Purpose of the study. To analyze the data of computed tomography (СТ) and magnetic resonance imaging (MRI) in children with ischemic stroke at different time stages of the pathological process and determine the significance of the results obtained.

Materials and methods. The study is based on the analysis of the examination results of 105 children (aged from 29 days to 18 years) with clinical manifestations of stroke, who underwent CT in 48 cases and MRI in 101 cases, of which a combination was in 44 cases. In statistical comparison of the characteristics of the MRI signal of the focus of ischemic cerebrovascular accident (iCVA) in T2-WI and FLAIR modes, the McNemar criterion was used. In descriptive statistics, the definition of the median (Me) was used, and in qualitative data – the definition of absolute and relative frequencies with an indication of the 95% confidence interval (CI).

Research results. CT allows to detect focal lesion in ischemic stroke at the initial stages of its development in 62.5% of cases, but does not provide the opportunity to differentiate the stage, unlike MRI, which allows to determine the hyperacute, acute, early and late subacute stages. Due to the poorly distinguishable characteristics of the MRI signal from the focus of ischemic stroke on T2-WI, T1-WI, FLAIR and DWI (b = 1000) in combination with the ADC map in the acute and early subacute stages, it is necessary to analyze perifocal changes in the focus of cerebral ischemia. It was found that in the acute and early subacute stages, the T2-WI and FLAIR modes can be interchangeable, since they have the same characteristics of the MR signal of the focal change in this time interval.

Discussion. The conducted study demonstrated the capabilities of CT and MRI in children with iCVA in identifying and determining the time stages of the pathological process development. MRI semiotics of the iCVA focus at the stage of the first 21 days from the moment of development of neurological symptoms were determined. A diagnostic MRI sign was established that allows differentiating the acute with the early subacute stage, as well as the modes in MRI examination necessary to establish the time from the moment of occurrence of neurological symptoms. Differences in MRI semiotics of iCVA in children and adults were revealed, which can occur as a result of physiological features of the child's brain, causing the course of the pathological process.

Conclusions. Neuroimaging using CT and MRI methods is mandatory in children with a clinical picture of cerebrovascular accident. The absence of focal lesions in the brain tissue on CT images with persistent or increasing neurological symptoms creates the need for MRI. The use of CT makes it possible to determine focal lesions in the brain tissue, but does not allow assessing the time limits for the development of ischemic stroke, unlike MRI, which, based on a combined analysis of different scanning modes and assessment of the peripheral parts of the focal lesion, allows differentiating the stages of ischemic stroke.

Introduction. Advances in neuroimaging and quantitative image analysis have enhanced our understanding of cerebral anatomy. Voxel-based morphometry (VBM) enables precise evaluation of structural brain changes. Early childhood is a critical period of rapid brain maturation. Research focusing on structural changes of the temporal lobes in children during normal ontogeny remains limited. Investigating these structural changes could improve diagnostics for neurological disorders such as epilepsy and neurodegenerative conditions. Investigating these structural changes in children may deepen our understanding of normal nervous system development and improve diagnostics for neurological disorders such as epilepsy and neurodegenerative diseases.

Aim. To perform morphometric analysis of temporal lobes structures in neurologically healthy children and analyze age- and gender-related variations.

Methods. VBM was performed using FreeSurfer software, determining morphometric parameters volume (mm³), area (mm²), and thickness (mm) for each structure of the temporal lobes. The study included 49 MRI data from children aged between 6 months and 18 years. All participants were divided into two age groups: from 0 to 7 years (17 individuals) and from 7 to 18 years (32 individuals).

Results. Age-related differences in the volume, surface area, and thickness were observed across temporal lobes regions in children. While no statistically significant gender differences in the morphometric parameters of these structures were observed, boys exhibited a tendency for greater relative sizes (normalized to intracranial volume) compared to girls. These results indicate a complex and dynamic developmental pattern of the temporal lobes, with evidence of both symmetric and asymmetric changes.

Conclusion. MRI morphometry is shown to be an effective method for assessing temporal lobes development in neurologically healthy children in this study. The morphometric data presented here can serve as reference points for identifying deviations from normal development in children with neurodegenerative disorders.

Aim. To determine the possibilities of visual evaluation of images weighted by amide proton transfer in evaluation of malignancy of glial brain tumors.

