Introduction. Despite the existence of generally accepted diagnostic protocols, when a new coronavirus infection is suspected, in some cases, it is increasingly difficult to detect changes in the lung tissue in a timely manner due to the heavy workload of the main method of radiation diagnostics – computed tomography.

 Purpose of the study. To determine the effectiveness of the appointment of an X-ray examination as first-line metgod, as well as to carry out a comparative analysis of the use of radiation diagnostics methods – computed tomography and radiography in relation to the diagnostic sensitivity to changes in lung tissue when a person is infected with the SARS-COV-2 virus.

Materials and methods. 150 patients (63.0 ± 8.4 years) with confirmed coronavirus infection were examined. Each of the participants underwent X-ray examination and computed tomography of the chest organs. The percentage of subjects studied for each of the degrees of severity of lung damage was determined to identify the proportion of involvement of lung tissue in the pathological process in the bulk of the examined individuals.

Results. Of the 150 patients, changes in the lung tissue during chest X-ray were detected in 97 (65%), respectively, in 53 (35%), pathological changes in the lungs were not visualized. When examining patients by computed tomography, changes in the lungs were detected in 143 patients (95%), X-ray morphological changes were not detected in 7 subjects (5%). When detecting the volume of lung damage, it turned out that the majority of the subjects – 86 people (57%) – had the degree of damage CT-2. The degree of CT-1 and CT-3 was determined in 26 (17%) and 25 (17%) patients, respectively. CT-4 was observed in 6 patients (4%), and in 5% of cases, CT was not able to detect pathological changes in the lung tissue, the degree of CT-0 was established.

Conclusion. In the assessment of viral lung damage, radiography takes a significant place, but in 35% of cases, radiographic examination failed to identify the existing pathological changes. CT of the chest organs confirms its value as the “gold standard” in the study of pulmonary pathology in coronavirus infection, but if it is impossible to perform it, radiography is recommended.

In this article we would like to discuss the issues of adrenal pathology and its diagnostics. This is a complex review according to modern sources, fundamental knowledge and author’s experience. All clinical cases are original and morphologically verified. There are different types of classifications with different features, showed in this article. The most useful diagnostic methods are computed tomography (CT) and magnetic resonance imaging (MRI) with special contrast enhancement protocols, described in article.

Relevance. Retroperitoneal lymphocele is one of the most common complications in renal transplant recipients.

Objective. To improve the results of treatment of kidney transplant recipients with retroperitoneal lymphocele by using a modern diagnostic and treatment algorithm

Materials and methods. Materials and methods: From June 2018 to March 2021 at the State Clinical Hospital named after S.P. Botkin, Moscow performed 174 kidney transplants from a posthumous donor. The accumulation of lymph in the retroperitoneal space was recorded in 24 patients, which amounted to 13.7%. Indications for surgical correction were found in 16 patients, which amounted to 9.1%. Computed tomography in 10 patients (62.5%) showed a wide adherence of the lymphocele cavity to the parietal peritoneum; peritoneum, the complexity of the planned laparoscopic surgery was assessed as high. These patients underwent laparoscopic peritoneal fenestration with ultrasound navigation. In 2 patients (12.5%), lymphocele adherence to the peritoneum was not revealed; these patients underwent open surgery.

Results. Results: No relapses of lymphocele were detected after surgery. Mortality was not recorded. In the group of patients who underwent laparoscopic peritoneal fenestration with predictable low complexity, one postoperative complication was diagnosed – migration of the loop of the small intestine into the lymphocele cavity with subsequent infringement. The duration of hospitalization with laparoscopic intervention was 2.1 ± 0.43 (2–3) days, with open one it was 8.45 ± 3.25 (7–12) (p = 0.001).

Conclusion. The use of a modern diagnostic and treatment algorithm can improve the results of treatment of kidney transplant recipients with retroperitoneal lymphocele.

Purpose. To demonstrate capabilities and features in spleen pathology diagnostics based on clinical experience of Botkin City Hospital.

Materials and methods. The analysis of 89 patients with spleen abnormalities was performed in the term from 01/2014 till 08/2020. All the patients underwent computed tomography (CT) and/or magnetic resonance imaging (MRI) with contrast enhancing. All cases verified surgically and/or clinically.

Results. There were 37 cases of trauma (42%). Accuracy and precision of the method was 100%. In detection of active bleeding the highest diagnostic accuracy (100%) was shown with extravasation symptom – 7 cases. In non-traumatic group (n = 52, 58%) two biggest sub-groups were abscesses (n = 19, 36% in this group) and infarctions (n = 15, 29%). There were 8 cases of cysts (15%), 3 of them – hydatid, 5 cases of spleen hemangiomas. (9.6%), 3 cases of spleen metastases (6%). There was 1 case of angiosarcoma (2%) and 1 case cystic lymphangioma (2%).

Conclusion. The most frequent condition in spleen pathology, diagnosed in radiology department is trauma. In non-traumatic cases two biggest groups are abscesses and infarctions. CT features of spleen infarction are pyramidal wedge of hypoperfused splenic tissue with the apex pointing towards the hilum, and the base on the splenic capsule. In all cases in our study cysts were incidental findings. Spleen metastases are rare due to organ hemodynamics. The most rare lesions of the spleen are primal tumors.

