Objective. Estimated using the method of CT perfusion clinical significance of changes in regional blood flow at the level of craniovertebral junction in children with Chiari malformation 1 (CM1). Material and methods. The study on the relationship of functional vascular disorders and headache in 17 patients with Chiari malformation 1 from 2 to 18 years by the methods of the duplex scanning (DS) and CT-angiography was conducted. The method of the CT perfusion was further used in this group of patients, to the objectification of the results obtained. Results. There is interrelation between parameters of CT brain perfusion and regression of headache in patients with CM1 without syringomyelia. There is correlation between the methods DS, CT-angiography and CT perfusion. Conclusions. The method of CT perfusion in patients with CM1 confirmed the assumption about the participation of functional vascular disorders of the craniovertebral junction in the pathogenesis of clinical manifestations. The findings of this study can be used in determining the indications for surgical treatment of patients with CA1 without syringomyelia.

Purpose: to determine the most useful quantitative parameter of diffusion-weighted images (DWI) in the differential diagnosis of focal liver lesions. Aim: To develop and assess the technique of intraoperative sonography during cryoablation of neuroepithelial brain tumors. Materials and methods. 27 patients with brain tumors of glial cells underwent cryosurgery under control of intraoperative sonography (IS). Cryotherapy was performed using a new cryosurgical apparatus. The tumors had both superficial and deep localization in functionally important areas of the brain, the size ranged from 4.4 to 240.5 cm³ (mean 40.1 cm³). Results. Cryotherapy and intraoperative sonography were performed through a single burr hole in 20 cases, through two burr holes - in 7. Through one burr hole accurate tumor volume measurement is possible only up to 23 cm³, with larger volumes measurement error significantly increases. Two burr hole technique helps to improve the accuracy up to 80 cm³. IS allows us to control the positioning and immersion depth of the cryoprobe. The analysis showed that the intraoperative values corresponded to the calculated values obtained from the preoperative planning. It should be noted that thanks to the possibility to intraoperatively monitor the formation and size of the iceball, for the group of total cryo-therapy, the area subjected to cryogenic treatment slightly exceeded the tumor volume (by an average of 2.7 cm³) in all cases after surgery. Conclusion. IS during brain tumor cryoablation increases the accuracy of cryogenic instrument positioning, allows us to visualize the iceball in real time, confidently perform several cycles of cryotherapy, reliably monitor all stages of cryosurgery.

Diagnostics and treatment of malignant neoplasms of a gastroenteric tract - is one of the actual problems of modern medicine. Purpose. To improve the diagnosis of stomach cancer with help of modern methods of echography (B-mode, duplex, triplex and three-dimensional echography) to assess the extent of local and general prevalence of tumor Material and methods. The study include 85 people who were divided into 2 groups. Research group: complex examination and treatment was performed 55 (64.7%) patients with stomach cancer aged 36 to 82 years. Men were 33 (60.0%), women were 22 (40.0%). Control group: 30 (35.3%) healthy individuals aged 35 to 80 years. Men - 19 (63.3%) and women - 11 (36.7%). Results. Our researches showed that at a cancer of a stomach the increase in speed of a blood-groove in a seliac artery by 2.5 times, in the superior mesenteric artery by 2,0 times, in the left gastric artery by 1.7 times in comparison with norm that was accompanied by a tendency to decrease of RI is noted. Conclusion. Analysis of B-mode with duplex scanning and three-dimensional reconstruction echography revealed additional sonographic sings of the traditional two-dimensional data and contrast ultrasound for stomach cancer to recommend greater use of integrated ultrasound diagnosis in the pathology of the stomach.

Intussusception is the most common cause of obstruction in children, which can occur at different ages and combined with other diseases. Presented by clinical observation of intestinal intussusception in the family background of juvenile polyposis in a child under the age of 10 years. Child enrolled in the surgical department of Children's Regional Hospital with suspected abdominal cavity formation, which was identified by ultrasound. The diagnosis of intestinal intussusception set by computed tomography. Intraoperatively revealed intestinal implementation caused by a polyp was jejunum. The peculiarity of this clinical observation is the difficulty of diagnosis and identity manifestation of this type of intestinal obstruction, which originated in the mother and child. The girl was discharged in satisfactory condition at the 23rd day.

