Purpose. To determine the possibilities of coronary CT-angiography (CTA) in evaluation of qualitative and qualitative parameters of coronary plaques in comparison with intravascular ultrasound (IVUS).

Matherials and methods. 37 patients (29 men, 8 women) with symptoms of acute coronary syndrome (ACS) were included in the study. Unstable angina was detected in 24 patients, acute myocardial infarction (AMI) – in 13 patients. Averageage was 58 [44; 65] years. CTA had been performed as the first method of beam diagnostics in all cases if it was not necessary to use the emergency selective coronary angiography (CAG). IVUS was performed in one, two or three coronary arteries of every patient. Total, 60 coronary lesionsin 55 arteries were examined with IVUS. IVUS data was compared with CTA data.

Results. Methods well correlated in detection of plaque burden (r = 0.823; p < 0.0001), plaque length (r = 0.932, p < 0.0001), remodeling index(RI) (r = 0.906; p < 0.0001). Sensitivity and specificity of CTA in detection of irregular contour was 96.1% and 88.9% (area under ROC-curve 0.925), positive remodeling – 100% and 97.4% (area under ROC-curve 0.974). CTA and IVUS in evaluation of spotty calcinates was not coincide in 9 plaques, sensitivity and specificity of CTA in detection of 71% and 100% (area under ROC-curve 0.855).
Discussion. Comparison of CTA and IVUS was performed in evaluation of plaques features in patients with ACS. This analysis showed high comparability of methods for evaluation of coronary stenosis degree, RI, plaque burden, length and contour. Thus, the characteristics of plaques according to CTA data can be used to stratify the risk of development of ACS.

Conclusion. CTA – fast non-invasive method of coronary plaques evaluation. CTA correlates well with IVUS.

Cardiac resynchronization therapy (CRT) is a contemporary and established treatment for patients with symptomatic heart failure, severely impaired left ventricular (LV) systolic dysfunction and a wide (>150 ms) complex. As with any other treatment, the response to CRT is variable. The degree of preimplant scar burden and scar localization to the vicinity of the LV pacing stimulus are known to influence response and outcome. As well as providing measurements of global and segmental cardiac function, coronary venograghy, CMR also permits localization and quantification of myocardial perfusion and scars. This review explores on the role of CMR in the assessment of patients undergoing CRT, with emphasis on risk stratification and RV and LV leads deployment.

Purpose. Evaluation of diagnostic efficiency and safety of volumetric dynamic 640-slice CT in the detection of stenotic lesions of the coronary arteries.

Materials and methods. In University clinic N1 in 2016–2017 years we investigated 86 patients with ischemic heart disease or valvular heart disease. All patients were fulfilled volumetric dynamic 640-slice CT-coronarography with retrospective ECG-synchronization and subsequent multiparametric reconstruction and evaluation of the coronary vessels. We determinate the degree of stenosis of the coronary arteries. The results are compared with data of the standard coronarography. 22 patients previously had stenting coronary arteries. In 12 cases, patients have atrial fibrillation. The selection criterion for the study was the absence of progression of the disease for at least 6 weeks and a minimum period of 3 months of optimal medical therapy. The study did not include patients with acute coronary syndrome and patients with aortic-coronary bypass surgery in history. All patients were performed CT-angiography on 640-slice CT Aquilion One (Toshiba, Japan). Contrast agent (Ultravist-370) of room temperature was injected into the cubital vein via catheter 18G at a speed of 4.5 ml/s.

Results. Statistical criteria in the detection of coronary artery stenosis at MSCT-coronarography were as follows: sensitivity – 94.3%, specificity – 93.5%, accuracy – 92.8%, positive prognostic value – 96.4%, negative prognostic value – 87.3%. Spearman rank correlation coefficient in the evaluation of coronary artery lesions according to these methods was 0.68.

Conclusion. Volumetric dynamic 640-slice CT-angiography is a highly sensitive safe non-invasive method of examination of patients with different cardiovascular diseases, which is characterized by low radiation dose and high security.

