Objective: to analysis of quantitative and qualitative changes in MR tractography in the diagnosis of structural brain damage in children with stroke.

Materials and methods. We examined 55 children with stroke in different periods between the ages of birth to 6 years (mean age 5.99 ± 1.67 months; Me = 2.0 months.). All patients underwent DTI evaluation by measuring the fractional anisotropy (FA) and apparent diffusion coefficient (ACD).

Results. During the assessment of the FA in the affected and healthy side of the brain we have revealed a statistically significant (p < 0.001) decrease of indicators of FA and increase of MCD along the corticospinal tracts and at all levels of its passage. In the area of cystic degeneration the value of FA was significantly lower (0.05 ± 0.02) than in the area of gliosis (0.15 ± 0.03). In the area of cystic degeneration ACD was within 2.91 ± 0.44 • 10–3 mm2/s, and in the area of gliosis – 1.49 ± 0.27 • 10–3 mm2/s. Comparison of ACD values depending on the motor deficits showed statistically significant differences between patients with monoparesis, hemiparesis and tetraparesis (p < 0.029).

Conclusion. Diffusion-tensor magnetic resonance imaging possible for not only to evaluate the available quantitative and qualitative changes brain pathways in different periods of stroke in children, but also it can predict the growth of motor deficits (in this case fractional anisotropy more sensitive indicator which significantly correlated with functional outcome (p < 0.05) in children with stroke).

Purpose: to improve the differential diagnosis of benign liver rumors and the liver metastasis of colorectal cancer with the ultrasound using contrast sonography.

Materials and methods. There were evaluated 92 patients with liver neoplasms (44 (47.8%) women and 48 (52.2%) men) age 41 to 83, with a mean age of 62.8 ± 2.64. Ultrasound exam was carried out in three stages: I stage – liver ultrasound in B-mode, II stage – ultrasound in B-mode with addition of color Doppler imaging and power Doppler scanning, III stage – contrast liver sonography employing the contrast agent SonoVue (Bracco Imaging SpA, Milan, Italy). According to the results of the examination the patients were either surgically treated if there were indications, or the nature of the neoplasm was verified via the needle biopsy. Thus the patients formed two groups: I group (n = 35 (38.0%) – patients with benign liver neoplasms: cavernous hemangiomas – 17, hepatocellular adenomas – 3, focal modular hyperplasia of the liver – 5; II group (n = 57 (62.0%) – patients with metastasis of colorectal cancer.

Results. With the use of the ultrasound in B-mode with addition of color Doppler imaging and power Doppler scanning in patients from group I (n = 35) with benign tumors of the liver – bilobar involvement in 2 cases, right lobe involvement in 28 cases, left lobe involvement in 5 cases. There were found both solitary (in 33 cases) and multiple (in 2 cases) neoplasms ranging from 2.5– 4.5 cm to conglomerates of 8–17 cm in diameter. In group II (n = 57), in patients with colorectal cancer metastasis who had an ultrasound examination in B-mode with addition of color Doppler imaging and power Doppler scanning, bilobar metastatic (91.2%) involvement of the liver prevailed over the monolobar, notably right lobe (84.21%) involvement was more frequent. Multiple metastasis were encountered more often (89.5%) then solitary. At the moment of metastatic liver disease discovery the size of the tumor nodules was over 5 cm in diameter in 33 (57.8%) patients. According to the results of contrast sonography in patients of group I (n = 35) with benign tumors of the liver, there was detected a prolonged enhancement of the neoplasm in the arterial, portal and delayed phases of enhancement. In patients of group II (n = 57) with metastasis of colorectal cancer to the liver, in the end of arterial phase there was noted a “washing out” of the contrast agent by 16th second – in 36 (63.1%) of the patients, by 23th se cond – in 17 (29.8%) and by the 26th second – in 4 (7.0%) of the patients. In portal and delayed phase of the enhancement all of the group II patients (100%) at the site of the metastasis there were located anechogenic round foci.

Conclusions. 1. Complex 3-stage ultrasound examination (B-mode, color Doppler imaging and power Doppler scanning, contrast sonography) of the liver neoplasms allows to get a more detailed information and differentiate benign and metastatic disease of the liver; 2. During contrast sonography the benign liver tumors “keep” the contrast gent during the arterial, portal and delayed enhancement phases, but with metastasis in liver the contrast agent gets “washed out” already in the arterial phase of enhancement.

