Introduction. X-ray is a common diagnostic procedure in a multi-disciplinary hospitals. In the available scientific litera ture, there are some studies of the radiography in nonspecialized conditions. However, there are few aggregate data of these studies to date.

Objectives. Analysis of the results of radiography in wards and resuscitation rooms, performed in multi-purpose hospitals, with the aim of forming requirements to the class of equipment for radiography in the conditions of the ward.

Materials and methods. 4081 X-ray studies were studied from 2015 to 2016.

Results. During the analysis it was determined that in unspecialized conditions 75.0% of the shots fell to chest organs, studies of the musculoskeletal system were revealed in 22.0% of cases and abdominal organs were observed in 3%. Pathological changes were not detected for 2221 patients, which amounted to 54.4%. It was found that the most frequent disease of the chest were pneumonia of various genesis, complicated by the presence of hydro thorax.

Conclusions. Based on the analysis of X-ray researches, the indications for the studies were refined and supplemented, medical requirements for X-ray machines for shooting under these conditions were formulated.

Research objective. The study aimed to evaluate cone-beam computed tomography (CBCT) capabilities in diagnostics of cystic masses of the jaw.

Methods. Over a period of 2015–2016 32 patients age 6 to 67 underwent both panoramic tomography and CBCT (using panoramic tomographic scanner STRATO 2000 and cone-beam computed tomographic scanner i-Cat respectively). 47% (n = 15) of the participants were women, 53% (n = 17) – men. Radiation exposure for a single procedure amounts to 0,05 mSv for panoramic tomography, 0,07 mSv for CBCT (FOV =13 cm), 0,06 mSv for CBCT (FOV =8 cm).

Results. Comparative analysis of obtained results demonstrates that CBCT showed 54% (n = 27) more cystic masses of the jaws than panoramic radiography could. CBCT additionally showed the following pathologies: granulomas smaller than4 mm diameter – 85% (n = 23), 83% (n = 23) of said granulomas were found on maxilla, radicular cysts of maxilla – 11% (n = 3), incisive canal cyst – 4% (n = 1). Additionally panoramic tomography analysis misdiagnosed 5 granulomas (80% (n = 4) on mandibular premolar and molar areas) that were not found during CBCT analysis.

Conclusion. The low effective dose and high informativity of CBCT enables the method to be used instead of intraoral radiography, panoramic tomography and MSCT as a screening procedure in diagnostics of dento-facial system pathologies, including cystic masses of the jaw. 

Aim: to assess MDCT abilities in imaging hyperperfusion syndrome (HPS) after carotid surgery.

Materials and methods. Cases of hyperperfusion syndrome after carotid revascularization were analyzed at 595 patients underwent surgery during 2012–2016. Preoperatively complex visualization: ultrasound imaging of brachiocephalic arteries and cerebral vessels, computer tomography of the brain, computed angiography (CTA) brachiocephalic arteries and cerebral vessels, perfusion computer tomography (PCT). Computer tomography was held with Philips iCT 256 slices. During CTA 50 ml on nonionic contrast media was injected (4–4.5 ml/sec flow) with further arterial and venous phases. PCT covered 6 sm (basal ganglia and cerebral hemispheres), 35 cycles with 2 sec interval. If HPS was considered all patients underwent CT: non-contrast brain imaging, CTA and PCT (in stable patient condition). Further dynamic imaging was made at MRI 3 Tl with standard sequences (T1, T2, FLAIR, DWI).

Results. HPS was detected in 7 cases, all patients had characteristic clinical presentation. According to imaging data all patients could be divided in three groups. Diffuse hemispheric edema on the operation side – 3 cases, at follow up imaging – regression of changes. Hemorrhagic component – 2 patients, one – with small hemorrhagic focus, another – with massive intracerebral hematoma. In 2 cases there were no new cerebral lesions detected. At CTA and PCT – increase of cerebral flow after operation. Mortality in patients with HPS was 28% (2 patients). In other cases there was regress of clinical symptoms.

Conclusion. In all cases in our study the one was able to either to diagnose either to suggest HPS on the CT data. Detailed analyses of acquired data and comparison with clinical status were necessary, sometimes – follow up studies were essential. 

