Aim of the study. To study the experience of using focused transthoracic echocardiography in patients with COVID-19 in prone position (fEchoPr) in intensive care units (ICU).

Materials and methods. The retrospective observational study included 53 patients (period from 15 April to 31 December 2020). Inclusion criteria: confirmed diagnosis of COVID-19, availability of fEchoPr data, outcome certainty (discharge/death). We analyzed electronic medical records. The fEchoPr was performed in patients in the prone position with a bolster under the left side of the chest and left arm raised (‘swimmer’s position’). We assessed the systolic function of the right ventricle (RV) (tricuspid annular plane systolic excursion (TAPSE)), RV size, RV/LV ratio, systolic function of the left ventricle (LV) (left ventricular outflow tract velocity time integral. (LVOT VTI)), and pulmonary hypertension (PH) (tricuspid regurgitation peak gradient (PGTR). Depending on the results, the patients were divided into 2 groups: informative (+fEchoPr) and non-informative (–fEchoPr) examinations.

Results. There was no statistically significant difference in the groups (+fEcho n = 35 vs –fEcho n = 18) by age (65.6 ± 15.3 vs 60.2 ± 15.8, p > 0.05), by gender (male: 23 (65.7%) vs 14 (77.8%), p > 0.05), by body mass index (31.3 ± 5.3 kg/m 2 vs 29.5 ± 5.4 kg/m2 , p > 0.05), by mechanical ventilation support (24 (68.6%) vs 17 (94.4%), p = 0.074), by NEWS scale indicators (6.9 ± 3.7 vs 8.5 ± 3.5 points), by mortality (82.8% vs 94.4%, p > 0.05). Correlation analysis revealed a moderate inverse relationship between being on mechanical ventilation and the informative value of the study (Spearman's r = −0.30 at p = 0.033). In the +fEchoPr group, the correct measurement of TAPSE and RV/LV was carried out in 100%: a decrease in RV systolic function was recorded in 5 patients (14%), expansion of the RV in 13 patients (37%). Signs of PH were detected in 11 patients (31%), PGTR could not be measured in 10 patients (28%). LV systolic dysfunction was detected in 7 patients (20%). No pathology was detected in 16 patients (46%). One patient was diagnosed with infective endocarditis of native mitral valve, which was later confirmed by autopsy.

Conclusion. In 66% of cases, fEchoPr examinations were informative, especially in terms of assessing the state of the right heart. fEchoPr examination is an affordable, valid and reproducible method to assess and monitor the state of the heart in ICU patients.

Background. Large-scale construction of industrial and transport facilities is underway in the Far North of Russia. The process involves more than 10,000 shift workers, and there was a Covid19 outbreak in this population. In order to contain the outbreak and prevent the spread of infection in this area the Russian Emergencies Ministry deployed an airmobile hospital.

Purpose. The purpose is to present an experience of work with the mobile CT scanner as part of an airmobile field hospital deployed in the Far North of Russia to combat the Covid-19 outbreak.

Materials and methods. On April 6, 2020, the construction site reported a “zero patient” who sought medical aid; the PCR test showed positive results of coronavirus. In the first half of April, over 300 rotation employees applied for medical care, most of them had a positive PCR test. On April 11, a state of emergency was declared in the construction site and, on April 17, 2020, airmobile hospital started operations. Its mission lasted 54 days. The mobile CT scanner (Brightspeed Elite Mobile, GE) was transported by land. The field hospital closely cooperated with the nearest medical institutions and the regional clinical hospital.

Results. During its work the airmobile hospital examined 1,678 rotational workers and 408 employees of the Ministry of Emergency Situations of the Murmansk region, with 2,086 CT scans performed. The average age of the patients was 37.8 years, men predominated. In 91.2% of patients, fever was the first symptom of the disease. Blood saturation results ranged from 92% to 99%. The degree of lung involvement ranged from CT 0 to CT 4. During the work of the airmobile hospital, COVID-19 was diagnosed in 500 people, including 328 cases of mild form, 98 – moderate, 74 – severe, no mortalities.