Objective: to explore the possibility of a hybrid imaging system for the visualization of an adjusted urinary tract. Materials and methods. The results of kidney and ureter ultrasonography, and excretory urography of 30 children (14 (47%) girls and 16 (53%) boys) aged from 1 to 15 years with hydronephrosis (11 (37%) children) and ureterohydronephrosis (19 (63%) children) were estimated. All patients underwent dynamic kidney scan followed by CT scanning on a hybrid imaging system Philips Precedence with 16-slice CT configuration. Results. This approach allowed us to obtain a complete visualization of ureter on CT scans, including intramural segment in 19 (63%) patients by a single CT scan. In 7 (23%) cases, the CT scan was able to visualize ureteropelvic junction. In 4 (14%) cases the ureter doubling was observed. Conclusion. The use of X-ray tomography, synchronized with a dynamic nephroscintigraphy allowed to visualize the ureter segment of interest in not more than by two CT scans. The latter was realized due to the accurate determination of the arrival time of the contrast agent in the ureter of interest by registering the kinetics of the radiotracer on dynamic recording. Therefore, the radiation dose to the child received in the performance of the hybrid study was less significant compared with that in the conventional CT scan, due to the lack of need for additional CT scans.

Objective: to estimate changes of a form and hemodynamics in the field of pathological tortuosity of the main neck's arteries depending on patient's position (in horizontal and in vertical position). Materials and methods. At duplex scanning, the neck's arteries and the intracranialarteries, which carried out to 350 patients, estimated a condition of the local and system hemodynamic importance of theinternal carotid artery tortuosity and the artificial deformations of vertebral arteries. For the first time research conducted not only in horizontal, but also in vertical position. Results. Among surveyed deformations of internal carotid artery revealed in 38.6% of cases, it was pathological tortuosity of left internal carotid artery in 18.5% and right in 23.7% of them. Some patients (66.7%) were with both side tortuosity. At pathological deformation observed acceleration of flow speed indicators from 55% to 65% in part of tortuosity, average value of systolic speeds of a blood flow was 166 ± 28.3 cm/s at the left and 174 ± 30.2 cm/s at the right side. In vertical position in 31.6% of cases at pathological deformation observed transformation of tortuosity form. Deformation corners became blunt, the gradient of flow speed indicators decreased or was absent, in some cases course of ICA became rectilinear. Artificial deformations of vertebral arteries course revealed in 79.4% of people, the deformations carried to the pathological in 15.1% cases of left and in 8.6% of right vertebral arteries, average value of systolic speed of a blood flow was 92 ± 15.3 cm/s at the left and 76 ± 12.5 cm/s at the right side.In vertical position in deformations of the vertebral arteries, which carried to pathological, in 28.8% of cases a form of deformation was transformed to unpathological tortuosity. Conclusions. Duplex sonography in vertical position in patients with tortuosity discovered new approaches in diagnostics of pathological deformations and defines indications to operative treatment.

Assessment of coronary flow is used during pharmacological tests. Nevertheless, supine bicycle tests have allowed the application of coronary flow assessments during exercise. The aim of the study was to define the outcomes of the consecutive cohort in three years period after coronary artery flow velocity analysis during exercise tests. Materials and methods. There is a single center prospective cohort study of 299 patients who underwent a bicycle exercise echocardiography with the analysis of coronary artery flow velocity in left anterior coronary artery (LAD). Coronary flow velocities were measured before and at the peak of exercise at the medium segment of the LAD. In addition, the coronary flow velocity reserve (CFVR) and the differences between the peak and rest velocities (ΔV) were calculated. Two hundred and fifty-nine patients were accessible for follow-up analysis (56 ± 9 years, 167 men). Cardiovascular death, nonfatal myocardial infarction, revascularization or cardiac arrests with cardiopulmonary resuscitation were defined as major adverse cardiac events (MACE). The period after stress test was 3.0 ± 0.1 years. Results. There were 77 patients with MACE. The group with MACE vs the rest patients had a lower velocity in LAD at the peak of exercise (58 ± 30 vs 68 ± 26 cm/s, p < 0.03), ΔV (18 ± 21 vs 35 ± 24 cm/s, p < 0.00002), and CFVR (1.5 ± 0.5 vs 2.0 ± 0.7, p < 0.00002). Among the group with CFVR > 2.1% had myocardial infarction, death or coronary artery bypass grafting in 3-year period. The group with CFVR ≤ 2 had МАСЕ in 40% of cases (p < 0.000001). Conclusion. The analysis of coronary flow in LAD during exercise can be used as a predictor of 3-year outcomes.

