The purpose. To determine relationshipsbetween the value of intracranial pressure obtained by direct measurement (using ICP sensors), the optic nerve sheath diameter (ONSD), and the optic nerve diameter obtained by ultrasound; to define a threshold for ONSD for diagnosing ICP more than 20 mm Hg.

Materials and methods. 33 patients with traumatic and non-traumatic intracranial hemorrhages were examined. All patients were continuously monitored by ICP and ultrasound of the optic nerve channel. We evaluated the ONSD and optic nerve diameter (OND) using ultrasound. 16 healthy volunteers were examined to determine the normal values of ONSD and OND.

Results. All patients were divided into 2 groups depending on the type of ICP dynamics. Group 1 (n = 26): an initial value of ICP is less than 20 mm Hg, group 2 (n = 7): initially high ICP values. Group 1 was divided into 3 subgroups: 1a (n = 7) – ICP did not increase during the whole monitoring period, 1b1 (n = 10) – ICP transiently increased in the postoperative period and normalized after treating, 1b2 (n = 9) – refractory intracranial hypertension was developed in the postoperative period. Group 2 was divided into two subgroups: 2a (n = 4) – ICP normalized in the postoperative period, 2b (n = 3) – refractory intracranial hypertension was developed in the postoperative period. There was a significant relationship between ICP and ONSD (Spearman n = 318, R = 0.31, p < 0.001; Kruskal– Wallis p < 0.001)in all groups of patients. The diameter of the optic nerve was the same for both groups: healthy volunteers and the experimental group (Spearmann = 334, R = 0.0054, p = 0.96). The optimal value of ONSD for detection the ICP > 20 mm Hg was morethan 5.8 mm.

Conclusion. The ultrasound of the optic nerve channel can be an additional screening non-invasive diagnostic method for patients with intracranial hypertension.

Purpose. To evaluate specific changes in MRI of the human brain, associated with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).

Materials and methods. We enrolled 24 patients with genetically confirmed CADASIL (19–81 y.o.). The following MRI sequences were performed for every subject: T1 MPR, T2, T2-FLAIR, DTI and SWI. Brain tissue lesions were assessed using STandards for ReportIng Vascular changes on nEuroimaging (STRIVE).

Results. In the CADASIL group the following changes were observed (in % of patients): recent small subcortical infarcts – none; lacunes – 54%; white matter hyperintensities (WMH) by Fazekas 1 – 12%, Fazekas 2 – 17%, Fazekas 3 – 71% (sites of predilection: anterior temporal lobe and external capsule); cerebral microbleeds – 42%; enlarged perivascular spaces – 88%; brain atrophy – 27%.

Conclusion. Neuroimaging signs of brain lesions are common for all types of cerebral small vessel disease, including CADASIL. However, there are some features in patients with CADASIL. The detection of petechial intraparenchymal hemorrhages is a diagnostically and prognostically useful marker, so it is very important to use gradient echo planar T2* or SWI sequence in the conventional MRI protocol.

Glomus tumor is one of the most common temporal bone tumors. Most of them are benign and locally invasive, some are occasionally able to metastasize and have signs of malignancy. Diagnostic imaging is necessary before treatment. Computer tomography (CT) is traditionally used as a primary method of diagnosis, to recognize changes in the temporal bone. Role of magnetic resonance imaging (MRI) in temporal bone tumor diagnosis is not definitively determined.

Purpose. To assess the possibilities of computer and magnetic resonance tomography, to develop an algorithm for the application of diagnostic imaging methods in the diagnosis of glomus tumors of the temporal bone.

Material and methods. The article presents the experience of diagnosing 30 patients with glomus tumors.

Results. The tympanic form of the glomus tumor was observed in 11 cases (37%), tympano-yugular in 19 cases (63%). CT and MRI data totally coincided in cases of small tumors (type A and B). In the presence of extended forms CT ability of assessing bone invasion, involvement of the internal carotid artery, internal jugular vein, and dural sinuses was lower than the MRI.

Purpose: to develop optimal technique of cardiac multidetector computed tomography (MDCT) before noninvasive cardiac mapping before cateter ablation of atrial fibrillation.

