Purpose. To compare the performance of static myocardial
DECT perfusion imaging (CTA) with DECT delayed enhancement for  detection of ischemic myocardial scars using LGE MRI as a diagnostic standard.

Materials and Methods. 29 patients (m/f –16/13 mean age 57.6 ± 2.1) with chronic myocardial infarction were prospectively enrolled in the study. The CCTA protocol consisted of prospectively gated static myocardial DECT perfusion imaging (angiographic phase) and DECT delayed enhancement with 8 min delay after contrast media injection. Study was performed with 64-row single-source dual energy CT with fast kilovoltage switching. DECT images were visually assessed for first-pass arterial enhancement deficit and delayed enhancement using iodine distribution maps by 2 observers in comparison with LGE MRI. Sensitivity and specificity, the normalized iodine concentration ratio of normal myocardium and scar tissue were calculated both for both methods.

Results. For scar detection static myocardial DECT perfusion had  accuracy, sensitivity and specificity 95%, 90%, 95%, resp. vs.  delayed DECT – 96%, 88%, 99%, resp. There was no significant  difference between accuracy, sensitivity and specificity for DECT  perfusion and delayed DECT (p = 0.32). However diagnostic  confidence and normalized iodine concentration ratio of normal  myocardium and scar for static myocardial DECT perfusion were  significantly lower than for delayed DECT (p < 0.0001).

Conclusion. DECT CTA and DECT delayed enhancement have a  good accuracy for detection of post-infarction scars in comparison  with LGE MRI. The overall diagnostic performance of DECT delayed  enhancement was better then of static myocardial DECT perfusion  imaging. Thus, delayed sequences should not be omitted from CTA  standard protocol if the aim is myocardial scar detection.

Coronary atherosclerosis and coronary artery disease (CAD) are the  most common causes of death and disability in the most of  industrialized countries. The problem of early diagnosis of CAD  detection is extremely relevant all over the world. Preclinical  identification of patients with risk factors of CAD is one of the most  important goal in routine clinical practice. Multislice computed  tomography (MSCT) of the heart with the determination of the  calcium index (CI) is a noninvasive screening of coronary arteries  assessment. The severity of coronary calcification has a close  relationship with the severity of coronary atherosclerosis and the risk of acute coronary events according to numerous studies. Initially, studies targeted on assessment of coronary calcification and determination of normative parameters were performed using electron-beam scanners (EBS). Subsequently multislice computed tomography (MSCT) replaced the electronic beam tomography (EBCT). The results of studies that performed with EBS have become the basis for a methodology of coronary calcification assessment with MSCT. The reproducibility of coronary calcium score is important for assessment of atherosclerosis for dynamic monitoring. The inter- observer and intra-observer reproducibility of this method is quite  high, the reproducibility according to repeated studies of the same  patient is lower. In recent years, a new generation of volumetric CT- scanners has been introduced into clinical practice. Reducing the radiation dose for coronary calcium screening to the minimum values (less than 1 mSv) is one of the important advantages of volumetric  computed tomography. Currently, new studies are needed to assess  the reproducibility of coronary calcium index calculation using a new  generation of volumetric CT-scanners.

Objective: to carried out the comparison of the data of MDCT of the patients, undergoing screening using the standard protocol MDCT aortography and FLASH “fast” protocol of scanning. It is discussed the possibility of the reduction of the injected amount of the contrast agent for “fast” aortography.

Materials and methods. The aorta examinations of 101 patients (69 men (68%) and 32 women (32%); the average age ± the standard deviation – 56.34 ± 11.5 years) were analyzed. The examinations have been carried out on MDCT with two sources of Х-ray (DSCT); 48 patients have been undergone the examination using “fast” FLASH scanning. It has been compared the scanning time, the length of the examination zone and ED (Effective Dose) load calculated for the groups for the standard and “fast” MDCT aortography.

