Objective: identify the structural features of the brain provision during motor loads of different complexity in healthy subjects. Material and methods. Comparison of fMRI cerebral reactions (individual and group) while active, passive and imagined right or left hand movement were analyzed in 20 right-handed healthy subjects by using paired t-test. Results. During active movements to clenching-unclenching the fingers motor fMRI responses were the more local and reproducible in comparison the bust fingers ones. This fact allows us to recommend this motor task as the most adequate at study of patients with cerebral disorders. The lower intensity of cortical responses and the more activation of subcortical structures was observed during left hand movement in comparison right hand one. During passive movements was observed the low volume of cerebral activation especially in cerebellum and primary motor cortex in comparison active ones. The main cortex fMRI response topography was similar while both active and passive tasks that allowed to use passive paradigm for patients with motor disorders and disturbance of consciousness. During imagined hand movements changes dramatically interplay of activated cerebral structures in comparison real movements: fMRI responses in the sensory-motor area and cerebellum were attenuated while activation of frontal zones and structures of ipsilateral hemisphere was increased. Conclusion. Comparative analysis of fMRI responses during active, passive and imagined hand movements showed that structural specificity of cerebral activity were determined by complexity of motor paradigms and by different including of motor and cognitive programs in their realization.

Hepatic Alveolar Echinococcosis (HAE) is a potentially dangerous natural focal parasitic disease, which is characterized by severe chronic progression and frequent recurrences. Although histopathologically a benign disease, HAE shows the characteristics of a malignant tumor with destructive tissue growth, invasion of adjacent organs, and distant dissemination. There are several characteristic features of HAE lesion, which depends on location of the parasitic lesion within the liver and stage of disease, none of them is specific. This is why the differential diagnostic of HAE is difficult. The article deals with characteristic features and diagnostic criteria of HAE, compares possibilities of different methods of visual examination. In conclusion the article determines the optimal indications for use one or the other examination method.

Aim: to evaluate possibilities of CT-perfusion methods for differential diagnosis of the liver tumors. Materials and methods. The study included results of CT-perfusion of the liver in 50 patients. In subsequent histological examination of the material in 45 patients different types of cancer were identified (in 42patients:metastasis of extra hepatic tumors - 22, hepatocellular carcinoma - 12, intrahepatic form of cholangiocellular cancer - 6), or benign tumors (in 3 patients: focal nodular hyperplasia - 1, hepatocellular adenoma - 1, hemangioma - 1). Liver disease was not confirmed in 5 patients. CT perfusion was performed on Siemens Biographm CT (KVp - 100, mAs - 150, the number of “Omnipak” 300 mg/ml by intravenous injection - 50 ml, the rate of administration of contrast agent - 2.5-4 ml/s, the time from the introduction of a contrast agent till the scanning - 8 seconds, total scan time - 45 seconds). After obtaining a series of images of CT perfusion the data processing was carried out at the Siemens Multy Modality Workplace workstation in off-line mode. Quantitative analysis was performed on the following parameters: BV (blood volume), BF (blood flow), ALP (arterial liver perfusion), PVP (portal liver perfusion), HPI (hepatic perfusion index) and PMB (permeability). Results. Average values of perfusion in the liver parenchyma in the group of patients with “conventional norm” were the following: BF - 29.97 ml / 100ml/min, BV - 13.16 ml / 100 ml, ALP - 20.69 ml / 100 ml/min, PVP - 91.33 ml / 100 ml/min, PMB - 44.88 ml / 100 ml/min and HPI - 20.90% (p ≤ 0.05), in the group of patients with hepatocellular carcinoma: BF - 53.71 ml / 100 ml/min, BV - 12.42 ml/100 ml, ALP - 49.13 ml / 100 ml/min, PVP - 11.89 ml / 100 ml/min, PMB - 31.35 ml / 100 ml/min and HPI - 81.20% (p ≤ 0.05), in the solid component of cholangiocellular cancer (CROMAC): BF - 44.94 ml / 100 ml/min, BV - 14.89 ml / 100 ml, ALP - 49.58 ml / 100 ml/min, PVP - 29.10 ml / 100 ml/min, PMB - 34.90 ml / 100 ml/min and HPI - 69.83%, in the solid components of metastasis: BF - 25.62 ml / 100 ml/min, BV - 17 11 ml / 100 ml, ALP - 30.61 ml / 100 ml/min, PVP - 20.87 ml / 100 ml/min, PMB - 21.12 ml / 100 ml/min and HPI - 62.67%. Conclusions. CT-perfusion method allows to assess quantitative the hemodynamic properties of tissues in the different liver tumors that can be used in a primary differential diagnostics as well as to evaluate the effectiveness of the treatment.

