Purpose: to investigate the diagnostic opportunities of contrast magnetic resonance imaging with the effect of magnetization transfer effect in the diagnosis of focal metastatic lesions in the brain.

Materials and methods. The material of the study was images of contrast MRI of the brain of 16 patients (mean age 49 ± 18.5 years). Diagnosis of the direction is focal brain lesion. All MRI studies were carried out using the Toshiba Titan Octave with magnetic field of 1.5 T. The contrast agent is “Magnevist” at concentration of 0.2 ml/kg was used. After contrasting process two T1-weighted studies were performed: without T1-SE magnetization transfer with parameters of pulse: TR = 540 ms, TE = 12 ms, DFOV = 24 sm, MX = 320 × 224 and with magnetization transfer – T1-SEMTC with parameters of pulse: ΔF = −210 Hz, FA(МТС) = 600°, TR = 700 ms, TE = 10 ms, DFOV = 23.9 sm, MX = 320 × 224. For each detected metastatic lesion, a contrast-to-brain ratio (CBR) was calculated. Comparative analysis of CBR values was carried out using a non-parametric Wilcoxon test at a significance level p < 0.05. To evaluate the sensitivity and specificity of the techniques in the detection of metastatic foci (T1-SE and T1-SE-MTC), ROC analysis was used. The sample is divided into groups: 1 group is foci ≤5 mm in size, 2 group is foci from 6 to 10 mm, and 3 group is foci >10 mm.

Results. Comparative analysis of CBR using non-parametric Wilcoxon test showed that the values of the CBR on T1-weighted images with magnetization transfer are significantly higher (p < 0.001) that on T1-weighted images without magnetization transfer. According to the results of the ROC analysis, sensitivity in detecting metastases (n = 90) in the brain on T1-SE-MTC and T1-SE was 91.7% and 81.6%, specificity was 100% and 97.6%, respectively. The accuracy of the T1-SE-MTC is 10% higher in comparison with the technique without magnetization transfer. Significant differences (p < 0.01) between the size of the foci detected in post-contrast T1-weighted images with magnetization transfer and in post-contrast T1-weighted images without magnetization transfer, in particular for foci ≤5 mm in size, were found.

Conclusions. 1. Comparative analysis of CBR showed significant (p < 0.001) increase of contrast between metastatic lesion and white matter on T1-SE-MTC in comparison with T1-SE. 2. The sensitivity, specificity and accuracy of the magnetization transfer program (T1-SE-MTC) in detecting foci of metastatic lesions in the brain is significantly higher (p < 0.01), relative to T1-SE. 3. The T1-SE-MTC program allows detecting more foci in comparison with T1-SE, in particular foci of ≤5 mm (96% and 86%, respectively, with p < 0.05).

Ependymoma is a brain tumor that develops from ependemic cells that lining the inside of all the ventricles of the brain. Ependymomas are twice as likely to appear in the region of the posterior cranial fossa. Pseudoprogression is a change that develops after surgical and/or chemoradiotherapy, caused by vascular changes leading to a transient increase in the permeability of the BBB. These changes coincide with early delayed reactions to radiotherapy and are considered as a subacute reaction of the brain. On MRI, there is a transient occurrence of foci that accumulate contrast for several weeks to 6 months or more after chemoradiotherapy. Dynamic control shows an improvement, which confirms the absence of true tumor growth. Changes take place without specific treatment. In the article, we give a rare clinical observation that shows the importance and effectiveness of dynamic MRI monitoring in differential diagnosis.

With transthoracic echocardiography, many pathologies can certainly be seen, but in a number of cases, due to the anatomical and physiological characteristics of the patient (thick layer of subcutaneous fat, large breast size in women, lung disease, chest deformation, etc.) hearts can not be fully explored. The use of a transoesophageal sensor can overcome all these difficulties. The review highlights the methodology, indications, and possibilities of transesophageal echocardiogram in the main heart diseases (coronary heart disease, congenital and acquired heart defects, arrhythmias) and acute pathological conditions (acute dissection of the aorta, air embolism).

Objectives: to determine the diagnostic performance of non-invasive FFR derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFRCT) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD).

Methods. Prospective study included 16 patients ((m/f – 13/3 mean age 47.8 ± 2.3 years) with CAD and coronary stenosis 40–75% lumen reduction. Coronary CTA was performed prior to ICA with invasive FFR measurement. FFRCT was calculated and interpreted in a blinded fashion by an independent Core Laboratory (HeartFlow, USA). Results were compared to invasively measured FFR, with ischemia defined as FFRCT or FFR ≤ 0.80.

