Editor-in-chief introduction.

In this article are reviewed the most recent diagnostic methods for patients with probable and verified rectal cancer, in different stages of treatment. The importance of high quality visualization of rectal cancer, opportunities of magnetic resonance imaging in primary diagnosis and restaging of the disease after neoadjuvant chemotherapy, optimal examination methods and interpretation of images in routine are discussed.

Computed tomography is an effective method of monitoring of percutaneous interventions. Conventional CT guidance and CT-fluoroscopy are used most frequently for proce dure monitoring. Image-guided robotic needle positioning is an alternative and relatively modern approach for interventional procedures.

Purpose: to demonstrate convenience, effectiveness and safety of robotic system for CT-guided interventions.

Materials and methods. CT-guided percutaneous interventions were performed in FSBI “N.N. Petrov NMRC of Oncology” Ministry of Healthcare of The Russian Federation using the Philips Ingenuity CT scanner and Maxio Perfint robotic system. This article presents clinical observations of adrenal tumor biopsy and cryoablation of a renal cell carcinoma. For cryoablation the Medical Cryotherapeutic System was used.

Results. The robotic system for CT-guided interventions allowed to perform corresponding surgical procedures.

Conclusions. The Maxio robotic console seems to be a promising technical solution for CT-guided interventions. Evaluation of the effectiveness of the robotic and traditional approaches of CT control in percutaneous procedures requires further investigations and analysis on larger data sample in longer periods of observation.

Objective: to assess the accuracy of CT densitometry as a method for measuring the X-ray density of an object, as well as factors affecting the measurement results.

Material and methods. X-ray density indicators were measured in various zones of phantoms containing drinking water with a volume of 0.5, 1.0, 1.5, and 2.0 l, as well as 5 identical vials with a capacity of 0.25 l with iopromide solutions with a concentration of 0, 5.2, 7.6, 10 and 20 ml/l. For each phantom, from 5 to 10 scans were made, followed by measuring the X-ray density of the contents in the central zone closest to the CT system center of rotation, and two zones located to the periphery from the center of rotation.

Results. As a result of analyzing the values of measuring X-ray density in various parts of water-containing phantoms, an increase in the values of X-ray density near the center of rotation of the system and in the upper sections of the phantom with an increase in the volume of phantom was revealed. In the lower peripheral zone in 1.5 and 2.0 liter phantoms, the X-ray density was unchanged. The overestimation of the X-ray density values of the CT images of phantoms with small and large concentrations of iopromide during co-scanning compared with separate scanning was determined.

Conclusion. CT densitometry is a highly sensitive method for measuring the X-ray density of image elements, however, the X-ray density of neighboring structures and the location of this zone relative to the center of rotation of the CT system affect the CT densitometry results. During jointly scanning phantoms of various densities, their mutual influence and the appearance of specific artifacts in the form of dark stripes on the lines of continuation of horizontal levels and “pulling up” the edges of these horizontal contrast levels to the center of rotation of the system were noted.

Langerhans cell histiocytosis is a clonal neoplastic process characterized by cell proliferation of the Langerhans type, with the expression of CD1a, CD207 and S100 proteins and the presence of Birbek granules. We present a case of a 31-year-old woman with a verified osteosarcoma of the proximal epimetaphysis of the left tibia. Also she has multiple thin-walled cysts and foci in the lungs. The case is interesting for the rare combination of osteosarcoma of the bone and pulmonary histiocytosis. This case show that foci in lungs can simulates metastatic disease according to computed tomography (CT). Multidisciplinary approach of pathologist, oncologist and radiologist help revealed diagnose.

Purpose: to study the possibilities of contrast enhanced dual-energy spectral mammography (CESM) in the diagnostics of malignant tumors in the breast.

Material and methods. Forty-seven patients with suspicious for breast cancer (BC) lesions underwent CESM. Digital mammography (MMG) and post-contrast images were correlated with the results of path morphological studies after surgery or puncture biopsy was performed.

Results. Sensitivity, specificity and overall accuracy in the diagnostics of breast cancer were 83.3%, 85.7%, 85.1% for digital mammography and 91.6%, 91.4%, 91.4% for CESM, respectively. The positive predictive value was 66.6% for digital MMG and 78.5% for CESM. The negative predictive value (NPV) was 96.9% for the CESM and exceeded NPV of the digital MMG, which was 93.7%.

Conclusion. Thus, these findings suggest that CESM is an effective method for the diagnostics of malignant tumors in the breast.