Purpose. To assess the state of the vascular bed and perfusion of the lungs in patients with chronic thromboembolic pulmonary hypertension (CTEPH) by the method of subtraction computed tomography (CT).
Materials and methods. Between November 2015 and May 2018, 65 patients with diagnosis of CTEPH were examined. All patients were examined on a computer tomograph Aquilion ONE 640 VISION Edition (Toshiba Medical Systems) with 320 rows of detectors, slice thickness – 0,5 mm. Assessment of perfusion disorders was carried out using new software, which allows combining contrast and noncontrast images by subtraction. Were analyzed parameters of the parenchyma, blood supply and perfusion status with the calculation of indices of obstruction and perfusion disorders. The obstruction index was compared with the index of perfusion abnormalities, a 6-minute walk test, and mean pulmonary artery pressure according to the right heart catheterization data.
Results. The significant correlation was found between the obstruction index and the index of perfusion disorders in patients with CTEPH (r = 0.605; p = 0.000001). Interrelations between vascular-perfusion indices (an obstruction index and an index of perfusion disorders), mean pulmonary artery pressure and distance in a 6-minute walk test were not revealed.
Conclusion. Subtraction CT pulmonary angiography allows to assess the severity of vascular lesion and perfusion disorders within a single study, also determine the effectiveness of treatment in patients with CTEPH.

Aim. Evaluation of proton MR spectroscopy in the diagnostics of non-alcoholic fatty liver disease.

Materials and methods. 70 patients (40 men, 30 women) with non-alcoholic fatty liver disease were included in the study. Average age of patients was 42 ± 11 years. All patients were divided in two groups. The first group included patients with liver steаthosis (n = 37). Patients with steatohepatitis detected by clinical data formed the second group (n = 33). All patients underwent MR spectroscopy for liver fat content evaluation in two time points (prescreening and after 6 months treatment).

Results. MR spectroscopy showed fat content in patients with liver steatosis in the range from 7.5% to 58.4%, the median was 22.4% (lower and upper quartiles were 14.9% and 28.7%). After 6 months the liver fat content significantly decreased up to 1.5–43.7%, the median was 13.5% (the lower and upper quartiles were 5.54% and 18.9%). In patients with steatohepatitis the fat content calculated by MR spectroscopy ranged from 10.5% to 60%, the median was 28.8% (the lower and upper quartiles were 16.5% and 31.2%). There was no significant difference in fat content in this group after 6 months therapy (the median was 26.7%, the lower and upper quartiles were 14.2% and 28.7%, p = 0.22).

Conclusion. Proton MR spectroscopy can be successfully used in patients with non-alcoholic fatty liver disease for liver fat content quantification in steatosis and steatohepatitis. MR spectroscopy can be discussed as a non-invasive biopsy alternative for dynamic evaluation during treatment.

We presented a clinical case of dual-energy computed tomography in a patient with urolithiasis. Was performed a complex evaluation of the specific parameters obtained in dual-energy computed tomography: dual-energy ratio, dual-energy difference, dual-energy index, Z effective and the chemical composition of the urinary stone in a patient in vivo to determine the tactics of surgical treatment and metaphylaxis.

The problem of diagnosis and treatment of diseases of the patellofemoral joint (PFJ) remains relevant currently, since joint damage affects mainly young employable patients. The review analyzes the data of foreign and domestic literature on methods of the visualization of pathological conditions of patellofemoral articulation. Analysis of the literature has shown that now there is no single algorithm for detecting the pathology of PFJ by radiological methods, especially on early stages, when the effectiveness of treatment is the highest.

“Stress” or “March” fractures is an important question for the traumatologists and radiologists. An important factor in this topic is the timely and qualitative diagnosis of this type of fractures. The choice of the optimal method of diagnosis, reliable visualization of bone-destructive changes significantly affect the tactics of further treatment and the amount of possible surgical intervention. In this article, the authors presents two clinical cases of diagnosis of “marching” fractures. 

The purpose. To determine the role of complex radiological diagnostics and diagnostic effectiveness of various radiological methods in drug-dependent patients with phosphorous osteonecrosis of the facial skeleton at the preoperative stage.

Materials and methods. The study included 85 drug addicted patients with a diagnosis of toxic phosphorus osteonecrosis of the facial skeleton. In the preoperative period all patients underwent full clinical and radiological examination. Orthopantomography (OPG), skull x-ray, multislice computed tomography (MSCT), cone-beam computed tomography (CBCT) were performed in 85 patients (100%) at the preoperative stage. Also, 19 patients (22.4 %) underwent radionuclide diagnostics, which included planar scintigraphy and single-photon emission computed tomography (SPECT). Further, all patients underwent surgical treatment to the extent of complete or partial resection of the jaws and other bones of the facial skeleton.