Alveolar echinococcosis (AE) is a rare anthropozoonotic parasitic disease, which can affects the liver, lungs and other organs. R0-radical liver resection is the sole curative therapy for the patients with AE. Size of the parasitic foci, distant dissemination, and involvement of main liver vessels – all this information allows the surgeon to make the right decision about practicability and volume of operation. Formerly, ultrasonography (US) was not method of choice for the qualitative pre-operative diagnostic of AE. Nevertheless nowadays development of new technologies allows US to be an equal to CT and MRI.

The aim: to estimate the possibilities of US in the planning of surgery in patients with AE. Materials and methods. The data of 64 patients who were undergone complete liver resection or reduction surgery in A.V. Vishnevsky Surgery Institute in period from January 2008 to December 2016 we respectively analyzed. Specificity and sensitivity of US, CT and MRI were analyzed and ROC-curves were constructed. Statistical significance was calculated using Chi-square.

Results. The efficiency of US was significantly comparable to CT and MRI when we analyzed the involved of porta hepatis, vena cava, hepatic veins. Assessment of involvement of liver arteries and vena porta was not statistical significant.

Conclusion. Accumulated experience of A.V. Vishnevsky Surgery Institute shows the possibility of qualitative preoperationUS evaluation of AE-lesion, which has to include assessment of distant dissemination and involvement of the liver main vessels. In a big surgical hospitals, which has an experience of AE treatment, pre-operative US can become the method of choice in planning of surgical operation. 

Despite the availability of a large number of state programs for the re-equipment of state medical institutions, ultrasonic research, due to the relative simplicity of the organization of the research process and the decisiveness, still remains relevant for the examination of patients and, in particular, kidney cancer. In recent years, a number of new ultrasound techniques have emerged – three-dimensional reconstruction of ultrasound imaging, tissue harmonic technology and echocontrast with intravenous contrast agents. Due to the continuous improvement of the capabilities of ultrasound scanners and ultrasound imaging techniques, a review of the significance of ultrasound in the diagnosis and differential diagnosis of renal cell carcinoma (RCC).

The purpose: to evaluate the diagnostic possibilities of ultrasound in patients with kidney tumors at the preoperative stage.

Materials and methods. 136 patients with kidney tumors aged 21 to 73 years were examined and treated in A.V. Vishnevsky Institute of Surgery in the period from 2012 to 2017. The study slightly dominated by men – 65.4%. All patients underwent a complex clinical and laboratory examination, which included the analysis of complaints, data of anamnesis, clinical examination, laboratory data, as well as a wide range of instrumental studies (ultrasound, MSCT and MRI). Each of the study methods was evaluated according to three criteria (localization, prevalence, presence of vein thrombosis), which are key to assessing the feasibility of surgical intervention and subsequent tactics of surgery. Evaluation of the informative value of each of the radiation methods of the study (ultrasound, MSCT, MRI) was carried out on the basis of the following criteria: sensitivity, specificity and overall accuracy of the method. All patients underwent surgical operations in various volumes, the formations were morphologically verified as RCC. As a “control” for each of the parameters used the protocol of subsequent surgery. The effectiveness of ultrasound is significantly comparable with CT and MRI in assessing such preoperative parameters as tumor localization in the kidney, the prevalence of the pathological process and thrombosis of the inferior vena cava and the main trunk of the renal vein. In the evaluation of thrombosis of segmental renal veins, ultrasound is also comparable to other methods of investigation, but these data can not be considered statistically reliable (due to the small number of observations) and their confirmation requires further study.

 Conclusion. In the conditions of a specialized surgical hospital focused on the diagnosis and treatment of kidney cancer, ultrasound can be comparable to CT and MRI in its effectiveness, providing the surgeon with pre-operative information sufficient for planning surgical intervention.

Purpose: to analyze the results of preoperative diagnosis and treatment of patients with renal arteriovenous malformation and compare them with the literature data.

Materials and methods. 5 patients with renal arteriovenous malformations were examined for the period from 2014 to2016 in the FSBI "A.V. Vishnevsky Institute of Surgery» MH RF, where simultaneously there are clinical departments of urology and vascular surgery, 4 of them were treated. All patients were female. The mean age was 31.8 ± 6.7 years (24–41 years). Ultrasound was done to all the patients in B-mode followed by a duplex scan using an abdominal 2–4 MHz convex. MDCT was performed in 4 patients out of 5. Patients underwent multiphase examination on a multidetector CT-scanner Philips Brilliance iCT-256 and Brilliance CT-64 (Philips Medical Systems (Cleveland) with the 120 kV and 100 kV protocols and an intravenous injection of the iodinated contrast agent. Digital subtraction angiography was performed in 3 patients.