Fecal impaction is a common and potentially dangerous disease that occurs in all age groups with a frequency of approximately 15%. Children, the elderly and people with disabilities are considered the most vulnerable. It is a complex diagnostic and therapeutic problem. Coprostasis usually occurs in conditions of chronic or severe constipation, anatomical anorectal abnormalities, and neurogenic or functional gastrointestinal disorders. Fecalomas are one of the manifestations of coprostasis and can lead to a large range of complications. Only knowledge of possible complications and their timely diagnosis can prevent the development of life-threatening conditions. In our work, we present the case of giant fecaloma, complicated by hydronephrosis and obstructive pyelonephritis.

Fecal stones are a collection of solid feces, most often in the distal colon. The formation of fecal stones occurs in people with damage to the autonomic nervous system (Chagas or Hirschsprung's disease), elderly patients suffering from prolonged constipation. Symptoms of coprolites are usually not specific (discomfort in the abdomen, constipation followed by severe diarrhea, weight loss). At clinical examination it is possible to suspect tumor formation. In diagnosis using a colonoscopy, X-ray methods (irrigoscopy, radiography of the abdomen, CT, MRI). The occurrence of fecal concretions can lead to complications such as intestinal obstruction, bedsores in the area of the fit of the stone, ulcers, bleeding, perforation, fecal peritonitis, the formation of a tumor process in the intestinal wall. Treatment is often conservative, in complicated cases surgery.

Present a rare case of intestinal obstruction in an 85-year-old male with colostoma caused by obstruction by a giant fecal calculus in an atypical location (proximal colon), with an erased clinical picture and diagnostic difficulties.

Purpose. To study various ways of diagnosing a vascular-pelvic-ureteral conflict using CT and the abillity to use it in routine work.

Materials and methods. Split-bolus contrastenhanced CT, and computer processing and subsequent three-dimensional modeling have been studieds, data from three patients are presented.

Results. Split-bolus contrasting allowed to estimate the ratio of the renal pelvis system and arteries in one series of images, but the methodology of this study is not specific, depends on the institution and on the patient's condition. Three-dimensional modeling is a more universal technique; it is postprocessing of standard urinary tract examination.

Findings. The use of both techniques allows to reliably visualize the compression of collecting system and ureter by abnormal vessels, and to eliminate other signs of hydronephrosis.

Acute abdominal pain (AAP) is a clinical symptom complex that develops with injuries and acute surgical diseases of the abdominal organs. This condition is one of the most frequent causes of admission of patients to the hospital through the ambulance. Patients with AAP consist of a large and heterogeneous group at the same time due to the etiology and many variations of the clinical picture of this condition. The article presents the results of CT scan of the abdominal cavity and small pelvis in 5 patients with AAP admitted to the S.P. Botkin Moscow City Clinical Hospital emergency department during 2017–2018, without indication of the possible traumatic nature of the pathology. All patients underwent a primary surgeon examination and first-line medical imaging methods such as plane radiography and ultrasound. The selection criterion for inclusion in the search was the need for CT due to the lack of data obtained for diagnosis. Subsequently, the findings of the CT scan were compared with the final diagnosis in the electronic medical file of the patient concerned, to assess the contribution of CT data to the diagnostic process. In a group of 5 patients included in the study, the results of CT were the decisive step in the diagnostic process in 100% of cases. Therefore, the study emphasizes the importance of using CT in patients with AAP. Using this method allows you to complete a diagnostic search as soon as possible from the time the patient enters the hospital, to begin timely treatment.

This article provides a comparative review of two systems for standardized evaluation of the results of hybrid PET imaging with radiolabeled PSMA ligands – PROMISE and PSMA-RADS version 1.0. The principles of classification, nomenclature and evaluation algorithms, as well as recommendations for structuring research and conclusion protocols, highlighting the advantages and disadvantages of the proposed systems, are considered in detail.

Purpose. To evaluate the effectiveness of prostate cancer detection with method of cognitive mpMRI/TRUS fusion biopsy using strain sonoelastography.

Materials and methods. Cognitive transrectal fusion biopsy of prostate was performed in 32 patients. According to the data of a preliminary conducted mpMRI, 33 foci suspicious of prostate cancer were included (PIRADSv2 = 3–5). Before the biopsy, all patients underwent ultrasound planning using compression sonoelastography.