Materials and methods. 94 patients with atrial fibrillation were included in study (60 males, 34 females; mean age = 58.3 ± 10 years; mean body mass index (BMI) = 29.9 ± ± 4.8). The patients were divided into 2 groups: I – 80 patients who underwent computer tomography (CT)-protocol for noninvasive cardiac mapping with standard contrast enhancement (single-bolus protocol); II – 14 patients who underwent CT with modified contrast enhancement technique with preliminary contrast injection (prebolus). To detect thrombotic masses in the left auricle the low-dose delayed phase was performed. The analysis of individual features of pulmonary veins, left atrium and adjacent structures was performed. Contrast enhancement of heart chambers was assessed by mean attenuation and homogeneity measurement.

Results and discussion. The typical anatomy of the right pulmonary veins was in 93.6% of cases; right middle pulmonary vein in 5.3%; right segmental veins in 1.1%. The typical anatomy at the left side was in 57.4% of cases; common vestibulum of the left pulmonary veins in 18.1%; common left trunk in 24.5%. Volume enlargement of the left atrium (LA) was in 96.8% of patients. In 6 cases left auricle thrombosis was suspected, low-dose delayed phase was performed. In 2 cases filling defects in left auricle persisted, thrombosis was proved by transesophageal echocardiography. With the single-bolus injection protocol the contrast enhancement of left heart chambers was best (mean attenuation of blood in LA = 296 ± 84 HU, in left ventricle (LV) = 286 ± 83 HU), but the contrast enhancement and homogeneity of the chambers were insufficient (mean attenuation of blood in right atrium (RA) = 179 ± 97 HU, in right ventricle (RV) = 176 ± 80 HU). With prebolus protocol the contrast enhancement and homogeneity of all chambers were optimal (mean attenuation of blood in LA = 259 ± 31 HU, in LV = 286 ± 83 HU, in RA = 270 ± 92 HU, in RV = 253 ± 80 HU). This allowed making more accurate epi-endocardial heart models in the noninvasive cardiac mapping and operation planning.

Conclusion. MDCT with standard contrast enhancement protocol provides detailed information about anatomy and size of pulmonary veins, the left atrium volume, the presence of intracardiac masses (including thrombotic masses), the anatomy of adjacent structures. The modified contrast enhancement technique with preliminary contrast injection (prebolus) allows to receive optimal contrast enhancement of all heart chambers and to make high accurate epi-endocardial models of both the right and left sides of the heart in case of noninvasive cardiac mapping.

The aim. To evaluate clinical, morphological, functional features and mortality in patients with congestive heart failure (CHF) and super-response to cardiac resynchronization therapy (CRT), to assess presence and severity of mechanical dyssynchrony in patients with super-response and to find potential predictors of super-response to CRT.

Methods. 106 CRT patients (mean age 54.7 ± 9.9 years; 83% men) with CHF II–IV NYHA functional class were enrolled for the study. At baseline and each 6 months after implantation clinical, electrocardiographic and echocardiographic parameters, NT-proBNP level were evaluated. According to the best decrease of left ventricular endsystolic volume (LVESV) (mean follow-up period 34.9 ± 16.1 months) patients were classified as super-responders (SR) (n = 45; reduction in LVESV ≥30%) and non-SR (n = 61; reduction in LVESV <30%).

Results. At baseline groups were matched for main clinical characteristics. The proportion of patients with atrial fibrillation, width of the QRS complex, and the presence of left bundle-branch block were comparable between groups. Parameters of mechanical dyssynchrony were higher in SR: left ventricular pre-ejection period (LVPEP) (153.0 ± 35.9 ms vs 126.6 ± 35.1 ms; р = 0.005), interventricular mechanical delay (55.9 ± 30.8 ms vs 40.4 ± 29.9 ms; р = 0.049), systolic dyssynchrony index (9.6 ± 2.6% vs 7.2 ± 0.7%; р = 0.048). NT-proBNP level was lower in SR. SR demonstrated better dynamics of LVESV, LVEF. At baseline and in dynamics level of NT-proBNP was lower in SR. In both groups NT-proBNP decreased significantly, but reduction of NT-proBNP was more evident in SR. The survival rates were 100%in SR and 83.6% in non-SR (log rank test p = 0.002).According to multiple logistic regression analysis LVPEP (HR 1.025; 95% CI 1.006–1.044; p = 0.010) and baseline NT-proBNP level (HR 0.624; 95% CI 0.426–0.913; p = 0.015) were independent predictors for CRT super-response with sensitivity 71.9% and specificity 78.6%.

