Diabetic foot syndrome is a polymorphic complication of diabetes mellitus, the prevalence of it is continuously increasing. A severe form of diabetic foot syndrome is neuropathic osteoarthropathy (NOAP), described by the French neurologist Jean-Martin Charcot in the second half of the XIX century. NOAP is a manifestation of a variety of diseases - leprosy, poliomyelitis, syringomyelia, rheumatoid arthritis, heavy metal poisoning, and others, and was first described as a manifestation of tertiary syphilis. There were several attempts to classify the stages of NOAP and optimal diagnostic methods for each stage. Today, there is uncertainty in the classification of stages of NOAP, and in diagnostic algorithms for suspected NOAP Early diagnosis of NOAP is critical, since early treatment can prevent the deformation of the foot, the occurrence of ulcers, and amputation of limbs. This review considers the most relevant NOAP classifications and demonstrates pathognomonic radiographic signs of NOAP Possible radiological visualisation algorithms of NOAP are also suggested, depending on the clinical picture and the stage of treatment.

The aim: an improvement of the algorithm of the examination the patients with diabetes mellitus (DM) with clinical manifestations of diabetic foot syndrome (DFS) using ultrasound diagnostics and to compare the obtained data with results of an electroneuromyography. Materials and methods. Examination of 33 patients from the department of purulent surgery with clinical manifestations of DFS. Complex ultrasound examination of peripheral nerves and arteries of the lower extremities, as well as electroneuromyography. Results. The signs of neuro- and angiopathy are received at a complex ultrasound examination of the arteries and nerves of the lower extremities simultaneously. Changes of a tibial nerve at ultrasonography were combined with deviations on ENMG in the form of decrease in carrying out impulses on nervous fiber in 29 (89.5%) cases. Duplex scanning has shown damage of arteries of the lower extremities and tibial nerves at 30 (63%) patients. Conclusion. Complex ultrasonic research is rather informative method of diagnostics in the identification of neuropathy at patients with DM, complicated by DFS. This inspection, unlike an electroneuromyography, can be carried out in various conditions and in any place (intensive care department), without causing discomfort and pain to the patient with SD complicated to SDS having damages of integuments. Changes of peripheral nerves are often combined with the expressed changes of peripheral arteries at such patients therefore the possibility of an assessment of the vasculars of an extremity according to ultrasound allows to expand the volume of the obtained data and directly influences tactics of treatment of the patients.

Clinical case of anomalies of the right heart, the upper and lower vena cava revealed by computed tomography with bolus enhancement. Lower hollow Vienna, bypassing the liver and in the thoracic cavity merged with the left superior vena cava, forming a common trunk, which flows into the left side is located in a "horseshoe" at the base of the right atrium of the heart. The right superior vena cava and hepatic Vienna fell into the right half of the right atrium.

This article is a review of scientific researches in a radiologist's school of Tomsk. It represents main radiological achievements obtained in major scientific centers of Tomsk (Siberian State Medical University, Tomsk Cardiology Research Institute, and Tomsk Cancer Research Institute). Scientific and practical problems marked in article are radionuclide indication of inflammatory processes, diagnostics of osteoporosis, diabetes mellitus complications, rheumatological, cardio-vascular, onkological and other socially significant diseases.

