During the pandemic COVID-19, there has been an increase in the number of patients with non-anginal chest pain at cardiologist appointments.

Objective. To assess the incidence of signs of pleurisy and pericarditis after COVID-19 in non-comorbid patients with atypical chest pain and describe their characteristics according to echocardiography and magnetic resonance imaging.

Materials and methods. From February 2021 to January 2022, 200 outpatients were prospectively enrolled in the study, all of them suffered from a discomfort in the heart region for the first time after SARS-CoV-2 infection. Inclusion criteria: 18–50 years old, 5–12 weeks after SARS-CoV-2 infection, non-anginal chest pain. Exclusion criteria: pneumonia or signs of pulmonary thromboembolism, coronary heart disease, congestive heart failure or kidney disease, clinical or laboratory signs of myocarditis, oncopathology, radiation or chemotherapy of the chest in past medical history. A survey was conducted (yes/no) for the presence of general malaise, quality of life deterioration, hyperthermia, cough. Ultrasound examination of the pericardium and pleura to detect effusion or postinflammatory changes was performed in accordance with the recommendations. Magnetic resonance imaging was performed if ultrasound imaging was poor or there was no evidence of pericardial or pleural involvement in patients with typical symptoms.

Results. 82 women and 118 men were included. Median of age 39 [28–46] years old. Pericarditis was diagnosed in 152 (76%) patients, including effusive pericarditis in 119 (78%), myocarditis in 6 (3%) and myopericarditis

in 49 (25%) patients, pleurisy was detected in 22 (11%) patients, exudative pleurisy – in 11 (5.5%) patients with a predominant unilateral lesion of the mediastinal-diaphragmatic region adjacent to the heart. Hyperthermia was recorded in 2.5% of cases, general malaise – in 60% and a decrease in the quality of life – in 84%.

Conclusion. Serositis as a cause of atypical chest pain among young non-comorbid patients in early postCOVID was identified in 87% of patients. In the coming years, it is probably worthwhile to perform ultrasound of the pericardium and pleura in all patients with chest pain.

Breast cancer occupies the 1st place in the structure of oncological morbidity and mortality in the female population in the Russian Federation and is the second most common metastasis of primary solid malignant tumor after lung cancer, and the incidence of these often fatal lesions is currently increasing after improving systemic treatment.

At the same time, the prognosis of patients who develop metastatic brain damage is usually unfavorable, since few of them live longer than 1 year.

The purpose of the study: to analyze recent studies related to the use of magnetic resonance imaging in the diagnosis of breast cancer metastases in the brain.

Conclusion. If there are characteristic results of MRI studies indicating the presence of possible primary gliomas of the brain, and not metastases, surgical intervention (biopsy) is necessary for histopathological studies, in order to finally establish the diagnosis of the underlying disease.

Objective. To present a unique clinical case of metastatic lesions of the perirenal space, ureter and bladder in Merkel's carcinoma with the development of transverse myelitis against the background of immuno-oncological therapy.
Matherial and methods. The modern states of issue in diagnose and treatment of metastatic Merkel's carcinoma within multidisciplinary approach based on the medical documentation and radiological examinations (CT, MRI) was analysed in this article.
Results. The unique clinical case of metastatic Merkel's carcinoma complicated by transverse myelitis during immuno-oncological therapy according to MSCT and MRI examinations report was demonstrated.
Conclusion. Radiological examinations such as MSCT, MRI, ultrasound and PET/CT needed for detection, assess the incidence of tumor (metastasis and staging) and treatment efficiency control because of the rare occurrence and insufficient knowledge of Merkel's carcinoma.

Aim. To form for viewers an actual vision of the issue of septic pulmonary embolism in the terminological, morphological and clinical aspects, as well as presentation of the methodic of medical imaging of such patients, to systematize and illustrate the main and rare CT signs of septic embolism.

Materials and methods. We analyze the data of national and foreign scientific papers for 2001-2021 on the platforms PubMed, Elibrary, etc., as well as earlier "classic" publications on sepsis, infectious endocarditis and septic pulmonary embolism. Also presents own experience of practice with such patients in multidisciplinary hospitals and typical cases, taking into account more than 5 years of experience on this topic in radiology departments in cooperation with related specialists (cardiologists, therapists, purulent surgeons, morphologists).

Results. 52 of the most relevant scientific papers were selected from 162 available articles. Based on the results, a review was compiled on the peculiarities of terminology, epidemiology, etiology, clinical presentations, as well as methods for diagnosis of septic pulmonary embolism, CT signs of verified cases during primary scanning, as well as follow-up images, which is extremely important in differential diagnosis. The part with the pathological anatomy of septic embolism makes it possible to better understand CT signs and the difference between this process from ordinary pneumonia.

Conclusion. Due to the fact that septic embolism is a secondary process, the correct and quick interpretation of the CT images initiates the search for the primary purulent source of embolism in the body, and follow-up CT-scans (especially in infectious endocarditis) allows you to assess the effectiveness of therapy.

