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No 4 (2019)
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THORAX

10-23 1119
Abstract

For a long time, there was a need to apply magnetic resonance imaging (MRI) technique for lung visualization in clinical practice. The development of this method is stimulated by necessity of the emergence of an alternative to computed tomography, especially when radiation and injection of iodine-containing contrast agents are contraindicated or undesirable, for example, in pregnant women and children, people with intolerance to iodinated contrast. One of the reasons why lung MRI is still rarely used is lack of elaborated standardized protocols that would be adapted to clinical needs of medical society. This publication is a current literature review on the use of MRI in lung studies.

24-41 2967
Abstract

Primary tumors of the heart are a rare pathology with a frequency of occurrence of 0.0017% to 0.28% according to autopsies, while 75% of them are benign in nature, 25% are malignant. Secondary tumors of the heart occur 20–40 times more often than primary tumors. Due to the rapid development of radiology diagnostic methods, the chances of early detection of heart tumors have improved significantly at present. Recently, large cardiology centers have accumulated a lot of experience in the diagnosis and treatment of these lesions. However, early detection in primary malignant lesions of the heart is still a problem, since the clinical symptoms appear when tumors reach a large size. Modern methods of treatment of the heart malignant tumors include radical surgery, and in case of impossibility – cytoreductive surgery.

We present literature review on the diagnostic methods and differential diagnosis of the heart lesions. The types of cardiac tumors are described; its morphological features, differential diagnostic imaging features and hemodynamic characteristics of the lesions are presented; the diagnostic effectiveness of modern imaging methods is analyzed.

42-49 1419
Abstract

Objective. To assess phase-contrast MRI in the evaluation of left ventricular hemodynamics changes in various forms of hypertrophic cardiomyopathy.

Materials and methods. 11 patients were examined: without pathology of the cardiovascular system (n = 3), with apical (n = 3), diffuse-septal (n = 2) and focal-basal (n = 3) types of hypertrophic cardiomyopathy. All patients underwent MRI of the heart with an additional phase-contrast sequence of the left ventricular area. Postprocessing carried out in the 4D FLOW application (Siemens).

Results. Data were obtained on the geometry and dynamics of vortex diastolic flows in the left ventricular of all patients. In patients with hypertrophic cardiomyopathy, an increase in the distance to the center of the vortex and a decrease in the normalized area and peak velocity of the vortex is determined. The diffuse-septal type is characterized by a minimal vortex peak velocity; apical type - by the maximum vortex sphericity index. For patients with a focalbasal type of hypertrophic cardiomyopathy the maximum changes in blood flow are determined in late diastole (absence of vortexes).

Conclusion. 4D FLOW Phase-contrast MRI allows identifying and assessing LV vortical flow. Quantitative analysis can be used to characterize the remodeling of LV blood flow of various types of hypertrophic cardiomyopathy.

ABDOMEN

50-56 710
Abstract

The purpose of this case report is to present a value of gadoxetic acid¬enhanced MRI in the detection of an early recurrent hepatocellular carcinoma in a patient with synchronous multiple malignant tumors. The specific indications of using liver-specific contrast agents were introduced.

57-67 1107
Abstract

Objective: efficacy evaluation of the CEUS LI RADS v2017® system for differential diagnosis of liver tumors in patients with and without cirrhosis.

Materials and methods. Retrospective analysis of diagnostic results of the 165 patients with liver tumors (177 nodules) was done. All patients underwent CEUS with results interpretation in accordance to the CEUS LIRADSv2017 ® criteria. Patients were divided into 2 groups based on clinical and morphological data. Group 1 included 62 patients with cirrhosis and/or CVH. Group 2 included 110 patients without risk factors for HCC.

Results. Diagnostic efficiency of CEUS LI RADS v2017® for HCC identification was: group 1 – Se – 100%, Sp – 88%, Ac – 95.5%; group 2 – Se – 100%, Sp – 68.8%, Ac – 72.7%; general group Se – 100%, Sp – 72.2%, Ac – 81.4%. In the 2nd group, 21 out of 22 neoplasms, confirmed morphologically as FNH, we classified as LR 4. By applying benign character and specific contrasting patterns of FNG, they were transferred from LR 4 to LR 3. This allowed to increase sensitivity and specificity of differential diagnosis in group 2 (Se – 100%, Sp – 90.6%, Ac – 91.8%) and in general group (Se – 100%, Sp – 90.1%, Ac – 93.2%). Diagnostic efficiency of the criteria for non hepatocellular malignant neoplasms (LR M) was: group 1 – Se – 77.8%, Sp – 100%, Ac – 97%; group 2 – Se – 90%, Sp – 96.7%, Ac – 93.6%; general group- Se – 88.1%, Sp – 98.3%, Ac – 94.9%.

Conclusion. Our study confirmed high accuracy of the CEUS LI RADS v2017® system in the differential diagnosis of focal liver tumors. Modification of the system (in particular, transfer of typical FNG forms from the LR 4 category) will make it possible to increase the accuracy of diagnostics by 20%. It will allow to use the LI RADS v2017® system for interpretation CEUS not only among patients with liver cirrhosis, but also in a general group without risk factors of GCC.

68-75 1602
Abstract

Purpose. To study contrast enhancement patterns of hepatocellular carcinoma (HCC) in cases with portal thrombosis and without it.

Materials and methods. 61 consecutive patients with HCC were included in the study and divided into two groups: 41 patient with portal vein thrombosis (main group) and 20 patients without thrombosis (control group). Each patient underwent a abdominal CE MDCT for the analysis of the lesion contrast enhancement.