Objective: to investigate the operating characteristics of contrast MRI of the liver using magnetization transfer effect in the differential diagnosis of hemangiomas and metastatic lesions in comparison with dynamic contrast.

Material and methods. The material of the study were dynamic contrast MRI images of 25 patients with diagnosis of direction of focal liver lesion. Inclusion criteria were detection of typical MR-semiotic for hemangioma (n = 10 to 40% of cases) or multiple liver metastases (n = 15 to 60% of cases).In the group with metastases exclusion criteria was the primary detection of obscure single focal lesions, as well as the diagnosis of other primary tumors, in particular cholangiocellular cancer (n = 1). All MRI studies were performed using MRI Toshiba Titan Octave with of 1.5 Tesla magnetic field. T1-weighted static contrast MRI investigation of liver performed after 3–5 minutes after a series of dynamic contrast MRI with modes: T1-FE-FSat and T1-TSEMTS (Δf = -210 Hz, FA = 600°). The magnevist at a dose of 0.1 mmol/kg was used as a contrast agent. Each focal liver lesion differentiated between hemangiomaand metastasis with the calculation of contrast ratio (CR) for each lesion. Statistical analysis of CR was performed using T-test and T-test Welch. The sensitivity and specificity parameters were compared during the ROC-analysis.

Results. In our statistical analysis groups formed not from patients, because we were compared results about focal lesions of a liver referred to metastasis or hemangiomas. All the patients included in a research had focal lesions mostly multiple and in the comparative analysis of contrast ratio in the T1-FE-FSat and T1-TSE-MTC was carried out on 21 (20%) hemangiomas and 84 (80%) metastasises. The significant (p < 10–4) contrast enhancement using T1-TSE-MTS, as in the case of hemangiomas and in metastatic lesions relative to T1-FE-FSat revealed by comparing the CRs. No significant differences were found in the differentiation of hemangiomas and liver metastases in modes T1-FE-FSat and T1-TSE-MTS when paired comparison of ROC-curves (p > 0.18). No significant differences were found when paired comparison of CRs between hemangiomas in T1-FE-FSat mode and metastases in T1-TSEMTSimages (p > 0.8). An additive effect (sensitivity and specificity – 98.8% and 85.7%) occurs when we used to CRcomm=35.7% in T1-FE-FSat modes and T1-TSE-MTS.

Conclusions. 1. Contrast MRI using magnetization transfer effect allows significantly increase the contrast of focal liver formations on the type of hemangiomas and metastases. 2. The achieved contrast level in 2D TSE images with magnetization transfer effect of liver metastatic foci corresponds to that of hemangiomas in 2D FE mode. 3. Maximum parameters of sensitivity and specificity in the differential diagnosis of hemangiomas and liver metastases obtained by using 2D-FE-FSat and 2D-TSE-MTC in post contrast phase.

The use of the contrast agent SonoVue has been allowed in Russia since June 2014. Since then, russian experts have been accumulating their own experience in the contrast agent application for various diseases. The analysis of the obtained data showed that, besides the typical characteristics of the lesions enhancement, described in the literature, there can be atypical cases due to various causes (longterm course of the disease, co-morbidity). We present a clinical case of pancreas cystic lesion in female patient, that was misunderstood as a cystic tumor preoperatively. Considering the epithelial lining nature, absence of the accurate signs of the presence of an ovarian-like stroma, and also the significant secondary changes in the cystic wall such as hyalinosis, cholesterol deposits and macrophage accumulations, the lesion was interpreted as a long-standing pancreatic retention cyst with secondary changes by a morphological study. The features of the enhancement patterns of this lesion can be explained by the presence of significant secondary changes in the wall of cyst, that was first diagnosed in this patient 10 years ago.

Renal cell carcinoma – the third on occurrence frequency tumor of urinogenital system and the most widespread renal tumor which makes about 2–3% of malignancies at adults. Doubling of inferior vena cava (IVC) is anomaly in case of which two inphrarenal segments of IVC are defined. Left IVC after lockin in it the left renal vein crosses an aorta in front, connects to the right renal vein and the right IVC. Combination of renal cell carcinoma and doubling IVC is rather seldom. The presented clinical case of a combination of renal cell carcinoma and doubling of IVC has the feature existence at the patient of metachronous multiple primary neoplasms that does necessary more careful inspection of the patient. Also a doubling of renal veins on both sides and a doubling of the left renal artery have been revealed. Possibilities of presurgical non-invasive diagnostics (ultrasonography and computer tomography) of retroperitoneal space vessels anomaly at the patient with transmural localization of kidney tumor allowing to plan and execute difficult surgery – an ex vivo resection of a left kidney in the conditions of pharmacological cold ischemia was shown. Performance of an ex vivo nephrectomy in the conditions of pharmacological cold ischemia allows to dilate indications to organ-preserving treatment of patients with the localized kidney cancer. However long cold ischemia and the subsequent vascular reconstruction demand dynamic observation over kidney’s functional conditions.