Objective. Comparison of the magnitude of the change in the density of lung tissue and the volume of these changes after radiation therapy over time based on the data obtained using the new method of quantitative analysis developed by us and with the usual visual assessment of the CT data.

Materials and methods. We used the data of dynamic observation of 90 patients who underwent RT for the tumors of thoracic localization during the period from 2014 to 2021 at the Federal Institution “Russian Scientific Center of Roentgenoradiology”. These patients had CT examinations performed before and after RT. Control CT studies were performed 1–237 days after RT (mean control interval 96 ± 64.3 days). A total of 238 CT studies of these patients were analyzed, with an average number of RCT studies per patient of 2.6. Among the selected patients, there were 36 (40%) men and 54 (60%) women aged 23 to 86 years (the average age was 51.9 ± 15.6 years).

Results. Radiation damage in the lungs using the method of quantitative analysis of CT data is detected starting from the value of ΔHU = 20 and volume from 3.2% for the early period (15–35 days) after the end of treatment. Starting from 15–25 to 50 days after the end of RT, quantitative analysis reveals primary changes in the lung tissue, incl. and undetectable visually (from 20 to 80 HU), and to suggest further dynamics of these changes depending on the characteristics of the performed RT. From 50 to 80 days – reveals the real volume of radiation pulmonitis by taking into account the changes invisible during visual analysis in the lung tissue irradiated at a dose of 20 Gy to 30 Gy. From 80 to 120 days – allows you to assess the presence and dynamics of changes in the lung tissue with the threshold radiation dose in the lung tissue 30–35 Gy. From 120 onwards, quantitative analysis of CT data, as well as visual assessment, reveals damage in areas of the lungs with the dose of more than 30–35 Gy, which is caused by post-radiation pneumofibrosis. On the basis of the obtained quantitative data on radiation lung damage, the mathematical regularities of the development of this process were calculated, taking into account the time and dose factors.

Conclusions. Quantitative assessment of changes in lung density according to CT data in dynamics, carried out using the technique developed by us, is a radiomic indicator of their radiation damage during therapeutic irradiation in cancer patients, which, in combination with the presented mathematical model, can be used for diagnostic purposes to quantify the severity and predicting the dynamics of radiation damage to the lungs in general, as well as identifying individual radiosensitivity.

The results obtained can be presented not only in the form of graphs, but also in the form of color maps with preservation of anatomical landmarks, which is convenient for use in clinical practice to support medical decision-making on patient management.

Aim of the study: to evaluate the possibilities of differential diagnosis of cystic metastases of pancreatic cancer in the lungs and pulmonary Langerhans cell histiocytosis (PLCH)

Materials and methods. Multiple cysts were visualized in the patient's lungs, which had thin and thick walls. We visualized in the patient's lung several small nodes with random distribution. These changes were located mainly in the upper and middle sections of the lungs, with the presence of several cysts and nodes near the costal-diaphragmatic angles. The differential diagnosis is formed from metastatic lung disease and pulmonary Langerhans cell histiocytosis. Morphological verification of changes in the lungs confirmed metastatic lung disease.

Conclusion. A careful assessment of the thickness of the walls of cysts and the type of location of nodes in the patient's lungs made it possible to diagnose metastatic lung disease according to CT scans.

The aim of this study was to evaluate average ¹¹C-methionine uptake for grade II (anaplastic) gliomas in a large cohort, as well as relations between MRI and PET characteristics and their unfluence on overall and progression-free survival.

Materials and methods. The study was based upon 78 patients with supratentorial tumors, among them 48 with anaplastic astrocytoma (AA) and 30 with anaplastic oligodendroglioma (AO). ALL patients underwent PET-CT with ¹¹C-methionine and MRI study (Т1, Т2, Т2-FLAIR, DWI и 3D Т1+Gd regimes). Tumor removal was performed in 71 cases, stereotactic biopsy in 8 patients. Tumor specimen were assessed by neuropatomorphologists and IDH1-status and 1p/19q co-deletion were evaluated.

Study results. AA IDH⁻ tumors demonstrated statistically significant bigger metabolic volume and radiotracer uptake comparing with AA IDH⁺. Moreover, AA IDH − characterized by higher fractional MET uptake. The smallest tumors (by MRI) were AOs, meanwhile their fractional contrast enhancement was higher than for AAs. AOs were also known as tumors with minimal difference between MRI and PET-CT volume. MET uptake decreased in a row АА IDH⁻ – АОД – AA IDH⁺, but the difference has not reached statistical significance. For wild-type AAs metabolic volume correlated with OS and PFS, meanwhile for IDH-mutant AAs tumor volume (measured by MRI) correlated only with PFS.

Conclusion. Present study based on the largest cohort of patients with anaplastic gliomas who underwent both MRI and PET with ¹¹C-methionine. It turned out, that unlike grade II oligodendogliomas, AOs do not always demonstrate higher than their astrocytic counterparts MET uptake levels.