Results. The area under the receiver operating characteristic curve (95% CI) for FFCT was 0.90. Per-vessel sensitivity and specificity to identify myocardial ischemia were 91% and 89% for FFRCT.

Conclusion. FFRCT provides high diagnostic accuracy, and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard. 

Purpose: to evaluate the dependence of absolute and relative thickness of damaged myocardium in the acute myocardial infarction (AMI) area from the time interval between oncet of pain and start of intravenous thrombolysis (so-called “pain–needle time”), in AMI patients treated with prehospital intravenous thrombolysis  and also later on with subsequent percutaneous coronary angiplasty (PCA) and stenting, using contrast-enhanced MRI of the heart 

Materials and methods. The study comprised data of CE-MRI studies in 25 patients with theyr first acute myocardial infarction, in whom the pre-hospital thrombolytic therapy (TLT) was carried out in the course of 35–300 min after onset of chest pain, with coronarography and percutaneous coronary angioplasty and stenting after admission to the institute of cardiology. In six patients the TLT was not success ful and in these the restoration of coronary blood flow was obtained only at PCA. In all patients in terms 18–34 hours after TLT the CE-MRI of the heart was carried out using gadobutrol or gadoversetamid, as 0.1 mM per kg of BW, in T1-weighted mode with fat suppression and as inversion-recovery with inversion time adjusted to get the normal myocardium “nulled”. We calculated the segmental extension of damage, the thickness of infarcted irreversibly damaged myocardium and of non-damaged myocardium in the same locations, the index of transmurality, as ratio of thickness of damaged myocardium to the overall wall thickness. We analyzed the dependence of these indices of damage from the time interval between pain oncet and beginning of intravenous thrombolytic therapy (or PCA – when TLT was unsuccessful).

Results. The dependence of thickness of non-damaged myocardium from the “pain-needle” time  was as exponential as Y = 2.08 + 17.11 · exp(−t/42.4), r = 0.843, p < 0.002. Index of transmurality did depend on the time interval “pain – needle” as Boltzmann function, pretty closely to reverse exponential one:                     

                            No-reflow zone with absent blood flow in the infarcted area was present only in cases with the “pain–needle” time interval over 70 min. Later on the full or partial restoration of contractility in infarcted segments was observed only if the IT was below 0.55–0.6.

Conclusion. CE-MRI delivers adequate quantitative estimates of anatomic transmural extent of myocardial infarction from early acute period of the AMI. The depth of myocardial damage is a function of “pain–needle” time and approaches the half of wall thickness for as short as 55–65 min, determining by this the future prognosis of the mechanical restitution of contractility in the infarcted region. It is suggested the CE-MRI of the heart must be carried out in every patient in whom due to AMI the thrombolytic therapy and/or percutaneous coronary angioplasty has been done, for unbiased  myocardium-focused control of efficiency of restoration of coronary arterial patency. 

Objective: retrospective assessment of preoperative radiologic evaluation of patients with chronic pleural empyema and bronchopleural fistula after pneumonectomy and its influence on the choice of transsternal main bronchial stump occlusion as definitive surgical treatment.

Methods. From April 2005 to December 2016 in A.V. Vishn evsky Institute of Surgery 25 patients with chronic pleural empyema (>12 weeks from the onset of the disease) and bronchopleural fistula (BPF) after pneumonectomy were treated. The main methods of preoperative diagnosis were fibrobronchoscopy and multispiral computed tomography. The results of treatment of BPF after pneumonectomy by transsternal bronchial occlusion as a method of choice were retrospectively analyzed.

Results. Depending on the length of the bronchial stump and the diameter of the BPF, evaluated with CT, patients were divided into two groups. In 9 (36%) patients with bronchial stump length ≥20 mm and BPF diameter ≥3mm performed transsternal bronchial closure. In 16 patients (64%) with short (less than 20 mm) bronchial stump BPF was covered with muscle flap (87.5%) or omental flap transposition (12.5%) was done. Perioperative mortality rate was 2 (8 %) of 25 (95% CI: 2.2–24.9) cases due to ARDS and severe sepsis in muscleflap group. Recurrence rate was 2 (12.5%) of 16 (95% CI: 3.5–36) patients in control group vs no recurrence rate in basic group according to 18–110 months follow up.