Conclusion. A positive experience of application of the mobile CT scanner as part of the AMH field hospital in unfavorable epidemiological conditions of the Far North of the Russian Federation was obtained. CT plays a key role in early detection of infection, differential diagnosis, and identification of complications. Determination of the severity of the disease based on CT data is crucial for patient routing.

Purpose. To identify and evaluate the effectiveness of sonographic signs of intestinal ischemia in patients with strangulated small bowel obstruction.

Materials and methods. For the period 2017–2019, 115 patients with SIO were treated at the N.V. Sklifosovsky Federal Research Institute of Emergency Medicine. There were 64 women (55.6%) and 51 men (44.4%). The mean age was 62 ± 15 years. In all patients, the diagnosis was verified intraoperatively. All patients underwent ultrasound examination of the abdominal cavity in B-mode with the assessment of blood flow of the intestinal wall in the mode of CDI. Patients were divided on the basis of intraoperative data into 2 groups. The first group: 63 (54.8%) patients with signs of ischemia of the strangulated loop of the intestine. The second group consisted of 21 (18.1%) patients in whom intestinal necrosis was detected. The comparison group included 31 (26.7%) patients with adhesive small bowel obstruction without intestinal strangulation.

Results. The most informative signs of ischemia of the strangulated intestine of the loop are infiltrative changes of its mesentery. In the second and third groups 9 (14.3%) and 12 (57.1%) participants, respectively, showed severity of intestinal ischemia, compared with 1 participant (3.2%) in the first group. The next informative criterion is the thickening of more than 0.4 cm and edema of the intestinal wall. In the second and third groups 30 (47.6%) and 14 (66.6%), in the comparison group 4 (12.9%), akinesis of the strangulated loop and paresis of the entire small intestine also directly correlated with intestinal ischemia. The absence of differentiation of intestinal wall layers occurs in (23.8%), the absence of blood flow in the intestinal wall in the CDI mode (19%), gas inclusions in the intestinal wall (4.3%).

Conclusion. The assessment of sonographic symptoms allows to diagnose the presence of ischemic changes in the intestinal wall and perform surgery before the development of necrosis in the early period. In cases of late admission of the patient to the hospital, with the onset of intestinal necrosis and the associated erased clinical picture, ultrasound allows to establish indications for surgery before the development of peritonitis.

We present a rare clinical case of a 66-year-old woman who had two different synchronuos tumors of pancreas: intraductal papillary mucinous neoplasm (IPMN) and neuroendocrine cancer. The preoperative CT/MRI diagnosis was not too difficult, because of the typical presentations, but the combination of features was very unusual. A morphological examination after surgical operation followed by fine-needle biopsy confirmed the preoperative diagnosis of combined the two different tumors.

Aim of the research. Standardization of the quantitative assessment of the contrast-enhanced ultrasound examination of the kidneys in patients with type 2 diabetes.

Materials and methods. On the basis of the Fundamental research laboratory “Diagnostic researches and minimally invasive technologies”, of the Federal State Budgetary Educational Institution of Higher Education “Smolensk State Medical University” of Smolensk State Medical University, the Ministry of Health of the Russian Federation, 12 patients with type 2 diabetes were examined in 2020. The age of the examined patients was 36–64 years old. Average age – 44 ± 1.8 years, of which 7 women (58.33%) and 5 men (41.67%). All patients were examined using a single diagnostic algorithm, which included 2 stages: 1 stage. Ultrasound examination of the kidneys (Aloka Hitachi Arietta 850 (Hitachi Medical Corporation, Japan) in B-mode; stage 2 – contrast-enhanced ultrasound examination (CEUS) of the kidneys. All patients were divided into 2 groups: the 1st group consisted of patients with type 2 diabetes type (n = 6), who underwent CEUS with subsequent assessment of the renal parenchyma in different areas of the cortex and medulla; group 2 consisted of patients with type 2 diabetes (n = 6) who underwent CEUS with subsequent standardized assessment in the indicated 5-th points of the arterial bed and 3 points of the venous bed.

