Aim. To determine ultrasound, computed tomography and angiographic image characteristics for soft tissue hemorrhages/hematomas, the sequence of using imaging methods in patients infected with SARS-CoV-2, to study the morphology of changes in soft tissues, to determine the essence of the concept and to develop treatment tactics for this complication of COVID-19.

Material and methods. During 4 months of treatment of elderly patients (+60) infected with SARS-CoV-2, 40 patients were identified with soft tissue hemorrhages/hematomas, of which 26 (65%) patients with large hematomas (>10 cm in size and > 1000 ml in volume). The analysis of clinical and laboratory parameters, methods of instrumental diagnostics (ultrasound – 26 patients, CT – 10 patients, angiography – 9 patients, punctures – 6 patients) was carried out; autopsy material was studied in 11 cases.

Results. Image characteristics of hemorrhages/hematomas of soft tissue density were obtained using modern instrumental methods, and the sequence of application of visualization methods was determined. A tactic for managing a patient with stopped and ongoing bleeding has been developed. The morphological substrate of hemorrhagic complications in a new viral infection was studied. All patients were treated with conservative and minimally invasive procedures (embolization, puncture with pressure bandage). 15 patients (57.7%) recovered, 11 patients (42.3%) died from the progression of COVID-19 complications.

Conclusion. Comprehensive clinical and laboratory sequential instrumental diagnosis of soft tissue hemorrhages in COVID-19. Treatment should be conservative and significantly invasive. The use of the term “soft tissue hematoma” in SARS-CoV-2 infected patients is not a natural quality of the normal pathological process and should not be observed from our point of view.

Research objective: establish the impact of Left Atrium Volume Index (LAVI) on on effectiveness of Thoracoscopic Ablation (TSA) in the Treatment of Atrial Fibrillation (AF) and define the risk factors for manifestation of supraventricular arrhythmias in the long-term follow-up results

Methods. Prospective cohort study of 121 patients with AF (from 2018 to 2021) who performed TSA. The patients were divided into two groups: patients with increased LAVI (group I), patients with normal LAVI less than 34 ml/m² (group II).

Results. According to echocardiography, the mean LAVI was 45.48 ± 9.3 ml/m² and 28.59 ± 4.13 ml/m² in groups I and II, respectively (p = 0.012). The mean value of left ventricular ejection fraction (LVEF) according to Teicholz in group I was 61.62 ± 7.041%, in group II 63.57 ± 6.16% (p = 0.8). Spearman's сorrelation analysis showed the relationship between LAVI and LVEF before surgery and in the long-term follow-up period, that is agreed with world literature data about contribution left atrial (LA) to left ventricular (LV) function. According to our study, only LAVI < 34 ml/m² is a risk factor for arrhythmia after TSA. Effectiveness TSA in I group was 77.8%, that is lower than the II group – 88.9%. 3 months after TSA, 20 (17%) patients were required catheter ablations (CA), mainly in I group.

Conclusions. Research results showed that an increase in LAVI significantly reduces the effectiveness of TSA in the long-term period by 11.1% compared with LAVI < 34 ml/m². That are conform with other data of previously submitted works.

Purpose. 1. Assess the consistency of echocardiographic measurements with catheterization data in severe aortic stenosis.

1. Assess if inter-method consistency improves after adjusting scores for the pressure recovery factor.
2. To identify factors affecting the consistency of echocardiography and catheterization data.

Materials and methods. Prospectively, 70 patients (mean age 72 ± 6 years, 38 females) have been included. All patient underwentcardiac catheterization with single-meter echoscanning of the parameters necessary to assess the severity of aortic valve stenosis before transcatheter aortic valve implantation. Inclusion criteria were isolated aortic stenosis (EOA <1 cm2, Gmax ≥64 mm Hg, Gmean ≥40 mm Hg. Exclusion criteria were LV stroke volume index <35 ml/m² and a reduced EF <50%, concomitant nontrivial regurgitation of the aortic and mitral valves.