Objective: to evaluate the possibility of SPECT-CT in the diagnosis of coronary artery stenosis in comparison with data of CA. Materials and methods. The SPECT-CT and coronary angiography 39 (100%) patients with ischemic heart disease. Perfusion scintigraphy of the myocardium was performed on the apparatus SPECT-CT “SIMBIA” Siemens ECG-synchronized mode alone and with load tests. Entered RN “Technical,^99mTc” in a dose of 500-700 MBq. CAG was performed by a standard method on the Siemens Artis Zee Floor, Thoshibalnfinix CF-I/SP. Results. Myocardial hypoperfusion was visualized in 29 (74.3%) patients according to SPECT-CT, pathological changes of the coronary arteries was determined in 25 (64.1%) with invasive coronary angiography. Impaired perfusion of the myocardium of the left ventricle in 41% of cases were diagnosed at the edge and hemodynamically significant stenoses of the coronary arteries. A comparative analysis of these two methods who also has the results were obtained in 21 (53.8%) of the patient, stenotritidae - 8 (20.5%), false-positive - 4 (10.2%), false-negative - 2 (5.1%). In 10.2% of cases incorrect interpretation tomoscintigraphy performed with CT resulted in erroneous conclusions.Excluded from the investigation 4 (10.2%) observations, as was not diagnostic errors. The sensitivity was 91%, specificity of 67%, an accuracy of 83%. Conclusion. SPECT-CT is an a highly informative method in detecting violations of perfusion of the myocardium of the left ventricle in patients with hemodynamically significant and borderline coronary stenoses. Only a thorough visual assessment of scintigraphic images with correction for attenuation and without it permits to set the correct diagnostic conclusion. Given the high sensitivity and predictive value of both positive and negative results of perfusion scintigraphy of the myocardium, as well as non-invasive, it can also be used as the first diagnostic method for selection of patients for invasive coronary angiography.

Aim. To study diagnostic capabilities of the new method Automated Breast Volume Sonography (ABVS) in the reference to mammography. Materials and methods. ABVS were performed in 152 patients on ACUSON S2000 ABVS with a special transducer for automated scanning 14L5BV 14 MGz. All lesions were classified according to BIRADS classification, topography, presence of the retraction fenomenon, microcalcification by 2 experts independently. Inter-observer variability were classified under kappa value. All results were verified by cytological and pathomorphological examinations of the specimens. Diagnostic confidence of the ABVS were calculated. Results. Interrater variability values were good for BIRADS classification (k = 0.78), poor - for benign lesions (k = 0.53), and excellent (k = 0.96) for malignant. Retraction phenomenon that is seen by mammography in breast cancer also was specifically showed by ABVS, interobserver variability was high (k = 0.85). This symptom was seen in 88.2% in breast cancer. Sensitivity and specificity of the ABVS in breast cancer diagnosis according to our results were 87% and 72%. High sensitivity and specificity was proved in the case with high density breasts (types C and D) - 100% and 96% respectively. Resume. ABVS was highly effective in women with higher breast density. ABVS data can be compared with mammography data therefore could be recommended as an adjunct to mammography in the cases of suspicious dense breast lesions.

Aim. Assess the accuracy of measurement of peripheral nerves by ultrasound (US). Material and methods. Peripheral nerve diameters on different sites were measured using US, MRI and with manual measurement intraoperatively. US measurement and direct measurement of nerve diameters were made independently by US operator and neurosurgeon. US measurement was done by two independent investigators. Maximal and minimal diameter was measured in each case. The data were collected and then estimated statistically using linear Pearson correlation and range Spearmen correlation methods. Results. Obtained data have shown high correlation between US measurements compared with MRI and with direct intraoperative measurement with +0.98 (Pearson c.c.), +0.97 (Spearmen c.c.) and +0.97 (Pearson c.c.), +0.95 (Spearmen c.c.) respectively, when compared with the independent operator +0.99. Also, nerve diameters measured with US were slightly greater in all cases in compare with MRI data and direct intraoperative measurements, that can be explained by US measurement features. Conclusion. Ultrasound examination allows to highly accurately measure the peripheral nerves. Dependence of results from the operator is minimized when measured by the standard method.

Ultrasonic research is the integral component of modern radiodiagnosis and in domestic clinical medicine belongs to the most widely used methods of medical visualization. Use the contrast agents at ultrasonic research became an indispensable condition of researches of patients of any clinical profile at continuous improvement and development new the contrast agents in world clinical practice today. The basic physics and technology principles of contrast ultrasonic diagnostics, merits and demerits of the preparations applied the contrast agents are covered in the review.