Results. According to the data of complex radiological examination at the preoperative stage it was revealed that in 48% (n = 41) cases the osteonecrosis zones were localized in the lower jaw, in 24% (n = 20) in the upper jaw, in 28% (24) patients the pathological process captured both jaws. Also, MSCT and CBCT data revealed the spread of the pathological process to other bones of the facial, in some cases, the brain part of the scull in 25 patients (29.5%). The data of radionuclide diagnostics allowed to reveal the zones of radiopharmaceutical accumulation both in the bones of the skull and outside it. Based on the results of the analysis of the data obtained, the role of complex radiation diagnosis was determined, as well as the diagnostic effectiveness of radiation methods (OPG, X-ray of the skull, MSCT, CBCT) in the examination of drug-dependent patients with phosphoric osteonecrosis of the facial skeleton at the preoperative stage.

Conclusion. The complex radiological diagnostics with application of high informative modern methods (MSCT, CBCT, radionuclide diagnostics) is the required step in the evaluation of patients with osteonecrosis of the facial skeleton at the preoperative stage. The diagnostic efficiency parameters for MSCT were: sensitivity – 98.1%, specificity – 99.6%, the accuracy – 98.8%, for CBCT: sensitivity – 97.3%, specificity – 99.1%, accuracy – 98.4%, for OPG: sensitivity – 78.6%, specificity – 76.3%, accuracy – 77.4%, for radiography of the skull: sensitivity – 61.1%, specificity – 59.2%, accuracy – 60.2%.

The article describes two cases of quite rare genetic disease, tuberous sclerosis, one of which was diagnosed as early as in adulthood in a patient with a history of episindrom, the other was diagnosed at the age of eleven in a patient with newly diagnosed seizures, having a history of heart rhabdomyoma. Complex use of radiological methods in the conditions of our clinic allowed to establish in short terms the diagnosis, to estimate a condition of internal organs and also to decide on further tactics of treatment and supervision of patients.

Aim: discover quantitative and qualitative variance of diffusion parameters in white and gray matter of healthyvolunteers brain. Discover correlation between diffusion and kurtosis parameters, find out if there is correlation between the parameters and aging microstructural changes.
Materials and methods. 14 healthy volunteers were investigated (9 men, 5 women; age from 21 to 55 years, mean 34). The volunteers were classified into two groups by age: 7 subjects who younger 35 (6 men and 1 woman, mean age 25) and 7 subjects who older 35 years (3 men and 4 women, mean age 44). We used 3.0 Tesla MRI (3.0T SignaHDxt, General Electric, USA) with 8 channel head coil, gradient strength 50 mT/m, slew rate 150 T/m/s. Diffusion imaging was based on echo planar “spin echo” sequence (SE EPI), TR = 10000 ms, TEmin = 102 ms, FOV = 240 mm, voxel size 3 × 3 × 3 mm3, 60 non-coplanar diffusion directions and three b-values: 0, 1000, 2500 s/mm2. Acquisition time of diffusion kurtosis imaging was 22 minutes. We excluded extracerebral areas on diffusion and kurtosis parametric maps using semi-automatic approach. After that, brain images were transformed to MNI152 space using affine method. Masks of 9 anatomical structures were applied to the transformed images. Diffusion and kurtosis values were measured in these structures.
Results. Fractional anisotropy (FA) changed from 0.06 in lateral occipital cortex to 0.25 in cerebral white matter, kurtosis anisotropy (KA) changed from 0.03 to 0.14 in the same cerebral structures. Axial (AK), radial (RK) and mean kurtosis (MK) were minimal in superior frontal gyrus and maximal in cerebral white matter. AK changed from 0.55 to 0.72, RK changed from 0.62 to 1.05, MK from 0.59 to 0.88. Axial(AxEAD) and radial extra axonal water diffusion (RadEAD) were minimal in putamen and maximal in superior frontal gyrus. AxEAD was changing from 1.38 • 10–3 to 2.57 • 10–3, RadEAD from 1.03 • 10–3 to 2.34 • 10–3. Axonal water fraction (AWF) had minimal value 0,18 in superior frontal gyrus and maximal value 0.29 in cerebral white matter. Tortuosity (TORT) changed from 1.06 in lateral occipital cortex to 1.43 in cerebral white matter. There was significant difference between age groups in AWF, RK, RadEAD in putamen and in KA in superior temporal gyrus. Maximal correlation with age was in MK in superior temporal gyrus, anterior division. It was equal to 0.562.
Conclusions: Diffusion kurtosis imaging is highly sensitive method of brain tissue microstructure assessment, which detects age-related changes.