Results. CDTIvol and DLP values were statistically proved lower (p < 0.001) at the examination of the patients that had been undergone “fast” protocol of scanning FLASH. The average ED was considerably lower in this group of the patients in comparison with the patients that had been examined using standard protocol (4.36 ± 1.69 mSv and 15.12 ± 4.62 mSv, р < 0.001). Without the reliable difference in the length of the examination zone in groups (42.91 ± 3.23 cm and 43.68 ± 2.66 cm, p = 0.55), the duration of the examination of MDCT aorta was considerably lower in the second group (9.29 ± 0.85s and 1.93 ± 0.12 s, p < 0.001).

Conclusion. The method of the superfast aorta МDCT make it possible to reduce ED and the amount of the injected contrast agent at the examination of the vast zone. At the same time, qualitative and quantitative analysis of the MDCT remains high.

Purpose: evaluation of brain substance’s morphological state and dynamics of cerebral tissue perfusion in patients undergoing on-pump CABG surgery compared preoperative and late postoperative period.

Materials and methods. The study included 14 male patients who underwent on-pump CABG surgery. CT and PCT with intravenous bolus radiopaque drug in the cubital vein conducted to all patients in the preoperative period. Cranio-ventricular index, width III ventricle was measured. The presence and degree leukoaraiosis, the presence of cysts, areas of gliosis, CBF, CBV, TTP in symmetric cortical and subcortical regions was recorded. CT and PCT repeat after 5 years.

Results. In preoperative period III ventricle width was 6.8 ± 1.4 mm; cranio-ventricular index = 4.9 ± 1.3. It were found cysts on the level of the basal ganglia in two cases (14%). Leukoaraiosis detected in four patients (28%). PCT in the preoperative period noted the absence of blood flow asymmetry, reducing blood flow to the frontal lobes, in the area of the junction of the parietal, temporal and occipital lobes. Significant expansion of the III ventricle 8.5 ± 2.5 mm, reducing cranio-ventricular index 3.6 ± 0.5, increasing the number of cysts and glial changes in 6 (43%) cases,  leukoaraiosis in 8 (57%) cases, a significant increase in TTP in the index of the thalamus (11.5 ± 2.1 sec) was determined after the operation.

Conclusions. Сhronic cerebral ischemia revealed progression of  manifestations in the late postoperative period in patients  undergoing on-pump CABG. The identified changes are not a direct  result of on-pump CABG, because similar changes observed in  patients with atherosclerotic lesions of the microvasculature and  damage the blood-brain barrier and also in patients without cardiac surgery.

Current paper reviews new opportunities in none invasive evaluation  of the left atrial fibrosis in atrial fibrillation using late gadolinium  enhancement magnetic resonance imaging. The first use of this  technology in clinical practice is discussed. In a group of prospective  studies it has been shown that structural atrial remodeling can  influence the clinical course of atrial fibrillation and the efficiency of  arrhythmia treatment. Several groups of national and European  experts in morphology and MRI studies in a consensus suggest  introduction of a new term fibrous atrial cardiomyopathy or fibrous  cardiomyopathy of atrii, representing the structural and functional pathology of atrii, of clinical value in atrial fibrillation. These data  make evidence for possibly wide noninvasive MRI studies of  cardiovascular out-patients in order to make obvious the structure of atrial myocardium and atrial anatomy as a whole. Progress in MRI technologies of heart studies provides the possibility of imaging of  thin atrial myocardium both in patients with primarily documented  atrial fibrillation and in persons after interventional treatment of the arrhythmia. There are reasons to expect that LGE MRI data  regarding atrial structure in atrial fibrillation are in a position to  provide in a nearest future the improvement of management of such patients.

Aim: to evaluate the possible role of contrast-enhanced MRI studies  of the kidneys in prognosis of clinical effect of the renal denervation treatment of the resistant hypertension.

Material and methods. 24 patients (57.8 ± 8.75 years) with  resistant hypertension were included, in everybody the  radiofrequency ablation (RFA) of the sympathetic nerves of renal  arteries was carried out. The average 24-h monitor of the arterial  pressure was as 137–210/57–148 mm Hg. The MRI studies were  performed using MRI scanner “Titan Vantage” (by “Toshiba Medical  Ltd”, with the field induction 1.5 Т). After this the intravenous  contrast enhancement has been carried out (with 0.5 М solution, 0.2 ml/Kg), with repeat acquisition of Т1-weighted spin-echo images in
3–5 min after contrast injection.

