Research goal. Comparative characteristics of the dynamics of CT semiotics and biochemical parameters of two groups of patients: with positive RT-PCR and with triple negative RT-PCR. Reflection of the results by comparing them with the data already available in the literature.

The aim of the study is to compare the dynamics of CT semiotics and biochemical parameters of blood tests in two groups of patients: with positive RT-PCR and with triple negative RT-PCR. We also reflect the results by comparing them with the data already available in the literature.

Materials and methods. We have performed a retrospective analysis of CT images of 66 patients: group I (n1 = 33) consists of patients who had three- time negative RT-PCR (nasopharyngeal swab for SARS-CoV-2 RNA) during hospitalization, and group II (n2 = 33) includes patients with triple positive RT-PCR. An important selection criterion is the presence of three CT examinations (primary, 1st CT and two dynamic examinations – 2nd CT and 3rd CT) and at least two results of biochemistry (C-reactive protein (CRP), fibrinogen, prothrombin time, procalcitonin) performed in a single time interval of ± 5 days from 1st CT, upon admission, and ± 5 days from 3st CT. A total of 198 CT examinations of the lungs were analyzed (3 examinations per patient).

Results. The average age of patients in the first group was 58 ± 14.4 years, in the second – 64.9 ± 15.7 years. The number of days from the moment of illness to the primary CT scan 6.21 ± 3.74 in group I, 7.0 (5.0–8.0) in group II, until the 2nd CT scan – 12.5 ± 4, 87 and 12.0 (10.0–15.0), before the 3rd CT scan – 22.0 (19.0–26.0) and 22.0 (16.0–26.0), respectively.

In both groups, all 66 patients (100%), the primary study identified the double-sided ground-glass opacity symptom and 36 of 66 (55%) patients showed consolidation of the lung tissue. Later on, a first follow-up CT defined GGO not in all the cases: it was presented in 22 of 33 (67%) patients with negative RT-PCR (group I) and in 28 of 33 (85%) patients with the positive one (group II). The percentage of studies showing consolidation increased significantly: up to 30 of 33 (91%) patients in group I, and up to 32 of 33 (97%) patients in group II. For the first time, radiological symptoms of “involutional changes” appeared: in 17 (52%) patients of the first group and in 5 (15%) patients of the second one. On second follow-up CT, GGO and consolidations were detected less often than on previous CT: in 1 and 27 patients of group I (3% and 82%, respectively) and in 6 and 30 patients of group II (18% and 91%, respectively), although the consolidation symptom still prevailed significantly . The peak of “involutional changes” occurred on last CT: 31 (94%) and 25 (76%) patients of groups I and II, respectively.So, in the groups studied, the dynamics of changes in lung CT were almost equal.

After analyzing the biochemistry parameters, we found out that CRP significantly decreased in 93% of patients (p < 0.001) in group I; in group II, there was a statistically significant decrease in the values of C-reactive protein in 81% of patients (p = 0.005). With an increase in CT severity of coronavirus infection by one degree, an increase in CRP by 41.8 mg/ml should be expected. In group I, a statistically significant (p = 0.001) decrease in fibrinogen was recorded in 77% of patients; and a similar dynamic of this indicator was observed in group II: fibrinogen values decreased in 66% of patients (p = 0.002).

Such parameters as procalcitonin and prothrombin time did not significantly change during inpatient treatment of the patients of the studied groups (p = 0.879 and p = 0.135), which may indicate that it is inappropriate to use these parameters in assessing dynamics of patients with a similar course of the disease. When comparing the outcomes of the studied groups, there was a statistically significant higher mortality in group II – 30.3%, in group I – 21.2% (p = 0.043).

Conclusion. According to our data, a course of the disease does not significantly differ in the groups of patients with positive RT-PCR and three-time negative RT-PCR. A negative RT-PCR analysis may be associated with an individual peculiarity of a patient such as a low viral load of SARS-CoV-2 in the upper respiratory tract. Therefore, with repeated negative results on the RNA of the virus in the oro- and nasopharynx, one should take into account the clinic, the X-ray picture and biochemical indicators in dynamics and not be afraid to make a diagnosis of COVID-19. 