Aim: to evaluate the possibilities of radionuclide renoscintigraphy in detecting of renal dysfunction in patients with chronic heart failure (CHF). Material and methods. The study included 85 CHF patients (all men, mean age 54.06.± 0.80 years). All patients underwent dynamic renal scintigraphy with 99mTc-DTPA and determination of of serum creatinine (SC) level. Creatinine clearance (CrC) (Cockcroft-Gault formula) and glomerular filtration rate (GFR) (radionuclide method and MDRD formula) were calculated. Results. The presence of a statistically significant correlation between the GFR determined by radionuclide method, and CrC was found (R = 0.30, p = 0.005). According to results of radionuclide renoscintigraphy functional renal activity disorders were not identified in only 16 (18.8%) out of 85 patients studied. However, only 21 (24.7%) patients had chronic renal diseases in anamnesis. Decreased GFR of one or both kidneys, in greater or lesser extent, was found in 64 (75.3%) patients studied. In 18 patients we found pronounced renal dysfunction (the GFR decline by more than 30% of normal values). Evacuation disorders in parenchyma were found in 34 patients (40%). The identified disorders were mostly moderate and minor (27 and 7 patients, respectively). The delay in indicator excretion from pelvicalyceal system occurred in 24 (28.2%) cases and mostly was expressed to a small extent. Conclusion. It is shown that the use of scintigraphic investigation improves detection of renal dysfunction compared with conventional methods of biochemical diagnostics.

Purpose. The purpose of the study was to evaluate the capabilities of lung scintigraphy and gated equilibrium radionuclide blood-pool SPECT in the differential diagnostics of acute pulmonary embolism and chronic postembolic pulmonary hypertension. Material and methods. The study included 78 patients, which have been divided into two groups: 62 (79.5%) patients had a verified diagnosis of acute pulmonary embolism and 16 (20.5%) patients - chronic postembolic pulmonary hypertension. Patients underwent a full range of clinical and diagnostic examinations, including ventilation/perfusion scintigraphy and gated equilibrium radionuclide blood-pool SPECT; 12 patients underwent multidetector computed tomographic (MDCT) angiography of the pulmonary arteries. Results. According to ventilation/perfusion lung scintigraphy data, perfusion defects were found in the upper and middle parts of the lungs in patients with acute pulmonary embolism. In these patients, perfusion defects were characterized by clear demarcation and by triangular or wedge-like shape. Localizations of the thrombosed vessels did not correspond to the areas with ventilation abnormalities. The ratio of transverse dimensions of right to left ventricular blood pools (RV/LV) in axial slices did not exceed 1.0. In patients diagnosed with chronic postembolic pulmonary hypertension, the areas of abnormal circulation were diffuse; the boundaries between the diseased areas and the intact pulmonary tissue were not clearly demarcated. In these patients, the RV/LV ratio in axial slices exceeded 1.0. Scintigraphic identification of pulmonary disorders was verified by MDCT pulmonary angiography. Conclusion. The use of scintigraphic methods aimed at assessment of the functional states of the heart and the lungs contributed to the accuracy of complicated differential diagnosis of acute pulmonary embolism and chronic postembolic pulmonary hypertension. Diagnostic information acquired with scintigraphic methods allowed for timely administration of adequate therapy.

Purpose: evaluation of pedal vascularisation in diabetic patients with pedal purulent necrotic processes of using contrast MR-angiography (3D DCE-MRA). Material and methods. 31 diabetic foot of 31 patients (14 male, 17 female; mean age 54.65 ± 15.1) underwent 3d DCE-MRA (Gadobutrol 15 ml) at 1.5 T. Imaging analysis included vascular architectonic’s condition, blood-flow’s speed and character of contrast’s accumulation. Results were compared with white blood cells-scan in identification of pyoinflamation. Osteomyelitis was verified according to operations in 100% cases. Results. All patients were divided in 3 groups: neuropathic (n = 12; 38.7%), neuroischemic (n = 14; 45.2%), ischemic (n = 5; 16.1%) forms of diabetic foot. First-pass MRA detected significantly delay in contrast’s arrival in ischemic group. There were no significant differences between the values of neuropathic and neuroischemic forms of diabetic foot. There was absence of any pedal vessels in patients. Contrast MR-angiography revealed the three types of contrast distribution in soft tissues: uniform, local increase and local absence. Osteomyelitis associated with diffuse enhanced contrast accumulation in all cases. Conclusion. So MRI blood vessel imaging is a promising and valuable method for examining peripheral arterial changes in diabetic foot and may be useful for treatment planning in different forms of diabetic foot.

