Purpose: to evaluate variants of location and displacement of the dilated lacrimal sac estimation in patients with dacryocystitis on the basis of non-enhanced computed tomography data in order to optimize the endoscopic surgery tactical decision. Materials and methods. Morphometry of lacrimal sac displacement in preoperative non-enhanced computed tomography scans of orbits was performed in 178 patients, which divided into two groups: test group - 106 (59.6%) orbits with clinically confirmed dacryocystitis and control group - 72 (40.4%) orbits without it. Obtained data were statistically processed and compared with operation protocols and 4D-rhinoendoscopy video data. Results. Data on variants of the lacrimal sac center location in normal and symptomatic dacryocystitis were obtained and statistically processed. It was demonstrated that the displacement of the lacrimal sac is not an actual dacryocystitis criterion. Heterogeneity of the data corresponds to the published data concerning high variability of intranasal landmarks. Method of virtual endonasal 4D-dacryocystorhinoendoscopy was developed to replace the qualitative and quantitative text description of CT scans. Visual information obtained using this method provides successful completion of endoscopic surgery even in cases with discrepancies of verbal description and computed tomography results with intraoperative data. Conclusions. Visual documentation of the investigation is more valuable for the surgeon-endoscopist and enables making precise tactical decision in rhinoendoscopic surgery even when doubtful CT description protocol data were provided before.

Objective: to study the data of ocular blood flow in patients with different clinical variants of the complications proliferative diabetic retinopathy, and regarding to intraoperative hemorrhagic complications. Material and methods. Through Duplex ultrasonography 62 persons were investigated: 42 (68%) patients (42 eyes) with complicated forms of proliferative diabetic retinopathy and 20 (32%) healthy individuals (20 eyes). Results. The results showed deficiency of retinal blood flow, correlating with the severity of proliferative diabetic retinopathy. The most severe cases of the disease, intraoperative hemorrhagic complications were associated with peak systolic velocity (PSV) reducing (32.14 ± 4.2 cm/s), end-diastolic velocity (EDV) increasing (9.24 ± 2.35 cm/s), resistive index (RI) decreasing (0.71 ± 0.07 cm/s) in ophthalmic artery. Conclusion. The Duplex ultrasonography with the color Doppler imaging and pulced-wave Doppler model can be used for predicting of intraoperative hemorrhagic complications in patients with proliferative diabetic retinopathy.

Objective. To determine the value of the integrated use of conventional radiography and computed tomography (MSCT) in the diagnosis and assessment of treatment outcomes in patients with fractures of the acetabulum. Materials and methods. The results of examination and treatment of 75 patients with fractures of the acetabulum aged 27 to 49 years using the methods of X-ray and MSCT for the objectification of the results of surgical treatment. Results. The five main types of pelvic fractures involving the acetabulum according to the most frequently used at present anatomical fractures classification of Judet- Letournel are described in detail and demonstrated. Presents the possibility of X-ray and MSCT in patients with injuries of the pelvis before and after reconstructive surgery to restore the integrity of the assessment of the pelvis. Conclusion. MSCT and X-ray are very informative methods of diagnosis of acetabular injury and can accurately determine the type of fracture of the acetabulum, determining the choice of medical tactics, as well as allowing you to assess the results of the treatment.

Breast Specific Gamma Imaging (BSGI) or Molecular Breast Imaging (MBI) is a highly sensitive and specific diagnostic method in activity assessment of pathological lesion including breast cancer and its metastases. Not being a competitor to X-ray mammography this technology provides more information in case of patients with dense breast glandular tissue and it can also be an additional diagnostic method in the algorithm of early diagnosis of breast cancer.

Objective. To determine the effectiveness of the application of automated bulk scanning (ABVS) in specifying the diagnosis of breast nodules. Materials and Methods. The study involved 39 patients with pathologic formations in the mammary glands taken from the 915 held comprehensive mammography, including: clinical examination, ultrasound, digital X-ray mammography and needle biopsy on the basis of State Organization “Russian Scientific Center of Radiology” (RNTSRR) Ministry health of the Russian Federation for the period of 05.06 on 26.06.2014. Results. Possibilities and advantages of ABVS were detected. It was found that the automated sonotomography (3D ABVS) has more high sensitivity in the qualifying diagnosis in young women, nulliparous developed glandular tissue. Sensitivity (3D ABVS) in detecting breast cancer was 99.9%. Conclusions. The ultrasound scan with automated volume breast is an additional method in the differential diagnosis of thyroid nodules and can be included in the diagnostic algorithm study of this group of patients.