Objective: to study the symptoms of tumor lesions of colon and to determine the CT criteria for assessing the depth of tumor invasion in patients with colon cancer.

Materials and methods. CT data were analyzed at 121 patients with colon cancer. All patients were fully resected and CT data were compared with data of morphological studies. Staging was performed according to TNM classification 7th ed. (2009).

Results. We evaluated CT symptoms of tumor lesions in comparison with the data of pathological category T (pT): type of tumor, its structure, the condition of the external colon contour, the state of paracolon fat and its density, the presence of fat image between the tumor and adjacent organs and tissues, CT signs of invasion of malignant process in the neighboring organs and adjacent structures. For tumors with extraintestinal growth (T3–4 category) are characteristic CT symptoms: tumor heterogeneous structure (p < 0.001) with a fuzzy outer contour of the colon in the affected area (p < 0.05), the presence of changes in the paracolon fat whose density −76,95 HU and more, the invasion into adjacent organs at T4 category. The diagnostic efficiency of CT in determining T3–4 category was as follows: 90.9% accuracy, sensitivity 93.6%, specificity of 81.5%.

Conclusions. Computed tomography is a highly informative method for determining extraorgan spread of colon cancer, which allows to determine the amount of preoperative surgical treatment and adjust treatment tactics.

PET/CT offers the most advanced possibilities for visualization of non-small cell lung cancer (NSCLC) nowadays. 18F-FDG PET/CT plays a significant role in staging of NSCLC, choosing of treatment strategy, planning of radiation therapy and evaluation of its efficacy. Clinical observation of the patient with non-small cell lung cancer with response assessments by 18F-FDG and 18FFLT PET/CT during the course of chemoirradiation is demonstrated. There was a correlation between 18F-FDG and 18F-FLT PET/CT with advantage of 18F-FLT PET/CT for early response evaluation. The combination of 18F-FDG and 18FFLT PET/CT will be helpful to personalize chemoirradiation and to predict response more accurately. The presented clinical case demonstrated the possibilities of 18F-FDG and 18F-FLT PET/CT for assessment of treatment efficacy in patient with non-small cell lung cancer.

The purpose: to evaluate the effectiveness of thrombolytic therapy in patients with ischemic stroke according to radiological methods.

Materials and methods. The study included 60 people who were divided into two groups. The main group included 34 (56.7%) patients with ischemic stroke (20 men and 14 women) aged 22 to 78 years (mean age 62 ± 8.6 years) who were treated in Republican research center of emergency medical care. The control group consisted of 26 (43.3%) patients to estimate the parameters of normeperidine in the middle cerebral artery (MCA): the maximum blood flow velocity, linear blood flow velocity, index Gosling (PI) and coefficient overshoot (KO). Evaluation of patients included: assessment of nevrostatus according NIHSS scale, computered tomograhy of brain to exclude hemorrhagic stroke, transcranial and extracranial arteries Duplex scanning, digital subtraction angiography. Thrombolysis was performed to all patients of main group with ischemic stroke: systemic thrombolysis with streptokinase – in 17 (50%) cases, selective thrombolysis of Actilyse – 17 (50%). Thrombolysis was performed in a period from 90 minutes to 4 hours after the manifestation of symptoms.

Results. Significant positive changes were observed in 22 (64.7%) patients. Asymptomatic hemorrhagic transformation of ischemic lesion was observed in 4 (11.7%). In acute occlusion of the internal carotid artery recanalization was registered only in 11.7% of cases, while the M1 MCA occlusion segment – at 52.9%. Transcranial Doppler is manifested by registration of hyperperfusion flow after thrombolysis in the presence of residual flow to thrombolysis. Re-occlusion was observed in 2 (5.8%) patients. In these cases, before and after thrombolysis TCD fixed flow hypoperfusion. Mortality was 14.7%.

