The purpose. The purpous of the present study is to compare the data of brain PET wih 2-18F-2-desoxi-D-glucose (18-FDG) of patients with dystonia with the results of patients with essential tremor (ET) by analyzing the data with the help of the new calculation method of Z-score of PET results.
Materials and methods. In 2010 in journal “Medical Visualization” we published results of PET study with 18-FDG of brain of 11 patients, which have been divided in two groups: the group with dystonia – 7 patients and the group with essential tremor – 4 patients. Glucose metabolism was studied by means of Siemens Exacthigh resolution tomograph. The results were presented in semi quantitative form of percentage of change of glucose metabolism, without comparison with the healthy control. The calculation has been done by means of software package SPM2, installated to the personal computer (OS Windows 2000). Later the Advantage Workstation of the same tomograph, used for the study, was equipped by software package Cortex ID that allows automatic structural and functional analyzes of PET visualization of the brain in comparison with the scans of control group of the same age. The results of such comparison are calculated by this program in the equation of Z-score, that is calculated automatically by special program for each brain zone. In present study we applied Z-score for analyzing again the comparison of the PET results of these two disorders. The group of essential tremor remained the same and included 4 patients studied before. As to the second group of dystonia, we added to it 3 new patients, studied since aforementioned study of 2010, the whole group of D rising up to ten patients. In order to level the conditions of our research, we also compared the former group of dystonia of 7 patients with the group of essential tremor by means of Z-score method.
Results. We have detected reliable difference between the group of dystonia and the group of essential tremor, presented in the form of different changes of glucose metabolism in 4 brain zones – left thalamus, right nucleus lentiformis, girus cingularis and the pons. Such result has not changed when we also compared the former staff of dystonia group of 7 patients with essential tremor group.
Conclusion. The study has confirmed efficacy PET in differential diagnosis of extrapyramidal disorders and of Z-score method in PET investigations by means of establishing of the correspondence of cinical heterogeneity to PET heterogeneity.

Paragangliomas of the head and neck are extremely rare tumors. During the period of professional activity, a radiologist can meet single patients with parangliomas. So it is important to know the main diagnostic signs when meeting with such patients, вecause on-time diagnosis and treatment contribute to reduce surgical risk. The purpose of this review is to study the most common localizations of paragangliomas of head and neck and describe main visualization characteristics which are necessary for correct diagnosis and differential diagnosis.

Aims: to evaluate the possibilities of low-dose MDCT protocols in visualization of liver and pancreatic tumors.
Materials and methods. 40 patients were enrolled in study and divided into 2 groups. Two scanning protocols were used, differing by the voltage on the X-ray tube-standard 120 kV, and the modified 100 kV. All studies were performed with intravenous administration of a contrast agent. The data – noise, a circumference of abdominal cavity, a relation “contrast-noise”, data of contrast strengthening of organs were evaluated. The tomograms were reconstructed using standard and iterative reconstruction algorithms. A qualitative assessment of the images was carried out according to 2 parameters – the evaluation of the whole image and the visualization of tumor on a 3-point scale.
Results. Radiation exposure decreased by 31.5% using the modified protocol. The noise level did not differ with the use of standard reconstruction, but it decreased markedly using iterative reconstruction. The contrast-to-noise ratio turned out to be higher in the “100 kV” group and consistently increased with increasing levels of iterative reconstruction. Evaluations of the visualization of tumors were significantly higher in the “100 kV” group.
Conclusion. The use of low-dose protocols is justified, it allows to seriously reduce the radiation exposure, improving visualization of the liver and pancreas tumors (primarily hypervascular). Application of iterative reconstruction algorithms allows achieving significant improvement in image quality and noise reduction.

