Purpose: to assess correlation between Ki-67/MIB-1 LI and WHO grade brain gliomas and parameters of diffusion kurtosis MRI (DK-MRI) in the tumor.

Patients and methods. The study includes 84 patients with supratentorial brain gliomas (35 gliomas with low grade malignancy, 20 gliomas with the 3-rd grade and 29 gliomas with the 4-th grade of malignancy). The study appraised correlation links between absolute and normalized parameters of diffusion tensor (mean, axial and radial (MD, AD, RD), fractional and relative anisotropy (FA and RA) and diffusion kurtosis (mean, axial and radial (MK, AK, RK), kurtosis anisotropy (KA)) with Ki-67/MIB-1 LI and WHO glioma grade in the most malignant regions (p < 0.05, Spirman coefficient).

Results. DK-MRI parameters showed statistically significant correlation with Ki-67/MIB-1 LI and WHO glioma grades. Presence of oligodendroglioma (ODG) component in gliomas and oligoastrocytomas (OASs) did not affect the correlation between DK-MRI parameters and Ki-67/MIB-1 LI. However it affected correlation between DK-MRI parameters and WHO glioma grades. When studying correlation between parameters of DK-MRI and Ki-67/MIB-1 LI in IV grade gliomas maximum correlation was detected in case of normalised kurtosis anisotropy (KA).

Conclusion. DK-MRI proved high sensitivity in detecting structural changes in gliomas, which are observed when WHO grade and Ki-67/MIB-1 LI tumors change. DK-MRI parameters depend on WHO grade and Ki-67/MIB-1 LI gliomas. Presence of oligodendroglioma component in gliomas does not affect the correlation between DK-MRI parameters and Ki-67/MIB-1 LI, but affect the correlation between DK-MRI parameters and WHO glioma grade. Complex analysis of DK-MRI parameters in gliomas with due account for WHO glioma grade, Ki-67/MIB-1 LI and presence of oligodendroglioma component in the tumor carried out in our study made it possible to study in depth the dynamics of DK-MRI parameters during various pathological processes developing in the tumor.

The purpose: to assess the value of techniques of virtual bronchoscopy(VB) in improving the diagnostic information content of multislice computed tomography (MSCT) in the diagnosis and prevalence of neoplastic lesions of the tracheobronchial system (TBS).

Materials and methods. Analyzed the data virtual bronchoscopy multislice computed tomography we have developed methods 87 patients with tumors of TBS.

Results. A comprehensive analysis of native, postprocessing data and volumetric reconstructions was possible to more fully assess the nature of the changes to the topography, the extent and prevalence of neoplastic lesions of the tracheobronchial system. To carry out differential diagnostics of benign and malignant lesions, especially in stenotic lesions, when the execution of bronchofibroscopy was impossible. Signs of malignancy of the tumor had a wide base and destroys the adjacent cartilage structures, a rough bumpy surface, infiltration of the wall of the trachea, bronchus.

Conclusion. WB MSCT optimal method of diagnosis, determining the probabilistic nature of neoplastic lesions of TBS, the prevalence of the process. When stenotic lesions of the trachea, WB MSCT is becoming the method of choice in assessing the extent of the process. 

The aim: to assess the impact CHD and surgical revascularization on parameters of strain (S) and strain rate (SR) longitudinal, circular and radial fibers of the LV.

Materials and methods. In 450 segments LV deformation (S and SR) longitudinal, circular and radial fibers was analyzed before and after surgical revascularization.

Results. The study of averages S and SR showed the low S longitudinal fibers, low S and SR circular fibers and normal S and high SR radial fibers, no changes in these parameters after revascularization. A detailanalysis the segments showed a decrease S and SR in 211 (46.8%) segments of longitudinal, 232 (51.5%) circular and 116 (25.7%) of the radial fibers of the LV. The same 239 (53.2%) segments of longitudinal, 218 (48.5%) and circular 328 (72.8%) segments of the radial fibers had normal and increased values of S and SR as well as with different options to change S or SR. After revascularization improved deformation properties of longitudinal and circular fibers of the left ventricle in the group with low values of S and SR. The increased number of segments with high or normal value of SR. Normal values of S and SR radial fibers observed in most segments (254 (56.7%).

Conclusion. Technology Velocity Vector Imaging to conduct a detailed analysis of LV segments and to estimate the dynamics of the deformation properties of longitudinal, circular and radial fibers after revascularization.