Purpose. To evaluate the influence of concomitant pathology of the myometrium on the sensitivity of complex ultrasonic research with application compression sonoelastography in patients with pathological processes in the endometrium. Materials and methods. 147 patients with various pathological processes in the endometrium were studied. Patients were devided on two groups: I group - 56 (38.1%) patients with isolated pathology of the endometrium; II group - 91 (61.9%) patients with combined pathology of the endometrium and the myometrium. All patients at the initial stage underwent standard ultrasound apparatus Hitachi Hi Vision Preirus, with subsequent inclusion of the methods of compression sonoelastography, by activating it on the same ultrasound machine. The results were compared with the data of pathomorphological studies following surgical intervention. Results. The sensitivity of the method of complex ultrasonic research with application compression sonoelastography in patients with combined pathology of the endometrium and the myometrium was 77%, which improved the methodology by 8,9% compared to the standard ultrasound. Conclusions. The inclusion of compression sonoelastography in complex ultrasound examination allows to increase the informativeness of diagnosis of pathological processes in the endometrium, including in patients with concomitant pathologies of the myometrium, which justifies its use as an additional method of research.

The aim: to define 1) coronary artery flow velocity values in healthy group at rest and during exercise tests; 2) differences of these values in the different age and sex groups. Materials and methods. There is a single center study of 145 consecutive healthy 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) was calculated. Results. The rest velocity in LAD was 31.9 ± 8.3 cm/s, at the peak of exercise 77.4 ± 15.3 cm/s, ΔV 45.3 ± 13.4 cm/s, and CFVR 2.51 ± 0.59. There was not a significant difference in the subgroups of the different ages. Women had a lower CFVR in comparison with men (2.32 ± 0.55 vs 2.63 ± 0.58; p < 0.02). Conclusion. There are the values of Doppler coronary artery velocity of the healthy subjects for exercise tests. The study does not demonstrate the impact of aging on CFVR. Women have a lower CFVR during exercise tests.

Aim: to evaluate with MRI technique the uptake of paramagnetic complex Mn-methoxyisobutylisonitrile (MIBI) to myocardium in rats in normal control animals and in experimental infarction. Material and methods. Complex Mn-MOBI was obtained with one-stage synthesis from manganese (II) carbonate and methoxyisobutylisonitrile hydroxide (produced by the Laboratory of technology and control of radiopharmaceuticals of the A.I. Burnazyan Russian state federal medical and biophysics Center), obtaining finally the 0.5 M solution of Mn-MIBI at pH = 6.3. The Mn-MIBI was injected intravenously slowly to sleeping rats (Telazol, i/m), as 0.05 ml of 0,5 M solution per Kg of BW. For this study nine normal control Whistar rats were employed as well as ten animals with previously induced anterior myocardial infarction of the left ventricle (all males). MRI scanning in T1-weighted spin-echo has been carried out with TR = 500 ms and TE = 15 ms, in axial and frontal slices as thin as 2-2.5 mm, to the matrix 256 х 256, with the field of view as large as 200 х 200 mm. The uptake was scored visually as change in intensity of T1-weighted MRI frontal scans of the whole body of the animals, of axial scans of chest and heart; and also quantitatively, with calculating for the T1-weighted MRI the index of enhancement (IE) of intensity per voxel, as : IE = (MeanInt of T1-w.MRI)Mn-MIBI / (MeanInt of T1-w.MRI)initial Results. Visually on whole-body T1-weighted SE frontal scans the MN-MIBI induced increase of intensity of the heart image, essentially equal for all parts of the left ventricle and less intense over the right ventricle. The values of the IE were over 2.5 for all parts of the left ventricle, whereas only 1.8-1.9 in case of the septum. IE of the right ventricle did not differ significantly when compared to the LV values. When injected to animals with experimental myocardial infarction the Mn-MIBI did not induced any essential changes of intensity in non-perfused regiones, with IE = 1.19 ± 0. 08, but raised the intensity over intact lateral wall of the left ventricle, with IE = 2.65 ± 0.14, and also over intact anterior wall, with IE = 2.28 ± 0.17. Conclusion. Complexonate Mn-MIBI provides well enough intense enhancement of myocardium in T1-SE MRI and makes possible to image severe disorders of myocardial blood flow in experimental models. The Mn-MIBI complex can be suggested as basic molecule for nearest future design of paramagnetic contrast agents for myocarrdial perfusion imaging, as well as for other organs taking up the MIBI. Manganese also is conceivable to be employed for labelling of other complexones currently in use in nuclear medicine.