Results. MRI was employed for quantitative calculation of renal  volumes of cortex, medulla and of kidney as total, as well as of  suprarenal’s volume. Significant negative correlation of postoperation decrease of arterial pressure has been detected with both volume of renal cortex, as {Decrease in AP = 42.7–0.35 • (V left kidney)}, and  also with mass of the right suprarenal gland as {Decrease in  SAP = 16.5–6.78 • • (V right suprarenal)}.

Conclusion. The anatomic quantitative data of the preoperative
MRI studies of the kidneys can be employed as prognostic tool in  patients referred to the renal denervation treatment of the resistant hypertension.

The purpose: to follow-up the pathological changes in the cardiac  muscle using contrast-enhanced MRI (in comparison with  endomyocardial biopsy), in patients with chronic heart failure due to dilated cardiomyopathy.

Materials and methods. This study comprised 29 pa tients (as  51.1 ± 11.03 years old). Everybody underwent cardiac contrast- enhanced MRI, at admission and in 6 month, the endomyocardial  biopsy was carried out in 19 patients.

Results. Myocarditis with different degrees of activity was revealed  in 14 patients, from the results of a histological examination of the  cardiac muscle. The patients were assembled to two groups,  depending on the severity of the inflammatory changes; the data were compared with the results of the endomyocardial biopsy. In the group of patients with a moderate degree of activity of the  inflammatory process, myocardial fibrosis prevailed, in the group of patients with pronounced activity it was oedema, with a relatively  smaller volume of myocardial fibrosis. In six months of monitoring,  the number of pathologically altered segments of the myocardium  increased (from 2.7 ± 1.7 to 3.05 ± 1.7) and the thickness of the  paramagnetic contrast uptake to the cardiac muscle also increased (from 4.4 ± 1.4 to 4.8 ± 1.9 mm), despite the specific therapy kept carried out this time.

Conclusion. The development of dilated cardiomyopathy and  chronic heart failure, in a significant number of cases causes of  inflammatory changes in the myocardium, followed by manifestation  of dilated cardiomyopathy, and the progression of fibrotic changes in  the myocardium was observed even after elimination of the causative agent.

Purpose: to assess the coronary flow reserve in patients with one,  two and multi-vessel coronary artery diseases by dynamic SPECT  using semiconductor (cadmium-zinctelluride)- based gamma camera.

Material and methods. This work included 42 patients with stable  coronary artery diseases. The first group consisted of 12 (28.6%)  patients with single and two-vessel coronary artery disease (STCAD)  (8 males and 4 females; mean age 61.5 ± 3.8 years) with  intermediate (50–70%) and significant (>70%) coronary artery  stenosis. Second group included 30 (71.4%) patients with multi- vessel coronary artery diseases (MVCAD) (22 males and 8 females;  mean age 60.1 ± 4.3 years) with a lesion >70% in at least 2 major epicardial vessels according to invasive coronary angiography. All patients underwent rest-stress dynamic SPECT as well as conventional myocardial perfusion imaging with 99mTc-MIBI as a radiopharmaceutical. All scintigraphic images were  acquired on the hybrid SPECT/CT unit (GE Discovery NM/CT 570C).  Patient with STCAD underwent invasive FFR detection.

Results. When comparing the results of MPI between the study  groups, there were no significant differences. ROC analysis showed  that the global MFR ≤ 1,42 allows to identify MVCAD with a  sensitivity and specificity 68% and 86,4%, for PSM, these values  are: 39.1% and 86.4% (AUC = 0.655, p < 0.05), respectively  (“gold” standard CAG). The sensitivity and specificity of the regional  MFR to identify the hemodynamic significance of coronary artery stenoses at a value of <1.33 was 100% (the “gold” standard of FFR). Most likely, high sensitivity and specificity in this case are associated with a small number of patients with true stenoses of FFR.

Conclusion. The performance of standard MPI in combination with  dynamic single-photon emission computed tomography allows to  increase the diagnostic significance of the scintigraphic approach in  the evaluation of myocardial microcirculation disorders in multivessel coronary artery disease. Dynamic SPECT is a promising  method of noninvasive assessment of hemodynamic significance of  coronary artery stenoses.