Methods: The study included 47 patients with histologically confirmed supratentorial gliomas who underwent surgical treatment at the university clinic of the FSBEI HE PRMU MOH from 2023 to 2024. The study was performed on a Philips Ingenia Elite X 3T magnetic resonance imaging machine (the Netherlands). The study protocol consisted of a standard protocol and images weighted by amide proton transfer (APT-WI). A visual assessment of APT-weighted images was performed in the Vidar Viewer 3.3 (Russia).  

Results. When visually evaluating images weighted by amide proton transfer, three evaluation parameters were identified: signal intensity, heterogeneity, correspondence of the volume of the modified signal and the T2-FLAIR-positive region. The signal characteristics of each tumor studied were evaluated on a scale from 1 to 3 points for signal intensity, from 1 to 2 points for heterogeneity, and from 1 to 3 points for length. Low grade gliomas (100%) were characterized by a weak homogeneous and heterogeneous type. Gliomas with a high degree of malignancy were characterized mainly by a high heterogeneous type – in 28 cases out of 40 (70%). The volume of the altered signal on APT-WI was smaller than in T2-FLAIR images in most gliomas of low malignancy (71%), in gliomas of high malignancy, 45% of all cases showed volume equality, and in 37.5% the tumor size on APT-WI exceeded the size on T2-FLAIR. According to the total score, a comparison was made between the groups of tumors according to the degree of malignancy. Statistically significant differences were found between low and high grade gliomas and 3[3;4] and 7 [6.25; 7.75] respectively (p = 0.001, Mann–Whitney test). Grade 4 gliomas had a higher score (7 [7; 8]) compared to grade 3 (5 [3; 7]), p = 0.006, Mann–Whitney test and grade 2 (3 [3; 4]), p = 0.001, Mann–Whitney test.

Conclusion. The use of the technique of visual assessment of images weighted by amide proton transfer increases the effectiveness of preoperative MR diagnostics in the differential analysis of glial tumors.

Introduction. X-ray navigation in modern cardiac surgery is a revolutionary technology that allows to increase the accuracy and safety of cardiac surgeries significantly. Currently, navigation under direct X-ray control in surgeries to restore the mitral valve chords is used only when implanting chords using the ChordArt method. In addition, X-ray navigation and external implantation of the mitral neochord are used in such methods of mitral regurgitation correction as MitraClip and transcatheter mitral valve replacement (TMVR).

The objective. To systematically review the scientific evidence on the use of radiographic navigation in mitral valve interventions in case of significant mitral regurgitation. To identify radiographic projections that allow the most accurate visualization of cardiac structures required for neochords implantation.

Materials and methods. An analysis of studies devoted to the use of X-ray navigation in transapical implantation of mitral neochords for significant mitral regurgitation on the beating heart was performed. The search was performed in the PubMed and Elibrary databases from 2009 to 2024 using the following keywords: “mitral valve”, “mitral regurgitation”, “X-ray navigation”, “cardiovascular surgery”, “transapical chord repair”, “transcatheter interventions”, “coronary sinus”, “circumflex artery”, “MitraClip”, “TMVR – Transcatheter Mitral Valve Repair” using AND, OR operators.

Results. A total of 257 articles were analyzed, 65 of which were used to compile the review. The analysis revealed that the main method of visualizing instruments in the heart cavities during interventions on the mitral valve is intraoperative fluoroscopy. The most acceptable projections for performing surgery on transapical implantation of mitral neochords in case of significant mitral regurgitation on a beating heart were determined.

Conclusion. The results of the conducted analysis showed that X-ray navigation is an integral method of intraoperative navigation, which should be used during transapical implantation of mitral neochords in case of significant mitral regurgitation on a beating heart.

Aortic valve (AV) bioprostheses can be divided into framed and frameless, as well as those implanted using surgical and endovascular methods. The study of hemodynamic criteria for the functioning of sutured, seamless and transcatheter biological prostheses, including the dynamics of reverse structural and functional remodeling of the heart in the long term, is necessary to select the most correct and effective treatment tactics.

The aim of the study: to evaluate, using objective radiation methods of research, hemodynamic parameters and the dynamics of reverse structural and functional remodeling of the heart in the late period after correction of degenerative aortic valve defect using cardiac surgery and endovascular methods.