The problem of complications during radiation therapy of the chest remains relevant in view of its dose-limiting influence. On the one hand it determines the effectiveness of the treatment of the underlying disease, and the other - the quality of life of the patient further. Monitoring these changes is traditionally carried out by performing a classical X-ray or CT scan. Although most radiologically detectable changes in the chest after the exposure of clinically asymptomatic, radiation therapy of the chest does not exclude the risk of radiation pneumonitis and late post-radiation fibrosis of the lungs. Clinical studies indicate that only the use of dosimetric factors are not enough to fully predict and limiting the risk of developing a pulmonary toxicity. Further improvements in radiotherapy techniques is not possible without a complete understanding of the causes and mechanisms of its development. Wanted to go to the multivariate prediction of the likelihood of such complications, based not only on the dose, but also on such factors as the amount of radiation zone, the combination with chemotherapeutic agents, smoking, topography and morphology of the tumor, the original state and related lung diseases, as well as individual sensitivity. The strategy of the multivariate prediction should in turn be based on non-invasive imaging techniques. The most promising method for an X-ray computed tomography with possibilities of qualitative and quantitative data description. In the first part of our review, we consider quality version of data description.

Purpose: to assess the usefulness of the spectral dualenergy CT for the differential diagnosis of focal liver lesions. Material and methods. 59 of focal liver lesions in 38 patients with various oncological diseases who underwent CT with intravenous bolus contrast enhancement with Multislice CT scanner, Discovery 750 HD GE Healthcare were analyzed. Porto-venous phase was performed in dual energy mode scanning and analyzed using a special software package GSI Volume viewer. The analysis included the synthesis of virtual monochromatic series of images, the construction of spectral curves, construction of iodine maps with quantitative assessment of iodine content. Results. All focal lesions in the liver parenchyma, irrespective of the histological structure, the spectral curve was hyperbola, characterized by higher values of density and sharply curve upwards at low values of energy (80-40 keV) was relatively flat at high values of energy (140-120 keV), but noted the dependence of the index of the slope of the curve from the studied tissue or tumors: malignant neoplasms curves were always below, and the curves of the spectral curves below hemangiomas of the liver parenchyma. We have statistically significant difference indicators at DECT (index of the slope of the spectral curve, absolute and normalized to the aorta and liver parenchyma iodine concentration), not only between hemangiomas and malignant tumors of the liver, but also between primary and secondary tumors. Conclusion. Our first experience shows that Use of spectral CT with fast tube voltage switching gives us new tools with which we can significantly increase the efficiency of the computer tomography in the detection and differential diagnosis of focal liver lesions.

Purpose: to develop optimal pulse sequence with magnetization transfer effect to detect metastases smaller than 1 cm diameter in the liver. Materials and Methods. Pilot tests were carried out using fat containing and contrast containing phantoms, which were scanned with the offset resonance frequency in the range from -1200 Hz to +1200 Hz and the flip angle from 0 to 800. Clinical studies (n = 13) of hepatoduodenal area were carried out with patients who have metastatic focal liver lesions (n = 103) in the T1-FatSat field-echo (T1-FE-FatSat) mode and in T1-turbo-spin-echo mod with Magnetization Transfer Contrast (T1-TSE-MTC) mode. Results. It was developed pulse sequence T1-TSE-MTC with parameters: offset frequency = -210 Hz and flip angle = 600. Using the protocol with T1-TSE-MTC, a significant increase of Contrast to Noise ratio (CNR) (p < 0.001) and contrast ratio (p < 0.05) between the focal changes up to 1 cm (n = 103) and the surrounding tissue of the liver has been shown as compared to the protocol T1-FE and predominantly due to better visualization of foci of up to 1 cm. A significant (p < 0.02) increase in sensitivity using T1-TSE MTC was also revealed. Conclusion. The use of T1-weighted images using the pulse sequence T1-TSE with the effect of the magnetization transfer increases the contrast and intensity of foci of liver metastatic lesions.

