Aim. To evaluate the possibility of differential diagnosis of progression and stabilization of brain tumor process by methods of dynamic contrast-enhanced magnetic-resonance angiography (DCE-MRA) and perfusion MRI in patients after surgical treatment. Materials and methods. The study included 13 patients who were imaged with suspected recurrent tumor disease after surgery. Pathological diagnosis: anaplastic astrocytoma (G3) - 6, astrocytoma (G2) - 4, anaplastic meningeoma - 1, meningioma - 1, cyst - 1. DCE-MRA was performed in 3DFFE imaging technique and in result we got a 3 phase: arterial, venous and equilibrium with slice thickness 1.2 mm. Tumor image and hemodynamics by DCE- MRA imaging and perfusion maps using a 3-point scale were assessed. In addition, it was used three-point scale to determine the contribution PWI and DCE-MRA in addition to the diagnosis of the main results of the contrast study. To describe the changes in the centers of lesions between the images which were obtained after the first and second administration of contrast agent we used a 4-point scale. Results. By comparing evaluation of hemodynamics there were detected significant differences in arterial and venous phase DCE-MRA (p < 0.016), and significant differences between mixed and venous phases were not detected (p > 0.06). Between the ranks of the perfusion maps (rCBV, rCBF and rMTT) there were not found any significant differences, and no differences between the ranks of venous phases DCE-MRA and PWI (p > 0.7). Evaluation of ranks contribution DCE-MRA and pWi for the decision on a definitive diagnosis showed no significant difference between them (p > 0.7). By comparative analysis of DCE-MRA contributions to the final diagnosis on the results of the study in contrasting with double dose there were revealed significant differences (p < 0.0003). Conclusion. The DCE-MRA of cerebral vessels can be considered as a biomarker of tumor neovascularization, reveals abnormal vasculature in postoperative patients with progressive disease and assess the state of hemodynamics after surgical intervention during the stabilized process.

We present a rare case of congenital malformations of the internal auditory canal with the presence CSF- perilymphatic fistula. The fistula occurring clinically under the mask of otosclerosis. However, traditionally used in otosclerosis surgery on the stapes in this case will inevitably lead to a sudden expiration of CSF from the window of the vestibule. Such intraoperative complication is called perilymphatic gusher (fountain) syndrome. Patients with congenital perilymphatic fistula surgery on the stapes contraindicated because it not only solves the problem of hearing impairment, but can lead to meningitis, deafness, and severe dizziness in the postsurgery period. The only method that before surgery allows to reliably distinguish between otosclerosis and congenital malformation of the internal auditory canal with CSF-perilymphatic fistula, is computed tomography. The article shows possibilities of a CT of the temporal bone and the efficiency of use of GE Healthcare CT with unique spatial resolution of GSI detectors in the preoperative diagnosis and prevent severe complications.

The diagnosis of rare forms of ruptured abdominal aortic aneurysms, such as aortocaval and aortoenteric fistula, is a difficult challenge due to rarity of case, severity of patient condition and non-specificity of clinical manifestations. Aim. To define the decision for multifield clinics usable criteria of aortic fistulas radiologic diagnosis Materials and methods. An experience of diagnosis and treatment of 8 (2.4%) patients with primary abdominal aortic fistulas (3 cases of aortoenteric and 5 cases of aortocaval) in group of 340 patients with complicated abdominal aortic aneurysms was analyzed. All of the patients were underwent ultrasound and CT-study. Clinical verification by means of surgical repair were done. Results. CTA was revealed as a “gold standard” in diagnosis of aortocaval and aortoenteric fistulas both. The principal sign was an extravasation of contrast agent into bowel or vein. However, specific signs were detected in ultrasound and CT study. There were a dense connection between aneurysm and intestine wall, gas bubbles in intraluminal thrombi and aortic wall for aortoenteric fistula; oval form of cava vein, pulsatile flow in its lumen or shunt pattern. Conclusion. The specific signs of aortic are feasible for identification in particular in multifield clinics.