Results. The overall sensitivity was 76% for the targeted biopsy, and 49% for systematic biopsy. The number of biopsy specimens with a clinically significant Gleason grade in the targeted biopsy group was 85% of all columns with cancer specimens, in the systematic biopsy group this number was 68%. On average, the Gleason grade after targeted biopsy was 7.5 ± 0.9, and it was 7.2 ± 0.9 in the columns after systematic biopsy. On average, the percentage of tumor in the columns after targeted biopsy was 72% ± 29% and it was 55% ± 35% in the columns after systematic biopsy. The false positive for mpMRI was 15%. The overall sensitivity for the strain sonoelastography was 69% in this study, clinically significant cancer was detected in 71% of all columns with cancer specimens. False positive for elastography was observed in 18% of cases.

Conclusion. Comparing with systematic biopsy, cognitive mpMRI / TRUS fusion biopsy can improve the detection rate of clinically significant prostate cancer and reduce the number of detected cases of clinically insignificant cancer. In cases of a total or subtotal tumor lesion in the peripheral zone detected on mpMRI, it is possible to take fewer columns for morphological verification of the tumor. The use of compression sonoelastography as an additional parameter of navigation in cognitive mpMRI/TRUS fusion biopsy can be considered as a promising way to increase the detection rate of clinically significant prostate cancer.

Purpose. To determine the capabilities of modern methods of radiology imaging in the diagnosis of bladder and urethral injuries in the pelvic trauma.

Materials and methods. Diagnostics results of 21 pa - tients with bladder and uretra injuries, concomitant with pelvic fractures or isolated injuries of bladder were analyzed. The X-ray, ultrasound and computed tomography examinations were used.

Results. Describing radiological signs of bladder and uretra injuries and radiological methods informativeness are based on the resulting data.

Conclusion. The use of complex radiological study of bladder and uretra injuries in pelvic trauma contributes to the optimal choice of treatment and the prevention of early and late complications.

Adhesive intestinal obstruction is one of the most common and potentially fatal complications after abdominal surgery. Among gynecological operations, leading to the development of adhesive intestinal obstruction, abdominal hysterectomy is the most common cause of emergency intervention. At the same time, in the recent past, mortality was observed from 40% to 60%. Currently ,due to the development of endovideosurgery, it was possible to reduce the postoperative mortality rate however, the mortality rate remains between 10% and 20% in all patients with adhesive small bowel obstruction. The cornerstone in the improvement of treatment results is the timely diagnosis of this complication. We have developed criteria for early computer tomographic diagnosis of adhesive intestinal obstruction in patients after gynecological surgery (patent No. 2669729). These include: free fluid in the lumen of the small intestine more than 200.0 ml, in two or more areas, pneumatized intestinal loops, expansion of the intestinal wall by 2.1 mm or more. The study was conducted in two groups of patients with adhesive peritoneal disease with intestinal obstruction, which included computed tomography (104 patients) and examined according to the traditional method (60 people). The validity of the diagnostic computer tomographic criteria of the study leaves no doubt about the need for their use in the preoperative prediction of access and the volume of surgery.

The purpose: to develop Doppler criteria in the evaluation of cerebral hemodynamics in predicting the outcome of the disease in patients with cerebral aneurysm rupture.

Materials and methods. 172 patients (76 male, 96 female) with cerebral aneurism rupture were participated in the research. All patients were continuously monitored by Doppler studies (a total of 803 studies) in the period from 1 to 20 days after the rupture of the arterial aneurysm. TCD was performed on the apparatus DWL MULTI-DOP T (Germany) with sensors 2 and 4 MHz. All patients were divided into 5 groups depending on the Glasgow outcome Scale (GOS) assessment. Group 1 (n = 87; 50.6%): with an excellent outcome of the disease (GOS 1); group 2 (n = 27; 15.7%): with an good outcome of the disease (GOS 2); group 3 (n = 8; 4.65%): with an acceptable outcome of the disease (GOS 3); group 4 (n = 6; 3.48%): with an acceptable outcome of the disease (GOS 4); group 5 (n = 8; 4.65%): with a lethal outcome of the disease (GOS 5) Systolic blood flow velocity (BFV), Lindegaard index and pulsatility index were estimated

Results. Doppler prognostic criterion of disease outcome were developed: early and progressive increase in blood flow velocity (development of spasm on the 1 day delay after hemorrhage); the development of critical spasm (blood flow velocity over 300 cm/s) by 7–8 days after subarachnoid hemorrhage, the rise of the blood flow velocity per day more than 36 cm/s; the duration of the spasm more than 16 days; increase in pulsatility index (more than 1.0) and Lindegaard index (more than 4.8), the presence of diffuse spasm.

Conclusion. The transcranial Doppler can be an additional screening non-invasive diagnostic method for cerebral hemodynamic evaluation and for determination complications in ruptured cerebral aneurysm.