The goal: to detect the possibilities of the software combined SPECT/ MRI in the detection of osteomyelitis (OM) in patients with diabetic foot syndrome (DFS). Materials and methods. 76 patients with diabetes type I and II, suspected OM (35 (46.0%) men and 41 (54.0%) women, mean age 59.4 ± 7.1 years) were studied. The study included patients with neuropathic (n = 25), ischemic (n = 13) and neuroischemic (n = 38) DFS forms. All patients underwent scintigraphy with labeled leukocytes, 30 patients underwent magnetic resonance imaging (MRI). The combination produced by using software RView 9.06 (Colin Studholme). Results. By using labeled leukocyte scintigraphy for the diagnosis of oM were obtained 25 TP, 38 TN, 12 FP and 1 FN results. The accuracy was 82.9%. FP results were due to the low resolution of the method and the small size of the object. One FN result was caused by reduced blood flow in a patient with ischemic form of the DFS. By using MRI obtained 20 TP, 16 TN, 4 FP and 2 FN results. The diagnostic accuracy of the method was 85.7%. The FP results were due to the complexity of the differential diagnosis of bone marrow edema and inflammatory infiltration. In assessing the 42 hybrid SPECT/MRI images of 21 TP, 17 TN, 3 FP, 1 FN result have been identified. Diagnostic accuracy was 95.9%. Conclusion. The study shows a higher diagnostic SPECT/MRI performance in detecting OM in patients with DFS (sensitivity and specificity were 95.5% and 85.0% respectively) compared with the isolated using of MRI and scintigraphy.

Epidermal cysts are considered as frequent benign epithelial origin with common localization. Scrotum refers to the typical localization of epidermal cysts, but multiple cysts are rare observation. Ultrasound examination is the method of choice in determining of the intra- and ekstratesticular localization of epidermal cysts, and in the assessment of the structure of the lesion. The clinical case of multiple epidermal cysts of the scrotum is demonstrated in the article.

The objective: to define possibilities of MRI pulse sequences with submillimeter scanning in the diagnosis of bladder tumors. Materials and methods. The study included 125 patients (105 (84%) men and 20 (16%) women, median age 63 years) with histologically verified diagnosis of transitional cell bladder cancer. The study protocol additionally included high-resolution pulse sequences to perform MR cystography and MR cystoscopy. Results. Comparative analysis revealed the advantages of tailored pulse sequence T2-rpc rst, used for MR cholangiopancreatography, consisting in the high contrast, faster scan time and the smallest volume voxel. When searching for tumors of small size, the use of MR cystography made it possible to increase the sensitivity of non-contrast MR scan by 25.6% (p = 0.0016). Conclusion. The data obtained allowed us to use MR cystography for fast and accurate visualization of exophytic bladder tumor and for determination of its size and shape, that was necessary for monitoring response to chemotherapy. In the visualization of tumors less than 10 mm, the sensitivity of non-contrast MRI was increased by 25.6% (p = 0.0016).

Purpose: To study the possibility of using new domestic radiopharmaceuticals based on^99mTc-aluminum gammaoxide to render the SLN in breast cancer and cervical cancer Materials and methods. The study included two groups of patients: I group - 34 (59.6%) patients with breast cancer (T1-2N0-1M0), II group - 23 (40.4%) patients with cervixcancer (T1A-2BN0-1M0). All patients were administered original radiopharmaceutical^99mTc-Al₂O₃ a day before the operationfor visualization of sentinel lymph nodes. Results. In the first group of patients identified 37 sentinel lymph nodes. The number of identified SLN per patient ranged from 1 to 2 (the average number of identified SLN - 1.08). The most frequently detected by us in SLE axillary region 36 (97.2%). The intensity of the inclusion of^99mTc-Al₂O₃ in SLE SpECT at 18 hours after administration is 7-11% of the injection site, with radiometry 17-31%. In the second group of sentinel lymph nodes were detected in all 23 patients of the second group. The intensity of the inclusion of^99mTc-Al₂O₃ in SLN with SpECT at 18 hours after administration is 3-6% of the injection site, with radiometry 14-26%. Conclusions. Designed on the basis of radiopharmaceutical^99mTc-Al₂O₃ 5-10 times more accumulated in the sentinel lymph nodes, firmly seating them, without further redistribution around the lymphatic collectors. Sensitivity and specificity of application of^99mTc-Al₂O₃ with single photon emission computed tomography and intraoperative radiometric display sentinel lymph nodes was 100%.