Conclusion. In patients with CHF greater mechanical dyssynchrony and lower level of NT-proBNP are associated with CRT super-response. SR demonstrate better survival and better dynamics of functional parameters in long-term period. LVPEP and NT-proBNP level can be used as independent predictors of CRT super-response.

Papillary fibroelastoma is a relatively rare cardiac tumor, which etiology is undisclosed and not entirely clear. A relatively small number of case descriptions and investigations makes it difficult to accumulate the material, which is absolutely necessary in view of the diversity and ambivalence of the tactics of the management of the different groups of patients. The article represents the case reports of the papillary fibroelastoma of the left coronary leaflet of the aortic valve in a 79 y.o. man and 15 y.o. woman. In both cases patients hadn't any complains; both fibroelastomas were accidentally detected. Due to echocardiography and CMR, it was succeed to obtain data on the hemodynamic significance of these tumors, to reveal their precize localization and to assess their mobility, also to differentiate them with other masses.

Introduction. Accessory spleen (splenunculus) is one of the most common benign congenital anomalies in humans. The location of splenunculus may vary from perisplenic, greater omental or mesenterial to intraparenchymal (pancreas, stomach, duodenum, etc.). In the latter case, the additional spleen is called ectopic (from the greekektoposdisplaced). Most frequently detection of such splenic lobules occurs accidentally via abdominal ultrasound.

Objective: two cases of verified intrapancreatic accessory spleen (IPAS) and main criteria for differential diagnosis with other hypervascular pancreatic lesions.

Materials and methods. We present two case reports: a 43-year-old woman with a history of kidney cancer and a healthy 61-year-old man. In both cases, pancreatic neuroendocrine neoplasia (NEN) was initially suspected. Preoperative diagnostics included abdominal ultrasound examination and multiphase dynamic computed tomography (CT) with intravenous bolus nonionic iodine-based contrast agent (native, arterial – 10 sec, venous – 60 sec and delayed – 300 sec after threshold density of 150 HU in the aorta was exceeded). In one case magnetic resonance imaging (MRI) including axial, sagittal and coronal T1and T2-weighted images, diffusion-weighted images and dynamiccontrast-enhanced series with gadolinium chelate was performed. Both patients underwent robotic assisted distal pancreas resection. Morphological examination revealed IPAS.

Results. In contrast-enhanced computed tomography IPAS has densitometric parameters similar to the spleen. Generally, magnetic resonance imaging does not differentiate IPAS, NEN and hypervascular metastases, since all three are generally T2-hyperintense and T1-hypointense. Contrast enhancement pattern with gadolinium chelateswas similar to CT-contrast enhancement pattern.

Conclusion. Intrapancreatic accessory spleen does not require surgical treatment. Therefore, differential diagnosis between IPAS and neuroendocrine neoplasia, solid pseudopapillary tumor and hypervascular pancreatic metastases is crucial. MRI has an advantage with non-invasive diffusionweighted images (DWI). The apparent diffusion coefficient (ADC) of IPAS will be quantitatively similar to the main spleen while other lesion will demonstrate lower ADC values. Scintigraphy with red blood cells bound with 99mTc utilizes the reticuloendothelial system (RES) in the spleen demonstrating characteristic uptake in the IPASand the main spleen. Ultrasound with color Doppler and contrast enhancement may be a good addition to our armamentarium. One can evaluate the vascular pedicle of the IPAS, as well as contrast agent retention in RES via sonography. We believe the multimodal approach including MRI with DWI/ADC to be the most effective.

