Purpose: to study the activity of demyelination process in patients with multiple sclerosis using magnetization transfer effect.

Materials and methods. Рatients group of 10 people aged from 19 to 48 years old with a confirmed diagnosis of multiple sclerosis was formed for clinical testing. Contrastcontaining and fat-containing substances scanned with offset frequency used as the material for the phantom studies. MRI investigation was performed on high field magnetic resonance tomograph with 1.5 Tesla magnetic field. To obtain T1-weighted images in the phantom experiment the Spin-Echo pulse sequence with parameters: TR = 650 ms, TE = 20 ms, FOV = 14 cm, MX = 96 × 256, STh = 4.7 mm with the imposition of a single pulse of magnetization transfer (MTS = 1) was used. Magnetization transfer ratio (MTR) was used to quantify the magnetization transfer effect. The Spin-Echo pulse sequence with the following parameters: TR = 621 ms, TE = 17 ms, FOV = 23.4 cm, MX = 208 × 320, STh = 5.0 mm was used in the clinical trial.After the administration of contrast medium the same pulse sequence with applying magnetization transfer pulse (MTC = 1) was used. Contrast ratio was calculated for evaluating the contrasting effect.

Results. The greatest MTR value was obtained when the phantom study with a combination of frequency offset (Δf) and flip angle (FA(MT)): Δf = −210 Hz and FA(MT) = 600° respectively. Clinical approbation of this combination showed a statistically significant increase in contrast ratio (p < 0.05) between the demyelination foci and white brain matter in comparison with the sequence without magnetization transfer effect. In addition significant differences in MTR coefficients revealed between the intact white matter and demyelination foci (p < 0.05). The sensitivity of T1-weighted sequence with the magnetization transfer effect in identification of active foci of demyelination was significantly higher (p < 0.001) than that sensitivity of T1-weighted sequences without the magnetization transfer effect.

Conclusion. The improved visualization of active foci of demyelination in patients with multiple sclerosis using a sequence with magnetization transfer effect with the following parameters: Δf = −210 Hz, FA(MT) = 600° due to the high values of contrast ratio compared with T1-Spin-Echo (p < 0.05) was shown and significant reduction in MTR coefficient in demyelination foci (p < 0.05).

Summary. Evaluation of the potential of PET/CT with 18F-FET in differential diagnosis recurrence from post-radiation changes in patients with metastatic brain lesions after stereotactic radiosurgery.

Materials and methods. The study included results of PET/CT with 18F-FET and MRI studies of 23 patients with brain metastases of primary tumors different localization after Gamma knife. Number of lesions in which was measured quantitative indicators were 48. All patients underwent three-phase PET/CT with 18F-FET and at least two dynamic MRI. PET/CT was performed in three stages: the first immediately after administration of 18F-FET, the second and third in 10 and 40 min after administration respectively. The data were evaluated visually with calculation of maxSUV1,2,3 and TBR1,2,3 respectively to the three phases of the studies.

Results. Accumulation of 18F-FET in the pathological lesions in the majority of cases (98%) were characterized by higher values of maxSUV1,2,3 relatively to the unaffected substance of the brain and only in one case the accumulation did not exceed background. The average values of the TBR1,2,3 were higher in the recurrence of metastases than in mixed and radiation necrosis changes. Determined the significance of the first stage of the scan with calculation TBR1 – values in the recurrence were higher than 2.0, than mixed changes and necrosis values that were below 2.0. Additional information gives graphical analysis of dynamics of TBR1,2,3, which also allows to differentiate mixed changes and postradiation necrosis by the vector curve.

Conclusion. Comprehensive analysis of TBR1 values and curve type are more accurate criteria than single analysis maxSUV1,2,3 in the pathological area. In case of recurrence it is possible to determine the most active site, which plays an important role in planning for repeated radiosurgery. Identification of the mixed nature of changes have a predictive character and, in most cases, involve dynamic control.

