Aim: to аББевв dranges in liver pаrenсhymа in the еаг1у, tate аnd remote postoperative periods аfter сryodestruсtion (CD) of foсаl lesions by MRI with diffusion-weighted images (DWI).

Mаteriаls аnd methods. Postoperative MRI monitoring wаs саrried out in 15 pаtients with mаlignаnt liver lesions. All pаtients were divided into two groups: with сomplete аnd inсumplete CD. All pаtients underwent MRI with dWi before surgery аnd in the postoperative period on the 1st dаy, 3 months, 6 аnd 12 months.

Results. In group 1 - 100% “overlаp” of the pаthologiсаl foсus агеа of postoperative edemra ассording to T1WI аnd T2WI. Before surgery ~ ADC in the foсus wаs 0.86 mm²/s, in the 1st dаy - 1.00 mm²/s, 3 months - 1.03 mm²/s, 6 months - 1.30 mm²/s, 12 months - 1.30 mm²/s. Before surgery, the average size of the focus - 46 mm, in the 1st day - 57 mm, 3 months - 46 mm, 6 months - 45 mm, after 12 months - 39 mm. By the 12th month in group 1 ~ ADC in the focus increased by 51.20%, and the average size of the focus decreased by 16.00%.

In group 2 - incomplete overlapping of the focus area of postoperative edema. Before surgery ~ ADC in the focus was 0.80 mm²/s, in the 1st day - 0.79 mm²/ s, in 3 months -0.75 mm²/s, in 6 months - 0.66 mm²/s, in 12 months -0.55 mm²/s. Before surgery, the average size of the focus -44 mm, in the 1st day - 47 mm, in 3 months - 55 mm, in 6 months - 78 mm, after 12 months - 112 mm. 12 months after CD group 2 ~ ADC in the focus decreased by 31.30%, and the average size of the focus increased by 155.20% due to the continued growth of the tumor.

Conclusion. MRI with DWI allows to assess changes in the liver and CD zone in the early, late and remote postoperative periods, to assess the completeness of the overlap zone of the CD focus and the dynamics of the continued growth of the tumor after incomplete CD.

Aim. To reveal and evaluate opportunities of preoperative computer tomography (CT) for pancreatic fistula (PF) prediction after pancreatoduodenectomy.

Materials and methods. In 2005 International Study Group on Pancreatic Fistula (ISGPF) developed grading criteria for PF, including asymptomatic biochemical (Grade A), that could be treated conservatively, and clinically relevant (Grade B, Grade C), with consecutive active surgical treatment. For now ISGPF definition of PF is widely accepted. We review the literature since 2005 for original articles in English describing quantitive assessment of the pancreatic parenchyma using CT with histological validation. Low sample trials (<10 cases) were excluded.

Results. Three original publications met the inclusion criteria. Fatty and fibrosis infiltration of the pancreatic parenchyma assessed by preoperative CT revealed statistically significant correlation with PF rate.

Conclusion. Preoperative CT offers accurate prediction opportunities for postoperative pancreatic fistula and may help caregivers to set up protocols for a strict and early detection of warning clinical signs, to tailor the clinical management of different risk classes, or to select high-risk patients who might be excluded from surgical resection. This would also improve patient selection for relevant research protocols and facilitate a more definitive assessment of collected data related to surgical outcomes, across different institutions and surgeons, and even among different surgeries, in either single-institution or multi-center trials that involve pancreatic surgery.

Purpose. To determine the possibility of MSCT in the differential diagnosis of acute appendicitis.

Materials and methods. MSCT was performed on a multidetector 64-slice computer tomograph Aquilion company Toshiba with multi-phase contrast enhancement. The results of MSCT 108 (100%) patients hospitalized for emergency indications with suspected acute appendicitis in the surgical Department of the “City clinical hospital them M.E. Zhadkevich Of the Department of health of the city of Moscow” were analyzed from July 2017 to July 2018.

Results. The age range of the subjects ranged from 18 to 81 years, including 53 women (49%), 55 men (51%).