The vulnerable plaque is an atherosclerotic plaque which can lead to  thrombosis of a coronary artery with development of an acute coronary  syndrome. Most myocardial infarctions occur in people with average  levels of risk factors and thrombosis mostly originate from lesions that  are less severely narrowed. Thus, in most cases, these plaques are clinically silent before the “unheralded” acute event and would not  be considered eligible for preventive treatment based on current  guidelines. The main question is to identify thrombosis-prone  “vulnerable” plaques before they rupture or become destabilized. IVUS  is a useful tool in identifying high risk plaque features and vulnerable lesions in patients.

The aim: to examine the possibility of using dynamic contrast  enhanced magnetic resonance imaging (DCE MRI) in clarifying the  diagnosis of glial brain tumors and the differentiation between them  on the basis of the malignancy degree. In this regard, the authors  evaluated the effectiveness of perfusion parameters (Ktrans, Kep, Ve and iAUC).

Materials and methods. The study included examination of 54  patients with an established presence of brain glial tumors. Glioma  Grade I–II diagnosed in 13 (24.1%) and glioma Grade III–IV in 41  (75.9%) cases. Morphological verification of the diagnosis obtained  as a result of either surgical removal of the tumor or stereotactic biopsy was achieved in 31 (57.4%) patients: glial tumors Grade I–II  identified in 6 (19.4%), and glioma Grade III–IV – 25 (80.6%) cases.

Results. According to DCE increasing of the malignancy degree of  glial tumors is followed by increasing of all perfusion parameters:  thus, the lowest values of Ktrans, Kep, Ve and iAUC were identified  in low grade gliomas (0.026 min−1, 0.845 min−1, 0.024 and 1.757,  respectively), the highest in gliomas Grade III–IV (0.052 min−1  1.083 min−1, 0.06 and 2.694, respectively). The most informative parameters with sensi tivity 90% and specificity 100% in the  differential diagnosis of gliomas Grade I-II and Grade III-IV are  Ktrans (cut-off = 0.16 min−1) and Ve (cut-off = 0.13).

Conclusion. DCE MRI can be used in differential diagnosis of glial brain tumors of different malignancy grade.

Aim: to explore the opportunities of application of diffusion
kurtosis imaging (DKI) for assessment and estimation of diffusion scalar metrics in different locations of peritumoral edema for extra- and intracerebral tumors and in contralateral normal tissue.

Materials and methods. 38 patients with supratentorial brain tumors were investigated: 24 (63%) patients with primarily revealed glioblastomas (GB) and 14 (37%) patients with solitary cancer brain metastasis (MTS). MRI was performed on 3.0 T MR-scanner (Signa HDxt, General Electric, USA) with the standard protocols for brain tumor and additional protocol for DKI. The standard protocol for brain tumor included: T1-, T2-weighted images, T2-FLAIR, DWI,  T1 with contrast enhancement. Diffusion kurtosis MRI based on SE  EPI with TR = 10000 ms, TE = 102 ms, FOV = 240 mm, isotropic voxel size 3 × 3 × 3 mm3, 60 noncoplanar diffusion directions. We  used three b-values: 0, 1000 and 2500 s/mm2. Аcquisition time was 22 min. Total acquisition time was near 40 min. This study was approved by Ethical committee of Burdenko National Scientific  and Practical Center for Neurosurgery. Parametric maps were  constructed for the following diffusion coefficients: mean (MK),  transverse / radial (RK), longitudinal / axial (AK) kurtozis; medium  (MD), transverse / radial (RD) and longitudinal / axial (AD) diffusion; fractional anisotropy (FA) and a bi-exponential diffusion model  coefficients: axonal water fractions (AWF), axial (AxEAD) and radial  (RadEAD) extra-axonal water diffusion and the water molecules  trajectory tortuosity index (TORT). Normative quantitative indicators  were obtained for the six regions of the peritumoral zone as they  moved away from the tumor (region 2) to the edema periphery  (regions 4–5), as well as in the normal brain on the contralateral  hemisphere (C/L) (zone 7). A comparative analysis of these  indicators was conducted for cases with GB and MTS. DKI scalar metrics were estimated using Explore DTI (http://www.exploredti.com/).

