The aim: to examine characteristics of functional brain activity in task switching in patients with speech disorders after brain damages and to examine of functional cerebral reorganization after course of rehabilitation. Materials and methods. There were 45 participants which were divided into two groups: 25 (55.6%) healthy people and 20 (44.4%) patients with different forms of aphasia and/or dysarthria. MRI and fMRI methods were used. In the fMRI task, the participants had to shift their attention between two objectives (classifying figures according to their form or number). Results. The results of the second session in the group of healthy individuals showed no significant changes in the brain activity as compared to the first session. In patients three patterns of activation were found: a powerful asymmetric activation in the frontal and parietal lobe in one hemisphere as compared to the other one (20% of patients); a very low activation mainly in frontal areas (40% of patients); and a very high and mostly diffuse brain activation (40% of patients). The second fMRI session revealed that patients with positive dynamics of recovery of higher mental functions showed that their brain activations are closer to average levels of those shown by healthy individuals (of the same sex and age). This was mainly expressed in frontal areas. Also it was found that activation in additional brain areas was lower or altogether absent which wasn't observed in healthy individuals. Conclusion. The results of this study support the view about the reliability of repeating the same fMRI task after a period of time, and allow to use this method for assessment of rehabilitation programs in patients with cerebral pathology as well as show the tendency to normalization of functional brain activity in patients with positive dynamics of recovery.

Aim: to develop an easy-to-use, accurate and reliable method for measurement of eyeballs’ protrusion in patients with facial scull asymmetry by using computered tomography (computered exophthalmometry) and compare its potential with Hertel’s exophthalmometry. Materials and methods. The retrospective study of computerized axial tomography scans and ambulatory medical records of 30 patients (43 computer axial tomography scans of 60 orbits) with various deformations of orbital area. The scans were evaluated with personal computer and RadiAnt DICOM Viewer software. With tools of the software we drew a straight line through the apices of styloid processeses of temporal bone. This line served as a reference line for all further measurements. On the image, where the cornea of the first eyeball was the most prominent, we constructed a perpendicular to the most prominent point of the cornea. In the same way, the distance from the most prominent point of cornea to the reference line was measured for the second eye. The difference between the lengths of two perpendiculars corresponded to the difference of protrusion between two eyes (exophthalmos or enophthalmos). The data of computer exophthalmometry were compared with the results obtained with Hertel’s exophthalmometer specified in the ambulatory medical records. Results. All 43 computer axial tomography scans were evaluated in this way of computer exophthalmometry. In patients with intact lateral walls of the orbits the differences of protrusion between two eyes measured with two methods were similar. In contrary to the Hertel’s exophthalmometer, the computer exophthalmometry showed reliable results in patients with trauma of lateral orbital walls. Conclusions. The developed method of computered tomography is easy-to-use and allow getting accurate and reliable data. It can be applied to preoperative diagnostics, planning and evaluation of treatment outcome in patients with different abnormalities of orbital area, in contrary to the Hertel’s exophthalmometer.

Objective: to study evaluation performance of malignancy of thyroid nodular formations by ultrasound specialists. Materials and methods. There were made the interactive trainings within the relevant scientific forums of different countries. 19 pictures of morphologically verified thyroid nodules were consistently represented by respondents and each of them were offered to be assessed as benign or malignant one, or to recognize the failure of the ultrasound data to assess the malignancy (nodes were called questionable) by making the appropriate notes on the standard form. The results were processed by standard methods of nonparametric statistics. Results. Number of correct answers per respondent ranged from 3 to 14, median was 8, Q1-Q3, respectively, were 6 and 9, fashion was 8, and averaged 8.0 ± 2.31. It was found that, in determining of malignancy on ultrasonic static image frequency of correct answers reaches 41.4%, for malignant formations it was 53.0%, and for doubtful and benign ones it was not significantly higher than the probability of a random selection - respectively, 34.3% and 35.2%. As detected regularities were typical for groups of experts from different countries, the identified trends can be determined by the general psychological legitimacies, and the lack of a unified standardized system of echographic risk assessment of malignancy, which is clear to ultrasound specialists and clinicians. Conclusion. The positive predictive value of the conclusion about the benign nodule was 25.0%, about the doubtful one was 41.0%, about malignant one was 57.3%. For objectification of ultrasound research we recommended the use of THIRADS classification, which is based on the totality of ultrasound signs, ranging thyroid nodules by malignancy risk.