This paper examines the relevance of the use of a single irradiation of lungs in treatment of pneumonia caused by a new coronavirus infection. Clinical observations are presented that demonstrate perspectives in the treatment of this disease. Patients with severe pneumonia who were prescribed LD-RT (low-dose radiation therapy) at a dose of 0.5–1.5 Gy showed shorter recovery times and no complications. This method of treatment has shown its effectiveness in a number of studies from different countries, predicting success and economic benefits in its further use and study. A literature search containing information on relevant studies was carried out in PubMed, EMBASE, Web of Science and Google Scholar systems. Attention was focused on full-text articles given their general availability in a pandemic.

Metastases in the pancreas are rather rare tumor lesion of this organ. According to different data, the incidence of metastatic pancreatic lesions varies from 1.8 to 4% of all pancreatictumors.

The article presents three clinical observations of metastases of melanoma, renal clearcell cancer, lung cancer in the pancreas. All patients were treatedusing cryosurgical methods with positive dynamics in the postoperative period.

A brief review of the literature discussing metastatic lesions of the pancreas is also done, and the management treatment tactics of these patients is described. 

Purpose. Our study aimed to identify an optimal full-cleanse bowel preparation scheme for patients undergoing CT colonography.

Material and methods. The final sample included 118 patients: 81 females (68.6%), with the median age being 75 years (IQR 675-80 years). For bowel preparation 39 (33.1%) patients used PM/Ca, 36 (30.5%) – 2 L PEG + Asc, 19 (16.1%) – 3 L PEG, 24 (20.3%) – 4 L PEG. Otherwise, the preparation did not differ in all four groups. Visual assessment of residual stool, residual fluid, and distension degree was performed using a 4-point Likert scale. The patient’s subjective tolerance assessment was executed according to the survey results using a 5-point Likert scale.

Results. There were no statistically significant differences in quality of bowel preparation in all four groups. Mean value of the total residual stool score in groups was 46.2 ± 2.87 for PM/Ca; 46.9 ± 2.34 for 2 L PEG + Asc; 46.5 ± 1.98 for 3 L PEG; 45.9 ± 3.18 for 4 L PEG (p > 0.05). The median of the total residual fluid score in groups was 36 (33–38) for PM/Ca; 36.5 (34–39) for 2 L PEG + Asc; 37 (36–39) for 3 L PEG; 36 (34–40) for 4 L PEG (p > 0.05). Mean value of the total distention degree score in groups was 43 ± 4.34 for PM/Ca; 44.6 ± 3.13 for 2 L PEG + Asc; 44.2 ± 3.98 for 3 L PEG; 43.5 ± 4.9 for 4 L PEG (p > 0.05). There was a statistically significant difference in the patient tolerance total score, depending on the laxative (p = 0.001). The total preparation score was significantly lower for PM/Ca when compared with 2 L PEG + Asc. (p = 0.021), 3 L PEG (p = 0.001), and 4 L PEG (p = 0.043).

Conclusion. Use of PM/Ca in CTC preparation lowers the burden of full cleanse exam preparation and can be recommended as a safe laxative choice, including senior age patients. 

Objective. Evaluate the main criteria for ASL-liver perfusion in viral hepatitis.

Material and methods. 111 patients with viral hepatitis, including 69 (62.2%) men and 42 (37.8) women, were examined on the basis of “Clinical hospital N 1”, Smolensk. The average age of patients was 48 ± 5.4 years. All subjects (n = 111) underwent abdominal ultrasound with Doppler vascular examination, clinical elastography, and ASL-liver perfusion with magnetic resonance imaging (MRI). The reference method was trepan liver biopsy in 69 (62.1%) people.