Results. One-sided lesion occurred in four cases (3 of them (60%) right-sided and 1 (20%) left-sided), in one patient (20%) arteriovenous malformation was bilateral As a result of the analysis of our own material and literature data, the diagnostic criteria of renal arteriovenous malformations according to ultrasound, MDCT and digital subtraction angiography were studied in detail. The results of the examinations of 5 patients with demonstration of ultrasound, MDCT and angiographic images are presented with the visualization of the characteristic features of renal AVM. In addition, the treatment options for such patients with the possibility of preserving the kidney are described.

Conclusion. Duplex scanning is an effective method of diagnosis and postoperative follow-up of patients with renal arteriovenous malformations. Preoperative computed tomography and selective digital subtraction angiography provide accurate information about the renal angioarchitectonics and AV-shunts for choosing the treatment tactics and planning the surgical intervention. 

Primary multiple tumors are an independent emergence and development two or more neoplasms in one patient. Thus can be the struck not only different bodies of various systems, but pair bodies (mammary glands, lungs, etc.) also, and one body with multicentric defeat. Primary multiple tumors can be synchronous and metachronous. The increase in frequency of multiple neoplasms is noted in recent years.

A clinical observation of a 62-year-old patient with synchronous-metachronous primary-multiple cancer of both kidney and prostate gland is presented. A feature of this observation is multiple lesions of both kidneys, as well as the presence of two different morphological forms of renal cell carcinoma in one kidney (papillary and clear cell). The difficulty in identifying and differentiating kidney tumors with a cystic structure was due to the presence of multiple cysts of both kidneys of different types according to Bosniak. 

Aim: to determine the diagnostic value of individual  echographic symptoms in abdominal cysts in newborns.

Мaterials and Methods. The results of ultrasound  examination of 65 newborns (the average age 15.93 ± 1.15 days) with intraabdominal cysts (IACs) diagnosed with echography from 2004 to 2016 are analyzed. Girls were 80% (52/65), boys – 20% (13/65).  

Results. 23 (35%) neonates had complicated ovarian cysts (OC) (antenatal torsion, necrosis of the cystic formation and ipsilateral ovary), in 16 (25%) cases uncomplicated OC were detected. In 14 (22%) cases enterocysts (8 girls, 6 boys) were detected, and mesenteric lymphangiomas (LAB) were diagnosed in 12 (18%) newborns (5 girls, 7 boys). The main echographic signs of various IACs were picked out.

Conclusion. Ultrasonography is an informative method of diagnostics the IACs in newborns. The presence of parietal intraluminal cysts was typical for OC. In the case of uncomplicated OC anechogenous contents were noted. In the case of complicated OC heterogeneous content of various echostructure (debris, clots, septa and a networked structure of the content) took place. For the enterocysts a thick wall was typical and it’s variants of echographic representation were the gut-signature (double wall sign), layered  structure of the wall and Y-configuration of the cyst wall. LAB were characterized by irregular shape, thin wall and anechogenous content, less often the disperse component and thin septa in the lumen were determined. The networked structure of the contents was detected at various nosological forms (complicated OC, LAB and delimited peritonitis typical for severe enterocolitis) and required careful diagnostics of the totality of all detected echographic symptoms.

Contrast-enhanced ultrasound began to develop rapidly  in recent years inRussia. Due to the physical properties of contrast agents it is possible to differentiate malignant and benign lesions. However, this method only involves a subjective evaluation of the obtained results. For the objectification of ultrasound with contrast enhancement implemented the function “TIC-analysis” (time intensity curve analysis).  

The aim: to assess the clinical value of the TIC-analysis in the differential diagnosis of adenocarcinoma of the pancreas and chronic pseudotumoral pancreatitis by contrast – enhanced ultrasound.

Materials and methods. In A.V. Vishnevsky Institute of surgery contrast – enhanced ultrasound and TIC-analysis was performed on 23 patients with focal lesions of the pancreas. All patients were operated on, tumors were verified morphologically: adenocarcinoma of the pancreas  in 18 (78%) patients, chronic pseudotumoral pancreatitis – in 5 (22%) patients.