Purpose: to evaluate the possibilities of MDCT and MRI in planning evisceration with locally advanced pelvic tumors. Materials and methods. A retrospective analysis of the results of MDCT and MRI of the pelvic organs was made in 13 patients (29 studies) who underwent evisceration. To evaluate the information content of the methods intraoperative data were used as a reference. In this article we analyzed the relationship of the primary or recurrent tumor in total with the 117 pelvic organs and structures in MDCT and with the 101 in MRI. Results. In all cases on the basis of the received information the right decision was made about the possibility and the need for pelvic evisceration. The number of matches results of MDCT and MRI with intraoperative data in assessing tumor involvement of organs and structures of the pelvis in most cases exceeded 70 %. MRI results are broadly consistent with those of foreign authors. However, we did not find in the literature articles, which would have focused on the possibilities of MDCT in the evaluation of locally advanced tumors in the planning of evisceration Conclusions. The results demonstrated the value of using MDCT and MRI in planning evisceration. Identified trends require further research on a larger group of patients.

The complicated abdominal aortic aneurysms are a difficult challenge for contemporary vascular surgery. The prompt diagnosis of pre-raptured cases gives an excellent opportunity for treatment results improvement. Aim: determination and arrangement of diagnostic criteria of the complicated aortic aneurysms. Materials and methods. A retrospective and prospective analysis of diagnostic results of 1015 patients with abdominal aortic aneurysms (AAA) were performed. The clinical symptoms of complications (abdominal pains in many cases) were revealed in 149 (14.68%) of patients. All cases with ruptured AAA (184 (8.13%) were excluded. The ultrasound duplex, computed tomography and PET-CT in nine cases were done. Results. The signs of complicated aneurysm (unstable and inflammatory aneurysms, impending rupture) were revealed in 156 patients (15.37%) separately or in combination. Such applicable for clinical use radiologic criteria were well-defined and described. The local lysis or disappearance of intraluminal thrombi, local dissection or protrusion of the aneurysmal wall, formation of secondary aneurysms and partial rupture were the most informative criteria. The local lesions of aortic wall were most specific for pre-ruptured forms of AAA. Conclusion. Defined criteria for diagnosis of the complicated, non-ruptured, abdominal aortic aneurysms permit to reveal such complication on time and to prevent a life-threatening rupture.

Goal: to analyze the possibilities and identify the benefits of new modes of ultrasonic examination - ASQ (Acoustic Structure Quantification), SMI (Superb Microvascular Imaging) with high spatial and temporal resolution, in an examination of the arterial bed among patients with diabetes type 2. Materials and methods. The study included 44 patients aged 65 to 92 years. Men were 26 (59.0%), women - 18 (41.0%). All patients underwent a complete clinical examination, an ultrasound examination of the lower extremities arterial bed in the ultrasonic unit Aplio ™ 500 from Toshiba was performed. Results. The inclusion of new ultrasound modes in the examination algorithm of patients with diabetes type 2, ASQ (Acoustic Structure Quantification), SMI (Superb Microvascular Imaging) with high spatial and temporal resolution, will expand the diagnostic capabilities of ultrasound studies to identify the signs of pathological changes of lower limb arteries. The data obtained will allow to generate a differentiated approach for precaution, and to identify priority areas for the treatment of diabetic foot syndrome among older age group patients. Conclusion. During examination of older patients with diabetes type 2 it is a necessary to include in the algorithm of ultrasound examination the new research modes - ASQ (Acoustic Structure Quantification), SMI (Superb Microvascular Imaging) with high spatial and temporal resolution for a reliable assessment of the lower limb arterial bed status. These data forms the reasonable tactics of treatment and prevention of diabetic foot syndrome.

Objective: to determine the main cause of the high repeatability error RE by realizing individual chronobiological investigations of the projection mineral density (PMD) in bone within the prosthesis zone by the dual energy X-ray absorptiometry (DEXA) method. Materials and methods. For the first time the chrono-biological evaluation is performed for the RE of the PMD measured in bone by DEXA method. The present results are obtained for Gruen regions of 10 patients after the total hip replacement. Results. The RE demonstrates hebdomadal oscillations. Possible causes of this phenomenon are examined. It is suggested that the tremor is one of them. Physical model of the tremor effect on intensity of X-rays transmitted through bone tissue is proposed. According to the model the effective pathway of X-rays in bone varies due to the tremor and depends on the hebdomadal rhythms. This model takes into account the bone architecture characterized by the regions with high and low atomic density (trabecular structure, young and old osteons) and allows us to argue the physical basis of the tremor impact on the attenuation of X-ray radiation in bone structure. Dependence of the measurements on the spatial fluctuations of bone structures caused by the tremor is predicted. Conclusion. It is recommended to consider the impact of tremor in the study of the PMD in the prosthesis area after hip replacement.