Results. Patients were observed for 9 months. A proportion of the prognosis of the course of the viral hepatitis was compiled, followed by a coefficient-PHBF/PABF, where PHBF is the coefficient of blood flow in the liver parenchyma, PABF is the blood flow in the hepatic artery or abdominal aorta. According to the results of observation of patients, it was found that 54 (48.6%) received more than 1, and 57 (51.3%) had a prognosis coefficient of less than 1. There was a high correlation between positive clinical and laboratory dynamics and an increase in ASL-perfusion of the liver (r = 0.889), as well as negative clinical and laboratory dynamics and a decrease in ASL-perfusion of the liver (r = 0.887). it was found that in patients with a minimum degree of VH activity, the volume of hepatic blood flow (HBF) according to ASL-perfusion of the liver during MRI was from 140 – 159 ml/100 g/min, with a moderate – 118–139 ml/100 g/min, with high – 40–117 ml/100 g/min.

Conclusion. Thus, if the ratio of forecast of more than 1 predict a favorable course (AUC = 0,897 (95% CI 0,884– 0,951)), with a coefficient less than 1 is unfavorable (AUC = 0,895 (95% CI 0,881–0,953)). 

Aim: to present a review of the literature on post-traumatic splenosis of different localization, as well as to complete the presentation of a rare clinical case of multiple post-traumatic intra-abdominal splenosis in combination with type 2 macroamylasemia, chronic pancreatitis in a 27-year-old woman.

Main results. The literature data of the pathogenesis and classification of splenosis are considered. Close attention is paid to the clinical manifestations of post-traumatic splenosis: the results of imaging studies in intrathoracic, disseminated abdominal, intrahepatic and intrapancreatic forms of splenosis are presented.

The end of the description of a rare clinical case of progressive multiple post-traumatic intra-abdominal splenosis in combination with type 2 macroamylasemia and chronic pancreatitis is presented. The process of diagnostic search, differential diagnosis is described, the controversial points to the patient’s management, the possibility and expediency of pregnancy are considered.

Conclusion. The exclusivity of this clinical case requires further dynamic monitoring, especially in the possible pregnancy. 

Review purpose: to study the occurrence predictors of postoperative atrial fibrillation (PAF), effective predicting and treating methods according to global literature.

Currently, PAF is considered one of the most frequent events among all cardiovascular complications as it develops in 30–65% of cases in patients after heart surgery. In recent decades, the PAF incidence has steadily increased despite advances in surgery and anesthesiology. PAF is a significant complication that affects the course of the postoperative period and requires special attention, since it leads to a longer hospital stay, increased treatment costs and can also lead to lethal outcomes in patients in this category. Considering PAF consequences, many studies have been performed to identify factors associated with the atrial fibrillation pathophysiology, to develop preventive measures aimed at treating high risk patients and minimize the side effects of antiarrhythmic drugs. The review and analysis of the global literature on the PAF causes, prevention and treatment are presented. 

In this literature review, the analysis of the studies of venous blood flow pathology in the inferior Vena cava system using magnetic resonance imaging (MRI) is carried out. Special attention is paid to the attempts made to use this method in the diagnosis of chronic lower limb vein disorders (CVD) through magnetic resonance venography (MRV). Historically and methodically, the gradual introduction of MRV methods in the diagnosis of lower limb vein thrombosis (LEDVT) and venous thromboembolism (VTE) has been shown.

Methods of non-contrast MRV based on the effect of blood flow, as in the case of MR-Angiography, are divided into two principal groups: methods based on the amplitude effects of Time-of-Flight (TOF) and methods based on Phase Contrast effects (PC). Techniques for conducting contrast-free MRV are described in detail. Attention is paid to pulse sequences used in the world for visualization of veins in contrast-free MRV in TOF and PC mode (FR-FBI, SPADE, SSFP) and post-processing methods: 2D-TOF MRV FLASH, 2D-TOF MRV CRASS, FIPS, VED, VENS.