Anomalous origin of the left coronary artery (LCA) arising from the pulmonary artery (ALCAPA or a Bland-WhiteGarland Syndrome) is a congenital heart pathology where the left main trunk (LM) originates from the pulmonary artery system (PA). Clinical signs of the defect were studied and described in 1933 by Cardiologists E. Bland, P. White, J. Garland; this anomaly took its name as “syndrome of Bland–White–Garland” (BWGS) from them. Frequency of LCA origin from LM is 0.025–0.05 per 1,000 newborns, 0.22% of all congenital heart defects (CHD) and 0.4–0.7% of critical CHD. Clinical supervision of a patient with BWGS first identified at age of 12 years, is exemplified. This example demonstrates that if CHD is suspected CT angiography of heart shall be made for the earliest and accurate diagnosis and determination of CHD type.

Diagnosis of the pancreatic lesions and the estimation of its staging very important, since the results have influence on the choice of treatment.

Aim: understanding tumor staging and assessment of operability of pancreatic cancer; consideration of the factors affecting the resectability of pancreatic tumors, vascular involvement, and assessment of the concept of “locally advanced cancer”; estimate survival following surgical resection and recurrent pancreatic tumors.

Methods of radiological diagnostics. Different radiological methods can be used. However, all of them need answering the most important questions – involving vessels in the tumor process and the presence of metastasis.

Results. All stages of pancreatic tumors can be represented as follows: Stage 0 (TisN0M0), 1a (T1N0M0) step, step 1b (T2N0M0), step 2a (T3N0M0), 2b (T1–3N1M0) step, step 3 (T4N0–1M0), stage 4 (T1–4N0–1M1). The rate of tumor growth (T category) is quite difficult to predict. But, even invisible tumor can be transformed into inoperable/unresectable after 2–3 months. Newly diagnosed small tumors of the pancreas, actively accumulating contrast agent during the arterial phase, most often is neuroendocrine neoplasias. The combination of two signs – tumor size less than 2 cm in diameter and high intensity contrast enhancement in the arterial phase – suggests a tumor with a minimal number of mitosis (Grade 1), and the ability to robotic assisted enucleation of the tumor.

Conclusions. The only treatment for pancreatic ductal adenocarcinoma cancer is surgery. Radiation methods can identify operable and inoperable tumors and to evaluate their resectability in most cases. Border resectability are the most unpredictable. This group of the pancreatic tumors should be subject to special vigilance and to maximize the attention of the radiologist. Modern methods of radiology is not possible to identify paravasal and perineural spreading of tumors. The only criterion of tumoral invasion is parapancreatic infiltration of adipose tissue. The inhomogeneous structure of the adipose tissue with a higher intensity density is a poor prognostic factor after surgery. Distant metastases, local recurrence of the tumor, paravasal and perineural spreading of the tumor can be most easily identified on diffusion-weighted images (high signal intensity on images with high b-factor) or by ultrasound (narrowing of the contours of the arteries and veins, changes in blood flow parameters), or as a darkening paravasal adipose tissue on CT scans.

Identification and differential diagnosis of solid pancreatic tumors remains an unsolved problem in modern pancreatology. Analysis of published data shows the high interest of researchers to this issue, and identifies a number of issues that require further study. The majority of publications concerns diagnosis of pancreatic adenocarcinoma, however, evaluation of their prevalence and early detection still remains a challenge. In addition, late diagnosis of insulinomas can not put a correct diagnosis for over 5 years. Differential diagnosis of neuroendocrine tumors and metastases of renal cell carcinoma still causes great difficulties. To improve diagnostic accuracy it is necessary to combine data techniques and estimate the zone of interest on a set of criteria.

In various diseases of the heart, accompanied by the development of right heart failure with increased сentral venous pressure, congestive hepatopathy develops with subsequent fibrosis, necrosis of hepatocytes and liver cirrhosis. The main methods of diagnostic imaging of congestive hepatopathy are ultrasound, multiphasic computed tomography and magnetic resonance imaging. Ultrasound reveals hepatomegaly, ascites, increase in the diameter of inferior vena cava, hepatic veins. Doppler study reveals a change in the spectrum of blood flow in the hepatic veins: three phase smoothing of peaks in scale, reduced ante grade systolic peak component or complete reversion of the systolic component, the movement of the bloodstream “to-and-fro” in hepatic veins and inferior vena. In multiphase computed tomography and magnetic resonance imaging the extension of the inferior vena cava and hepatic veins is determined. In the arterial phase of enhancement reflux of contrast medium from the right atrium into the inferior vena cava and hepatic vein is marked. In the portal phase of contrast enhancement the heterogeneous, mottled, mosaic parenchymal pattern is determined, signs of interstitial lymph edema, peripheral patchy areas of weak or delayed contrast enhancement are revealed.