Objective: to evaluate the possibilities and advantages of the new technology-microvascular mapping with high spatiotemporal resolution SMI (Superb Microvascular Imaging), in a survey of older patients with acute venous thrombosis. As well as to compare SMI technique with color (DRC) or power Doppler mapping. Materials and methods. The study included 67 patients (134 limbs), admitted to the hospital with acute venous thrombosis of the lower extremities in age from 65 to 88 years with a significant restriction of movement and selfservice. Men were 43 (64%), women - 24 (35.8%). All patients underwent standard ultrasound examination using B-mode and color mode or power Doppler mapping. In addition, the newest survey mode has been used, advertised by Toshiba corporation, used in the ultrasonic unit Aplio ™ 500, equipped with settings that allow to apply this technique. Results. All the diagnostic programs of evaluation patients with acute venous thrombosis in the inferior vena cava system are based on color duplex scanning to date,. However, despite this fact, there are still outstanding issues to be addressed and which based on the receipt of new views on the problem. That is why the application of new ultrasound technology will provide more accurate information about the state of the venous system among older patients with acute venous thrombosis, which is so necessary for the clinician to answer the questions raised. It was evaluated the state of the main veins of the lower extremities and determination the level and nature of the thrombotic masses spread. Options for the bypass venous flow thrombosis in a main thoroughfare were identified. The advantages of the techniques used in the comparison with a standard ultrasound were revealed. Conclusion. Technique of SMI ultrasonic instrument Aplio ™ 500 Toshiba company can be successfully used for the evaluation patients with acute venous thrombosis in the inferior vena cava. Considering the information content of this technique , a small time spending, cost and ease of use, and the ability in most cases to limit the use of diagnostic tests that elderly patients are extremely difficult to carry out for, can be recommended for inclusion in the scope of a standard ultrasound.

Objective: to evaluate the effect of transarterial chemoembolization (TACE) of breast cancer hepatic metastases, based on the calculation of changes in the volume of tumor tissue in metastatic lesions, and comparing this criteria with the RECIST criteria. Materials and methods. CT data of 21 patients with breast cancer metastatic liver lesions before and after treatment was analyzed. Evaluation of the treatment results was made separately for each patient according to RECIST criteria and according to criteria based on the indicator of tumor growth kinetics (reciprocal of doubling time, RDT). Comparative analysis of different criteria was conducted. Results. There was a statistically significant better performance of overall and disease-free survival in patients with an objective response by RDT indicator. The results indicate that the use of RECIST criteria may underestimate the objective response to treatment. Conclusion. The proposed tumor response evaluation criteria, based on the analysis of tumor growth kinetics, proves to be more accurate and respond adequately to the nature of morphological changes in the lesion and to the disease dynamics as well.

Elastofibroma dorsi is a benign soft-tissue tumor with typical localization in subscapular area. It belongs to the category of rare tumors and doesn’t reveal itself clinically in most cases. The tumor of various sizes with an asymptomatic course can be recognized in 2% of the examined patients for various pathology of a thorax on CT. Elastofibroma patterns on CT- and MR-tomograms are rather specific and they often allow to make the right diagnosis and to choose the treatment of a patient even without histological verification of tumor.

Purpose. To evaluate the features of ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT) in cases of foreign bodies (FB) injuries. Materials and methods. 25 patients (25 eyes) with suspected foreign bodies of AS were observed. Besides of the standard ophthalmological examination UBM and AS-OCT were performed. Results. Using the biomicroscopy nonpenetrating corneal injury with glass (2 eyes), metal (1 eye) and wood (1 eye) were diagnosed in 4 patients, but their exact location was difficult. AS-OCT allowed to specify the location and size of the foreign body (FB) and determined the penetration of cornea in 1 case. Penetrating wound of AS with glass (3 eyes), metal (16 eyes), plastic (1 eye) were diagnosed in 21 patients using biomicroscopy. X-ray examination was performed in 13 patients, in 5 of them FB of AS was revealed and suspected Fb in 3 cases. We determined FB of lower eyelid in 1 case. AS-OCT confirmed the presence of FB in almost all cases (20 eyes) independently of nature of FB and only in 1 case FB was not visualized. The localization, the size of the FB and the condition of surrounding tissues were determined using UBM and OCT. Data of AS-OCT - and UBM were correlated with those of X-ray examination. Conclusions. In cases of foreign bodies injuries of anterior segment AS-OCT and UBM allow to determine the location, the size of FB, their relationship with the surrounding tissues. Due to the diagnostic features of UBM and AS-OCT in patients with foreign bodies injuries of AS, the management of these patients has been identified.