Result. The linear regression method showed a weak correlation between the G_max (Doppler) and P_mean indices, r = 0.48, p = 0.001. Revealed high values of the average difference between the two methods in comparison with the Blent–Altman (SR 19 ± 17 mm Hg.) and low intraclasscorrelation values (ICC = 0.34). After adjusting the Gmax (Doppler) indices for the pressure recovery factor, the correlation between the methods r = 0.84, p ≤ 0.001, significantly improved. There was a decrease in the mean indices, the difference between the two HR methods was (3.15 ± 12 mm Hg.) with highly significant intraclasscorrelation values (ICC = 0.89). Similarly, a low correlation with high values of the average difference was observed when comparing EOA (Doppler) and EOA (catheterization) r = 0.55, p = 0.01, SR 0.21 ± 0.15 cm², ICC = 0.53. With an improvement in the correlation between the methods after adjustment for the pressure recovery coefficient, r = 0.9, p ≤ 0.001, CP = 0.04 ± 0.08 cm², ICC = 0.92. Comparison of Gmean (Doppler) indices with catheter Pmean has showed a high correlation between the methods, r = 0.7, p ≤ 0.001, there were relatively low indices of the average difference between the two methods of HR = 7.2 ± 22 mm Hg and a significant intraclass correlation (ICC = 0.72). The method of analysis of multiple regression revealed that the diameter of the sinotubular ridge was a significant factor affecting the correlation between echocardiography and catheterization data, OR 1.2 (CI 0.09; 2.9).

Conclusions

1. The maximum Doppler gradient (G_max) and the effective orifice area (EOA) have low consistency and weak correlation with catheterization data, in contrast to the average Doppler gradient (G_mean) which have a high consistency with catheterization data.
2. After correcting for pressure recovery factor, there is a significant improvement in the consistency between G_max and EOA with catheterization data.
3. The diameter of the sinotobular junction is a significant factor influencing the consistency of echocardiography and catheterization data, which must be taken into account when assessing the severity of aortic stenosis.

Purpose. To establish the methods for estimating the volume of the true and false aortic canals applying computed tomography angiography (CTA) to a clinical case with hybrid stent-graft thoracic aorta with distal stent-graftinduced new entry associated (d-SINE) in the long-term follow-up period in comparison with a widely used technique of measuring diameters of the aorta on different levels.

Materials and methods. Sequential analysis of CTA in a 7-year follow-up was performed. Aorta was divided into 3 segments, in each segment total aortic volumes (AV), volume of the true canal (TC), and volume of functional lumen of the false canal (FLFC) were calculated. The following were mathematically calculated: volume of the false canal (FC) via difference in volume between AV and TC, volume of the thrombosed lumen of FC as the difference between FC and FLFC, the coefficient of FC thrombosis, the degree of stent-graft opening. Mathematical assessment of excess volume of the graft was performed.

Results. Modelling of aortic cavity, evaluation of changes in the volumes of TC and FC during a long-term follow-up, analysis of the factors inducing the development of the d-SINE syndrome were performed. When comparing the volume of the graft and the volume of the implantation zone, an excess of 234% was found, while the opening of the graft was 80%. When using the reference method based on the diameter of the true lumen of the aorta, the excess was 22% during one-year follow-up period showing no changes subsequently.

Conclusion. Potentially, the method of measuring volumes based on CTA results can be used to complement the generally accepted method based on measuring diameters, since it does not require additional financial resources and has the potential to estimate effectiveness of treatment and identify complications predictors in the postoperative period to determine indications for reoperation. 

Background. Giant coronary artery aneurysms are extremely rare findings. According to foreign authors, their prevalence as a result of autopsy ranged from 0.02 to 0.2%. Most often, they do not have specific symptoms and are detected after the development of complications, such as acute coronary syndrome, myocardial infarction. The risk of sudden complications causes an unfavorable prognosis of the disease and requires immediate surgical correction.

Aim: to demonstrate the effectiveness of radiology methods in assessing coronary anatomy and the possibility of visualization before planning surgery.

Materials and methods. The patient was referred to the Federal State Budgetary Institution “FCCVS” of the Ministry of Health of Russia (Penza) for additional examination and surgical treatment. Before surgery, to clarify the features of the macromorphology of the aneurysm, selective coronary angiography and CT coronary angiography were performed.

Results. Before surgery, according to CT coronary angiography, a partially thrombosed fusiform aneurysm was detected in the anterior descending artery with a maximum size of 7.0 x 3.5 cm, adjacent to the pulmonary artery trunk and left atrial appendage.

Conclusion. In modern conditions, the methods of radiology are successfully used to clarify the localization of aneurysms and individual topographic and anatomical features of the coronary arteries.

Purpose: to study the contribution of perfusion iodine maps to diagnosis of acute pulmonary embolism (PE) and compare pulmonary perfusion defects with the main imaging biomarkers of PE.