Materials and methods. A comparative, non-randomized, longitudinal study was conducted, including 89 people with severe aortic stenosis, who underwent isolated surgical or endovascular valve replacement. The patients were divided into three groups: a group with AV prosthetics using the method of implantation of a seamless biological prosthesis (n = 23); a group using a sewn-in biological prosthesis (n = 45); a group with a transcatheter aortic valve implantation technique (TAVI) (n = 21). The median age of patients using a sutured biological prosthesis was 71.0 [66.7; 74.0] years, the age of patients with implantation of a seamless biological prosthesis was 73.0 [69.0; 76.8] years (p = 0.055); in the group with a transcatheter technique for implantation of a biological prosthesis, the median age was 75.0 [69.0; 79.0] years (p = 0.013). The female gender was 20 (44.4%), 16 (69.6%), 11 (52.4%) (p = 0.050), respectively. In the dynamics of objective monitoring of the condition and implementation of the study goal, all patients underwent echocardiography (ECHO) according to the generally accepted method.

Results. In three groups, a comparison of structural and functional parameters “before” and “after” the intervention was carried out, and an intergroup comparison was performed between two groups (surgical correction using suture and sutureless bioprostheses), since the initial characteristics of the group with endovascular treatment, in particular, age, differed from the other groups. After correction of aortic stenosis using both cardiac surgery and transcatheter methods, reverse structural and functional remodeling of the heart is observed in the long term. In patients using sutured biological prostheses, LVMM decreased by -22.0 [-28.0; -17.0]% (p = 0.0002), seamless biological prostheses – by -20.0 [-27.0; -13.0]% (p = 0.01), with transcatheter aortic valve implantation – by -16.0 [-22.0; -10.0]% (p = 0.0001); left ventricular (LV) hypertrophy concentricity decreased by -21.0 [-29.0; -14.0]% (p < 0.0001), -24.0 [-31.0; -15.0]% (p = 0.0002), -24.2 [-35.6; -1.1]% (p = 0.002), respectively.

In groups using cardiac surgical methods, an improvement in longitudinal systolic function was demonstrated: absolute values of global systolic longitudinal deformation of the LV, assessed by the speckle-tracking method, increased in patients with implanted biological prostheses by 19.3 [7.5; 54.0]% (p = 0.032), with seamless biological prostheses – by 18.4 [3.3; 42.8]% (p = 0.027), the S’_{lat mv} tissue dopplerography indicator increased – by 36.7 [22.1; 51.3]% (p < 0.0001) and 42.8 [17.5; 57.1]% (p = 0.0005), respectively. In individuals with TAVI, the S’_{lat mv} values increased by 25.0 [14.3; 55.3]% (p = 0.005).

Recovery of left ventricular systolic function in the remote period, established on the basis of the results of 2D speckle tracking echocardiography, was diagnosed in 12 (60.0%) patients with sutured and sutureless biological prostheses.

Conclusion. Correction of severe AS using cardiac surgical and endovascular methods is associated in the long term with favorable indicators of intracardiac hemodynamics and reverse structural and functional remodeling of the LV.

Despite the reduction in mortality after pancreatoduodenal resections, the incidence of postoperative complications remains high (20–60%). One of the most severe complications is postoperative pancreatic fistula. Predicting the risks of a complicated postoperative period remains an urgent problem. One of the key risk factors is the pancreatic structure, and modern approaches to predicting clinically relevant pancreatic fistula integrate not only morphological but also radiomic parameters of CT images using artificial intelligence methods.

Aim. To evaluate the potential of machine learning in radiomics for predicting clinically relevant pancreatic fistulas after pancreatoduodenal resection and to develop a clinical decision support system based on the “Virtual Biopsy” platform.

Methods. Retrospective analysis of data from 117 patients who underwent pancreatoduodenal resection (2016–2019) at the A.V. Vishnevsky National Medical Research Center of Surgery. Machine learning methods were applied to assess textural features of preoperative CT scans.

Results. Сlinically relevant pancreatic fistulas were recorded in 31 patients (26.5%). Clinically significant fistula alone was diagnosed in 11 patients (9.4%), while its combination with arrosive bleeding was observed in 20 patients (17.1%). The peak incidence of fistulas occurred on days 4–6, and of bleeding on days 8–14. The radiomic AdaBoost model demonstrated the highest efficacy (ROC AUC = 0.815), outperforming alternative approaches: Gradient Boosting (0.631), XGBoost (0.677), LightGBM (0.631), and Stacking (0.662). Integration of morphological features did not improve predictive capability, likely due to data noise. Models based on semantic parameters (max. ROC AUC = 0.653) confirmed limited clinical applicability.