Results. The results about intensity of the tumors obtained by the TIC analysis do not allow to differentiate these pathological processes statistically significant (p > 0.05), which, in all probability, due to the fact that pancreatic  adenocarcinoma and chronic pseudotumoral pancreatitis have similar morphological characteristics in the form of pronounced desmoplastic stromal response and fibrosis-hyalinosis, respectively. The “Time to peak| parameter allowed us to determine statistically significant that pancreatic adenocarcinoma had an early accumulation of contrast agent (average 16 sec) and early washout (from an average of 17 sec); the chronic pseudotumoral pancreatitis had the slow accumulation of contrast agent (average  85 sec) and slow washout (from an average of 86 seconds) (p < 0.05).

Conclusion. The “Time to peak” parameter at ultrasound examination with echocontrast allows statistically significantly differentiate adenocarcinoma of the pancreas  and chronic pseudotumoral pancreatitis.  

The aim: to study of the effect of NAFLD on the results of shear elastography (based on the results of liver biopsy).  

Materials and methods. We have performed outcome analysis in 137 patients, treated from 2015 to 2016. All patients had chronic diffuse liver diseases and were hospitalized for morphological evaluation and diagnosis clarification. Group 1 (n = 117) with no fat changes in the liver parenchyma. Group 2 (n = 20) with steatosis of the liver.  In our work, we used: scanner Aixplorer (France). All patients underwent shear wave elastography (2DSWE) with the study of the quantitative index of stiffness of liver tissue, staging the results on the Metavir scale.

Results. In the 1st group of patients (without steatosis), in the ROC analysis, cutoff values of elasticity were obtained, the diagnostic efficiency of the Metavir stage of fibrosis was the most optimal: for F2 > 6.8 kPa (sensitivity 85.7, specificity 52, 9, AUROC 0.684); For F3 > 8.5 kPa (sensitivity 91, specificity 57.1, AUROC 0.745); For F4 > 14 kPa (sensitivity 95.7, specificity 52.2, AUROC 0.791). It was found, that the presence of steatosis significantly increases the elasticity of the liver tissue. So, in the subgroup sF0 (with steatosis) was a significant increasing of young's module Ме = 11,2 kPa (95% CI 7,3–17,5) compared to Ме = 6,1 kPa (95% CI 5,4– 9,6) in the subgroup F0 (without steatosis) (P = 0,0168, AUROC = 0,741) and up to Ме=9,95 kPa (95% CI 6,8–13,0) in the subgroup sF0 + sF1 (with steatosis) compared with Ме=6,65 kPa (95%CI 5,6–9,5) of the subgroup F0 + F1 (without steatosis) (P = 0.0295, = 0.707). This increase was, respectively, 83,6% and 49.6%  

Сonclusions. This study confirmed the effectiveness of the shear wave elastography method in assessing the relationship between stiffness parameters and the morphological fibrosis of the liver parenchyma and also contributed to the final confirmation of the effect of steatosis on  liver stiffness.

Solitary fibrous tumor (SFT) is an extremely rare tumor of the pancreas. The content of stromal tissue in the pancreas is insignificant, this fact explains the extremely rare occurrence of mesenchymal tumors (less than 1% of pancreatic neoplasms). It has been described only 16 such cases in the world literature.

A clinical case of solitary fibrous tumor of the pancreatic head of a man 43 years old, illustrating the difficulty of diagnosis is presents in the article/ In order to emphasize difficulties in diagnostics we introduce you another clinical case of extrapleural solitary fibrous tumors of the retroperitoneal space of a woman 63 years old.

Pancreatic SFT and NEN cannot be reliably differentiated on the basis of lesion structure and contrast medium uptake. However, in most cases SFT will progradiently enhance due to abundant collagen stroma, leading to marked difference between delayed-phase images of SFT and NEN with cystic degeneration. SFT is a rare tumour and radiologist should be aware of its characteristics, particularly in the setting of NEN with cystic degeneration or atypical contrast uptake. 

Nonfunctioning neuroendocrine tumors (NFET) account for up to 33% of the neuroendocrine tumors of the pancreas, ranging from 1 to20 cmin diameter and showing a higher malignancy rate, up to 90%. The clinical presentation of nonfunctioning neuroendocrine tumors is nonspecific. These tumors, in fact, are predominantly characterized by an expansive growth pattern; therefore, they are clinically silent until adjacent viscera and structures are involved. This makes it difficult to diagnose NFET at an early stage. Correct diagnosis is typically delayed by several years. About 15% of pancreatic NFET are cystic and difficult to differentiation from other cystic pancreatic lesions. In such cases, the important role played by hypervascular rim in the arterial phase image. Literature review and case report оf diagnostics and treatment of Neuroendocrine Tumor with cystic transformation are presented in the article. 