Materials and methods. 130 patients with suspected acute pulmonary thromboembolism were studied using pulmonary computed tomographic angiography with perfusion iodine map`s analysis. Pulmonary embolism was revealed in 42 cases. There were evaluated: the number and level of vessel occlusion (Qanadli index), number and grades of lung perfusion defects on perfusion iodine maps (perfusion index), signs of right heart failure, changes of lung parenchyma.

Results. Analysis of the data showed a strong correlation between the index Qanadli  and perfusion index, rather than signs of right failure. In 3 cases, the segmental and subsegmential pulmonary embolism was revealed form the iodine map’s analysis only.

Conclusion. Thus, perfusion iodine maps improve the diagnosis of acute pulmonary embolism due to characterizing the changes of pulmonary microcirculation. From our data, the iodine maps can be employed as a prognostic tool for further therapy.

Background. The amount of extracellular myocardial matrix is a non-invasive tool for quantitative assessment of myocardial fibrosis. MRI with late gadolinium-enhancement is considered to be the “Gold standard” of non-invasive practice.  Dual Energy computed tomography is a new non-invasive approach for detection of myocardial fibrosis and its prognostic value remains unclear. The purpose of this study was to summarize all available data and to study prognostic value of DECT for the detection of fibrotic changes in myocardium.

Methods. We searched MEDLINE, EMBASE, Cochrane, SCOPUS and Web of Science for cohort studies up to October 2021 that reported myocardial extracellular volume fraction quantification using contrast enhanced dual energy CT or/and MRI with delayed enhancement.

Results. Eleven studies met eligibility criteria. A systematic analysis demonstrated the difference in extracellular volume fraction in patients with fibrotic and inflammation changes of the myocardium, as well as good comparability between DECT and MRI. The value of extracellular volume fraction in myocardium with fibrotic or inflammatory changes was higher than in healthy tissue, which makes it possible to use the ECV as a non-invasive marker of myocardial fibrosis.

The purpose of the study. To clarify the possibilities of using radiation research methods in the framework of complex diagnostics of local peritonitis for timely recognition and treatment of intra-abdominal abscesses and infiltrates.

Materials and methods. The analysis of the results of a complex radiation examination in 61 patients with local peritonitis of various etiologies who were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine was carried out. The complex of radiation diagnostics included ultrasound and X-ray examinations, computed tomography (CT). The studies were performed both initially at admission and in dynamics.

Results. The diagnostic algorithm for local peritonitis is analyzed, three stages are identified with the determination of the method of choice on each of them. Ultrasound and X-ray examination methods are mainly used at the stage of primary diagnostics and for dynamic control. CT allows you to clarify the type, localization and volume of inflammatory changes, their relationship with the surrounding organs and structures. When analyzing the results of radiation diagnostics, it was determined the need to identify and evaluate the main signs of local peritonitis, both direct: the presence of voluminous formation of inflammatory genesis (infiltrate and/or abscess); and indirect: changes in the source organ of peritonitis; changes in structures adjacent to the infiltrate /abscess; the presence of reactive effusion into the thoracic and abdominal cavities.

Conclusion. Comprehensive radiation diagnostics for local peritonitis makes it possible to obtain complete information about the nature of both inflammatory changes in local peritonitis and the causes of them. The obtained data of complex diagnostics help the surgeon to choose a rational treatment strategy for these patients, including minimally invasive. Diagnostic monitoring allows you to evaluate the effectiveness of treatment and carry out timely correction of tactics.

The purpose: to determine the influence of various aspects of the MR-enterography technique on the quality of the obtained images.

Materials and methods. MR-enterography was performed in 634 patients for verified Crohn's disease and suspected inflammatory and tumor diseases of the small intestine. The following drugs containing polyethylene glycol (PEG) were used as an oral contrast agent in 573 patients, mannitol in 32 patients, pineapple juice in 16 patients, water in 11 patients, milk in 2 patients. Oral administration of 1500 ml of contrast agent was carried out fractional for an hour in 3 stages of 15 minutes with an interval of 10 minutes. Each patient underwent programs: T2-FIESTA mode in three planes, diffusion-weighted images with a slice thickness of 5 mm through 1 mm.