In present days positron emission tomography combined with X-ray computed tomography (PET/CT) is a highly informative, actively developing method of visualization in oncology, and in particular in oncourology. It is widely used to determine the localization of biochemical recurrence (BR) of prostate cancer (PCa). This survey article presents modern trends and prospects of the development of PET visualization of BR of PCa. It shows the diagnostic capabilities of PET/CT with various radiopharmaceuticals, including ligands for prostate-specific membrane antigen (PSMA), their main advantages and disadvantages. Brief historical information, the evolution of radiopharmaceuticals based on ligands to PSMA as the most promising group of radiopharmaceuticals are provided in the article. The biochemical basis of visualization, the main difficulties and possible errors in the interpretation of data, as well as the ways of overcoming them proposed by the researchers are highlighted.

The purpose. Optimization of radiographic study of the shoulder in patients with SIS and estimation of the clinical value of radiographic measurements in SIS diagnosis and rotator cuff tears (RCT).

Materials and methods. 128 patients with a painful shoulder (67 women, 61 men), mean age 57.3 ± 12.8 y.o. and 35 patients without shoulder pain mean age 56 ± 10.4 y.o. underwent a complex study including radiography, MRI, MDCTor MR-arthrography, arthroscopy. Special angles and distances were estimated on a Radiographic Work Station by 2 radiologists (acromion tilt (AT), acromion slope, inferior acromion protrusion, acromio-humeral distance, acromio-humeral index, critical shoulder angle (CSA), lateral acromion angle, transverse acromion angle). Mean values of these parameters were compared between patients with SIS and control group, and between patients with RCT and without . Test-retest reproducibility and inter rater agreement were calculated with Kohen’s kappa. Diagnostic value of the most informative parameters was compared with estimation of AUC under the ROC curve.

Results. CSA and AT demonstrated independence with age and excellent test-retest reproducibility. In SIS patients mean values of CSA were statistically higher (35.78 ± 4.64°), AT values – lower (25.90 ± 4.27°), then in controls. In all patients with CSA more then 35, the frequency of RCT was 74%. In patients with RCT were detected higher values of CSA (36.70 ± 2.61°) and lower values of AT (23.67 ± 3.07°), then in patients without tears. Lateral acromion angle (acromion type) demonstrated correlation with patient’s age and moderate reproducibility in test-retest studies.

Conclusion. AT (measured on the outlet X-ray view) and CSA (measured in direct views) could be recommended for clinical use for evaluation of patients with SIS and prognosing RCT.

Background. Question about the quality and format of postgraduate education of doctors raises increasingly in recent years. Development of professional standards and transition to a system of continuing professional education have allowed professional communities to raise issues of the quality of modern education but there is no clear evidence of the dependence of the level of education and the quality of medical care in the accessible literature. Experts of Research and Practical Center of Medical Radiology carried out the identification of dependence of post-graduate education length for radiologists and the quality of their work that can serve as a rationale for amending the system of doctors training.

Patients and methods. The data on education and actual work of 85 radiologists of out-patient and in-patient units of medical organizations of the Moscow Healthcare Department have been analyzed. According to the results of the audit of diagnostic studies, carried out in the “Unified Radiological Information Service” system by the specialists of the Research and Practical Center of Medical Radiology, the final assessment of the work of each radiologist was formed, which reflects the presence or absence of diagnostic discrepancies.

Results. Parameters of diagnostic errors depending on the age of doctors, the general length of service and the length of service as radiologist, the duration of postgraduate education in the clinical specialty and the specialty “radiology” have been compared.As a result of the analysis, it was found that the increase in the proportion of diagnostic differences is directly related to the increase in the age of the doctor and does not depend on either the length of service or the time of work in the specialty. Differences between the groups of physicians with the largest (professional retraining after clinical residency) and the smallest (clinical education + radiology) percentage of clinically significant discrepancies are statistically significant (p = 0.05, at the normative value of the Student's test score of 2.16).

Conclusion. The inverse relationship between the duration of training of the radiologist in the specialty and the proportion of diagnostic errors, which can serve as a significant justification for making proposals for the exclusion of professional retraining within 576 hours for admission to professional activities of radiologists.