The purpose: to develop differential diagnostic criteria  of recurrence and scarring by using various MRI techniques.

Materials and methods. MRI of the pelvis was performed in 139 patients at different times after removal of colorectal cancer. Recurrence was diagnosed in 48 (34.5%) patients. The shape, size, structure, signal characteristics and the intensity of the accumulation of contrast agent in zones of recurrence and scarring were analyzed. The patients were divided into three groups with different types of postoperative MRI pattern of pelvic: patients without scarring in the pelvis, patients with a homogeneous scarring, patients with inhomogeneous scarring. The present  study was compared with MRI data performed in the early  stages after surgery.

Results. The recurrences with typical MR characteristics were so easy to identify and did not require differential  diagnosis. The patients with recurrence occurred in severe  scar process in the pelvis needed for differential diagnosis.  The detection of recurrence and monitoring of patients  without scarring in the pelvis was not difficult. The greatest  difficulties arose during the initial examination of patients  with inhomogeneous scarring. The difficulties in the differential diagnosis occurred at small sizes of recurrence up to 15 mm, making it impossible to assess their structure and  signal characteristics; in the event of relapse in presacral  areas of scarring, the presence of areas of hemorrhage  in the tumor structure.

Conclusions. The presence of severe scar process in the pelvis was the main reason for difficulties in detection and differential diagnosis of recurrence of rectal cancer. 

Coloncancer is one of the first places in the structure of oncological diseases. According to statistics, edited by A.D. Kaprin, V.V. Starinskii, G.V. Petrova ofRussiafor 2015 was initially 36494 case of colorectal cancer, while 2% of cases are not diagnosed. Recurrence of colon cancer can occur at any stage regardless of the time elapsed after the radical treatment. Locoregionally originally is the presence of a tumor in the area of primary operation, which is represented by the primary tumor bed, the anastomosis, mesentery of the colon with lymphatic system, peritoneum and adjacent organs. Often after a diagnosis of “recurrence of the tumor in the colon” to the patient it is possible to provide only palliative care (colostomy, chemotherapy). The article cited clinical observation, confirming the important role of radiation techniques in determination of tactics of treatment of locoregional recurrence of the cecum cancer. 

Objective: to study the technique of contrast-enhanced  mammography (CESM) and to make a comparative analysis of the accuracy of CESM and MRI in dense breasts.

Materials and methods. Was analyzed data of the world researches dedicated comparative characteristics of contrast-enhanced mammography (CESM) and MRI. The MRI and contrast-enhanced mammography (CESM) were performed 61 patients in our center from 04.2017 to 05.2017. The sensitivity and specificity of the methods  were evaluated, these data were compared with the results  of published studies.

Results. Contrast mammography (CESM) is a highly  sensitive and specific technique in detecting cancer in dense breasts, comparable in informativeness of contrastenhanced MRI. The sensitivity of CESM and MRI was 100%, the specificity was 100% and 94% respectively.

Conclusion. Contrast mammography (CESM) is a perspective techique for earlier diagnosis of breast carcinomas,  even with dense breasts.  

Objective: the aim of the study was to estimate the informative value of  multimodality imaging in differential diagnostics of nonpalpable breast architectural distortion of different  origin.

Matherials and methods. We analyzed the results of multimodality examination of 307 women with nonpalpable breast architectural distortion of different origin. They underwent mammography, handheld sonography (B-mode), compressive elastosonography, Doppler angiography, automated breast volume US-scanning, US-guided core needle biopsy (n = 115; 38%) and stereotactic core needle  biopsy (n = 192; 62%), pathomorphologic analysis.  

Results. Breast cancer were diagnosed in 221 (72%) women, benign lesions – in 86 (28%) women. Surgical treatment was performed In 254 (83%) cases and 31 (10%) breast lesions were removed with vacuum-assisted aspiration biopsy.

Conclusion. Multimodality imaging with the invasive procedures gave 92.5% sensitivity, 100% specificity,  100% showed positive prognosis, 72.5% negative prognosis, 93.1% accuracy index.