Objective: to assess the diagnostic value of contrast enhanced ultrasound examination (CEUS) in the diagnosis of breast lesions in women and men. Methods and materials. We analyzed CEUS reports of 41 patients with breast masses (26 (63,4%) women and 15 (36.6%) men of 24-78 years of age). The results were compared with the data of cytologic and histological examinations. Qualitative and quantitative characteristics of contrast enhancement in benign and malignant lesions were assessed. Results. Accumulation and distribution of US contrast agent in breast carcinoma were characterized with the following features: 66.6% exhibited intense, irregular accumulation of contrast agent, 19% - only peripheral enhancement, 14.4% - marginal enhancement. CEUS in breast carcinoma demonstrated the following quantitative characteristics: time to peak (TTP) - 21.89 ± 1.6 (13.2-26.27); peak intensity (PI) - 21.8 ± 0.8 (18.7-25.34); descending time (DT/2) - 53.67 ± 5.04 (31.86-72.2). The sensitivity of CEUS in detection of breast carcinoma in women was 87.5% with specificity of 90 % and diagnostic accuracy of 88.5%. The sensitivity of CEUS in diagnosis of breast carcinoma in men was 83.3%, specificity - 80%, and diagnostic accuracy - 81.25%. Conclusion. CEUS is an effective additional diagnostic technology, which increases the efficacy of complex US in patients with breast carcinoma. Further analysis of application and methodological aspects of CEUS demand additional studies and accumulation of the data, standardization of the method with introduction of the technology in practical public health services.

Oncological patient undergo CT up to 2-6 times per year, that leads to high radiation dose. One of the factor of high doses while abdomen CT study is multiphasic scanning. Purpose: optimization of contrast enhanced CT in dynamic monitoring of oncological patients. Materials and methods. Simultaneous venous-arterial phase MSCT technique was developed, which was based on serial injection on two contrast boluses to receive combined images of arterial and venous phases in a single scanning. Method was tested on 103 patients. Results. The data received in all cases of venous-arterial scanning enable to evaluate treatment response with RECIST criteria, determine tumor invasion in vessels and organs. Conclusion. Simultaneous venous-arterial scanning enable to evaluate treatment response and to significantly reduce radiation dose in compare with bi-phasic CT of abdomen.

Oxygen plays significant physiological role in fetal development. It is important in major embryonic processes like angiogenesis, hematopoiesis, chondrogenesis, and placental development. Acute or chronic hypoxia can have negative impact on a fetus at any stage of the process of development. Prenatal hypoxia is an important cause of brain injury of the newborn. It may lead to a variety of different long-term neurological disorders: from mild behavioral deficits to severe compromise with seizures, mental retardation and cerebral palsy. Fetal cerebrovascular responses to hypoxia are fundamentally different from those observed in the adult cerebral circulation. This article discusses the causes and mechanisms of perinatal hypoxia, as well as its early and late postnatal consequences. The study of the pathogenesis of the formation of fetal cerebrovascular disorders, as well as the description of their features are of particular importance for complex diagnostics of pathological obstetric conditions and neurological disorders, and for optimization of therapeutic interventions to reduce perinatal losses.

Purpose. To develop the reference range of the craniocaudal diameter and anteroposterior diameter of the cerebellar vermis. 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 craniocaudal diameter and anteroposterior diameter of the cerebellar vermis. Cranio-caudal diameter was defined as maximum distance between cranial and caudal surfaces of the vermis, anteroposterior diameter was defined as the maximum distance between anterior and posterior surfaces of the vermis. Results. In 98% satisfactory visualization and measurements of the cerebellar vermis were obtained. Size of the cerebellar vermis is increasing during the second trimester of pregnancy. Developed the reference range (mean, 5th and 95th percentiles) of the cranio-caudal diameter and anteroposterior diameter of the cerebellar vermis. Conclusion. Sizing of the cerebellar vermis may be useful for assessment development of the cerebellar vermis in cases of suspicion on cerebral anomalies like cerebellar vermian hypoplasia, partial agenesia of the cerebellar vermis, Blake’s pouch cyst. The use of normative values of the cranio-caudal diameter and anteroposterior diameter of the cerebellar vermis will assess its development and increase the percentage of detection of anomalies of the fetal brain during the second trimester

The tendency to increase the role of radiation therapy in complex treatment of cancer patients is observed in the world nowadays. Taking into account today's wear of the equipment and the needs of its modernization, not less than 50 accelerators have to be installed in Russia annually. The method of calculation of the protection set forth in the current regulations, does not take into account a number of important conditions that can significantly affect the parameters of necessary protection. This article suggests a new approach to the calculation of radiation protection and standardization of accelerator parameters used for the calculation. The concept of a standardized weekly workload at the isocenter is proposed as well as the values of the directivity factor, the shift index, the occupancy rate. When carrying out dosimetric control, it is required to move from the dose rate measurement to the measurement of the dose at the point for the faction. These measures will allow to simplify the calculation of radiation protection from accelerator that would eliminate abuses by design and oversight organizations when developing and reviewing projects. If the measurement of the dose at the point is introduced as a dosimetric criteria, it will allow to avoid significant errors, as in the measurements and in their interpretation.