Conclusions. Thrombolytic therapy is effective treatment for ischemic stroke, especially in the delivery of the patient to a hospital for the first 2 hours after the manifestation of clinical symptoms. The marker of effectiveness thrombolysis is registration on the CMA normoperfusion or hyperperfusion pattern. Good functional outcome marked when a patient achieved result ≤2 points on the mRS. Asymptomatic hemorrhagic transformation can also be considered as a marker of effective thrombolysis. The combination of a CT scan of the brain with transcranial Doppler allows to assess not only the size of the lesion of the brain, but also to investigate the nature of cerebral hemodynamics. Further development of a set of measures designed to raise awareness among the population and general practitioners about the symptoms of stroke and its effective treatment in the case of delivery of the patient to a specialized hospital in which is possible to conduct thrombolysis.

Pulmonary or intercostal hernia appears as a bulge lung tissue result in the subcutaneous fat through a natural orifice or pathologically caused defects of the chest wall. Difficulties of diagnosis of the true pulmonary hernia owing to extremely infrequent occurrence of this pathology are, as a rule, bound to poor knowledge of doctors and quite often lead to inaccurate medical tactics. In the diagnosis of lung hernia along with clinical and laboratory data are used such research methods as x-ray, ultrasound, CT, among which, CT is a highly informative investigation method that allows to evaluate the status of lung tissue in the hernia sac and in other parts of the lungs, just to visualize the structures of the mediastinum, as well as the condition of the pleural cavity and chest wall, determining its proper treatment.

This paper contains historical review of prostate gland zonal anatomy approaches from morphological and radiological points of view. Nowadays, someconfusion remains in “central zone” term usage. Thus, authors propose to avoid using this termin conclusions of MR and TRUS exams. It’s also recommended to use 39 sectors prostate scheme for tumor localization only in cases, where MR exams were technically corresponded to PIRADSv2 system requirements.

Aim. Investigation of possibilities of magnetic resonance imaging as a whole, as well as different modes of MR scanning (without intravenous contrast, with intravenous contrast, with the use of diffusion-weighted imaging) in the diagnosis of cryptogenic fistulas of the rectum.

Materials and methods. In the study were included 50 patients with cryptogenic fistulas of the rectum (21 women and 29 men). All patients underwent magnetic resonance imaging of the pelvic organs.

Results. The sensitivity of MRI in the diagnosis of the primary fistulas was 100%. With regard to secondary fistulas MRI sensitivity was 91.7%, specificity was 94.3%. The sensitivity of MRI in the diagnosis of chronic abscesses paraproctitis was 82.6%, specificity was 95.2%. The sensitivity of the method in the visualization of internal opening was 95.5%, specificity was 80.0%. The sensitivity of the method in the diagnosis of external openings was 91.7% and specificity was 100%. In the analysis of separates MR scanning mode we didn’t find statistically significant differences between them (p < 0.05).

Conclusions. Magnetic resonance imaging has a high diagnostic efficacy in the diagnosis of cryptogenic perianal fistulas. We didn’t find statistically significant differences between MR scanning modes.

The number of women resorting to endoprosthesis replacement of breast is growing from year to year. To date, the most popular and safe method of correcting the shape and size of the breast is augmentation mammoplasty with silicone gel prostheses. Unfortunately, the diagnosis of breast cancer in patients who have had recourse to the augmentation mammoplasty at preclinical stages, is difficult. Most often this is due to the fact that the patient does not undergo preventive examinations. This research exemplifies a comprehensive procedure facilitating diagnostication of a breast cancer in a patient previously subjected to augmentation mammoplasty. A physical examination, a digital and an ultrasound mammography reveals a BI-RADS 5 nodal formation in the patient’s right breast. An ultrasound-guided biopsy of the newly formed tissue over the breast implant is morphologically cross-checked. The diagnosis of breast cancer is thus confirmed histologically.

Aim: to compare the diagnostic efficacy of generation I and II computer aided detection (CAD) systems for mammography of our own design using the large set of unselect ed mammography images obtained in a routine clinical practice settings.

Material and methods. Both CADs were tested on the set of 1532 mammography images of 356 women with confirmed breast cancer (BC). We assessed their value in the detection of suspicious areas with various characteristics located on the different density background. Size of BC lesions varied from 4 to 35 mm (mean – 13,4 ± 6,3 mm). We excluded BC representing only with microcalcification clusters from this analysis, because this task is solved using the separate universal module compatible with both CADs.