Gall Bladder Cancer of a (GBC) though in general is considered rare, is the most widespread malignant disease of biliary tract and makes 80-95%. Early diagnostics of GBC is very important as its clinical manifestations aren't specific and can be observed at inflammatory processes. Therefore the tumor is revealed more often late enough, already during its distribution out of gall bladder. Features of an etiology and a clinical picture of GBC, which cause difficulties of its diagnostics and differential diagnostics are covered in article. The review of opportunities and restrictions of an ultrasonic method of research at diagnostics of GBC with application of various ultrasonic modalities (B-mode, duplex scanning, three-dimensional reconstruction, endosonography, application of contrast ultrasonic agents, elastometry) is submitted. The reasons of false positive and false and negative cases of diagnostics of GBC are analysed. The most effective methods of an additional examination of the patients at difficulties of differential ultrasonic diagnostics are shown.

Intraductal papillary neoplasms of the bile duct (IPNBs) is a collective term for such neoplasms and bile-duct mucin-producing and cystic tumors. Similar to intraductal papillary mucinous tumors of pancreas, authors identify 4 histologic types of IPNB based on mucin expression differences. We describe a rare case of intraductal oncocytic papillary neoplasms of the bile duct. Prognosis for IPNB is unclear; however, no doubt, it is more favourable for patients without an invasive component compared with IPNb combined with invasive carcinoma.

Pancreatic adenocarcinoma is one of the most challenging tumors to diagnose and to treat. Most patients present with advanced disease that obviates any attempt for curative surgery. Cross-sectional imaging has gained a vital role in the detection of pancreatic cancer and in the stratification of patients according to their tumor stage. Contrastenhanced MDCT is the main pillar in the diagnosis of pancreatic cancer, whereas MRI including MRCP, dynamic gadolinium-enhanced sequences and DWI has an established role as problem-solving tool. For tumor staging, the presence or absence of vascular infiltration, liver and lymph node metastases has to determined. According to their status, tumors can be categorized as clearly resectable, borderline resectable, and nonresectable (with distant metastases or infiltration into celiac trunk or superior mesenteric artery). It is the most difficult task for radiologists and surgeons alike to deal with the group of patients deemed borderline resectable. These patients may profit from a multidisciplinary therapy approach. A variety of neoplastic and non-neoplastic conditions may imitate the appearance of pancreatic adenocarcinoma. Radiologists should be aware of the imaging findings. In equivocal cases multimodality imaging including biopsy may be sought to make a confident alternative diagnosis.

Objective. To determine whether MDCT features of pancreatic neuroendocrine tumors can predict the pathological tumor grade. Materials and methods. 30 patients with histologically confirmed pancreatic neuroendocrine tumors (pNET) underwent preoperative contrast CT examinations from 2012 to 2015. 19 tumors were classified as G1 and 11 as G2 according to the WHO 2010 classification. We evaluated several CT-features of pNET, such as tumor contrast enhancement pattern, homogeneity, cystic or necrotic change, size, vascular involvement, upstream pancreatic duct dilatation, presence of regional and distant metastasis. Tumor density was measured at all phases. CT-features were compared between tumor grades using Mann-Whitney U-test and f-Fisher test. We evaluated the performances of the CT findings to diagnose G2 tumors. Results. Mean tumor size was significantly higher (p < 0.05) in grade 2 pNET. G2 pNET were more often nonhomogenous and had poorly defined margin. Tumor density was significantly higher in the group of grade 1 tumors. Mean arterial enhancement ratio in G1 pNET was 1.66 ± 0.42, in G2 pNET - 1.04 ± 0.39 (p < 0.01). Mean portal enhancement ratio in G1 pNET was 1.28 ± 0.25, in G2 pNET - 0.9 ± 0.1 (p < 0.05). Arterial enhancement ratio <1.1, tumor size > 20 mm, ill-defined borders and non-homogenous contrast enhancement showed 83%, 74%, 67% and 63% accuracy in differentiating Grade 2 pNET from Grade 1 pNET. Conclusion. Several CT-features of pNET, such as tumor contrast enhancement, homogeneity and size can predict the tumor grade.

Objective. To determine usefulness of diffusionweighted magnetic resonance imaging (MRI-DWI) with calculation of the apparent diffusion coefficient (ADC) for monitoring and early prediction of tumor response during chemotherapy (ChT) of lymphoma. Materials and Methods. Study included 25 patients with Hodgkin lymphoma and 26 patients with non-Hodgkin lymphoma (NHL). Whole body DWI-MRI was performed before and after ChT. MRI-DWI at the level of target lesion was performed after 1 cycle, before and after 2 cycles of ChT. The largest not necrotic lymph node was chosen as a target lesion. Built-in coil was used for whole body DWIMRI, surface and built-in coils were used for DWI-MRI of the target lesion. Results. During lymphoma ChT tumors decrease in size and ADC increases rapidly, to the maximum extent after 1 cycle of ChT. Earliest ADC increase was recorded on day 3 after the start of ChT. At subsequent stages of treatment ADC increase is slowing down. In case of tumor progression ADC decreases. In NHL target lesion ADC increase before 2nd cycle of ChT >37% predicts adequate response after 2 cycles with sensitivity of 93%, specificity of 90% and an accuracy of 92%. In patients with complete tumor response after ChT mean pre-treatment target lesion ADC was significantly lower (0.65 ± 0.15 ⋅ 10^-3 mm²/s) than in patients with non-complete response (0.94 ± 0.39 ⋅ 10^-3 mm²/s; p <0.05). Pre-treatment ADC ≤ 0.88 ⋅ 10^-3 mm²/s predicts complete response after ChT with a sensitivity of 100%, specificity of 50% and accuracy of 77%; an increase of ADC after the 1^st cycle >25% - with a sensitivity of 83%, specificity of 67% and an accuracy of 75%. When two parameters are used combined prediction accuracy increases to 83%. ADC values obtained using the built-in coil showed a lower prognostic properties compared with the values obtained using a surface coil. Conclusions. MRI-DWI can be used as a non-irradiative method of monitoring and early tumor response prediction during lymphoma ChT. ADC is a sensitive biomarker of tumor regression and progression in lymphoma.