Conclusion. Machine learning methods are effective in predicting clinically relevant pancreatic fistulas after pancreatoduodenal resections. Radiomic analysis extends the diagnostic potential of CT, demonstrating superior model accuracy metrics compared to classical semantic features alone.

The aim: To analyze and compare the structure, size, and semiotic features of secondary tumors of the ovary (STO) in different primary malignant neoplasms using magnetic resonance imaging.

Materials and methods. The study included 27 women with various primary malignancies who had secondary (metastatic) ovarian lesion (OVA). The study did not include patients with primary ovarian cancer or benign ovarian tumors. The MRI protocol of the pelvic organs corresponded to the recommendations of the European Society of Urogenital Radiology from 2020 (European Society of Urogenital Radiology, ESUR). The statistical indicators were calculated in a computer program for statistical data processing IBM SPSS Statistics 23.

Results. A total of 44 metastatic ovarian tumors (MOT, second ovarian tumors- SOT) were detected in 27 patients. In the analysis of patients with SOT, unilateral ovarian lesion was detected in 10/27 cases (37%); bilateral ovarian lesion was detected in 17/27 cases (63%). At the same time, with a unilateral lesion, a predominant (7/10, 70%) lesion of the left ovary was noted. There were no statistically significant differences in the sign of a single or bilateral lesion in the analyzed groups of SOT (p-value = 0.115). In the SOT subgroups, it was found that the volume of metastatically altered ovaries in gastric (GC), colon (CC) and endometrial (EC) cancers was significantly higher than in breast cancer (BC) and cervical cancer (p < 0.05). At the same time, the largest volume of metastatically altered ovaries is observed in colon cancer (PK) (p < 0.05).

Conclusions. The study analyzed the volumes and structure of the ovaries in patients with secondary tumors of the ovary in various primary nosologies (stomach cancer, colorectal cancer, breast cancer, uterine cancer). The article describes in detail the semiotic MR characteristics, analyzes the sizes of STO in different subgroups, provides illustrative clinical examples, which will improve the diagnosis of ovarian pathologies and which will allow timely initiation of treatment of the underlying disease. 

To investigate the causes of low diagnostic accuracy of MRI criteria for prostate cancer by correlation with histopathological findings from MRI-targeted fusion biopsy.

Materials and methods. A retrospective analysis of prostate MRI data was performed in 38 patients who subsequently underwent MRI-targeted fusion biopsy. All imaging studies were independently reviewed by a radiologist with 7 years of experience in prostate imaging. Identified suspicious lesions were correlated with histopathological findings from corresponding prostate biopsy samples. The causes of discordant results were systematically analyzed and categorized.

Results. The MRI studies identified 54 MRI-positive lesions that subsequently underwent fusion biopsy. Among these, 34 cases demonstrated false-positive MRI findings attributed to the following causes: localized inflammation exhibiting T2-weighted hypointensity, restricted diffusion, and early contrast enhancement (16 cases, including wedge-shaped lesions); encapsulated hyperplastic nodules (7 cases); and minimal lesion size (3 cases). Two cases resulted from overinterpretation of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI data. Systematic biopsy revealed adenocarcinoma in 24 tissue samples obtained from areas not identified as suspicious on MRI (false-negative results). Retrospective analysis of MRI findings allowed detection of subtle abnormalities in only one of these cases. The MRI demonstrated a sensitivity of 45% and positive predictive value of 37%.

Conclusion. The study results revealed substantial subjectivity in MRI data interpretation for prostate cancer diagnosis. Overdiagnosis of tumorous changes was significant, with false-positive rates of 55% in the peripheral zone (PZ) and 72% in the transition zone (TZ). The highest proportion of errors (76%) occurred in PI-RADS category 3 lesions, where 26 out of 34 false-positive findings were associated with this group. The primary cause of misdiagnosis (32% of cases) was morphologic changes caused by diffuse or localized inflammation mimicking tumor features: hypointensity on T2-weighted imaging (T2WI), restricted diffusion, and early enhancement on dynamic contrast-enhanced (DCE) MRI. In 21% of TZ cases, errors were related to insufficient attention to the complete encapsulation sign of suspicious nodules, which can be confirmed through sequential analysis of T2WI on adjacent slices. An additional 15% of false-positive results in the PZ occurred due to underestimation of wedge-shaped lesion morphology, a key differential diagnostic feature. These findings highlight the need for standardized MRI evaluation criteria, detailed analysis of lesion characteristics, and incorporation of clinical inflammation data to reduce overdiagnosis.