Results. Anatomic MRI (T1 without/with contrast enhancement) for  all cases with GB and MTS visualized a contrast enhancement tumor.  The peritumoral edema, spreading mainly over the brain white  matter, was well visualized on T2-FLAIR. Diffusion kurtosis  coefficients decreased in the near peritumoral edema (regions 2–3)  and a gradually increased to the edema periphery (regions 5–6). In Region 2, MK in both GB and MTS groups were MKGB(2) = 0.637 ±  0.140 and MKMTS(2) = 0.550 ± 0.046; RK in this region were  RKGB(2) = 0.690 ± 0.154 and RKMTS (2) = 0.584 ± 0.051.  Differences both MK and RK coefficients in patients with GB and MTS of region 2 were significant (p < 0.001). There were no differences in AK values for GB and MTS in region 2 (p > 0.05), but in regions 3  and 4 differences were observed (p < 0.01). The minimum value of  AK in the central edema (regions 3–4) was AKMTS(3–4) = 0.433 ± 0.063 in patients with MTS. The values of MK and RK on the  contralateral side in patients with MTS were significantly higher than  in the GB group (p < 0.02); MKC/LMTC = 0.954 ± 0.140, RKC/LMTC  = 1.257 ± 0.308 and MKC/LGB = 0.829 ± 0.146, RKc/LGB = 0.989  ± 0.282. There was no significant difference for contralateral AK between the groups.

Conclusions. We found that DKI scalar metrics are the sensitive  tumor biomarkers. It allows us to perform a robust differentiation  between the infiltrating GB tumor and purely vasogenic edema of  МТS. The obtained results will allow further differential diagnosis of  extra- and intracerebral tumors and can be used to plan surgical /  radiosurgical treatment for brain tumors.

Purpose. To carry out the correlation of the lumen structure of internal carotid artery (ICA) to the neurological symptoms in patients with small-intermediate (30–69%) degree stenosis based on multislice computed tomography angiography (MSCTA) data; evaluate potential embologenicity of atherosclerotic plaques in patients with small-intermediate stenosis of ICA.

Materials and methods. The data of 49 patients with 30–69% stenosis of ICA were evaluated, 43 (87.8%) men and 6 (12.2%) women; age varied from 51 to 78 years (medium age 59.8 ± 12.2 years). Depending on neurological presentation, patients were divided into 4 groups, according to academician A.V. Pokrovsky classification of cerebro-vascular insufficiency (1979). All patients underwent CTA on the apparatus Toshiba Aquilion One. The CTA data was transferred to the Vitrea workstation for the analysis. Following 3D-recontractions were used: MIP –Maximal Intensity projection, MPR – Multi-Planar Reconstruction, SSD – Shaded Surface Display. Along with estimation of the lumen shape, attention was paid to the presence of ulcerations, which appeared as the indentation of the contour and/or as a plaque with multiple hollows or cavernous appearance.

Results. Mean stenosis degree appeared to be 59.7% in all 49  patients (stenosis index varied from 36% to 67%). In 27  asymptomatic patients mean value of stenosis was 57.8%, in case of discirculatory encephalopathy – 59.6%, in case of transient ischemic attack (TIA) – 60.1%, and in 2 patients with stroke – 62.4%. Based on the analysis of the CTA in 23 (46.9%) cases plaque surface was irregular (Type II and II ulceration prevailed). Type I ulcerations were noted in 5 (10.2%), type II –in 11 (22.4%) and type III – in 7 (14.2%) cases. CTA images showed circular lumen in 15 (30.6%) patient, elliptic lumen in 19 (38.8%) patients, semicircular lumen was seen in 65(12.2%) cases and multilobular – in 9 (18.3%) cases. Correlation of the lumen structure with the clinical presentation showed prevalence of cases with irregular lumen contours in patients with symptomatic cerebral ischemia: impairment of cerebral circulation was seen in 1 out of 15 (6.7) circular narrowings, in 1 out of 19 (5.2%) elliptic narrowings, in 5 out of 9 (55.6%) multilobular and in 2 out of 6 (33.3%) semicircular narrowings.