Conclusion. Radiologic methods are the gold standard in the diagnosis of pleural empyema with BPF. A differential approach based on the assessment of risk factors (the etiology of empyema, length of the stump of the main bronchus, diameter of bronchial fistula and initial state of residual pleural cavity) makes it possible to reduce morbidity and mortality in patients with BPF. 

Objective: to study the basic characteristics of changes revealed by MRI in patients with syringomyelia associated arachnopathy before and after surgery.

Materials and methods. MRI was performed in 58 pat ients with syringomyelia before and after surgery in period from 2013 to 2016.

Results. The diagnosis “syringomyelia” was approved in 41 patients. There was huge regression (more than 50% of volume) of syringomyelia cavity in 17 (41.4%) patients. In 20 (48.7%) patients marked decrease in size syringomyelia cavity (less than 50%), the volume expansion of the front and rear of cerebrospinal fluid spaces.

Conclusions. The use of modern MRI Protocol in various types of syringomyelia allows not only to detect and give a comprehensive feature cavities, but also to detect adhesions, location and length, as well as to assess the dynamics of the disease after surgical treatment.

Hepatocellular adenoma (HCA) is a rare primary benign tumor of the liver that generally occurs in women taking oral contraceptives. HCA in men is rare, and it is usually associated with anabolic steroid intake, glycogen storage disease I, III. There are some instances where HCA is induced by antiepileptic drugs. Malignant transformation is one of the complications of HCA, and it is 10 times more often in men than in women. We present a case, where a man, 23 years old, was taking antiepileptic drugs for a long time. The lesion in third liver segment was revealed under routine examination. MRI with hepatobiliary contrast agent was performed. Hepatocellular cancer (HCC) was suspected, however HCA was not excluded. The patient underwent resection of third liver segment. Histological and immunohistochemical examinations revealed that the tumor was β-catenin activated HCA with focus of well differentiated HCC. The article describes the clinical case and provides a brief literature review on this subject.

Splenic cysts are rare. Most true (congenital) splenic cysts are epithelial in origin and have embryonic inclusion of epithelial cells from adjacent structures. Congenital spleen cysts are also called epidermoid or epithelial cysts. They form when there is an invagination of the mesothelium-lined splenic capsule during development. The lining is pluripotential and may undergo metaplastic changes and fluid accumulation with resultant cyst expansion. We present our own clinical case of the true spleen cysts in twins. Both patients did’t have any complains. In one of the twins, the lesion was up to 85.0 mm in diameter, localized in the spleen gates and squeezed the spleen vascular pedicle, which necessitated the surgical treatment. In the second twin, the cyst also localized in the spleen gates, however, it was of minor dimensions and, there was no growth at dynamic monitoring at the present time.

Esthesioneuroblastoma is included in the group of rare malignant neuroectodermal tumors. Since 1924 up to the present, around 1,000 cases of this tumor have been detected worldwide, with only one case of splenic metastasis in a patient with esthesioneuroblastoma described. We present yet another clinical observation of splenic metastasis in a patient with esthesioneuroblastoma (nasal cavity tumor).

Minimally invasive surgical procedures represent an extensive group of techniques that complement the arsenal of treating physicians to help patients. One of the directions are intravascular operations. Endovascular embolization of the prostate arteries is a competitive form of treatment for prostate adenoma in patients with contraindications to an open surgical manual. It is known, that prostate adenoma more often affects age-related men who have a variety of concomitant diseases. Such patients are not shown transurethral resection of the gland due to the severity of their condition. Therefore, to help these patients develop alternative methods of treatment. The article reviews the world data on the effectiveness of endovascular operations in patients with symptoms of the lower urinary tract.

Сlinical case of a rare and poorly studied disease – intravenous leiomyomatosis (IVL) is presented. Presented the literature data and our own clinical case of this rare pathology with dissemination to the v. cava inferior, to the right ventricle of the heart. The radiology semiotics of metastatic intravenous leiomyomatosis is described, the advantages and limitations of the methods of radiation diagnosis are noted. The clinical case is of particular interest, because there is a combination of simultaneous intravenous injury, heart damage and benign metastatic lung injury. The final diagnosis is verified by the data of morphological and molecular-genetic research based on the results of surgical intervention.