Purpose of the study: to improve the reliability of prediction of lymphovascular invasion (LVI) by hybrid morpho-radiomic naive Bayesian models in patients with malignant breast cancer (MBC) by elucidating the role of morphologic magnetic resonance (m-MR) features.

Materials and Methods. Data from 191 patients with MBC were analyzed in the form of 13 m-MR features, 6194 radiomic MR (r-MR) indicators of the whole tumor volume, and the target feature, LVI. Among the m-MR features, predictors of LVI were selected using crosstabulation, multivariate logistic regression, and Entropy-MDL discretization. Among 6194 r-MR indicators, predictors of LVI were selected by Entropy-MDL discretization. The selected indicators were used in training the naive Bayes algorithm. The performance of LVI predictors was compared.

Results. According to multivariate logistic regression, the odds of LVI increased when tumor rim feature was detected on DWI image 4.05-fold (OR 4.05, 95%CI: 1.63–10.47, p = 0.003), peritumoral edema 5.66-fold (OR 5.66, 95%CI: 2.27–14.94, p < 0.001). 3 hybrid models with high discriminatory abilities were obtained: 1 model with DWI rim and radiomic signature from 4 p-MR indicators (AUC = 0.886, sensitivity – 89.5%, specificity – 79.1%, classification correctness – 89.5%, correctness of prediction of LVI – 73.3% and its absence – 95.2%), 2 model with peritumoral edema and radiomic signature from 6 p-MR indicators (AUC = 0.879, sensitivity – 82.5%, specificity – 80,9%, classification correctness – 82.5%, correctness in predicting LVI – 80.0% and its absence – 83.3%) and 3 models with peritumoral edema, rim DWI sign and radiomic signature from 8 p-MR indicators (AUS = 0.957, sensitivity – 96.5%, specificity – 90.2%, classification correctness – 96.5%, correctness in predicting LVI – 86.7% and its absence – 100%). Removing the DWI rim feature from 1 model worsens its discriminatory power (AUC-ROC, 0.801 ± 0.074 vs 0.886 ± 0.059, p = 0.001) and correctness of LVI prediction (40 vs 73%, p = 0.066). Similar but less pronounced, non-statistically significant changes were observed after removal of the peritumoral edema feature from the 2 models (AUC-ROC, 0.843 ± 0.067 vs 0.879 ± 0.060, p = 0.190; LVI prediction correctness, 60 vs 80%, p = 0.232). Removing 2 m-MR features from the 3 model worsens its discriminatory power (AUC-ROC, 0.957 ± 0.038 vs 0.901 ± 0.055, p = 0.024) and correctness of LVI prediction (80 vs 86.7%, p = 0.624).

Conclusion. The use of hybrid models combining m-MR traits and r-MR indices improve the discriminatory power of prediction compared to models using only intratumoral r-MR indices.

Aim: the article presents the results of the effectiveness of bronchoscopy with various options of bronchobiopsy under CT control in fluoroscopy mode with preliminary CT navigation in the diagnosis of peripheral foci in the lungs of the “ground glass” type.

To evaluate the capabilities of a combined technique of bronchoscopy with forceps and brush biopsies under CT control in fluoroscopy mode (SmartView Rx) with preliminary CT navigation (CTn+BS+CTf) in the diagnosis of peripheral lesions in the lungs of the "ground glass" type up to 3 cm in maximum dimension, in particular for the detection of stage 1 lung cancer.

Materials and methods. In a prospective study, the effectiveness of CT-guided bronchobiopsy in fluoroscopy mode with preliminary CT navigation was examined in 32 patients with newly detected ground-glass opacity lesions up to 3 cm in the lungs with suspected malignancy.

Results.This article presents the effectiveness of bronchoscopy with various CT-guided bronchobiopsy options using fluoroscopy and preliminary CT navigation in the diagnosis of peripheral ground-glass pulmonary lesions. The effectiveness of the procedure in the study group was 62.5% versus 21.1% in the control group (p = 0.006), an increase of +41.4%.

Conclusion. The use of CT navigation and CT fluoroscopy in bronchoscopy of peripheral ground-glass pulmonary lesions improves diagnostic efficiency and accuracy while reducing the invasiveness of the procedure. Bronchoscopy combined with CT navigation and CT fluoroscopy can be considered the method of choice for morphological verification of peripheral ground-glass pulmonary lesions.