CT-picture of acute appendicitis was observed in 23 (21%) patients. In 85 (79%) cases, according to MSCT, no direct signs of inflammatory changes in the Appendix were determined. In this case, acute appendicitis was confirmed during surgery in 22 (20%) cases. A false positive result was obtained in one patient. In a comprehensive examination were diagnosed: acute mesenteric thrombosis -1(1%) case, acute mesadenitis - 1 (1%) case, acute pyelonephritis - 2 (2%) case, concretion of the right ureter -2 (2%) case, hemorrhage in the cyst of the right ovary -1 (1%) case, diverticulitis - 6 (5%) cases, tumors of the blind and ascending intestines - 2 (2%) case. In 68 (63%) cases, patients were discharged without surgery after intestinal colic relief. 2 (2%) patients were operated on with negative MSCT results, as the acute abdominal clinic was preserved. Acute phlegmonous appendicitis was diagnosed intraoperatively. The sensitivity of MSCT in the detection of acute appendicitis in our observations was 91.7%, specificity -98.8%, the prognostic value of the positive result-95.7%, the prognostic value of the negative result - 95.4%.

Conclusion. Multispiral computed tomography is highly informative in the differential diagnosis of acute appendicitis, its use avoids unreasonable surgical interventions.

Invagination is the process of introducing one part of the intestine into another, which is a type of acute intestinal obstruction. Most often occurs in infants. Diagnosis in adults causes difficulties, often the disease simulates the clinic of other diseases of the abdominal cavity (pancreatitis, appendicitis, etc.). Distinguish between different types of invagination of the intestine: the cecal intussusception, colonic intussusception, ileal-colonic intussusception, small bowel invagination. The diagnosis uses ultrasound, CT, X-ray examination. Treatment of intestinal invagination in adults is surgical in most cases. We present a case of iliac-colonic invagination in an adult male with acute abdomen.

The aim of this prospective study was to evaluate ultrasound capabilities in differential diagnosis of intestinal diverticular disease, diverticulitis and other acute abdomen pathology.

Material and methods. The study included 29 patients at the age of 48-95 years, which were admitted to emergency department with clinical symptoms of acute abdomen pain. All patients underwent complex clinical examination, comprising laboratory and instrumental diagnostic methods. Ultrasound of intestines was performed according to a specially developed step-by-step algorithm.

Results. Sensitivity of the method was 68%, specificity 80%, accuracy 72.0%, PPT 86.0%, NPT 57.0%.

Conclusion. Rather high diagnostic informative value and non-invasiveness of intestine's ultrasound allow to reconsider the sequence of instrumental methods of diagnosis for patients with suspicion on acute diverticulitis, and to consider ultrasound as a first line method of diagnosis.

Stomach bezoar is a foreign body in the digestive organ, formed as a result of ingestion and digestion of certain substances that have vegetable, animal or chemical origin. This pathology, rarely found in patients, has another name, that is, gastric concretions. The article presents a clinical case of complex diagnosis and treatment of intestinal obstruction caused by plant bezoar (persimmon). The results of traditional x-ray, ultrasound, MSCT and endoscopic methods are presented. Surgical treatment was carried out: laparotomy, enterotomy, removal of bezoar.

Aim. Quantitative follow-up of the intensity of paramagnetic contrast enhancement of the aortal wall and renal arteries walls, as indicator of the pathological subinitimal and media neoangiogenesis was carried out in patients with arterial hypertension, focusing on changes after renal denervation.

Material and methods. 31 patients (as old as 57.3 ± 9.8 years) with resistant hypertension comprised the study group. The average systolic/diastolic pressure obtained from 24-h monitor study was as high as 154 ± 12 / 89 ± 9 mm Hg. The MRI studies were carried out using 1.5 Т MRI Toshiba Vantage Titan scanner. After this the intravenous contrast enhancement has been carried out (with 0.5 М paramagnetic, as 0.2 ml/Kg). The radiofrequency ablation (RFA) desympathising the kidneys was performed on X-ray operating room using the Symplicity system: Symplicity Flex renal ablation electrode with a 4F end electrode as thin as 1.33 mm and with length of 1.5 mm, and also automated RF voltage generator with built-in power management algorithms temperature (Medtronic, USA) were employed. The comparison group included 28 people who were referred for MRI study of lumbar spine (average age - 53.2 ± 17.8), without any evidence that could be attributed to the pathology of the cardiovascular system.