Aim of the study: the development of a classification of bisphosphonate - related osteonecrosis of the jaw (BRONJ) based on the analysis of multispiral computed tomography (MSCT), carried out during the treatment of patients with BRONJ. Materials and methods. Retrospective analysis of the results of 200 patients with bisphosphonate osteonecrosis of the jaw MSCT, which were treated at the Department of oral and maxillofacial, reconstructive and plastic surgery in the period from 2009 to 2015. All patients received therapy with bisphosphonates in the context of metastatic bone lesions, the development of osteonecrosis in the majority of cases were preceded by tooth extraction, trauma by prosthesis or the presence of chronic foci of infection. The patients underwent conservative treatment with a view to stimulating the formation of a sequestrum with a local application of UV-ozone therapy, operative therapy (sequestrectomy) performed in the presence of a sequestrum. MSCT was performed 1 time per 6 months, to determine the dynamics of treatment. Results. A new classification of BRONJ: the initial stage of a pathological increase in bone density, stage 1 - destructive lesion, stage 2 - formation of sequestration, stage 3 - progression of sequestration, stage 4 - reparation. Conclusion. The proposed classification is based on staging of the disease in the dynamics of its course. The proposed classification allows to assess a lesion of bisphosphonate osteonecrosis of the jaws in dynamics, as a basis for selection of appropriate treatment - conservative or surgical (definition of sequestrectomy).

Duodenal dystrophy, in the English literature known as paraduodenal pancreatitis, is a type of chronic pancreatitis that develops in the area between the pancreatic head, duodenum and common bile duct, and can mimic, mask or co-exist with carcinoma of the pancreas. This should be considered in the differential diagnosis of pancreatic mass lesions or stenosis of the duodenum. The relative rarity of this disease, probably due to its underdiagnosis. To denote this condition in the literature uses many terms, which makes difficult to obtain accurate information.

Objective: to determine the effectiveness of multidetector commuted tomography (MDCT) for evaluating the grading (Fuhrman grade) of clear cell renal cell carcinoma (CCRCC) Materials and methods. Four-phase contrast-enhanced MDCT of 54 patients with histologically verified clear cell renal carcinoma operated on in A.V. Vishnevsky Institute of Surgery from April 2011 to March 2015 have been retrospectively analyzed. The patients were divided in two groups based on Furhman grade (1982). The first Group included Grade I and Grade II (n = 37). The second group included Grade III and Grade IV tumors (n = 17). Contrast enhancement was calculated for each group via manual ROI placement in arterial, portal, delayed phases and averaging tumor density. The non-parametric Mann-Whitney U test and Fisher criterion were used to determine whether there was a significant correlation between contrast enhancement and Fuhrman grade; p value of < 0.05 was considered statistically significant. The evaluated parameters were: the average contrast enhancement for each phase of research, tumor size and structure, contours of the tumor, the presence of tumor thrombus, the spread of tumor in the renal capsule and perirenal fat. Results. High grade clear cell adenocarcinoma showed significantly smaller lesion size (<60 mm) with distinct lesion contour, tumor structure was less heterogeneous due to less frequently observed areas of necrosis and hemorrhage, greater arterial (>90 HU) and venous (>80 HU) (p < 0.05) contrast medium washout in the excretory phase and intact renal capsule. Lower grade clear cell adenocarcinoma showed significantly larger lesion size (p < 0.05), irregular lesion contour tumor structure was heterogeneous due to the frequently observed areas of necrosis and hemorrhage, lower arterial and venous contrast enhancement (arterial and venous phase enhancement due to necrosis and hemorrhage), slow and heterogeneous contrast medium washout in the excretory phase, with renal capsule invasion (p < 0.05), inferior cava vein, renal vein tumoral thrombosis was frequent in lower grade lesion group. Conclusion. Parameters of contrast-enhanced multiphase computed tomography allow to evaluate clear cell renal cancer differentiation were determined.