Results and discussions. Taking into account the current epidemiological situation in 2020, the number of performed radiation diagnostic methods, such as X-ray and computer examinations of the chest organs, significantly increased the overall background of radiation exposure on the bulk of patients. Taking into account the anxiety index of patients, ionizing research methods for the diagnosis of angionephrosclerosis are undesirable. The standardized method for quantitative parameters of CEUS showed good agreement (0.61–0.76). In turn, the assessment of the quantitative parameters of renal CEUS when using the routine technique showed low consistency (0.21–0.3). Cohen's kappa (CK) scores of 0 to 0.2 indicate a lack of agreement among clinicians; 0.21–0.4 – weak consistency; 0.41–0.6 – moderate agreement between doctors; 0.61–0.8 – good consistency; 0.81–1.0 – complete consistency.

The circulatory system of the kidneys is characterized by the presence of a developed capillary network and, accordingly, low peripheral resistance, which confirms the importance of a standardized approach in conducting this study. In the context of the prevailing epidemiological circumstances, we understand that it is necessary to choose a reference research method that would allow us to accurately assess the characteristics of the experimental evaluation of this method. As a result of renal C EUS using a routine technique, hypoperfusion of the right kidney was revealed in 50% (n = 3) cases and the data were interpreted as normal in 50% (n = 3) cases. As a result of the renal CEUS using the proposed method, pronounced hypoperfusion of the right kidney was revealed in 100% (n = 6) cases. Dynamic nephroscintigraphy was used as a reference method to determine the functional work of the kidneys. According to the results of dynamic nephroscintigraphy of the kidneys, hypoperfusion of the right kidney was revealed in all cases in both groups of patients.

Conclusion. 1. The standardized method for assessing the quantitative parameters of the kidney CEUS is more reproducible by the ultrasound doctors than the routine one. 2. Enhanced ultrasound can be used to assess the efficacy of hypoperfusion with the maximum efficacy of an equivalent dose per patient.

The purpose. To evaluate brain microcirculation using contrast and non-contrast magnetic resonance perfusion in patients with type 1 diabetes and cognitive dysfunction.

Material and methods. The study complies with generally accepted ethical rules. The study included 45 patients with type 1 diabetes and cognitive dysfunction and 20 patients without. Every patient included in the study was continuously monitoring glycemia with evaluation of variability coefficients. MRI was performed using a magnetic resonance imaging scanner Signa Creator “E”, GE Healthcare, 1.5 Tl, China: methods – dynamic contrast (“Gadovist”, w/w, bolusno, 5 ml) and arterial spin marks. SPSS Statistic software package was used for statistical analysis.

Results. Blood flow decreased in patients with type 1 type and cognitive dysfunction in the areas of white and gray matter of frontal, occipital and temporal lobes, and shells (p ≤ 0.05). According to perfusion data, hyperglycemia and the following glycemic variability indices have the greatest influence on cortical structures: glycemic index of prolonged glycemia increase, risk of hyperglycemia and hypoglycemia, glycemic rate of change, glycemic control quality indicator, and in case of non-contrast glycemic control quality and glycemic rate of change, risks of hypo and hyperglycemia. The main factors of changes in brain microcirculation are episodes of severe hypoglycemia in the anamnesis, duration of the disease, arterial hypertension, high cholesterol levels. No separate markers for the evaluation of cognitive disturbances in type 1 diabetes were revealed.

Conclusions. The basis of microcirculatory brain disorders in type 1 diabetes is the level of HbA_1c and variability of glycemia as well as acute complications, duration of diabetes and associated conditions (arterial hypertension and hypercholesterolemia). The most important data were obtained during contrast perfusion.

Purpose of study. The possibility of simultaneous and combined use of magnetic resonance imaging (MRI) with paramagnetic contrast enhancement (CE-MRI) and single-photon emission computed tomography (SPECT) with ^99mTc-MIBI in assessing the prognosis in patients with glial brain tumors after complex chemo – and radiotherapy treatment was studied.