Contrast-enhanced MRV (CE MRV) is based on the use of “blood pool” contrast agents, which feature the ability to form stable compounds with blood plasma proteins. Worldwidesubstances with magnetic and supermagnetic properties based on gadolinium or iron oxide are used as contrast agents for CE MRV. The result of using these contrast agents is an increase in the quality of visualization due to a better signal to noise ratio (SNR) using 3D image processing (3D CE MRV) using fast sequences: GRE, TFLAS, VESPA, CAT, in conditions of direct and indirect CE MRV.

It is noted that in recent years, certain restrictions have been imposed on certain linear contrast agents containing gadolinium in their further use. Therefore, for the purpose of CE MRV, it is efficientl to use only cyclic contrast agents to avoid unnecessary risks.

Contrast-free MRV has again received intensive development in recent years, due to the restrictions imposed, one of these methods is direct thrombus imaging (Direct Thrombus Imaging – DTI or Magnetic Resonance Direct Thrombus Imaging - MRDTI) using fast pulse sequences: bSSFP, BBTI, DANTE. The latest research on this LEDVT diagnostic method was published in 2019 and has shown high diagnostic value.

For all the most commonly used methods of MRV, specificity and sensitivity are shown.Further MRV in patients with CVD and DVT is a promising diagnostic task in modern phlebology. MRV should be introduced into clinical practice more actively than it is today.

Heart fibroma accounts for about 5% of all primary neoplasms and is registered in children in 80% of cases. The ventricles or interventricular septum (IVS) are most often affected; in half of cases, the tumor has intracavitary growth. The clinical picture of the disease and its prognosis depend on the size and location of the tumor. The most unfavorable is the defeat of the IVS, since it causes obstruction of the output tract of one of the ventricles. Being localized in IVS, can involve a conducting system of heart, thereby increasing risk of sudden death.

A retrospective study of a case of cardiac fibroma in a child aged 4.5 months, confirmed by echocardiography, magnetic resonance imaging and successfully operated on in the Central Federal District Center of Penza, is presented. A large tumor, localized in the IVS, caused atypical obstruction of the outflow tracts of both ventricles simultaneously. In the domestic and foreign literature, hemodynamic disturbances of only one of the ventricles are described, and we did not find a single case with simultaneous obstruction of both tracts. The possibility of MRI in the diagnosis of heart tumors has been shown.

The aim of the study was to assess T2/T2-FLAIR mismatch phenomenon as a predictor of particular genetic profile in the anaplastic astrocytoma group, including those tumors demonstrating contrast enhancement on MRI.

Materials and methods. It is a retrospective study. All MR images were anonymized.

MRI analysis. We studied 242 MRIs of patients with anaplastic astrocytomas (AA) and anaplastic oligodendrogliomas (AO) who were surgically treated at Burdenko Neurosurgery Center from 01.01.2017 to 31.12.2019. Among 242 patients we identified 23 (9.5%) whose MRI fulfilled the criteria for T2/FLAIR mismatch sign. The images were studied by 3 experienced neuroradiologist and patients were allocated to the T2/FLAIR mismatch group only upon consensus. Readers evaluated T2WI and FLAIR sequences of each MRI examination. They determined thr following characteristics of the tumours, using a binary scoring system for each: 1) presence or absence of homogeneous signal intensity on T2WI; 2) presence or absence of complete/near-complete hyperintence signal on T2WI, and relatively hypointence on FLAIR except for a hyperintense peripheral rim; 3) margins of lesion sharp or indistinct; 4) presence or absence of peritumoral edema. Discordant results were resolved by consensus with more experienced neuroradiologist.