The rare case of disseminated hepatocellular cancer in 7-year-old male patient has been analyzed using PET/СТ with 18F-choline and 18F-FDG and MRI with intravenous hepatotropic agent (“MultiНance”). Data confirming the presence of metastatic lesions of the left lung and the right lobe of the liver were obtained. Differences in the uptake of 18F-choline and 18F-fluorodeoxyglucose in the metastasis of hepatocellular carcinomahave been detected. PET/CT with 18F-choline showed a high sensitivity in the diagnosis of metastatic highly differentiated hepatocellular carcinoma. PET/CT can be used successfully in the diagnosis of hepatocellular carcinoma in pediatric patients.

Actinomycosis is a rare disease of the liver, which often manifests as an abscess or as a tumor. This disease is quite difficult to differentiate from other pathological changes in the liver. 4 patients with the verified diagnosis of actinomycosis of a liver have been treated at A.V. Vishnevsky Institute of surgery. Based on the analysis of literature data and results of clinical examination of the patients basic forms and most important US, CT and MRI diagnostic signs of hepatic actinomycosis were revealed. The third form of actinomycosis imitating a tumor of gate of a liver and which is followed by liver abscesses is for the first time revealed. It is expedient to consider this form of actinomycosis when performing differential diagnostics.

The development of false aneurysms of visceral arteries on the background of chronic pancreatitis is a relatively rare complication, the frequency of which, according to the literature, is 1–10%. When aneurysm rupture occurs massive gastrointestinal or intra-abdominal bleeding that is clinically difficult to differentiate from other pathologies of the gastrointestinal tract. To search for the source of bleeding used ultrasound, computed tomography, angiography.

25 patients with CP complicated by FA artery of the celiac trunk and the superior mesenteric artery аor the period from 2010 to November 2016 were treated in the A.V. Vishnevsky Institute of surgery. A clinical case is presented the principles of diagnosis and treatment of chronic pancreatitis complicated by a pseudoaneurysm of the splenic artery.

Sufficient experience of differential diagnostics of focal renal lesions according to contrast-enhanced ultrasound is accumulated in the world now, however, only the own experience of use of this agent gives the chance of accumulation of the corresponding knowledge and skills.

Objective: to estimate the possibilities of SonoVue contrast agent for differential ultrasonic diagnostics of focal renal lesions and to compare the obtained data with results of morphology.

Materials and methods. During the period from March, 2015 to September, 2016 at A.V. Vishnevsky Institute of surgery 47 patient with focal renal lesdions have been surveyed and were operated on. There were 27 (57.4%) men and 20 (42.6%) women aged from 19 up to 66 years. All patient carried out ultrasonography in B-mode, duplex scanning, threedimensional reconstruction of the ultrasonic image, and contrast-enhanced research with SonoVue agent was carried out also. All neoplasms were morphologically verified: clear cell carcinoma – 34 (72.4%); papillary cancer – 4 (8.5%); chromophobe cancer – 1 (2.1%); juxtaglomerular cell tumor – 1 (2.1%); oncocytoma – 1 (2.1%); neurogenic tumor – 1 (2.1%); adenoma – 2 (4.3%); chronic inflammatory infiltrate – 1 (2.1%); a cyst – 2 (4.3%). We consider to take up expedient separately questions of diagnosis of lightcellular cancer and rare forms of kidney and cellular cancer.

Results. Part 1. Assessment of opportunities of SonoVue contrast agent at differential diagnosis of renal clear cell carcinoma. Ultrasonography in the B-mode, duplex scanning, three-dimensional reconstruction, doesn’t always allow to obtain accurate information on localization of renal tumor, and the nature of the lesion, therefore contrastenhanced ultrasonography with SonoVue agent was applied. Sensitivity, specificity and accuracy of сontrast-enhanced ultrasonography at diagnosis of renal clear cell carcinoma were 92%, 100%, 92%, respectively.

Conclusion. Contrast-enhanced ultrasonography with SonoVue agent is rather cheap, doesn't bear beam load of the patient and isn't nephrotoxic owing to what it is expedient to include it in the protocol of inspection of patients with suspicion of renal cancer.

Objective. To evaluate the possibility of computed tomography in the diagnostisc and staging of cancer of the upper urinary tract (UUT).