Results. Enhancement index (EI) of the aortic wall of patients with hypertension (1.57) was significantly over the aortic EI of healthy people (1.23), p < 0.0001, reflecting inflammatory neoangiogenetic changes in the vascular wall in hypertension. The correlation between EI in the wall of both renal arteries is highly reliable and linear, which confirms the idea of the systemic nature of neoangiogenesis in hypertension. Analysis of data from an MRI study of the renal arteries showed that the intensity of the accumulation of the contrast agent in their wall after RD, as a rule, decreases (the right RA distal segment 1.78, 1.61, 1.59 - at baseline, at 6 and 12 months after RD, respectively (p < 0.05). Thus, a visual MRI proves electro-induced damage to the wall of the renal artery and the development of fibrosis at the site of radiofrequency exposure. At the same time, there are no significant differences in EI between studies at the sixth (p = 0.56) and twelfth (p = 0.48) months of observation after RFA, which argues in favor of maintaining fibrosis and, respectively, the absence of reinnervation and inflammatory neoangiogenesis of the arterial wall.

Conclusion. MR-tomographic examination of the aorta and renal arteries with contrast enhancement should be carried out to assess the state of the walls of these vessels and to dynamically monitor their condition after renal denervation.

Introduction. Digital tensor tractography (DTT) is well-known and efficient method for white-matter tracts visualization. However, few publications show its effectiveness in cranial nerves tractography. The aim of the study is to develop and to implement the protocol for visualizing cranial nerve tracts.

Materials and methods. DTT was implemented in 6 patients with vestibular schwannoma (VS) W. Koos 3-4 grade, preliminary coordinated by the study of 5 patients with trigeminal neuralgia. The tracts were “built” using 3D Slicer software.

Results. In 5 of 6 cases, full correlation of pre- and intraoperative data was registered. In 1 case, the tracts were non-identifiable.

Conclusion. Presented algorithm provides effective preoperative visualization of cranial nerves (V, VII). Obtained results allow to consider the method of DTT a promising technique for preoperative visualization of trigeminal and facial nerves in patients with posterior fossa lesions.

Purpose. We developed and applied for quantification of microvascular permeability in damaged myocardium a model - based approach employing the dynamic acquisition of magnetic resonance imaging of paramagnetic diffusion to damaged myocardium and kinetic Gjedde-Rutlend-Patlak (GRP) analysis of blood clearance of the contrast concomitantly with it’s rise in the damaged tissue, in ischemic or inflamed tissue.

Material and methods. The model is based on the passive gradient-driven diffusion, unidirectional for first minutes after injection of the contrast, used as Gjedd-Rutland-Patlak technique. If the Cmyoc - depicts the concentration of the paramagnetic in the blood, and the Cblood -means the blood level of the contrast agent, whereas the kblood–myocardium – is the index of diffusion of the contrast from blood to myocardium, then assuming the diffusion unidirectional for first minutes post injection we can plot the ratio {(∫Cblood(t)dt) / Cblood} – as abscissa X, and {Cmyoc /Cblood} – as ordinata Y, kblood-myocardium can be obtained then from such linear plot as it’s slope. We substituted the concentrations themselves with the values of intensities of the echo-planar ECG-synchronized scans of the heart and validated this approach with comparison of MRI intensity data over LV cavity to Gd content in blood samples.

MRI of the heart with contrast enhancement was carried out using dynamic scannig, after bolus injection of 2 ml of 0.5 M of paramagnetic contrast (Gadoversetamide -TMOptimark) per 10 Kg of BW. TR = 3.4 ms, TE = 1.7 ms, inversion time 176.0 ms, deviation angle = 40 deg, scanning field 38 х 38 cm, slice thickness = 8-10 мм, acqu-sition matrix 256 х 256, or 192 х 192, echo train length = 1. The groups of patients comprised twenty one persons with acute myocardial infarction treated clically successfully with intravenous thrombolysis and coronary stenting and also nine persons with firstly revealed inflammatory myocarditis. Uptake kinetics to the myocardium was imaged using protocols with fat supression for up to 12 minutes after bolus injection and then processed using RadiAnt software (Medixant, Poznan, Polska), and also original software for dynamic data analysis written using MATLAB 6.1 (SCILAB also), with output of plots of MRI signal intensities over time for various myocardial regions and also of GRP plots and calculation of  kblood-myocardium values.