Results. There were no significant differences in the severity of filling of the loops of the small and large intestine in patients taking polyethylene glycol (n = 573) and mannitol (n = 32) as an oral agent. Adequate stretching of the loops of the small intestine was achieved in 94% of patients, the expansion of the loops was considered moderate or unsatisfactory in 11 patients (4%), which is associated with poor tolerance of the contrast agent or individual characteristics of peristalsis. After coloprotectomy in 14 patients, the volume of the contrast agent was reduced to 1000 ml and the time of its administration to 30–40 minutes due to the rapid passage. MR-enterography could not be performed in 27 patients due to intolerance to PEG and mannitol drugs, which caused a pronounced gag reflex. In these cases, we resorted to alternative options in the form of water (n = 11) and pineapple juice (n = 16).

Conclusions. A qualitative assessment of the condition of the small intestine is possible only with the exact observance of all aspects of the research methodology in the form of: an interval between the last meal and MR-enterography of at least 8 hours, the volume of oral contrast agent (mannitol or PEG) 1200–1500 ml, taken 60 minutes before the study. When performing MR-enterography in patients after coloprotectomy, we recommend reducing the volume of oral contrast agent to 1000 ml and the preparation time for the study to 30–40 minutes.

Aim. This review is devoted to the analysis of available on-line services and programs using artificial neural networks (ANNs) in dentistry, especially for cephalometric analysis.

Materials and methods. We searched for scientific publications in the information and analytical databases PubMed, Google Scholar and eLibrary using combinations of the following keywords: artificial intelligence, deep learning, computer vision, neural network, dentistry, orthodontics, cephalometry, cephalometric analysis. 1612 articles were analyzed, of which 23 publications were included in our review.

Results. Deep machine learning based on ANN has been successfully used in various branches of medicine as an analytical tool for processing various data. ANNs are especially successfully used for image recognition in radiology and histology. In dentistry, computer vision is used to diagnose diseases of the maxillofacial region, plan surgical treatment, including dental implantation, as well as for cephalometric analysis for the needs of orthodontists and maxillofacial surgeons.

Conclusion. Currently, there are many programs and on-line services for cephalometric analysis. However, only 7 of them use ANNs for automatic landmarking and image analysis. Also, there is not enough data to evaluate the accuracy of their work and convenience.

The aim of the study: to analyze the features of the classification and diagnosis of hydrocephalus in pediatric patients.

Results. Hydrocephalus is a common pathology of the CSF system, often occurring in childhood. The central place in the examination of this group of patients is taken by new neuroimaging technologies, in particular, MRI. Pediatric patients have specific features regarding classification of hydrocephalus and MRI studies. This review presents the research protocol and modern classification of hydrocephalus in children.

Conclusion. Examination of pediatric patients for hydrocephalus should be based on the estimated etiology. When conducting an MRI study, the protocol must include modern MRI sequences: FIESTA, T2-CUBE, phasecontrast MRI.

Purpose: systematization of the knowledge about diffusion tensor magnetic resonance tomography; analysis of literature related to current limitations of this method and possibilities of overcoming these limitations.

Materials and methods. We have analyzed 74 publications (6 Проанализировано 74 публикации (6 Russian, 68 foreign), published in the time period from 1986 to 2021years.  More, than half of these articles were published in the last ten years, 19 studies-in the time period from 2016 to 2021years.

Results. In this article we  represent the physical basis of diffusion weighted techniques of magnetic resonance tomography, principles of obtaining diffusion weighted images and diffusion tensor, cover the specific features of the probabilistic and deterministic approaches of the diffusion tensor MRI data processing, describe methods of evaluation of the diffusion characteristics of tissues in clinical practice. Article provides a thorough introduction to the reasons of existing limitations of diffusion tensor MRI and systematization the main developed approaches of overcoming these limitations, such as multi-tensor model, high angular resolution diffusion imaging, diffusion kurtosis visualization. The article consistently reviews the stages of data processing of diffusion tensor magnetic resonance tomography (preprocessing, processing and post processing). We also describe the special aspects of the main approaches to the quantitative data analysis of diffusion tensor magnetic resonance tomography (such as analysis of the region of interest, analysis of the total data amount, quantitative tractography).

Conclusion. Magnetic resonance tractography is a unique technique for noninvasive in vivo visualization of brain white matter tracts and assessment of the structural integrity of their constituent axons. In the meantime this technique, which has found applications in numerous pathologies of central nervous system, has a number of significant limitations, and the main of them are the inability to adequately visualize the crossing fibers and the relatively low reproducibility of the results. Standardization of the data postprocessing algorithms, further upgrading of the magnetic resonance scanners and implementation of the alternative tractography methods have the potential of partially reducing of the current limitations.