Material and methods. Contrast-enhanced MRI of the brain and SPECT with ^99mTc-Technetril were performed in 19 patients who were observed after complex chemoradiotherapy of brain tumors (gliomas of grade 3 and 4). The treatment included remote gamma irradiation and chemotherapy with temozolomide. The radiation dose was 60 Gy (30 fractions of 2 Gy × 1 once a day). The drug Temodal was prescribed in a single dose of 75 mg/sq. m. (120–140 mg) an hour before gamma therapy for up to 40 days (in a total dose of 5000–5900 mg) and in the post – radiation period according to the scheme – 6 courses of the drug for 5 days every 23 days in a single dose of 200 mg/sq.m. (280–400 mg). The total dose of Temodal for 1 course was 1400–2000 mg. In everybody, after the study, the time period of subsequent survival of patients was registered from to the primary health care data.

Results. The survival time was over 20 months in case of patients after surgical removal of glial tumor and with subsequent adjuvant chemotherapy if simultaneous low values of “Tumor-to Normal Tissue” index for both ^99mTc-Technetryl SPECT and CE-MRI were met, i.e. if < 1,15 for ^99mTc-Technetryl SPECT and < 1,19 for CE-MRI. If index “Tumor-to Normal Tissue” was over > 1,25 ^99mTc-Technetryl SPECT and > 1,35 for CE-MRI then the survival time was below one year. If the “Tumor-to Normal Tissue”ratio on ^99mTc-Technetryl SPECT scan was in benefit ranges whereas the on CE-MRI kept itself in high pathologic ranges the survival time was also over 19 months.

Conclusion. Thus, the concomitant quantification and fusion of uptake of ^99mTc-Technetryl and paramagnetic contrast agents on SPECT and MRI scans provides prognostic data on survival of patients and is worth routine use for therapy control.

The aim of the study was to develop a score scale for assessing the high risk of establishing chronic heart failure with preserved ejection fraction (HFpEF), based on echocardiography (EchoCG) evidence.

Materials and methods. A clinical and instrumental study of 175 patients, of which 108 (61.7%) women and 67 (38.3%) men, aged 71 [64; 78] years was performed in the 1st City Clinical Hospital in Minsk in 2017–2018. In order to validate the score scale for assessing the risk of HFpEF establishment in 2019–2020 a reproductive clinical and instrumental study of 129 patients was performed at the Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, of which 55 (42.6%) were men and 74 (57.4%) women aged 65 [58; 70] years. Inclusion criteria: sinus rhythm, essential arterial hypertension, chronic coronary heart disease: atherosclerotic heart disease, past myocardial infarction of left ventricle (LV), after which at least six months have passed, necessary to stabilize the structural and functional parameters of the LV, HFpEF, informed consent of the patient. Exclusion criteria: primary mitral regurgitation, mitral stenosis, mitral valve repair or prosthetics, congenital heart defects, acute and chronic diseases of the kidneys, lungs. EchoCG was performed on ultrasound machines Siemens Acuson S1000 (Germany) and Vivid E9 (GE Healthcare, USA).

Results. The developed scale for assessing the risk of establishing HFpEF in a patient with sinus rhythm including the criteria: LV diastolic dysfunction type II – 47 points, deceleration time of peak E of the transmitral blood flow DT_E ≤171 ms – 25 points, the speed of early diastolic movement of the septal part of the mitral fibrous ring e'_septal ≤7 cm/s – 25 points, LV early diastolic filling index E/е'_septal >7.72 – 20 points, index of the end-systolic volume of the left atrium >34.3 ml/m² – 24 points, has high diagnostic reliability (AUC 0.96, sensitivity (S) 96.6%, specificity (Sp) 83.2%) and reproducibility of results in an examination cohort of patients (AUC 0.99, S 98.8%, Sp 98.0%). A total score > 45 indicates a high probability of HFpEF. If the total score is ≤45, it is recommended to perform 2D Speckle Tracking EchoCG. The leading patho-functional mechanisms for the development of HFpEF are a decrease of LV global systolic longitudinal strain GLS_AVG > −18.9% (S 94.9%, Sp 98.0%), GLS of the right ventricle (RV) > −19.9% (S 76.5%, Sp 88.5%), mechanical dispersion with LV mechanical dispersion index > 54.69 ms (S 70.7%, Sp 90.2%), RV mechanical dispersion index > 50.29 msec (S 78.1%, Sp 73.9%) and ventricular dyssynergy with LV global post systolic index >5.59% (S 82.6%, Sp 87.5%), RV global post systolic index > 2.17% (S 84.5%, Sp 69.9%).