Results. For I and II generation CADs we obtained the following results: detection of small nodular BCs (≤10 mm) – 41 of 52 (78.85%) and 48 of 52 (92.31%; p > 0.05), respectively; detection of BCs visible as asymmetric areas – 18 of 18 (100%) and 13 of 18 (72.2%; p > 0.05), respectively; detection of only partially visible masses – 15 of 18 (83.3%) and 17 of 18 (94.4%; p > 0.05); detection of lesions poorly visible or invisible on standard mammography images due to the high density background (C-D types according to the ACR 2013 classification) – 9 of 16 (56.3%) and 7 of 16 (70.0%; p = 0.046). Total detection rate was 88.76% (316 of 356 cases) – for CAD I and 90.73% (323 of 356 cases; р > 0.05) – for CAD II. Mean false positive marks rate was 1.8 and 1.3 per image, respectively, – for ACR А-В images and 2.6 and 1.8 per image, respectively – for ACR C-D images (p < 0.05).

Conclusion. Generally the diagnostic value of CAD II is not inferior that of CAD I in all analyzed situations, except the poorly visible or invisible lesions on the dense breast background. Moreover, CAD II is probably superior CAD I in the detection of spiculated small masses. The rate of false positive marks was significantly higher for CAD I.

Introduction. The number of contrast enhanced MDCT is growing everywhere. The risk adverse events after intravascular injection of contrast media increased also. One of these adverse events is an acute renal injury (known in the literature as a “contrast-induced nephropathy, CIN”). Literature data are often contradictory. We need an objective analysis of information on the incidence of CIN and evaluation of risk groups for MDCT-CIN.

The aim of the study: the evaluation of factors affecting the development of CIN, understanding of its pathophysiology, including patients with diabetes mellitus, at contrast-enhanced MDCT.

Material and methods. 62 English-language scientific publications, the full text of which and bibliography is available for search in PubMed (2013–2016 years), were analyzed. Factors of pathophysiology of CIN were divided into groups and subgroups for critical analysis and understanding the contraindications to the use of contrast-enhanced MDCT in the diagnostic process.

Results. Age older than 65 years, low baseline estimated glomerular filtration rate (eGFR), diabetes, low levels of serum albumin, hypertension predispose patients to CIN more often than the modified baseline serum creatinine. Intravenous injection of low osmolar CM is not a risk factor in patients with eGFR ≥45 ml /kg /1.73 m2. SCr levels may vary to levels greater than or less than 25% of baseline even without administration of iodinated CM and may not be a reliable diagnostic test.

Conclusion. The introduction into the everyday practice of screening CIN such test as the eGFR, considering the risk of CIN threshold level lower than 45 mL/ min / 1.73 m2, will reduce the risk of misidentification of CIN in a large number of adult inpatients with a threshold level of serum creatinine (SCr) > 1,5 mg /dl.

The purpose: analysis of the use by radiologists techniques of post-processing of digital radiographs and the development of practical recommendations on their application.

Materials and methods. The technique of post-processing was taken for analysis: negative/positive; filters/optimization of dynamic range; the intensification of the contours and smoothing; image magnification; level/window width densities, and gamma correction. Compiled questionnaire, which the doctor and the radiologist had to answer the questions of how often he uses a particular technique of digital image processing; which, in some cases, the study of what organs he uses post-processing? In total, we analyzed 18 questionnaires and their own experience in digital x-ray machines since 2003.

Results. On the basis of interviews and our own experience, the author recommends that you always use the techniques of post-processing x-ray images, starting with the optimization of the dynamic range / filter, which greatly improves the quality of the picture.

Conclusions. 1. Doctors radiologists in the majority of cases (83%) use the methods of post-processing to analyse digital radiographs. 

2. Additional option of post-processing are used most of the time (90–100%), this level and the window width, the intensification of the contours increase.
3. Command path smoothing is applied in 1/3 cases (33%).
4. Rarely used to optimize dynamic range and FonEqualize.
5. Understanding all of the options post-processing of digital radiographs and their active use in practice of the radiologist, will improve the accuracy of x-ray, to avoid repeated shots, and as a consequence, to reduce the radiation dose of the patient.
6. Recommended: start post-processing images with optimal dynamic range/filter; for detail is necessary – to change the level/window width, zoom in, sharpen the contours.