In this clinical case of surgical treatment of craniovertebral junction meningioma (CVJ-area) of ventrolateral location. Meningiomas of CVJ-region are relatively rare compared with intracranial meningiomas at other location. About 90% meningiomas of CVJ-region has ventral and ventrolateral location. Surgical treatment of tumors of this area is associated with a high risk of neurological complications. At the same time, surgical outcomes and postoperative projections depend on the degree of removal of these radical benign tumors. For the best exposure of the tumor and control of vital structures (major vessels, cranial and spinal nerves, the brain stem) requires the use of appropriate approaches to the pathological process. In this case, an example of the total removal of the ventrolateral craniospinal meningioma of the extreme lateral (far-lateral) access to almost complete regression of neurological symptoms in the postoperative period.

The aim: to determine if the multislice computed tomography is effective in detecting the oral cavity and tongue cancer.

Materials and methods. A data set from MSCT research study containing records from 243 patients aged between 19 and 89 has been analyzed. The data included personal records of two groups: 124 (51.0%) patients of the main group with the diagnosis “tongue and oral cavity cancer” and 119 (49.0%) patients the control group, receiving assessment and treatment at Oncology in-patient specialized clinic №1, during a period from 2012 to 2016 years. The findings were compared to information received from clinical, instrumental examination and morphological results.

Results. Some typical CT signs of tongue and oral cavity cancer are identified as following: the asymmetry of anatomical structures; tissue densities ranging +39 HU...+43 HU (min/max −13…+86 HU); obliteration of fatty layers; the postcontrast densities increasing on 36–47 HU (min/max +26…+68 HU); the presence of a hypodense contrast agent-avoiding area; signs of additional tissue; signs of local tissue defect. Similar calculations are made for the four signs of the greatest figures in complex resulting in 97.6% sensitivity, 99.2% specificity and 98.4% accuracy. The analysis of parametric data showed a direct dependency between the degree of lymph nodes involvement and the thickness and width of the tongue tumor.

Conclusion. The results of this study indicate a high diagnostic efficacy of MSCT in detecting cancer of different localization in the mouth and on the tongue, determining the area affected and the identification of local metastasis.

Presents literature data about the morphological changes of the liver in hepatocancerogenesis. There are given the histological criteria for differential diagnosis of hepatocellular regenerative and dysplastic nodules, as well as early and progressive cancer. Specified the capabilities of MRI studies and the MRI characteristics of hepatocellular nodular lesions. At the basis of the changes MRI semiotics of preneoplastic lesions and tumors of the liver are increasing cell density, the appearance of intracellular accumulation and changes in arterial and venous blood supply. Noted that MRI is a highly effective method for the detection and differential diagnosis of nodular lesions in the liver.

The majority (50–70%) of biliary tract cancer accounts for the hilar cholangiocarcinoma (Klatskin tumor). Despite the relative availability and advances in imaging techniques, Klatskin tumor is one of the most difficult tumors to diagnose. In most cases, it is detected in later, advanced stages, and therefore prognosis is poor. The review describes epidemiology, existing classifications of hilar cholangiocarcinoma (outlining advantages and disadvantages for each one), risk factors and clinical course of the disease. Diagnostic features of the tumor for principal methods of visualization (ultrasound, contrast-enhanced CT, MRI with MRCP) are described along with respectability criteria. The algorithm of complex diagnostics of Klatskin tumour is augmented.

The aim: study the possibility of using data elastometry hearth tumors in the liver parenchyma and “unchanged” the liver parenchyma in this patient for the differential diagnosis of tumors in premorphological diagnostic stage.

Materials and Methods. 46 patients with liver tumor underwent ultrasound. The stiffness (elastometry)of the tissues in the tumor and intact liver parenchyma was studied. The ultrasound data were compared with the results of morphological studies, obtained by biopsy. Statistical methods for the study included analysis of variance, and to develop decision rules determine the type of tumor formation method of classification of trees applied.

Results. During the work we have been able to implement a new approach to the differential diagnosis of focal liver formations based on the simultaneous study of rigidity not only the pathological focus, but also the “intact” parenchyma, lying outside the chamber and away from the capsule of the body.

Conclusion. The algorithm allows, based on the measurement of Young’s modulus in the pathological focus in the “intact” parenchyma of the liver to make the conclusion about the nature of the neoplasm.

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. 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, three-dimensional 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 – 5 (10.6%); chromophobe cancer – 1 (2.1%); juxtaglomerular cell tumor – 1 (2.1%); oncocytoma – 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 light-cellular cancer and rare forms of kidney and cellular cancer.