Conclusion. Asymmetric lumen of ICA revealed by MSCTA with the bigger probability is connected to the presence of ipsilateral symptomatic ischemia, including transient amavrosis, TIA and ischemic stroke. Our study showed, that evaluation of ICA lumen morphology makes possible to reveal patients with increased risk of focal disturbance of brain circulation in case of small-intermediate degree (30–69%) of stenosis.

Aim: to analize computed tomography data while planning autotransplantation of the liver for advanced alveococcosis.

Materials and Methods. A retrospective analysis of the results of multidetector computed tomography of the abdomen and retroperitoneal space of 7 patients with advanced liver alveococcosis was made in order to plan autotransplantation. Besides a description of the location and size of parasitic lesion for each patient relationship with main vessels was evaluated - the inferior vena cava, hepatic and portal veins, hepatic arteries, and the presence of extrahepatic component. The vessel assessed as involved in the pathological process not only in case of clear invasion, but also with abutment because of infiltrative growth of alveococcus. The accuracy of the method was estimated by comparison with the intraoperative data.

Results. The data of computed tomography while the planning of liver autotransplantation coincided with the intraoperative data in all examined patients. The main criteria indicating the need for this type of surgical intervention was the involvement of the retrohepatic part of the inferior vena cava to the caval gates inclusive and/or hepatic veins. With extrahepatic spread of parasitic masses it is possible to affect not only the surrounding organs, but also the main vessels, for example, with growth in the hepatic-duodenal ligament. Thus, in one patient during the operation, the occlusion of artery hepatica propria was confirmed. In two cases of recurrence of the parasitic process after rightsided hemihepatectomy, the almost identical pattern of involvement of the liver resection surface, inferior cava and portal veins, diaphragm, adrenal gland in combination with a extent adhesive process in the right subdiaphragmal space.

Conclusions. CT scan data allowed to correctly plan the volume of operative intervention – autotransplantation of the liver – in all the examined patients. It is of interest to evaluate the accuracy of the method on a larger group of patients.

Purpose: the study of postmortem MRI possibilities for the diagnosis of lung hypoplasia in congenital diaphragmatic hernia.

Materials and methods. A comparison of the results of postmortem MRI study and data of pathoanatomical autopsy of 23 newborns was performed. In group I, the bodies of 10 deceased newborns with congenital diaphragmatic hernia without operative intervention were examined. In group II – the bodies of 7 newborns who died after surgery for congenital diaphragmatic hernia. Group III (control) included 6 bodies of newborns without diaphragmatic hernia and signs of lung hypoplasia. Before the autopsy, an MRI study was performed on a 3T Magnetom Verio device (Siemens, Germany) in standard T1 and T2 modes. The volumes of the lungs and chest cavity were calculated in the analysis of the tomograms data and their 3D reconstruction. The stage of the lung development and number of radial alveoli were identified at the microscopic study of histological preparations.

Results. As a result of the postmortem MRI study, it was established that the observations of group I are characterized by minimal lung volumes. The mean lung volume on the side of the diaphragmatic hernia was 4.1 times less than the contralateral lung (p < 0.01), and the mean values of the volume of both lungs were 4.6 times less than the corresponding values of the control group (p < 0.01) . The average value of the specific volume of the lungs in newborns who died as a result of congenital diaphragmatic hernia (group I) was 8.8%, which is 4.2 times less than the control group (p < 0.01) and was accompanied by histological signs of hypoplasia. The operation in Group II observations led to an increase in lung size. However, the specific volume of the lungs in this group remained by 18.6% less than the control group, and on histological specimens there were signs of lung hypoplasia.

Conclusion. The postmortem MRI of dead newborns allows for an objective quantification of lung volumes and verifies the presence of hypoplasia. This helps to clarify the pathogenesis and determine the immediate cause of death. Indices of specific lung volume relative to the chest cavity of less than 20% indicate lung hypoplasia as the immediate cause of death of the newborn.