Results. The physiological sence of the kblood–myocardiumdiffusion koefficient means this value depicts the clearance of paramagnetic to myocardium, i.e. the amount of blood cleared from the paramagnetic due to paramagnetic’ diffusion to damaged myocardium, per minute, per unit of myocardial volume. The value of the kblood–myocardiumdiffusion koefficient was, respectively, as high as 3.09 ± 1.32 (2.36-11.9) ml/min/100 g of tissue, in myocardial infarction although treated successfully with thrombolysis and stenting (n = 21) and 1.78 ± 0.67 (0.50-2.42) ml/min/100 g of tissue -in inflammatory myocarditis damage of myocardium (n = 9); In normal controls kblood–myocardium was close to zero values and namely as low as 0.09 ± 0.06 (<0.2) (ml/min/100 g of tissue). Use of this dynamic protocol provided highly significant separation of ishemic and iflammatory conditions.

Conclusion. Dynamic MRI echo-planar ECG-synchro-nised contrast-enhanced echo-planar study of the heart can be successfully carried out using both high- and middle-field MRI scanner. The model-based indexes of diffusion of paramagnetic to the infarction or inflammation are significantly different and deliver additional object-based characteristics of the vascular permeability of the damaged haematomyocardial barrier.

The objective. Revelation of informative markers of qualitative analysis CEUS in the differential diagnosis of breast lesions, determination of effectiveness CEUS in the breast cancer examination.

Materials and methods. The work is based on the results of a retrospective comparison ultrasound data with the histological results conducted in 145 women with breast lesions at the age of 17-71 years (average age was 45.5 years) from December 2017 until November 2018 year.

Results. Statistical analysis of markers of qualitative assessment CEUS showed that more important markers in the differential diagnosis were - indicators of definition of the boundaries of lesion during CEUS (Se 79,27 Sp 63,41); the velocity of accumulation of contrast agent (Se 78,05 Sp 80,95); wash-out velocity from lesion (Se 68,29 Sp 95,24).

Conclusion. Qualitative data analysis of CEUS provides to detail of breast lesions and surround tissues vascular architecture, improves differential diagnosis of breast tumors, which allows to reduce the number of additional methods of examination and biopsies, predict the volume of surgical and complex treatment.

Objective: to determine the informational significance of the length of the cervix for predicting of premature delivery using ultrasound measurement cervical length at a period of 16-20 weeks, taking into account the body mass index (BMI) of pregnant women.

Materials and methods. A survey of 340 pregnant women from 16 to 20 weeks at the age of 20-35 years, with the use of ultrasound measurement of cervical length. The analysis of the relationship of the outcome of childbirth (premature birth or delivery in time) depending on the length of the cervix and BMI in the period from 16 to 20 weeks of pregnancy.

Results. Women were divided into 4 groups based on BMI: group 1 (BMI less than 18.5 kg/m²), group 2 (BMI from 18.5 to 24.9 kg/m²), group 3 (BMI from 25.0 to 29.9 kg/m²) and group 4 (BMI of 30.0 kg/m² and more). The shortest average cervical length (CL) of 27.32 ± 1.97 mm was observed in the group of pregnant women with a BMI of <18.5 kg / m² (p < 0.001). In the group of patients in whom preterm birth (PB) started, the average length of the cervix at 16-20 weeks (27.52 ± 3.15 mm) was significantly less than in patients of other groups (p < 0.001). Delayed delivery was significantly more common in patients with an average long cervix of 40.92 ± 2.79 mm (p < 0.001). In the group of women with underweight, there was a high percentage of onset of CL. In women with normal BMI, overweight and obesity, there was no significant difference in the incidence rate of PB (p > 0.05). Overweight and obesity were significantly more likely to be a risk factor for delayed delivery (p < 0.05).