The purpose of the study. To analyze possibilities of computed tomography (CT) for esophageal injuries and their complications as part of a differentiated approach to the choice of a minimally invasive treatment method.

Materials and methods. The results of CT scans were analyzed in 25 patients with esophageal injuries of various etiologies who were treated at the N.V. Sklifosovsky Research Institute of SP in the period 2019–2020. CT was performed with oral and intravenous bolus contrast, primarily at admission and in dynamics, a total of 77 studies.

Results. In all cases, direct and indirect CT signs of esophageal damage were detected, and the degree of involvement of surrounding organs and tissues in the pathological process was assessed. Based on the data obtained, the following variants of esophageal damage and its complications were identified: intramural esophageal hematoma (2); rupture of the thoracic esophagus without the development of purulent complications (2); rupture of the thoracic esophagus complicated by the development of mediastinitis (4); rupture of the thoracic esophagus with the development of mediastinitis and pleural empyema (13); rupture of the cervical calving of the esophagus, complicated by phlegmon of the neck and descending mediastinitis (4). Different patient management tactics were used for each variant. Thus, the selection and sequence of minimally invasive interventions, such as thoracoscopic sanitation mediastinal and pleural cavity, esophageal stenting, percutaneous endoscopic gastrostomy (CEG) and endoscopic vacuum aspiration system (E-VAS), were carried out taking into account CT data, including observations in dynamics.

Conclusion. CT scan for esophageal injuries allows you to get complete information about both the nature of esophageal damage and its complications, to determine their type, localization and volume. CT data allow us to justify a minimally invasive approach in the treatment of esophageal injuries, to determine the order of interventions. CT studies performed in dynamics allow us to evaluate the effectiveness of treatment and to carry out timely correction of tactics.

Knowledge of the variant vascular anatomy of the celiac and mesenteric basin is of paramount importance in operative interventions in the hepatopancreatobiliary zone, stomach and duodenum, liver transplantation. The article presents various classifications of vessels of the celiac and mesenteric basin, created by the authors as a result of numerous studies using various techniques. The main advantages and disadvantages of the main classifications of blood vessels are considered, the features of application in clinical practice are given.

The article discusses the modern possibilities of identifying inflammatory bowel diseases using methods of radiation diagnosis. Methods of radiation diagnostics help determine the stages of inflammatory bowel diseases helping in timely diagnosis, prescription and timely correction of therapy. The use of an adequate amount of diagnostic measures allows early detection of complications requiring immediate surgical treatment, such as fibrostenotic lesions, fistulae, and abscesses.

The sources of the review were publications included in peer-reviewed databases E-library, PubMed, GoogleScholar, conference materials and non-indexed publications, including web pages of conferences and repositories of scientific data from universities.

Neuroendocrine tumors (NEТ) are a heterogeneous group of neoplasms of various locations originating from the APUD system cells with biologically active properties. Although immunohistochemical assay for Ki-67 has been proved to have prognostic significance in GEP-NENs, pitfalls may lead to misjudgment of the tumor grades, prognosis and during treatment planning due to the presence of cells with varying degrees of differentiation and proliferative activity within a single lesion, as well as the entire neoplastic process. These features can affect the results of imaging and therapy planning.

An increase in the number of somatostatin receptors on the surface of membrane cells, as well as an increase in glycolysis may occur in NETs. These phenomena play role when choosing imaging methods, as well as in treatment planning.

Combined dual-tracer imaging, specifically PET/CT or SPECT/CT using labeled somatostatin analogues can be used in intermediate assessment of cellular heterogeneity in the entire neoplastic process in NENs and help to minimize diagnostic pitfalls listed above.

We present an observation of a patient with metastatic GEP-NEN of unknown primary in which ¹⁸F-FDG PET/CT and ^99mTc-HYNIC-TOC SPECT/CT were performed for initial staging. In the framework of this, aspects of use of dual-tracer radionuclide imaging in patients with NENs are widely discussed.

In view of the rare occurrence, the small spectrum of clinical manifestations and the non-specificity of changes in instrumental and laboratory data, the diagnosis of ganglioneuroma at the moment is a very difficult task for the routine of a doctor. Ganglioneuromas have a slow growth, which leads to a long asymptomatic course and, as a result, complicates its early diagnosis. In most cases, ganglioneuroma is random. Complaints in these patients are non-specific and are directly dependent on localization.One of the available methods for imaging retroperitoneal tumors is ultrasound (ultrasound)., which makes preventive and regular ultrasound an indispensable method for early detection of extraorgan formations. This article describes the clinical case of ganglioneroma in a young man with the pathology of the upper gastrointestinal tract.

Purpose. To develop a methodology for assessing the degree of cerebrovascular insufficiency in patients with moyamoya angiopathy (AMM) based on measurement of cerebral blood flow (CBF) and determination the presence of arterial transit artifact (ATA) using MR method of arterial spin labeling (ASL).