Purpose: to evaluate the diagnostic value of contrastenhanced ultrasound (CEUS) with SonoVue in differential diagnosis of focal liver lesions (FLL) in a multidisciplinary clinic in Russian Federation.
Materials and methods. Bolus intravenous administration of 1.2 ml of SonoVue (Bracco Swiss CA, Switzerland) followed with 5ml saline flush was used for liver CEUS. We utilized the scanners Mindray DC-8 (Mindrаy, China), Logiq S8 (GE, USA), Philips Epiq 7 (Philips, Holland), SonoScape S9 (SonoScape, China), Hitachi Ascendus (Hitachi, Japan) with 3.0–5.0 MHz convex probes in specialized “contrast” mode with low mechanic index (MI 0.08–0.1). The study conferred 73 patients in the age between 18 and 84 years (mean age 49 years) with FLL. CEUS was performed in 22 patients with previously verified diagnosis, while the rest of patients underwent CEUS before the final diagnosis. Contrast-enhanced liver CT was performed in all patients. In 49 (67.12%) of 73 cases, a pathology was performed after a targeted core-needle biopsy or autopsy. Qualitative features of US contrast enhancement of FLL were evaluated.
Results. Qualitative aspects of CEUS for differentiation of FLL were defined. The principal sign for diagnosis between benign and malignant masses with CEUS was hypoenhancement of malignant lesions in comparison to surrounding normal parenchyma in portal and late venous phase (p ≤ 0.01). Alternatively, hyper- or isoenhancement throughout late venous phase was characteristic for benign FLL. Diffuse heterogeneous contrast enhancement was indicative of malignant FLL, and homogeneous – for benign. Additional diagnostic feature (p ≤ 0.05) was the type of contrast enhancement in the arterial phase. Heterogeneous diffuse contrast enhancement was observed in malignant FLL, while homogeneous – in benign FLL. Peripheral nodular contrast enhancement with centripetal filling was characteristic for liver hemangioma, centrifugal filling with “spoke-wheel” vascular pattern – for FNH, and peripheral rim-like hyperenhancement with rapid achievement of hypoenhancement at the beginning of the portal phase – for liver metastasis.
Conclusion. Complex analysis of qualitative characteristics of CEUS with SonoVue is a promising option for differential diagnosis of FLL (sensitivity 92.85%, specificity 91.3%, diagnostic accuracy 92.15%) and can be utilized in daily practice.

Purpose: the aim of this study was to assess the values of ARFI elastometry in normal subjects and effects of food intake and physical effort.
Material and methods. ARFI elastometry measurements were done in 32 patients (20 (62.5%) volunteers and 12 (37.5%) potential liver fragment donors). Mean age of patients was 26.9 ± 5.3 years. The study was performed in fasting condition in right intercostals approach, while the patients were asked to stop normal breathing for a moment lying in supine position with the right hand placed above the head. For 20 volunteers ARFI elastometry was performed at 30 minutes after food intake (about 350 kcal) and at next day immediately after physical effort (20 squats). The study was performed using Siemens Acuson S2000 ultrasound system with a 6C1 transducer.
Results. The stiffness of the right liver lobe in 32 healthy subjects was 1.16 ± 0.12 m/s (95% CI 0.92 ± 1.38), the mean liver stiffness values of 20 volunteers in fasting condition were 1,21±0,09 m/s (95% CI 1.06 ± 1.38), 30 minutes after the meal – 1.22 ± 0.12 m/s (95% CI 1.01 ± 1.43) (р > 0.05). Physical effort didn’t make significant influence on the liver stiffness measurements (1.16 ± 0.12 m/s vs 1.20 ± 0.07 m/s, р > 0.05).
Conclusion. Liver stiffness value in healthy subjects was 1.16 ± 0.12 m/s (95% CI 0.92 ± 1.38). There was no significant influence of food intake and physical effort on the liver stiffness measurements.

In modern pancreatology, diagnostics of acute pancreatitis is one of the most complex and urgent problems. In recent decades, the incidence of acute pancreatitis (AP) has more than doubled and now it exceeds 25% among acute surgical diseases. Pancreonecrosis accounts for about 20–35% of all complications. General and postoperative mortality reaches 15–45%. Modern radiology methods in patients with AP and pancreatic necrosis aid in determination of disease form and its complications. In this article, the importance of radiological methods for treatment planning is reviewed. Close attention is paid to the interpretation of computer tomography (CT) data using various CT-scales and classifications. High incidence among young and healthy people highlights socio-economic significance of AP. Therefore, in this literature review, we focus on the publications and clinical cases of acute pancreatitis. 