Diagnostic capabilities of a new hybrid computer technology named Fusion in musculo-skeletal applications which provides a combined use of X-ray, scintigraphy, CT, PET, MRI with US are discussed in the issue. Questions of combined use of Fusion with Doppler, contrast enhancement and elastography are reviewed. Advantages of the Fusion technology in examination of different parts of musculo-skeletal system are clearly showed. Diagnostic capabilities of Fusion technology using US-device My Lab Class C (ESAOTE) with a special virtual navigator module was studied for hip, knee, shoulder joints. Combination of X-ray, MSCT and MRI images before planning surgery and after, and in rehabilitation period were performed in 16 patients. Possibilities of Fusion technology in evaluation of different joint’s elements was carefully illustrated.

The aim: to improve the outcomes of vertebroplasty of the vertebral bodies in osteoporosis based on the evaluation of X-ray results morphometry. Material and methods. Observation of 267 patients who have undergone spondilography thoracic and lumbar spine and computerized tomographic examination before and just after vertebroplasty, as well as 1 and 2 years after it. Vertebroplasty was performed by the standard technique and with the use of the proposed method. Results. Following the results of the X-ray morphometry of thoracic and lumbar vertebrae in patients with osteoporosis, the position was formulated concerning the necessity to strengthen the anterior and posterior segments of damaged vertebra body in all variations of its deformation. Insulated filling with polymer at the optimal level in case of 2-fragment type of vertebral body fracture allows to achieve reliable stabilization and avoid iatrogenic complications associated with extravertebral output of polymethylmethacrylate. Conclusion. In order to achieve persistent positive results of treatment of patients with uncomplicated fractures of vertebral bodies of the thoracic and lumbar the background affected by osteoporosis when planning to perform vertebroplasty it is necessary to take into consideration X-ray morphometry parameters of the damaged vertebra.

The aim: to estimate the use of MRI at the examination of patients with hallux valgus. Materials and methods. We examined 22 patients with hallux valgus getting surgical treatment in the orthopedic department of Irkutsk Scientific Center of Surgery and Traumatology. All the patients were women from 19 to 57 years (32 ± 2.07). All patients had X-ray, MRI and intraoperative examination of the affected foot before the surgery and in postoperative period. All patients had osteosynthesis conducted with the use of biodegradable screws, that allowed to carry out MRI in postoperative period. Results. X-ray examination determined hallux valgus angle (M1P1) - 30.67 ± 0.68° on average, intermetatarsal angle (M1M2) - 14.67 ± 0.66° on average. Proximal articular set angle (PASA) was calculated according to X-ray, MRI and intraoperative data, and the results were compared. PASA calculated by X-ray pictures was 13.67 ± 0.78° on the average. PASA calculated by MRI scans was 21.5 ± 0.35° on the average and significantly exceeded the value obtained with use of X-ray imaging. Considering more precise PASA values obtained with the use of MRI, an optimal surgical procedure was chosen and the expected level of I metatarsal osteotomy was determined before the operation. After the operation we revealed the M1P1 angle correction down to 9,67±0,78°, M1M2 angle correction - down to 10.17 ± 0.56°, i.e. to the normal values. According to the postoperative MRI, PASA correction was conducted down to normal values (4.17 ± 0.09°). The treatment caused complete correction of hallux valgus in all patients. No poor results and hallux valgus relapses was found. Conclusion. MRI as compared to the X-ray allow to define PASA values more precisely by means of the visualization of chondral layer of I metatarsal articular surface. Complex use of X-ray and MRI in hallux valgus patients improves the quality of diagnosis of pathological changes and the treatment outcomes. MRI of the foot should be included in the plan of examination of hallux valgus patients.