Method probe confocal laser endomicroscopy can be crucial in case of inefficiency or a small informative other methods of diagnosis in diseases of the pancreato-biliary area. The article presents clinical observation of various diseases of the bile ducts, including cholangiocarcinoma, developed on the background of chronic diseases of the pancreato-biliary area. Reflects the complexity of instrumental diagnosis at an early stage of the disease. For the first time in this pathology diagnostic purpose method applied scanning probe confocal laser endomicroscopy, allowing in all cases to Refine and verify the diagnosis. The method of research, its results are compared with other diagnostic methods.

Kidney cancer - one of the most often found urological tumors making 2% of all malignant new growths. The main method of a cancer therapy of a kidney is surgical. Removal of primary center increases survival at all stages of a dis ease. The best results at the first stage are yielded by a nephrectomy (full removal of the affected kidney); however if the sizes of a tumor are small (or a kidney only one, or the bilateral cancer of kidneys is diagnosed), apply organ-preserving treatment - a kidney resection. The resection of a kidney provides survival indicators, comparable with a nephrectomy, without recurrence for tumors <4 cm in the diameter. Also the resection of a kidney is connected with lower risk of long renal dysfunction. Clinical case of treatment of the patient, 39 years, with a cancer of the only kidney and recurrence in the form of tumoral blood clot in pelvis is presented.

Goal: to define diagnostic opportunities of multiparametrical ultrasonic research (ultrasonography) at the stomach ulcer and a duodenum. Material and methods. Results of complex research of 117 patients with stomach ulcer and DPK are analysed. Everything carried out ultrasonic, endoscopic, radiological, MRI researches of a stomach and duodenum. Ultrasonography carried out on the Aixplorer scanners (Supersonic Imagine, France) also Accuvix V10 and Accuvix V20 (Medison, South Korea), on an empty stomach and at hard filling of cavities of a stomach and duodenum (DPK) by water of room temperature. The received parameters were processed by standard methods of statistics, at p ≤ 0.05 values were considered reliable (reliability of ultrasonography is confirmed with histomorphological researches of endoscopic bioptic and postoperative materials). Results. Characteristic for benign stomach ulcer and duodenum is complex following ultrasound signs encountered in 94.9% (p < 0.001) of cases: ulcerative defect in the wall of a peptic pits with hyperechoic inner contour edges and the bottom of the ulcer, the clarity of differentiation sonographic layers of the gastric wall on near-ulcerated peripheral border infiltration and healthy walls, limited nearulcerated infiltration on the wall. Also valid are (p < 0.05): the correct form of peptic fossa (83.9%), uniform thickness reduction near-ulcerated infiltration to the peripheral edge (77.8%), the symmetry with respect to near-ulcerated infiltration pits ulcer (76.9%). The sensitivity multiparametric ultrasonography in the diagnosis of gastric gastroduodenal ulcers was 97.9%, specificity - 84.6%, accuracy - 96.4%. Conclusion. Implementation of the proposed technology multiparametric layered ultrasound of the stomach and duodenum, including the study of their water tight filling of cavities, allowing time to identify significant signs of gastric and duodenal ulcers, and allow us to recommend the use of the method in the earliest date of onset in patients with gastroduodenal ulceration.

The purpose: approbation of the method of multislice computed tomography colonography in the diagnosis of chronic colostasis. Materials and methods. Multislice computed tomography colonography, using the Philips Brilliance 64 (collimation 1,5 mm; 120 kV; 50 mAs, total duration of procedure - 18 seconds, equivalent dose-14 mSv), had been evaluated during clinical examination of 26 patients with decompensated forms of chronic constipation. Results. We have received encouraging results from a pilot study of multislice computed tomography colonography, allowing to obtain three-dimensional volumetric image of the colon with abnormal architectonics and unusual location in the abdominal cavity were noted. Method objectively reflects the characteristics of colonic structure, the anatomical and topographical relationships of its various parts, degenerative changes in the wall, the localization of stasis of intestinal contents and allows us to visualize the rare forms of colonic anomalies, due to the peculiarities of the colonic structure and the anatomic-topographic changes in the pelvic cavity. Diagnosis of pathological mobility of the gut by this method is difficult and requires additional clarification by other radiological methods. Conclusions. Multislice computed tomography colonography is a promising method of study the large intestine. It expands the range of diagnostic methods of chronic constipation and allows making a differentiated choice of proper type of treatment. The method can be considered as an alternative to the barium enema - the traditional diagnostic method of congenital and acquired anomalies of structure and position of the colon in the abdominal cavity.