Results. Part 2. Observations of US with contrastenhanced of rare morphological forms of benign and malignant renal tumors of in comparison to results of morphological researches are presented. It allows to study the nature of tumors bloodsupply in more detail, that gives the chance to provide their differentiation. Further accumulating of material and the analysis of bigger data array for development of own line item concerning opportunities of verification of rare renal tumors according to US with contrastenhanced are reasonably.

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.

Nephrolithiasis is a pandemic distributed disease that affects 4-20% of the population worldwide and is characterized by a high recurrence rate. Currently computed tomography without contrast remains the gold standard for diagnosis of urolithiasis because of its high accuracy to detect stones, their location and size. However, the modality has limited effectiveness in determination of urinary calculi chemical composition. Recently introduced imaging modality dual-energy computed tomography based on acquiring images at two different energy levels has showed high effectiveness in determination of urinary calculi composition. The review is focused on dual energy computed tomography principles and methods performed on different scanners. Recently published data on the application of this imaging modality in the diagnostic of urinary stone disease for calculi composition determination are analysed. The pitfalls of the method are reviewed. Future perspectives of this technique in urinary stone disease diagnosing will be discussed.

Backgrond. Efficiency of low-invasive angiosurgical revascularisation techniques essentially depends on precise and individualised anatomic localization of arteries involved to the procedure. In particular when carrying out the lowinvasive mammarocoronary bypass surgery this means the optimal selection of intercostal anatomic approach adjusted to real position of internal thoracic and coronary arteries. Nevertheless the real possibilities of use of the MRI simultaneously with MR-angiography (MRA) for 3D pre-surgical design and personalization of surgical technique in every personal case according to real anatomic relation of coronary and internal thoracic arteries remain underemployed. Both the feasibilities and long-term results of individual virtual design of mammarocoronary bypass surgery based on routine chest MRI and MRA data are not yet studied, and the real efficiency of such approach remains unclear.

Aim: comprised first the development of a technique of 3D virtual anatomic design of mammarocoronary bypass surgery basing on the data of simultaneous ssfp-MRA imaging of coronary and internal mammary arteries and on set of chest MRI tomographic images, in order to improve the results of mammarocoronary mini-invasive transthoracic technique of bypass; and second, the technique was briefly evaluated from the one-year follow-up clinical results.

Material and Methods. The patient’s material comprised overall 23 persons who were assigned to two groups – first the fourteen (61%) patients of the main group, in whom the low-invasive mammarocoronary bypass surgeru was carried out; and the nine patients (39%) of the comparison group, recruited from earlier cases, in whom the surgical intervention was performed without evaluation of chest MR-angiographic data. The MRI and MR-angiography, later employed for threedimensional quantification of inter-position of heart surface, of anterior descendent coronary artery, of internal mammary artery, of bone, chet wall muscular and catilage structures, comprised chest breath- and ECG-synchronized MRI with detailed imaging of anterior chest wall, intercostal spaces and internal mammary artery, imaging of the heart itself using two- and four-chamber long-axis positions, and pan-angiography of chest aorta and major arteries, including coronary arteries and internal thoracic arteries. The slices were 4–7 mm thin, acquired to matrix 256 × 256 or 256 × 392 voxels, with field of view as big as 30 × 40 cm. From the 3D model of thoracic and coronary arteries the optimal surgical technique was designed in every clinical case basing on critrion of minimal distance between internal thoracic artey and antrior descending artery as rationale for selection of intercostal level for endoscope introduction and location of aretrio-arterial anastomosis between internal thoracic and coronary arteries.

Results. The possibilities of individual anatomic adjustment based on MR-angiography of thoracic arteries were evaluated in fourteen patients in whom the mammarocoronary shunts were carried out basing on MRA data, delivering no any occlusion of the shunt during 12.5 ± 2.2 mnths follow- up. As a control group nine patients who underwent mammarocoronay bypass surgery without pre-operational MRI anatomic simulation were employed, in whom in two of nine occlusion of the shunt occured. The anatomic extent of isolation of internal mammary artery was in the group of patients in whom the 3D MRI-based design of surgey was employed as long as 20–35 mm, in average 29 ± 6 mm, whereas in patients without 3D anatomic simulation and design it was over 30 mm in all cases.