Introduction. Anatomical variants of the abdominal and retroperitoneal vessels distinguished by a great diversity. Most often they are asymptomatic, but in some cases may have clinical manifestations. Information about the features of vascular anatomy is necessary when planning a surgical operations and interventional procedures in the abdominal cavity and retroperitoneal space. Purpose of the study. To analyze incidence of abdominal vessel anomalies at MDCT examination of the abdomen and retroperitoneum and to evaluate clinical significance of the observed changes. Materials and methods. 440 patients with various diseases of the abdominal cavity and retroperitoneal space underwent MDCT with bolus intravenous enhancement. Identified aberrations of hepatic arteries were classified by N. Michels, anomalies of the inferior vena cava and its tributaries - by Huntington G.S. and C.F.W. McLure, anomalies of the renal arteries - depending on the variant of the aberration. Information obtained after the analysis of the diagnostic images was compared with intraoperative and initial clinical data. Results. In the study group, different malformations of the arterial and venous vessels were detected in 378 (86%) patients, and combined with each other in many cases. The most common were aberrations of the renal arteries (60%), followed by anatomical variants of the celiac and mesenteric arteries (43.7%). Features of development of the renal veins were identified in 42.7% of cases. Anomalies of the inferior vena cava met only in 1.6% of cases. Conclusion. In evaluating the results of MDCT of the abdomen and retroperitoneal space, in addition to the main research problem, it is advisable to pay attention to the diagnostics of the anatomical variants of the arterial and venous vessels in order to provide clinicians the information necessary for planning and the success of surgical treatment.

The combination of abdominal aortic aneurysm and horseshoe kidney is rare. As a rule, the isthmus of the horseshoe kidney is anterior to the inferior vena cava and the aorta, which greatly complicates the implementation of surgery on the abdominal aorta. Surgical treatment of such patients may be technically challenging because of the variable renal arterial blood supply also. Accurate preoperative diagnosis of the abnormal blood supply to the kidneys is a prerequisite for successful planning and treatment of such patients. The clinical observation of the patient, 64 years old, with infrarenal aortic aneurysm concurrent with horseshoe kidney is presented. The possibilities of radiological methods in determining of abnormally positioned vessels of such kidney, and assessing the results of surgical treatment of the patient were demonstrated.

The risk of radiation-induced lung injury is a major cause of limitation of radiation dose in different types of radiation therapy of the chest area. Studies of these injuries are aimed at the detection of unknown factors responsible for their development. However, as already described, modern approaches to the assessment of lung lesions are mainly qualitative or semi-quantitative. This leads to uncertainty in the diagnosis of early and late post-radiation changes and hence a lack of standardization studies. Accordingly, this in turn reduces the importance of imaging in CT study a continuous spectrum of gravity of basic biological manifestations of radiation damage in the form of spectral density changes of the lung tissue. All these drawbacks are eliminated in the quantitative analysis of CT data. The main peaks of research in this area accounts for the last 5-6 years. To describe the post-radiation damage to different authors used different quantitative approaches. This time dependence of the changes, and changes in the average density of the light dose, and the variability of the standard deviation of average density, and quantitative assessment of local structural changes and even a software image analysis. This also occurred variability patients contingent on the underlying disease, the difference of methods and techniques of radiation therapy, and combination of radiation with chemotherapy drugs. In all studies, there was a large interindividual variation magnitudes of “effect”, which has not been analyzed by the authors themselves, but can be caused by both genetic characteristics of patients and histopathology induced complications themselves, which in turn confirms the importance and relevance of the quantitative analysis in CT ray study of lung damage.

In the review is paid particular attention to actual problem of the high incidence of tuberculosis in the world and Russian Federation. It considers the evolutionary development of digital tomosynthesis, and also features of image’s reconstruction at this study. It describes the possibility of using tomosynthesis for diseases of the chest cavity organs and prospects for its using in the diagnosis, monitoring of treatment efficacy of tuberculosis of respiratory system. In modern ftizioradiology the main methods of diagnosis of pulmonary tuberculosis include radiography, linear tomography and computerized tomography. A relatively new method of radiation research of tuberculosis patients in Russia is digital tomosynthesis (DT). Because of multisection imaging and sufficiently high resolution of DT, it may be relevant in specifying diagnosis relieved by pneumonography changes, as well as in monitoring of treatment efficacy of tuberculosis. Optimization of conducting of the trial, as well as clarification of its capabilities in visualization of various forms of tuberculosis has both scientific interest and practical importance.

Semiotics presents a rare vascular tumor of the pancreas, hemangiomas according to radiological methods. Estensione by ultrasound and computer tomography research methods, which is hyperintens T2 magnetic resonance imaging education showed typical for hemangiomas of dancefest change in different phases of the circulation of the contrast agent in computer tomography.