Conclusions. The use of the developed scale will improve the efficiency of ultrasound imaging of HFpEF.

Granulomatosis with polyangiitis (GPA) (Wegener's granulomatosis) is a rare systemic autoimmune disease from the group of vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCAs). GPA is proceeding with granulomatous inflammation, mainly of the upper and lower respiratory tract and low-immune necrotizing vasculitis that affects small- and medium-size vessels in lungs, kidneys, skin. The disease is an extremely rare long-term systemic disorder, is rarely the object of research, the literature data are few and unsystematic.

Purpose. The purpose of the literature review was to study the published materials, analyze the received information and define tasks for further study of this pathology, primarily from the standpoint of radiation diagnostics.

Materials and methods. The search was carried out in bibliographic databases MedLine, PubMed, if necessary, links to external full-text sources were used. 36 of the most significant publications were selected and worked out, including 8 domestic and 28 foreign. One of the selection criteria for articles was the availability of information about the radiological diagnosis of GPA in them.

Results. Most authors focus their attention on clinical manifestations and features of treatment, not paying sufficient attention to diagnostic methods. Many studies have been carried out on a small sample of patients or are limited to individual clinical observations; there is practically no information on changes in the computed tomographic picture of the lungs in GPA in dynamics. The most complete semiotics of lung damage according to CT data is presented in the article by F. Martinez et al. (2012).

Conclusions. It was found that in case of lung lesions by GPA, nodules, nodes and masses are more often determined, in half of cases – with cavities of decay, less often areas of ground-glass opacity and consolidation are detected. However, at present there is no unified approach to the interpretation of the radiological semiotics of the disease and the determination of the diagnostic value of individual computed tomographic patterns of lung damage. This requires their further detailed study for the correct and timely diagnosis of such a rare, but complex and potentially life-threatening disease.

Background. Sinonasal diseases are widespread in childhood. Radiological studies, including computer tomography, are an optimal and effective method of diagnosis. The child's body is more sensitive to radiation exposure than adults. The threshold of exposure, which may induce internal organs injury in children, requires a precise selection of the radiological method with minimal radiation dose. There is currently no unified position in the professional community on the appropriateness of the use of ultra-low-dose computed tomography in pediatrics.

We reviewed the data on the appropriateness and effectiveness of paranasal low-dose computed tomography in pediatrics.

Materials. 57 domestic and foreign publications, for the period from January 2001 to November 2019. In order to achieve the objective, we analyzed relevant domestic and foreign publications in scientific libraries e-LIBRARY, PubMed, Google Scholar per the keywords: “low-dose CT”, “children”, “paranasal sinus”, “pediatric”, “diagnosis”, “children”, “low-dose computed tomography”, “sinusitis”, “paranasal sinuses”.

Results. The analysis of the available literature allowed summarizing the current data on pediatric paranasal disease diagnostics and the use of computed tomography, as well as to identify possible options for reducing radiation dose.

Conclusions. Conducting many radiological examinations in a child leads to the risk of cancer. However, these examinations are an effective way to diagnose paranasal diseases, and a CT scan is the “gold standard”. The actual task is to develop a CT technique with reduced radiation exposure without compromising image quality. The need to review and optimize the standard protocols of radiological studies to determine the efficacy and feasibility of studies with minimal radiation exposure to children is justified.