Conclusion. Thus, the use of simultaneous MRA imaging of coronary and internal mammary arteries significantly improved both technique of mammarocoronary bypassing itself and provided no cases of shunt occlusion during the one-year folow-up.

Diabetic foot syndrome – a dangerous complication of diabetes that occurs on a background of destruction of peripheral nerves, blood vessels, skin, soft tissues, bonesand joints, manifested by acute and chronic ulcers, osteoarticular and purulent necrotic processes. Diagnosis forms of complications sometimes causes difficulties. This literature review shows the leading pathogenesis factors form the basic methods of diagnosis of diabetic foot syndrome. Separately considered are methods of radiation diagnosis as a classical X-ray, computed tomography, magnetic resonance imaging. It provides the most commonly used classification.

Papillary fibroelastomy (PF) revealed rare, the incidence according to the autopsy is to 0,0017-0.33% of cases. Most often affects the valves of the left heart chamber. The literature describes isolated cases of pulmonary valve lesion. The complexity of clinical diagnosis due to the lack of pathognomonic signs and asymptomatic. Instrumental diagnosis is difficult and the small size of the tumor localization of the valve. The retrospective study of two cases of PD, confirmed by echocardiography and magnetic resonance imaging (MRI) and successfully operated in FCCVS of Penza are presented. The possibility of cardiac MRI in the diagnosis of tumors of the valve localization. MRI allows us to study the anatomy of the individual morphological features of tumors, demonstrate and evaluate the topography of detail that helps surgical decisionmaking.

Objective: to study the capabilities of ultrasound imaging in the diagnosis of soft tissue foreign bodies.

Materials and methods. 93 patients with a preliminary diagnosis of foreign bodies soft tissue ultrasound examination performed on the, HDI 5000 and the Aplio 500scanners;transducer elected respectively scan depth of interest in the location area. To improve the ultrasound diagnostics of foreign bodies used the original method of initializing, Twinkling artifact. Identified foreign bodies were extracted intraoperatively – in 11 (11.8%) patients, either through the wound channel – in 75 (80.6%). Diagnosis of foreign body was expelled in 7 (7.5%) patients (own bone sequesters (4) and parasitic invasion (dirofilariasis) (3)).

Results. Ultrasound reveals foreign bodies, including not determined radiographically, to differentiate them from other disease states with similar clinical picture. Echographic characteristics in conjunction with the study history presumably prevented to judge the foreign body material (wood, glass, bone, gauze, latex etc.).Optimization of diagnosis of foreign bodies contributed to the use of the original method of initiation, Twinkling artifact. Ultrasound also allows to evaluate the localization of foreign bodies and their relative positions to the surrounding anatomical and pathological structures, identify the signs of inflammation, abscess formation.

Conclusion. Studies have shown high information ultrasonography in the diagnosis of foreign bodies, including not determined radiographically. The data can be the basis for the differentiated choice of medical tactics, in particular, the establishment of indications for surgical or minimally invasive treatment.

Purpose. Revealing the trends of the inappropriate X-Ray attenuation estimations on MSCT.

Data and Methods. There have been analyzed abdominal CT results of 100 patients, archived in the Radiological Information System of Moscow. The standard water phantom has been scannedalsowith different parameters. Scans were made on 64-row detectors CT scanners.All devices were calibrated on water and air.

Results. There have been discovered inappropriate estimations of X-Ray attenuation, mainlays understating by 4–20 HU, more apparent in peripheral areas of the FOV. These distortions had resulted in the overdiagnosis of diffused diseases of liver, pancreasand kidney. Phantom scans have confirmed that the estimations of X-Ray attenuation coefficient are really inhomogeneous. The trend is the rising understatement from FOV center to periphery. This doesn’t depend on the tube current change in range of 100–550 mA. More appropriate estimations were noted using the narrowed FOV.

Conclusions. There is a problem of the inappropriate X-Ray attenuation estimations on MDCT, mainly as thefalse hypoattenuation, more in the FOV periphery,which does not depend on the tube current. FOV decrease and use of 5-mm slices for measurements may enhance the estimation accuracy.