Non-palpable breast benign and malignant lesions have similar radiographic manifestations. The difficulties of interpretation of non-palpable breast lesions increase the number of unwarranted biopsies. Purpose of the study. Identify significant radiological parameters for a correct assessment of the nature of change and indirect signs of breast lesions for categorization in the BI-RADS system; develop a strategy for ultrasound negative for the first time and newly identified impalpable lesions. Materials and methods. The study included 423 patients with non-palpable mammary premenopausal, have identified 129 (30.4%) breast cancer. The diagnosis was verified on the basis of the results of complex clinical and instrumental examination, including standard, diagnostic X-ray mammography, ultrasound, MRI, MSCT and breast biopsy data. There were significant radiological signs of malignancy lesions, defined their diagnostic value. Results. The use of additional diagnostic techniques mammography contributes confident visualization significant radiological criteria of malignancy increases the information content of the method is 5%, helping to reduce the number of unwarranted biopsies by 11%. Conclusion. The diagnosis of non-palpable lesions of breast, including ultrasound-negative lesions based on a comprehensive analysis of relevant and indirect radiological signs, taking into account the localization of the changes depends on the screening round and requires the use of additional diagnostic techniques. X-ray mammography diagnostic value in this approach is increased from 91% to 98% sensitivity and specificity of 61% to 75%. MSCT-MG and MG-MRI demonstrated an even higher efficiency: MSCT-MG with KU (100%) and MRI-MG with KU (100% sensitivity, 98% specificity). Consistent application of radiation and morphological studies with a gradual increase in the degree of invasiveness increases the quality of the diagnosis of non-palpable breast cancer.

The active implementation in practice of ultrasound contrast agents opens up new possibilities in the differential diagnosis of focal changes in various organs and tissues. Official year and a half experience in the domestic application of this technique requires the primary analysis, synthesis, systematization of chaotic research to determine the future direction of the study and implementation of new technology to the clinic. Objective. To analyze the technical and methodological aspects of the use of ultrasound contrast agents for various inflammatory and neoplastic diseases. Materials and methods. 183 ultrasound examinations with contrast enhancement at 7 state medical clinics from January 2015 to March 2016 were conducted. Zones of interest in various diseases were: eye, superficial tissue, abdominal organs (liver, pancreas, spleen, duodenum), retroperitoneal area (kidney, adrenal gland, non-organic tumor,), prostate gland. Results. New terminology to describe the changes was offered identified by ultrasound with contrast enhancement based on the analysis of the research, the technical aspects of implementation and nuances of technique of contrast enhancement of different organs and tissues were described. Conclusion. Ultrasonography with contrast enhancement provides a greater amount of information for the differential diagnosis of formations of various localization. Compliance with the general principles of the methodology and consistency in the description of the identified changes will enable to compare data from different medical institutions, to create a joint database for more in-depth study of the problem.

Introduction. Pancreatic tumors have solid or cystic structures. Most often in such tumors there are signs of malignancy at the time of radiological examination. Tumors can be diagnosed incidentally (incidentalomas), or at differential diagnosis with other focal pancreatic lesions. Aim. To evaluate the protocols radiological examinations and criteria for differential diagnosis. Results. Multidetector computed tomography with bolus contrast enhancement is the “gold standard” for diagnosis of pancreatic cancer, but other methods, such as MRI with DWI, endoscopic ultrasonography are increasingly used to assess operability, staging and resectability of the pancreatic tumors. The pancreatic ductal adenocarcinoma need to be differentiated from neuroendocrine tumors, solid pseudopapillary tumor, local forms of pancreatitis and other rare pancreatic solid lesions. Conclusion. MDCT is the most common diagnostic method, but any radiological method can be used. Decision about “histological” diagnosis will be, if it is confirmed by two or more radiological examinations. Pancreatic ductal adenocarcinoma is the most aggressive tumour with the lowest period of survival after surgical treatment. Accordingly, the differential diagnosis of solid pancreatic lesion is needed. There are not benign solid tumours of the pancreas. All tumours are or malignant at the time of diagnosis, or they had the potential to become malignant.

Magnetic resonance imaging “plays” a major role in the diagnostics of the biliary hypertension. Objective: optimization radiodiagnostics of biliary hypertension using magnetic resonance imaging. Materials and methods. The article presents the results of radiodiagnostics 144 patients with biliary dilatation due to the obstruction of the distal part of the common bile duct. To optimize the use of techniques and methods of radiation diagnosis identified two groups to optimize the diagnostics: In 95 causes biliary dilatation was as a result of the benign disease and in 49 causes - malignant disease. Volume of inspection of patients: MRI, US performed in all patients, EUS, ERCP, Ct performed in smaller quantities. Results. Magnetic resonance cholangiopancreatography, in 51.6% of cases complete with the traditional protocol MRI study allowed us to determine benign biliary hypertension with a diagnostic accuracy of 96.5%. MRI including contrast enhancement and DWI, allows to diagnose biliary malignant hypertension origin with an accuracy of 97.9%. Endoscopic ultrasonography allows differential diagnosis of choledocholithiasis in patients with benign biliary hypertension, in patients with malignant biliary hypertension allows the differential diagnosis of tumors. Conclusions. MRI let us receive the most complete information about the hepatobiliary system. Its combination with EUS allows to “make” an optimal surgical card and carry out diagnostic and treatment manipulations.