Aneurysms of the visceral arteries are a rare pathology, characterized by a combination of asymptomatic disease course with the risk of life-threatening complication – rupture and hemorrhage. Currently, due to availability and extensive use of ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI), early and accurate diagnosis of aneurysms of the visceral arteries has become possible. In some cases the pathology is discovered incidentally during examination for other diseases. Development of angiographic and laparoscopic techniques has opened new possibilities in the treatment of visceral arteries aneurysms, i.e. minimally invasive interventions. In this review of the literature, we present current data on epidemiology, etiology, clinical course and treatment of visceral arteries aneurysms with close attention paid to diagnostic problems. 

Caroli’s disease is a rare inherited disorder characterized by nonobstructive saccular or fusiform dilation of the intrahepatic bile ducts. Two main types of Caroli’s disease are reported, the true type with isolated dilation of intrahepatic bile ducts of single liver segment with formation of stones and development of cholangitis. The second type is combined with a congenital hepatic fibrosis. The true type of Caroli’s disease is distinct from primary sclerosing cholangitis, polycystic disease, cholangiolithiasis and other diseases. This paper presents a literature review and a case of monolobar Caroli’s disease with intrahepatic stones. The difficulties of preoperative differential diagnosis are shown. 

Despite the ongoing treatment, in 10–20% of patients with obliterating diseases of the arteries of the lower limbs, the progression of the disease leads to amputation, with mortality rates being up to 50%.

The aim: to determine the effectiveness of MSCT angiography in patients with type-D femoral-popliteal arteries according to TASC II with critical ischemia of the lower extremities and poor condition of outflow tracts for performing arterialization of venous blood flow and / or superimposition of arteriovenous fistula.

Material and methods. 145 MSCT angiographic studies were performed for patients with arterial diseases of the lower extremities performed in “RAMSAY Diagnostics Rus”Moscow. For the analysis, 53 (37% of the total) of the patient with lesions of the femoropopliteal segment of Type D according to TASC II were selected. The analysis of the state of the arterial outflow pathways was carried out according to the modified Rutherford classification, where each artery of the shin was maximally assigned 3 points depending on the degree of stenosis, the blood flow resistance was estimated as 0 points – the absence of stenosis or stenosis less than 20%, 1 point stenosis 20–49% 2 points stenosis 50–99%, 3 points – occlusion.

Results. The degree of resistance of arteries of outflow tracts of 39 limbs (16 right and 23 left) was calculated in 53 patients: 10 points in 23.7% of cases; 9 points in 5.1%; 8 points – 2.5%; 7 points 18%, 6 points in 5%; 5 points 2.5%; 4 points 15.4%; 3 points 7.7%; 2 points 0; 1 point 20.5%. In patients with poor arterial outflow, with a score greater than 7, there is a high risk of early thrombosis of the prosthesis, so such patients undergo an operation with the formation of an unloading arteriovenous fistula.

Conclusion. MSCT angiography of the arteries of the lower extremities is an effective method for determining the severity of arterial damage with an accurate definition of the level, extent, prevalence with the possibility of using different classifications, including TASC II and theRutherford classification. It can be used as a screening, expert method in patients with arterial diseases of the lower extremities, may be an alternative to direct angiography, used to assess patients in the postoperative period.

Key words: peripheral arterial disease, outflow score, ball classification of outflow tracts, runoff score, computed tomography, angiography. 

The mitral valve prolapse is characterized by the degeneration of the valve leaflets, accompanied by their thickening, increasing surface area and flexibility. The mitral valves leaflets bulge (prolapse) beyond the plane of the atrioventricular ring into the left atrium during ventricular systole and lose the ability to close tightly, leading to the mitral regurgitation. Acute chord rupture of the mitral valve posterior leaflet is a rare but important cause of severe mitral regurgitation and the development of acute or progressive chronic heart failure. Acute mitral insufficiency, accompanied by hemodynamic disorders, requires an urgent valve plastic surgery or valve prosthetics. The mitral valve plastic surgery gives a number of undeniable advantages over prosthetics, providing the best hemodynamic parameters, saving the patient from lifelong receiving of anticoagulant drugs. Detailed qualified echocardiographic evaluation of all structures of the mitral valve (fibrous ring, MV leaflets by segments, overlapping structures, structure of the chordal apparatus, papillary muscles) provides the necessary information for the mitral valve reconstructive plastic surgery with the choice of the method that is most optimal for a certain patient at the preoperative stage. We report herein a clinical observation of the patient with a diagnosis: acquired heart disease, the mitral valve posterior leaflet prolapse with mitral insufficiency Grade 3. Chronic heart failure IIA. II FC. Atrial fibrillation. The patient underwent multicomponent mitral valve reconstruction with the creation of a neochord and the fibrous ring plastic on the duplicate of a PTFE strip (soft support ring), pairwise isolation of the pulmonary vein entrance and right cavotricuspid isthmus.