Introduction. Correct diagnosis is based on visualization and knowledge of fracture patterns characteristic of children. Traditionally, radiography is used to visualize bone damage. In fractures in children due to the high risk of damage to the germinal zones, it is necessary to have clear and reliable information about their condition, which cannot always be obtained by x-ray method. For these purposes and the requirements of modern surgery, CT is used, which with high diagnostic accuracy clarifies the degree of displacement of fragments, present a qualitative characteristic of fractures and reveals associated damage.

Purpose: to show the capabilities of computed tomography in diagnosis of fractures of ankle joint.

Materials and methods. The results of computed tomography (CT) are presented in 226 children and adolescents aged 3 to 17 years. There were 142 boys (62.8%), 84 girls (37.2%). Scanning was carried out depending on the weight and age of the patient with the minimum indicators of kV and mAS, a slice thickness of 0.75 mm.

Results. Average time for seeking medical help was 32 hours from moment of injury. Among causes of injury in the first place was domestic injury (73, 8%), followed by sports injury (22, 3%) and traffic accidents (3.9%). Right-sided ankle fractures were found in 147 (65.1%), left-sided – in 79 (34.9%) children. The most common types of tibial fractures were metaepiphysiolysis of the distal tibia and metaepiphysiolysis of the distal tibia of both tibia, which together accounted for 67.7% (n = 153) of all tibial fractures.

Conclusion. Computed tomography should be performed in all cases of intraarticular fractures of the ankle joint. It is especially important for evaluating fractures with damage to germ zones. Scanning must be carried out with a cutting thickness of not more than 1 mm. CT with multi-planar data reformatting is an important factor in determining whether a patient needs surgical treatment. As a result of CT, a final diagnosis was established and a decision was made on treatment tactics.

Spontaneous abortion occur in 15–20% of all detected pregnancies, and 45–70% of all spontaneous miscarriages take place up to 10 weeks. Thrombophilia is one of the main causes of miscarriage and its effect on the course of pregnancy remains poorly understood. In this regard, there is great interest in the problem of diagnosing thrombophilia and further prevention of thrombosis in obstetric practice.

Purpose. Compare the parameters of volumetric blood flow in the chorion with different types of trophoblastic blood flow disturbance in pregnant women with thrombophilia in the first trimester for their quantitative verification.

Materials and methods. The study included 129 pregnant women at the 7th to 10th week of gestation with a diagnosis of thrombophilia and a control group - pregnant women with a normal course of this pregnancy and a successful outcome of past pregnancies.

The patients were divided into III clinical groups:

I. Pregnant women with a normal course of this pregnancy and a successful outcome of past pregnancies (n = 33) – comparison group;

II. Pregnant women with thrombophilia, in whom current pregnancy occurred on anticoagulant therapy (n = 28);

III. Pregnant women with thrombophilia without taking anticoagulant drugs before registration of pregnancy (n = 68).

Ultrasound was performed on Voluson E8 and S8 machines. All pregnant women underwent transabdominal and transvaginal ultrasound in B-mode, in color-doppler (CD) mode, and volumetric reconstruction of chorion was performed using the VOCAL program. In B-mode, the state of the embryo and extraembryonic structures were examined. The identification of trophoblastic vessels was carried out using the CD – region of interest was placed in the trophoblast area detected in B-mode, size and shape was adapted for a particular section.

Using three-dimensional echography, the chorion volume was performed. The degree of blood supply in chorionic volume were calculated; vascularization index (VI), flow index (FI) and perfusion index (VFI) were displayed on a histogram with quantitative indicators.

Results

In the CD mode, the types of trophoblastic blood flow were identified in the chorionic vessels:

1) continuous type – blood flow loci are continuously identified over the entire area of the basal surface of the trophoblast;

2) intermittent type – blood flow loci are unevenly identified along the basal surface of the trophoblast;

3) single loci – single blood flow loci are identified along the basal surface of the trophoblast;

4) lack of blood flow – blood flow loci are not determined along the basal surface of the trophoblast.

Assessment of the quantitative parameters of the volumetric blood flow was used in the corresponding type of blood flow to verify the classification of types of trophoblastic blood flow in the CD mode.