Results. The 1st – “classic” – contrast enhancement pattern with a peak at arterial phase was observed in 2 (5%) patients with HCC complicated by portal thrombosis and in 10 (50%) patients without thrombosis (p < 0.01). The 2nd – “hypervascular” pattern with a peak shifted in 60–120s after contrast agent administration and no wash out was observed in 14 (34%) patients in the main group and in 10 (50%) patients in the control group (p = 0.4). The 3rd pattern – inhomogeneous contrast enhancement of liver parenchyma in the territory of thrombosed vein without visible tumor was discovered in 17 (41%) cases (p < 0.01). The 4th pattern – peripheral enhancement in arterial and portal phase with insignificant central enhancement in delayed phase was visualized in 8 cases (20%, p = 0.072).

Conclusion. Portal thrombosis, which complicates the course of HCC, significantly changes the patterns of tumor’s contrast enhancement. This should be taken into account when image analysis to avoid diagnostic errors.

76-85 1446
Abstract

Hepatocellular adenoma (HCA) is the uncommon benign liver tumor, which is characterized by monoclonal proliferation of mature hepatocytes. HCAs have many genetic and molecular features that determine their natural behavior (such as malignant transformation), but MRI features are studied just for two subtypes (H-HCA и I-ICA). This article presents clinical case of 58 y.o. woman with hepatitis C, hepatic adenomatosis and malignant transformation of one of multiple HCAs.

86-92 2202
Abstract

Objective. We aimed to research abilities of magnetic resonance imaging (MRI) in determination of the contents of the cysts, including fat suspension.

Methods. MRI study of patient with mesenteric chylous lymphangioma and experimental MRI study of a fantom containing fat suspension were done.

Results. MRI study of patient revealed non organic abdominal cystic lesion with significant decrease of MR-signal intensity on out-of-phase GRE images. MRI imaging of fantom with fat suspension also showed low MR-signal intensity on out-of-phase images.

Conclusion. Opposed-phase GRE sequences can be used not only for determining high content intracellular fat in tissues, but for determining lipids in fat containing suspensions as well. Homogeneous decrease of signal intensity on out-of-phase images in extraorgan abdominal cystic lesion indicate its chylous character. That is why cystic lesion, presented in this article, most likely to be chylous cyst or mesenteric lymphangioma.

93-99 987
Abstract

Meckel diverticulum is a non-permanent diverticulum of the distal part of the ileum, which is the remnant of the yolk duct. Meckel diverticulum is a true diverticulum formed by all layers of the ileum wall. Usually it is located on the antimesenteric edge of the ileum at 60 cm from the ileocecal angle. This pathology is often asymptomatic, and the patient begins to be examined only when complications appear. Clinical manifestations depend on the type of complications.

100-113 2252
Abstract

Aim. To systematize modern literature data on medical imaging of textile iatrogenic foreign bodies.

Materials and methods. We analyzed the articles about the identification of textile iatrogenic foreign bodies, published until 2019.

Discussion. Foreign body detection should be included in the differential diagnostic algorithm for patients who have a history of surgical interventions and unexplained symptoms. In all cases of suspected iatrogenic foreign body, it is desirable to use at least two available techiques of medical imaging: ultrasound, X-ray, MDCT, MRI.

Conclusions. Left foreign body entails medical and legal consequences that adversely affect both the reputation of the surgeon and the reputation of the medical institution, as they are considered a classic example of iatrogenic damage and indicate a violation of the quality standards of medical care. The article presents data on the features of medical imaging of textile iatrogenic foreign bodies left in the patient’s body as a result of planned and emergency surgical interventions, and determining the optimal tactics for examination and treatment of this category of patients.

NEW TECHNOLOGIES IN RADIOLOGY

114-130 6548
Abstract

This article provides a literature overview of biochemical basics and the clinical application of positron emission tomography, one of the most promising technologies of nuclear imaging in oncology. In the first part we discuss the biokinetics of metabolic radiopharmaceuticals, such as 18F-fluorodeoxyglucose, radiolabeled markers of lipid metabolism 11C- and 18F-choline, 11C-acetate, as well as amino acids analogues – 18F-dihydroxyphenylalanine, 11C-methionine, 18F-fluoroe thyltyrosine, 11C-tryptophan, 18F-flucyclovine. This article includes results of scientific researches, that studied radiopharmaceuticals’ effectiveness in oncological practice. The main indications for use, as well as promising scientific developments in this industry are presented.

PEOPLE WHO LEFT A BRIGHT MARK IN RADIOLOGY

131-135 914
Abstract

The article presents the main stages of life and work of the professor L.S. Rosenstrauch (1918–2016). L.S. Rosenstrauch is the author of more than 300 scientific papers including 10 monographies. The important direction of his scientific works was development of new radiological techniques such as parasternal mediastinography, and development and integration of the domestic contrast agents. L.S. Rosenstrauch intensively engaged in teaching. More than 30 doctoral and more than 60 candidate dissertations were defended under his guidance or consultation. Professor was a honorary member of domestic and foreign societies of radiology, editorial Board member of the “Journal of radiology and nuclear medicine” and the international journal “Radiology – diagnostics”, coeditor of radiological section of the BME. Under his guidance a unified program of postgraduate medical education in radiology was developed.



ISSN 1607-0763 (Print)
ISSN 2408-9516 (Online)