Purpose: verification of reliability of MRI signs of damage to the structures of the knee joint in comparison with the data of arthroscopy knee joints.

Materials and methods. 59 patients were examined (59 knee joints: 41 right (69.5%) and 18 left (30.5%)) with various knee injuries, aged 17 to 49 years (mean age 33.6 years). All patients underwent magnetic resonance imaging and medical diagnostic arthroscopy.

Results. The sensitivity of the MRI to the diagnosis of meniscus ruptures was highest: 91.7% for the lateral meniscus and 95.4% for the medial meniscus. At the same time, in the diagnosis of anterior cruciate ligament ruptures, the MRI examination does not have such a high sensitivity (88.2%). In addition to the above features, MRI provides the ability to determine the damage to bone and cartilage structures. And also according to MRT it is possible to determine the plan of surgical intervention for tears of meniscuses and cruciate ligaments.

Conclusion. The obtained data confirm sufficient efficiency of MRI for diagnostics of damages of knee joint structures. Further improvement of methods and increase in experience of interpretation of images will probably reduce amount of false positive and false-negative results in the future.

Cervical cancer is the 4th most common cancer in women. Early diagnosis of cervical cancer remains a clinical problem. Most of the published literature refers to the evalu ation of patients with macroscopically visible tumors. Currently, the use of sequences with dynamic contrast enhancement (DCE) and diffusion-weighted images MRI allows for detection of tumors smaller than7 mm. Several articles on the use of transvaginal ultrasound have been published, indicating sensitivity and specificity comparable to MRI. Computed tomography is used primarily to detect metastases in the lymph nodes. In this review, we focus on the accuracy and role of various diagnostic methods in patients with cervical cancer, as well as advantages anddisadvantages of the most commonly used classifications.

Objective. To clarify MRI semiotics of non-neoplastic changes in the vagina in women undergoing treatment for cancer of the female genital organs.

Materials and methods. 141 patients with suspected tumor vaginal involvement were included in the study. In all the patients, the diagnosis was confirmed morphologically. According to the study, a tumor lesion of the vagina was established in 96 (68.1%) patients, with primary vaginal cancer detected in only 11 (11%) of the examined, the largest number of cases was a secondary organ damage – 85 (89%). The basis for differential diagnosis was the results of a comprehensive MR-study of 45 (31.9%) patients who did not receive data for the new formation, but determined the posttherapeutic changes in the small pelvis. MR-studies were performed on a Toshiba Vantage Atlas, 1.5T. A multiparametric MRI protocol was used for the study of pelvic organs, including T2WI with and without suppression of fat tissue signal, T1WI, diffusion-weighted images, T1WI with dynamic contrast enhancement. For the purpose of moderate expansion of the physiological folding of the vagina, we used an MP-compatible plastic applicator.

Results. In the course of monitoring changes in the form of fibrosis of the dome of the vaginal stump were determined in 51.9% of observations, fibrous thickening of the vaginal walls with a narrowing of its lumen – in 18.5% of observations, prolonged edema of the vaginal tissues with a moderate change in anatomo-topographic relationships – in 73.3% of observations. In 12 (26.6%) patients with clinically pronounced fibrosis of the vaginal walls, strictures of different localization, accompanied by dyspareunia, dryness and increased bleeding of the vaginal tissues, even the possibility of examination was significantly limited, and MRI was practically the only complete differential diagnostic method.

Conclusion. Knowledge of the anatomy of the operated vagina made it possible to correctly interpret the revealed changes in the vagina, to perform a detailed differentiation between the unchanged tissues of the dome of the vaginal stump and its tumor lesion.

To 85th Anniversary