The submission summarizes the experience of the scientific team of the Tomsk Cancer Research Institute to develop a new original radiopharmaceuticals for nuclear medicine. The basic tendencies and prospects of development of nuclear medicine, the next challenges to the development and possible solutions. The basic scientific directions in the development of radiopharmaceuticals. The results of their own efforts to develop drugs. It demonstrated the functional suitability of developed products, development prospects.

Doppler mapping is used along with the B-mode to identify the vascularization of the periosteum in patients with suspected osteomyelitis. Objective: to estimate the information content in duplex scanning mode, color and power Doppler mapping (DSM and PDM) in diagnosing different phases of acute hematogenous osteomyelitis in children. Material and methods. The study included 23 children aged from 2 to 15 with acute hematogenous osteomyelitis who came by way of ambulance to the children's surgical hospital in Tomsk in the period 2009-2015 in the period from 1 to 14 days after the onset of clinical signs of disease. Ultrasonography (ultrasound scanner Mindray M7 with multifrequency linear transducer 9-12 MHz) was performed on5the day of receipt of all the children (n = 23; 100%) in B-mode and using color and power Doppler imaging. Results. Ultrasound picture of intramedullary phase of acute osteomyelitis was detected on 1-3 day from the onset of the disease and is a combination of hypo echogenicity of the periosteum and increased vascularization in the form of multiple loci and increased reactive vascularization of the adjacent soft tissues. Ultrasound data have the highest sensitivity for acute hematogenous osteomyelitis in extramedullary phase with subperiosteal abscess in B-mode, and in the color and power Doppler in connection with a clear visualization of the fluid, demarcated exfoliated periosteum and high vascularization of the periosteum. Osteomyelitis due to melting periosteum phlegmon, liquid accumulations adjacent to bone is accompanied by poor vascularization that color and power Doppler mapping increases the false-negative results and thus - to reduce sensitivity (87.5%) compared with the picture subperiosteal abscess (100%). Conclusion. Diagnostic significance during all phases of the osteomyelitic process can increase the information content of indicators method in comparison with the B-mode and shorten the diagnostic phase of the study.

Joints of the hands are the target organs for different nosologic forms of rheumatic diseases. The nature of lesions, their localization and prevalence, provide a differential diagnosis between the various forms of rheumatic diseases. Radiography, as a standardized method of visualization in rheumatic diseases has low sensitivity in detecting early to erosive manifestations. Magnetic resonance imaging has the advantage in comparison with the X-ray in the simultaneous determination of the state of bone and soft tissue intra-articular structures including the presence or absence of bone erosions in the earlier stages of the disease. The article presents the main features of the most common rheumatic diseases that can be detected by magnetic resonance tomography of the hand.

Among the cases with malignant tumor we have only 0,01% of patients diagnosed with dermatofibrosarcoma, and 2-6% affected with soft tissue tumor. This article deals with the morphological peculiarities of this tumor, character of disease progression, the criteria and complexity of diagnosis, and the tactics of treatment, as well as the estimation of the long-term treatment results. We consider a clinical case of a man (37 years old) diagnosed with the recurrence of soft tissue tumor which shows the complexity of diagnosis and treatment of this disease.