Histological examination and molecular markers. Histological examination was carried out by 2 qua lified pathologists after staining the preparations with hematoxylin and eosin and calculating the index of proliferative activity. The final diagnosis was established on the basis of a combination of morphological and molecular genetic studies. The material for the study was 242 biopsies from patients operated on at Burdenko Neurosurgery Center with anaplastic astrocytomas and anaplastic oligodendrogliomas WHO Grade III, fixed in 10% neutral formalin and embedded in Histomax (Leica) paraffin. Among 23 patients with T2 / FLAIR mismatch in 4 archival cases was performed an immunohistochemical study with Anti-IDH1 R132H (clone H09) (dianova) antibodies to establish the mutational status of the IDH-1 gene; in 19 remaining cases the IDH1 R132H mutation was studied by real-time PCR using self-selected primers and probes. One of the samples showed the wild type IDH1 R132H and it was further investigated by Sanger sequencing to determine the mutational status of the IDH1 and IDH2 genes using direct primers.

Determination of 1p / 19q co-deletion was performed by in situ fluorescence hybridization using a ZytoLight Glioma 1p / 19q Probe Set (ZytoVision).

Study results. T2/T2-FLAIR mismatch sign was found in 23 patients with AA, in 8 cases tumors demonstrated contrast enhancement, including 3 of them with substantial enhancement. The mean age in the T2/T2-FLAIR mismatch group was lower than in the main group (34 vs. 42.7 years), as well as percentage of patients with contrastenhancing tumors (36.4% vs. 55.8%). The proportion of tumors with substantial contrast enhancement was similar in both groups (37.5% vs. 46.7%).

Discussion

S.H. Patel et al. in their pioneer paper demonstrated 12% frequency of T2/FLAIR mismatch sign in the experimental group (125 patients) and 17% in validation group (60 patients). M.P.G. Broen et al. present with a higher rate of the sign – 25%. S. Deguchi et al. have demonstrated even higher frequency of T2/FLAIR mismatch among IDHmutant grade II astrocytomas -45%. Our results revealed 9.5% rate of this sign.

The first article declaring less than 100% specificity of T2/FLAIR mismatch sign, after great success and acknowledgement of this predictive diagnostic method, was published by T.A. Juratli et al. 2019: the sign was observed in 73% of patients (versus 12% in Patel’s group). Herewith, 29% of patients with T2/FLAIR mismatch sign demonstrated both IDH-1 mutation and 1p/19q co-deletion. The reason for this phenomenon were less strict inclusion criteria in Juratli’s study. Moreover, authors did not specify the number of patients with contrast-enhancing tumors, although according to R. Jain et al., all these tumors must be excluded from the study. It is noteworthy, that even with these non-strict inclusion criteria, T2/FLAIR mismatch sign has demonstrated 100% predictive value for IDH-1 mutation in Jurartli’s study (none of the patients presented with IDH-wild type tumour). In the meta-analysis performed by Goyal et al. 2019, based on several T2/FLAIR mismatch studies with 746 patients, authors demonstrated high specificity (98.5%) and low sensitivity (33.7%) of this sign for detecting IDH-1+ and 1p/19q- cooperation. The main conclusion of this paper is that T2/FLAIR mismatch sign has high specificity and low sensitivity for detecting IDH-1 mutation, but not 1p/19q co-deletion, although there might be exceptions from this rule.

Recent studies devoted to the T2/FLAIR mismatch sign included mostly grade II gliomas and a small amount of AA and AO, emphasizing that those tumors did not demonstrate contrast enhancement M.P.G. Broen, S.H. Patel. Moreover, this characteristic is referred as a necessary qualification for T2/FLAIR mismatch sign, since contrastenhancing parts of the tumor may overlap area of interest and confound MRI signal in other sequences.

Results of our study convincingly demonstrate possibility of T2/FLAIR mismatch sign in grade III gliomas with contrast enhancement. We observed this phenomenon in 8 cases out of 22 (36.4%). Moreover, among those8 patients, 3 presented with intensive contrast enhancement. Comparing main group with control one, we revealed, that mean age in the group with T2/FLAIR mismatch sign was lower (34 vs. 42.7). and among 8 patients with contrast enhancement only 1 was older than 40 years. Tumors from the main group demonstrated contrast enhancement significantly on a more frequent basis (55.8% vs. 36.4%), meanwhile rate of intensive contrast enhancement was similar (46.7% vs. 37.5%). Thus, we demonstrated correlation between tumour grade and contrast enhancement and T2/FLAIR mismatch sign.