Materials and methods. The study included 47 patients with AMM who underwent 148 MR studies in PCASL mode (296 hemispheres), of which 47 (94 hemispheres) were done before surgical treatment. On received perfusion maps 7 areas of interest (ROI) were manually set in the gray and white matter of the brain using “Fusion” technique outside the ATA zones. The CBF values at the central point of the ATA were estimated. In the preoperative stage, 47 patients underwent direct angiography to assess the stage of the disease according to Suzuki, the presence and severity of leptomeningeal and transdural collaterals and MR angiography to assess the stage of the disease according to Houkin and the level of ICA stenosis. Statistical processing included univariate analysis of variance (ANOVA) and chi-square test (IBM SPSS Statistics 23).

Results. ATA was detected in 77% of studies (69% of hemispheres). The average minimum CBF in ATA was 120.2 ± 21.1 ml/min/ 100 g at the lower bound of the confidence interval of 117.43 ml/min / 100 g. The average maximum CBF in ATA was 234.9. Depending on the CBF values in the MCA territory and the presence of ATA, 4 degrees of perfusion deficiency were identified: degree 0 (CBF = 64.5 ± 16.2 ml/min / 100 g, without ATA) corresponded to the stage of “compensation” of cerebral blood flow, degree 1 (CBF = 61.5 ± 16.6 ml/min/ 100 g, with ATA) – “subcompensation”, degree 2 (CBF = 26.5 ± 7.2 ml/min/100 g, with ATA) – “initial decompensation”, degree 3 (CBF = 16.0 ± 4.7 ml/min / 100 g, without ATA) – “decompensation”. The highlighted degrees statistically significantly differed among themselves in all ROIs (p < 0.0001). More severe perfusion deficiency corresponded to the more developed stages of AMM according to Suzuki and Houkin, proximal stenosis of the ICA (p < 0.0001), and more severe neurological deficit (p < 0.02). The occurrence of ATA reliably reflected the presence of leptomeningeal collaterals (p < 0.001).

Conclusions. The proposed method for assessing patterns of ASL perfusion has a good agreement with the stage of the disease, the presence of sources of collateral circulation, the severity of neurological deficit and can be used to assess cerebrovascular insufficiency in patients with AMM.

Dermatomyositis – a systemic connective tissue disease, from the group of idiopathic inflammatory myopathies. Affection of the skeletal muscle tissue in inflammatory myopathies causes progressive muscle weakness. In dermatomyositis reduction in contraction ability of the muscles involved in the act of swallowing, leads to violation of the mechanism of respiratory protection from getting food masses inside and from development of dysphagia.

The purpose of the study was to evaluate the changes detected in the process of radiologic examination of the dermatomyositis patient’s throat.

Materials and methods. Patient K. 61 years old, he has dermatomyositis and clinical signs of oropharyngeal dysphagia. The patient underwent a pharyngeal radiologic examination, which allowed to confirm the disturbance of swallowing function and to establish the fact of aspiration.

Results and discussion. Radiological examination of the pharynx showed signs of pharynx hypotony, pharyngeal ectasia, stasis, residual amount of radiocontrast agent in caudal section of larynx, penetration, aspiration.

Conclusion. Radiological examination of the pharynx in patients with dermatomyositis is important method examination of studying swallowing disorders and predicting risk of serve complications.

The peculiarity of this case is the demonstration of swallowing dysfunction dynamics in a patient with dermatomyositis at admission to the clinic and after treatment.

Presented clinical case is a rare case of poorly differentiated squamous cell non-keratinizing cancer of the right lung with ingrowth into the diaphragm and liver, metastatic liver damage in combination with recurrent echinococcosis of the liver. Taking into account the epidemiological history, the surgery, the features of radiation imaging and the results of serology in the preoperative period, the diagnosis of “echinococcosis of the liver with spread to the lungs” was made, which turned out to be incorrect. The diagnosis during the surgical operation was changed, but also turned out to be incorrect. The final diagnosis was made only on the basis of histological and immunohistochemical studies.

The reasons of diagnostic errors are analyzed, the emphasis is made on the criteria of differential diagnosis. Typical features of visualization of liver echinococcosis, lung cancer with local and distant spread are presented.

Case study: a parathyroid tumor ectopic to the mediastinum. The diagnostic capabilities and advantages of the ^99mТс-sestamibi SPECT/CT hybrid method in the preoperative localization of abnormally located parathyroma are demonstrated.

Multiparametric MRI (mpMRI) has superb sensitivity in prostate cancer detection. mpMRI is increasingly used not only for primary diagnostics, but for location of suspicious lesion before biopsy in case of targeted biopsy (TB). In many recent studies have been shown higher level of TB accuracy in prostate cancer detection in comparison with traditional systemic biopsy. In recent EAU, NICE, ACR recommendations mpMRI is indicated for men with high level of prostate cancer suspicion with previous negative results of systemic biopsy. However, it is not absolutely clear, whether mpMRI is indicated for biopsy-naïve men. This study is dedicated for prostate biopsy planning in the groups of biopsy-naïve men and with the history of previous biopsy.