Conclusion. Women who are underweight are more susceptible to PB, since they have a short cervix, while women with overweight and obesity tend to be late in childbirth and have an elongated cervix.

Objective. To study some of the qualitative features of the bone tissue of the bodies of the lumbar vertebrae in women with different bone mineral density values according to quantitative x-ray computed tomography.

Materials and methods. Results of quantitative computed tomography of the lumbar vertebrae of 127 women of different ages who were in the cardiology department of the Yaroslavl Regional Clinical Hospital for hypertronic disease of the II st. without a crisis flow, divided into five groups depending on the average mineral density of the spongy bone tissue.

Results and discussion. A decrease in the mineral density of cancellous bone tissue was determined by 22-26% with each subsequent group observed to an average mineral density of 50-74 mg/mm³; in a group with an average mineral density of less than 50 mg/mm³, the reduction in this index was 38% values. In general, the decrease in the mineral density of spongy bone tissue in the observed groups was 72%, cortical 42%. The difference in density of the spongy bone in the measurement zone (density interval) between the most mineralized elements such as bone beams and the least mineralized such as bone matrix and intertrabecular space, was reduced to the level of the average mineral density of the trabecular bone 100-124 mg/mm³, then in the observed groups remained almost unchanged. The density of the least mineralized components of cancellous bone tissue in the measurement zone in the group of an average density value of less than 50 mg/mm³ was close to zero.

Conclusions. The degree of decrease in the mineral density of the spongy bone with the development of osteopenia and osteoporosis is much higher than in cortical bone tissue. Reduction of the bone mass of the spongy bone is accompanied by a narrowing of the density interval with a pronounced decrease in the minimum density in the measurement zone. Similar changes in cortical bone tissue are not observed. Reduction of the mineral density of the spongy bone as osteoporosis develops fairly uniformly with an increase in bone mass of less than 50 mg/mm³. Reduction of the mineral density of the cortical bone occurs less evenly with an increase in its decrease in the stage of osteopenia (T-test - from -1,0 to -2,5) and with the most pronounced manifestations of osteoporosis, with bone mass less than 50 mg/mm³.

The development of secondary tumors is a rare but well-known late effect of radiation therapy of lesions of the central nervous system. At the same time, malignant gliomas most often occur.

This article presents a rare clinical case of secondary anaplastic astrocytoma in a child who received chemoradia-tion therapy for medulloblastoma after surgical treatment.

Purpose. Demonstration of a rare occurrence of anaplastic astrocytoma after surgical and chemoradiation treatment of medulloblastoma.

The main milestones of life and scientific activity of professor A.E. Prozorov are provided. It is noted that Alexander Evgrafovich organized the first X-ray radiotherapeutic office at Gynecologic institute. From 1918 to 1924 served in the Red Army as the radiologist in various military institutions. It is shown that since 1925 until the end of life directed radiological office of the Central scientific research institute of tuberculosis M3 of the USSR. That circumstance that Prozorov along with 1926 for 1940 managed radiological office of hospital of S.P. Botkin is analyzed; in 1947-1949 headed department of a radiology of the 2nd MMI. A.E. Prozorov published more than 60 scientific works, including the monograph “Radiodiagnosis of a Pulmonary Tuberculosis” (1940), long time serving as one of the main guides to this question. A.E. Prozorov showed that the essential value in development of tubercular process has aggravation of the calmed-down tuberculous focuses (rein-fekt). It is noted that he paid attention to possibility of an atelectasis at tubercular bronchadenites. Its researches in the field of studying of the normal pulmonary drawing and roots of lungs and also descriptions of versions of the pulmonary drawing played a significant role for specification of early radiological manifestations of tuberculosis and other pulmonary diseases. A.E. Prozorov offered a method of the sliding mark for specification of localization of pleurisy, paid attention to a phenomenon of shift and change of a form of a shadow of an exudate at pleurisy in connection with breath phases. A number of works devoted to nonspecific diseases of lungs.