the process. Typically, the final diagnosis is made after diagnostic operation sometimes repeated (partial resection). Powered observation case demonstrates that timely use of breast MRI with gadolinium-containing drugs has allowed a correct diagnosis and to avoid the next surgery.

Emission imaging and radionuclide diagnostics of inflammation and infection are based on local physical and chemical changes of affected tissue. Emission imaging allows demonstrating functional status of pathology while other modern methods (CT, USG and MRI) are based on morphological changes. Imaging using radiopharmaceutical allows estimating foci of early development stage. Unfortunately, nowadays there is no “ideal” radiopharmaceutical (fast accumulation in inflammation, fast excretion, low toxicity, discrimination between inflammation and infection, low cost). Therefore, the world experience of radiopharmaceutical using for inflammation imaging and their positive results were providing foundation of sufficient number of radiopharmaceuticals for independent select of using different labeled agents.

Radioology plays a primary role in the diagnosis of various cancer diseases. Continuous development and improvement of ultrasound method compels us pay more attention to emerging new technologies, in order to timely implement them in clinical practice. In the present article we have tried to highlight the main aspects and possible applications echo contrast agents, as well as the ability to synchronize ultrasound, CT and MRI images. In the current article are described classification, physical principles and the basic types of echo contrast agents (ECA), the methodology of performing ultrasound study with contrast agents, the most important advantages and disadvantages of this technique and our own clinical observations. Especially promising is the synchronization of CT and MRI images with contrast ultrasound images when there is an opportunity to take advantage of CEUS and avoid the adverse effects of the additional radiation exposure, and introduction of iodine and gadolinium-containing agents. Undoubtedly, the use of ehokontrastirovaniya opens new horizons in ultrasound diagnostics, allowing to increase its effectiveness and informativity, providing a largely unique diagnostic information.

The contrast-enhanced ultrasonography with the usage of SonoVue agent have become widespread and clinically significant in recent years in foreign countries. In Russia this method has never been used, but with the state registration of the SonoVue a prospect of its implementation in clinical practice appeared. The experience of foreign colleagues in contrast-enhanced ultrasonography of liver, pancreas and kidney diseases was analyzed, up-to-date results were generalized and main directions of using this method in clinical practice were determined. Searching in PubMed with keywords “sonovue”, “contrast enhanced ultrasound”, “sonovue liver”, “sonovue pancreas”, “sonovue kidney” showed 65 recent publications, which have been grouped according to the sections of this article. The systematic ultrasound semiotics of focal lesions of the abdominal cavity described the indications and contraindications to the contrast-enhanced ultrasonography. The usage of the second generation contrast agent - SonoVue in ultrasound diagnosis of liver, pancreas and kidney diseases is a promising, safe and accurate method, so that will decrease the need for more expensive imaging techniques such as CT and MRI, especially in patients requiring continuous dynamic monitoring of the effectiveness of treatment.

We analize the data from a literature on an employment of contrast-enhanced ultrasound in studying the structure and stability of atherosclerotic carotid plaque and estimate the first attempt of use of the Sonovew contrast in this work. Adjustment of approach was performed on 3 patients with the atherosclerotic lesion of the carotid artery. It was carried out the traditional duplex scanning and investigation of plaque with use of the Sonovew contrast. Two plaques extracted during carotid endarterectomy were investigated hystologically. Both extracted during carotid endarterectomy plaques were characterized in ultrasonoc investigation as heterogeneous, mainly hypoechogenic. The application of the contrast reveals neovascularization in both plaques wich was proved in hystological investigation. Conclusions. The use of the Sonovew contrast allows to reveal neovascularization in the carotid plaque which serves as a marker of its nonstability. It may be used for stratification of risk and also for monitoring of an antisclerotic therapy. This is very actual for patients with the distributed atherosclerotic lessions because it allows to choose a tactic and sequence of operations in multistep surgical treatment.

The role of ultrasound is well-known to be the noninvasive imaging modality chosen for the first evaluation of the pancreas. The advent of ultrasound contrast agents has raised the possibility of techniques to identify and differential diagnosis of pancreatic lesions. Analysis of the literature over the past 20 years has shown the advantages and disadvantages of various ultrasound in the evaluation of focal lesions of the pancreas.