Spondylitis is an inflammatory disease of the spine, which is manifested destruction of the vertebral body and subsequent deformation of the spine. Under specific spondylitis more often (40-50%) is Tuberculosis of the spine. With the progression of tuberculosis process and the transition to the adjacent vertebrae and complicated clinical picture can resemble hematogenous osteomyelitis of the spine. Identification and differential diagnosis of tuberculosis of the spine is often associated with a number of difficulties arising largely nonspecific clinical picture of the disease and the hidden currents. Improving the diagnosis of tuberculous spondylitis, taking into account medical history, clinical manifestations, laboratory data and the results of surveys of patients radiological methods of research remains an urgent problem. The aim: to clarify the possibilities of radiological methods of examination and improving the efficiency of the differential diagnosis of tuberculous spondylitis and osteomyelitis of the spine. Material and methods. The results of a comprehensive clinical and instrumental examination of 46 patients with a diagnosis of “tuberculosis of the spine” and 71 patients with a diagnosis of “hematogenous osteomyelitis of the spine”, treated at Hospital of Phthisiopneumology for the period from 2010 to 2015. Results. X-ray examination of patients with suspected tuberculous lesion development spine is necessary to assess complaints, history and duration of the disease. For tuberculosis of the spine characterized by sluggish development of symptoms (p < 0.03) and the presence of TB burdened by history (p < 0.01), in contrast to osteomyelitis of the spine. For the purpose of differential diagnosis of tuberculosis and osteomyelitis of the spine was analyzed diagnostic value of methods of radiation diagnosis, which showed that high levels of sensitivity in the detection of tuberculosis of the spine occur in the application of computed tomography (89.7%) and multislice linear X-ray imaging (84.6%) compared with standard radiography (82.2%). The specificity of the method was respectively 84.0%, 79.3% and 76.1%. Conclusions. In our study clarified clinical-ray signs of tuberculous spondylitis and osteomyelitis of the spine and for the first time in world literature revealed signs of radiation at multislice linear X-ray tomography. Obtain performance indicators (sensitivity, specificity, accuracy) of different X-ray methods in the diagnosis of tuberculosis and osteomyelitis of the spine.

The information on the developmental brain malformation megalencephaly is absent in modern manuals on prenatal diagnostics. There are data in the literature on diagnostics of megalencephaly in children. The cerebral gigantism (megalencephaly) is explained by the increase of cerebral parenchima, which can occur in response to several reasons. It has been argued that this abnormality is connected with initial disorders in neuronal proliferation. The body size of these children is not compatible with the large size of the head. This was the reason of the name - cerebral gigantism. This picture harmonizes with prosilient (porrect) forehead, Gothis palate, hypertelorism, dolichocephaly, large hands and legs. Unilateral megalencephaly - is a hamarto-shaped local or total increase of cerebral hemisphere with the defects of neutrons migration. Clinically unilateral megalencephaly is early evident by medicamentally resistant epilepsy, hemiplegia and hard subpar growth curve (arrested development). Assessments of two medical cases of prenatal determined diagnosis “unilateral megalencephaly” with emphasis on possibility of diagnostics are presented.

Given the literature data on the use of magnetic resonance imaging (MRI) for the detection of pathological processes in the dead fetuses and dead newborns. It is shown that the implementation of postmortem MRI allows to an objective and clear analysis of the pathological processes with their documentation and subsequent analysis. The highest indices of sensitivity and specificity of MRI were observed in the detection of lesions of the brain and spinal cord. Often the results of the MRI studies are superior to traditional autopsy data. It is noted that postmortem MRI cannot be the alternative for conducting autopsies, since it does not allow for histological, microbiological and molecular-genetic study of tissue samples and organs. MRI should be used as a complement to pathology examination, including as a kind of guide for better detection of pathology during autopsy.

Cancer of the cervix has invasive growth and affects adjacent organs. Clinical observation illustrates the features of radiation diagnosis of invasive cervical cancer. CT data were inaccurate. MRI had contraindications. A set of additional options has expanded the possibility of Ultrasound method. Strain Elastography combined with Doppler were the only possible methods for identifying invasive cervical cancer in the bladder. Correct diagnosis allowed choosing the right treatment for cervical cancer patient.