Purpose: to estimate the possibilities of ultrasonic research in identification of complications after injection lip augmentation with products on the basis of polydimethylsiloxane acid (biopolymer gels). Material and methods. 175 women, aged from 24 till 65 years, which have been divided into two groups have entered research. 19 (10.9%) female without lip augmentation and contour correction have entered into the I (control) group. Normal condition of soft tissues of lips and nasolabial triangle of females of this group was estimated by ultrasound. 156 (89,1%) female which addressed to A.V. Vishnevsky Institute of surgery with complaints to complications (asymmetry and/or visual defects of lips) after carrying out lip augmentation, contour correction with biopolymer gels in various clinics during the period since October 2013 till present entered into the II (main) group. Ultrasonic research of soft tissues of the lips and nasolabial triangle was carried out to all patients preoperatively and further in the postoperative period, or at dynamic control. Results. The main layers of tissues of lips in normal have been differentiated at an assessment of ultrasound at the women of the I group (19 (10.9%)). The tissue of the lips have been replaced with hyperechoic diffusion masses with effect of repayment of an echosignal to the periphery of the image at ultrasound at all patients of the II group. The blood-groove wasn't traced in this masses At duplex scanning. This ultrasound pictures corresponded to the expressed fibrosis of fabrics. Conclusion. US-research of the condition of soft tissues of lips and a nasolabial triangle after lip augmentation and contour correction allows to assess the situation effectively, to reveal the arisen complications and to choose tactics of their correction and/or elimination. US-monitoring of soft tissues condition is possible if it’s necessary.

Choledochal cysts (CC) are a rare congenital cystic dilation of the biliary tract. The main methods applied to diagnosis of this disease: Ultrasonography, MSCT with bolus contrast enhancement, ERCP and MRI with MRCP. MRCP is a choice method at the moment as has high spatial resolution and allows to visualize well biliary anatomy and to estimate relationship of the cysts with a biliary tract. The main principle in treatment of cC is their full removal with the purpose to prevent development of complications, first of all, of a malignancy. At cysts of intra hepatic biliary tract carrying out a resection or transplantation of a liver, depending on prevalence of process is necessary. Thus, preoperative diagnostics and identification of CC on T. Todani’s classification is very important for definition of further surgical tactics. The main characteristics, options of a clinical current, features of diagnostics and tactics of treatment of the patients with CC are presented in the article. Opportunities and diagnostic efficiency of modern methods of diagnostics are described.

Retroperitoneal neoplasms are rare pathology, considering the frequency up to 1.0% of all tumors. Most of retroperitoneal tumors (70%) have the mesenchymal origin, and the tumors composed of adipose tissue are the most common. Small size tumors are almost asymptomatic. Complains usually appear in patients with increasing size of tumor (more than 10-15 cm) because of the compression of adjacent structures and great vessels. Therefore, the problem of early diagnosis of retroperitoneal neoplasms is practically significant. We introduce literature data about the possibilities of the radiological differential diagnosis of such retroperitoneal adipose tissue neoplasms as lipoma, liposarcoma, angiomyolipoma and hibernoma.

What is the criteria for qualitatively and quantitatively assessment of radiologist work? The aim of this study was to develop criteria for evaluation the effectiveness of the intellectual, analytical work of radiologist, to create objective conditions used in the analysis of diagnostic data - the second opinion (external, remote consultation). Materials and methods. The authors identify three types of diagnostic errors: 1. Inaccuracies in the description due to negligence, lack edits of text. 2. Incomplete description of the examination, not marked comorbidities requiring no emergency, urgent interventions. 3. Incomplete description of the underlying disease, entailed inadequately designated physician treatment. 4. Errors due to misinterpretation of the data - pseudo diagnostics. 5. Errors related to the non-implementation or incomplete survey required the patient for the correct diagnosis. Results. The second level of the third type of errors occurred in 4 of the 335 cases, the third level of error was in 1 case. Pseudo-diagnosis (4th level error) was also in 1 case. Conclusion. The selection of the fourth and fifth levels of diagnostic errors of the third type allows not only to expand the scope of quality control (use a second opinion), but objectify the feasibility of the development of distance learning system based on an objective analysis of efficacy of each radiologist and the team as a whole and highlight various areas remote training.