Statistical analysis of the volumetric blood flow indices using three-dimensional chorionic reconstruction showed a high degree of reliability (p < 0.0001) in the VI and VFI values between all corresponding types of blood flow.

Discussion. High incidence of spontaneous abortion and the significant role of thrombophilia in this pathology leads to necessity of expanding the research in this area. There has been a lot of research done over the past decade. The quantitative threshold values of the resistance indices in the chorionic vessels were calculated using pulse-wave Doppler, the chorionic blood supply indices were determined using volumetric reconstruction for various pathologies.

However, we have not previously met the classification of chorionic blood supply in the CD mode. This technique is very simple to perform and is a highly informative for predicting miscarriage in the first trimester. For the first time, we proposed the above classification of trophoblastic blood flow; for the first time, we proved the reliability of the classification developed by us using the method of volumetric reconstruction of the chorion with an assessment of trophoblastic blood flow, which allows us to recommend its use when writing a protocol for ultrasound of the fetus in the first trimester in pregnant women with thrombophilia.

Conclusion. The classification of trophoblastic blood flow was verified by three-dimensional echography with quantitative indicators of the volumetric blood flow of the trophoblast vessels, with a high degree of reliability (p < 0.001) which to indicates the reliability of this classification. It can be recommended to conduct a multicenter study for investigating fetal ultrasound with the additional use of the CD in the first trimester in pregnant women with a diagnosis of thrombophilia.

Objective: comparative study of the possibilities of radiation methods in control of bone regeneration in fractures.

Materials and methods. A study of bone calluse formation was conducted in 116 patients with broken tubular bones of the upper and lower limbs from the first day of the fracture to the complete consolidation of the fractures. In X-rays and CT determined the mineral density of bone calluses, with ultrasonic elastography shear wave and compression elastography determined the rigidity of bone calluses in kPa.

Results. X-ray bone corn was determined at the end of the second – the beginning of the third stage of bone calluse formation. On CT bone corn density (in the HU), its structure and the condition of bone breaks were determined in some patients in all stages of bone regenerate formation. In ultrasound examination in the multiparametric mode studied the rigidity, structure and vascularization of bone calluses, the correct comparison of bone breaks from the first day of the fracture to their complete fusion.

Conclusions. Ultrasonic studies in multiparametric mode can be used to control bone regeneration in fractures. Ultrasonic elastography shear wave, in determining the rigidity of bone calluse, in sensitivity and specificity exceeds the indicators of ultrasonic compression elastography at all stages of bone regenerate formation.

Timely diagnosis of Ewing's sarcoma is an actual problem of our time, since this tumor is characterized by fairly rapid growth and aggressive course. According to literature data, it ranks 2-nd among all bone tumors, second only to osteosarcoma, and is 8.64%. This review article discusses the possibilities of radiation research methods in the early diagnosis of this tumor on the example a clinical observation of the extra-skeletal form of Ewing's sarcoma.

Research goal: evaluation of the possibility of using an ultrasound twinkling artifact in the detection of breast calcifications as a diagnostic criterion for breast cancer.

Material and methods. A targeted ultrasound study using color Doppler mapping was performed to determine the presence of a twinkling artifact in 112 patients who had calcifications detected during X-ray mammography.

Results. According to the ultrasound examination, the twinkling artifact was registered only in 10 of the 112 women examined. A pronounced twinkling artifact was registered in 3 patients, the calcifications were single, mainly lobular, with a size of more than 1 mm. In 5 cases, the flicker artifact was determined to be of moderate severity, and the distribution pattern was also dominated by single ones, more than 1 mm. Two patients with grouped calcinates had a weakly expressed twinkling artifact, their dimensions were also more than 1 mm.

Conclusion. The data obtained indicate that the Doppler twinkling artifact in the mammary glands occurs only in macrocalcinates (larger than 1 mm) and, mainly, single ones. Modern ultrasound devices do not allow registering a twinkling artifact in calcinates smaller than 1 mm, which indicates that it is impossible to use Doppler color coding to detect microcalcinates as a predictor of breast cancer.