Material and methods. The study included 23 patients with cancer of the upper urinary tract. All patients underwent contrast-enhanced MSCT, urine cytology (to detect atypical cells or cancer cells). Upon detection of the tumor of UUT according to MSCT, patients underwent ureteropieloscopy with a biopsy. After the surgery was performed to verify the diagnosis histological examination of surgical material.

Results. The leading computer-tomographic finding of UUT cancer is a “defect” in renal pyelocaliceal system, in the ureter in the excretory phase. MSCT allows exactly speak about cancer in the case of accumulation of contrast material, can detect even small-sized neoplasm in patients without an extension renal pyelocaliceal system. Systematized and formulated a computer-tomographic signs of staging of malignant tumors of the UUT.

Conclusion. MSCT is the most effective diagnostic method of upper urinary tract cancer, and the method allows to establish the stage of disease. 

Objective. To identify the features of trophoblastic blood flow in pregnant women with thrombophilia in the first trimester of pregnancy, according to doppler velocimetry.

Materials and methods. It was made ultrasound doppler velocimetry and the determination of parameters of blood flow in the vessels of the trophoblast in 80 pregnant women aged between 18 and 40 years on the stage of pregnancy from 7 th to 10 th weeks of gestation. According to the doppler velocimetry it was allocated 4 types of trophoblastic blood flow in pregnant women in this period. According to the pulse – wave doppler highlighted type 2 trophoblastic blood flow.

Results. In pregnant women with indicators of highly resistant type of blood flow, as well as a lack of locus trophoblastic blood flow there is a high correlation between the resistance index in the vessels of the trophoblast with indicators of blood hemostasis analysis system. The course of pregnancy until the end of the first trimester. It was determined that: highly resistant type, as well as the absence of loci trophoblastic blood flow is poor prognostic ultrasound feature and lowe resistant blood flow – prognostically favorable US-sign percentage safely occurring pregnancies in women with lowe resistant trophoblastic blood flow in the two times higher than in the group with highly resistant type loci and absence trophoblastic circulation. It was show the high specificity and sensitivity of the doppler velocimetry study trophoblastic blood flow.

Conclusions. Using the proposed method allows to reveal risk to predict spontaneous abortion and missed abortion in the first trimester and assign anticoagulant therapy in a timely manner.

Objective. To analyze of numerous works devoted to the evaluation of microcalcifications, their classification into benign and malignant, as well as the prognosis of malignant diseases in the presence of calcifications in them.

Materials and methods. Was analyzed works devoted to the evaluation of microcalcifications, as well as was evaluated 1195 mammograms, which was performed on the AMULET digital mammography system by FUJIFILM in our center in January–February of 2015. These data was compared.

Results. Breast microcalcifications are widespread criteria both benign and malignant lesions of the breast. It occurs in about 40% of breast cancers, and a half of them are not palpable. Besides, breast cancer with microcalcifications have worse prognosis.

Conclusion. Microcalcifications are one of the most important marker of breast cancer. It needs to be studied more carefully. 

In recent years, Hirsch index (HI) has become one of the most important criteria for evaluating creative and publication activity of the researcher. However, it is not universal, and causes a lot of complaints.

Purpose: to show a wide audience the role of Hirsch index in the modern scientific process and give it a critical evaluation.

Materials and methods. Search in the scientific electronic library (http://elibrary.ru/) for “h-index” gave the following result – 2074 publication. Narrowing this search for “HI medicine”, we got the following results – published and stored in a library 458 articles on the subject. Analyze a number of publications is not washed away, especially since their number dominant – it is not cited publication. From the general list work, which cited more than 10 times were selected (they are presented in the bibliography). Not all of them presented as free full version. Texts which are available for reading, used in the discussion. Besides the work done in the critical analysis of the recommendations to improve the Hirsch index, presented on the site http://elibrary.pro/rinc-i-indeksy.html.

Results and discussion. The article presents the author's views on the role of HI and were gave critical point of view on the subject.

Conclusion. The Hirsch index is good as an excellent researcher catalyst, but it is bad as the criterion of truth. One can not but agree with the majority of Russian professionals, that HI is more like a kind of pseudo-confusion, rather than the real objective tool used in the process of cognition. But, at the same time, its historical role is enormous. Appearance of HI on our domestic scientific field roused the Russian scientific process, forced to seek more equitable criteria for the assessment of high-tech research. 

Book Review

Kotlyarov P.M.

Virtual Bronchoscopy Computed Tomography (Multislice Computed Tomography in the Diagnosis of Diseases of the Lungs and Tracheobronchial System) 

Palmarium Academic Publishing; Germany, 2016, P. 127. ISBN: 978-3-659-77275-2