Earlier studies made attempts to predict tumor mutational status upon MRI: for instance, frontal lobe tumours, not spreading to the midline structures more often demonstrate IDH mutation Z.L. Sun, A. Lai. Moreover, it is wellknown fact, that IDH+ gliomas present with more distinct borders, more homogeneous MR-signal and less frequently demonstrate contrast enhancement A. Lai, G. Reyes-Botero. However, all these characteristics are very subjective and only advisory. More explicit results can be revealed by using MR-perfusion P. Kickingereder, MR-spectroscopy (2-hydroxyglutarat) M.I. de la Fuente and PET B. Suchorska 2017. However, abovementioned methods are not so widespread, unlike MRI, which is capable to predict genetic profile (IDH and 1p/19q status) with almost 100% accuracy. Unconditioned weakness of this method is qualitative, not quantitative his nature, sometimes demanding discussion and still not unambiguous. Probably, future achievements in neuroradiology will allow to perform quantitative analysis of MR-signal and formalize T2/FLAIR mismatch sign.

It is difficult to overestimate T2/FLAIR mismatch sign for diagnosis, surgery planning and overall treatment strategy. These aspects were disputed for grade II gliomas Sofietti, A.S. Jakola, M.M.J. Wijnenga. Anaplastic tumours possess worse prognosis and this additional information might be of extreme use. T. Kawaguchi et al. evaluated correlation between radical resection and prognosis of treatment for AA tumours with and without IDHmutation: it turned out, that for IDH-negative tumors radical surgery did not significantly affect overall survival (although these groups demonstrated different OS). On the contrary, radical resection significantly affected OS for IDH+ gliomas. Our study has demonstrated capability T2/FLAIR mismatch sign detection for anaplastic gliomas regardless of tumour contrast enhancement.

It is still unclear why not all IDH-positive 1p/19q-negative gliomas demonstrate T2/FLAIR mismatch sign. These “exceptions” were documented earlier by S.H. Patel, M.P.G. Broen for grade II gliomas and in our study for grade III gliomas: only 23 out of 26 patients with above-mentioned molecular profile presented with T2/FLAIR mismatch sign. S.H. Patel et al. speculate about activation of pathways by mTOR protein, which is involved in IDH-positive gliomas malignant change H. Wakimoto, but lack of data precludes authors from statistically significant conclusions.

Conclusion. Study results confirm the hypothesis of relevance of T2/T2-FLAIR mismatch sign for anaplastic atrocytomas with contrast enhancement on MRI as highly specific biomarker for tumor genetic profile. In some cases information provided by MRI in this group of patients may improve preoperative diagnostic and affect treatment strategy. 

Early and complete diagnosis of carcinoid lung tumors is of great interest in the clinical oncology, since this is the basis for the possibility of using options for organ-preserving surgical treatment. According to the 2015 WHO classification, carcinoids of the group of neuroendocrine tumors are divided into two types: typical and atypical carcinoids. Based on literature data, there are 0.2–2 cases per 100,000 people. This article discusses the possibilities of radiation research methods in the early diagnosis of this tumor, as well as the assessment of surgical treatment using them. 

Research objectives data analysis of the radiological methods different types of dysregenerations, based on the clinical cases.

Material and methods. Literature review about radiation semiotics regeneration and dysregeneration phenomena, applicability of different types of radiological methods has been done. A review of 2 cases of delayed union and 5 cases of fracture nonunion is presented.

Conclusion. Despite the improvement and technical simplicity of visualizing the phenomena of dysregeneration, it is difficult to differentiate delayed union from nonunion using only by radiological methods, respectively, a consensus of an orthopedic surgeon and a radiologist is required in each individual case. The clinician chooses the treatment tactics based on the complex data set, including radiological methods.