Background. It has been shown that prognosis following acute myocardial infarction (MI) strongly correlates with intensity of inflammatory reactions in response to myocardial injury. Thereby diagnostic methods for myocardial post-infarction inflammation (PII) monitoring are needed. Scintigraphy with somatostatin receptor targeted radiotracers has prospects for PII imaging, but its clinical value is poorly studied.

Methods. Six patients with ST-segment elevation anterior myocardial infarction (STEMI) were examined by chest SPECT/СT with ^99mTc-Tektrotyd and rest myocardial perfusion scintigraphy (MPS) at subacute and remote (8 th month) period of the disease. Parameters of both scintigraphic methods were estimated.

Results. In subacute stage of MI myocardial perfusion defects were revealed in all 6 patients (mean SRS 11.83 ± 8.89), ^99mTc-Tektrotyd uptake in myocardium was revealed in 3 of 6 patients. At remote period intense uptake of ^99mTc-Tektrotyd was found only in 1 patient. This uptake was more spread and clears, comparing with accumulation in subacute stage of AMI.

Conclusion. Myocardium scintigraphy with ^99mTc-Tektrotyd allows identifying overexpression of somatostatin receptors in areas of recent and old myocardium infarction. In some patients the radiopharmaceutical uptake may expands to a remote period of the disease. Further larger studies and histological validation of scintigraphic results are needed.

Objective: to develop a diagnostic model that includes CT and radiomic features for the differential diagnosis of pancreatic neuroendocrine tumors (PNETs) G1 and G2 and pancreatic renal cell carcinoma (RCC) metastases.

Material and Methods. 78 patients with 79 hypervascular PNETs and 17 patients with 24 pancreatic RCC metastases who underwent pancreatic resection and histological verification were selected in the study. All the patients underwent preoperative contrast enhanced CT (CECT). We assessed tumor attenuation, composition (cystic/solid), homogeneity (homogeneous/heterogeneous), calcification and presence of the main pancreatic duct (MPD) dilation. We calculated lesion-to-parenchyma contrast (LPC), relative tumor enhancement ratio (RTE) and extracted 52 texture features for arterial phase of CECT. Qualitative and texture features were compared between PNETs and pancreatic RCC metastasis. The selection of predictors for the logistic model was carried out in 2 successive stages: 1) selection of predictors based on one-factor logistic models, the selection criterion was p < 0.2; 2) selection of predictors using L2 regularization (LASSO regression after standardization of independent variables). The selected predictors were included in a logistic regression model without interactions, the coefficients of which were estimated using the maximum likelihood method with a penalty of 0.8.

Results. There was no difference in composition, homogeneity (homogeneous/heterogeneous) and presence of the MPD dilation between groups. We did not find calcification in pancreatic RCC metastasis, in contrast to the PNETs (9% contained calcifications). After selection, the LCR, CONVENTIONAL_HUmin, GLCM_Correlation, NGLDM_Coarseness were included in the final diagnostic model, which showed a sensitivity and specificity of 95.8%; 62% in the prediction of pancreatic RCC metastases.

Conclusion. The diagnostic model developed on the basis of texture and CT-features has high sensitivity (95.8%) with moderate specificity (62%), which allows it to be used in complex diagnostic cases to determine the patient's treatment tactics.

Purpose: analysis of echographic signs of benign and malignant formations of the uterine appendages using the recommendations of the IOTA group.
Materials and methods. 17 articles published in the journal Ultrasound in Obstetrics & Gynecology for 2007–2020 were analyzed. Each article is devoted to the histologically verified pathology of the uterine appendages, of which 431 are benign and 1205 are malignant neoplasms. When describing pathological formations, the re-searchers used a single protocol recommended by the IOTA group. 21 parameters were assessed, including the morphology of the formation, the structure of fluid inclusions and solid component, the presence of fluid in the posterior uterine pocket and ascites, as well as the degree of tumor vascularization.
Results. Аll ultrasound signs of tumors were found in both groups, but the frequency of their occurrence was different. Thus, unilocular neoplasms were more often detected in benign tumors than in malignant ones (p = 0.05). Also, acoustic shadows were found significantly more frequently in benign tumors (p < 0.05). When assessing tumor morphology, attention should be paid to tendencies that are more characteristic of malignant tumors, which include a solid structure (p = 0.13) and the occurrence of ascites (p = 0.13), while a multilocular structure without a solid component was more common in benign (p = 0.10). The size of the neoplasm, uneven contour, papillary growths, hyperechoic inclusions and the nature of the internal contents of the cystic cavities are found with approximately the same frequency in both groups. When as-sessing the blood supply to a pathological formation, hypervascularization confidently indicated a malignant tumor (p < 0.05), while avascularization in such neoplasms was rare, however, the differences with benign ones were insignificant (p = 0.06).
Conclusions. There are no reliable echographic signs of the nature of the neo-plasm. The set of criteria will improve the quality of preoperative ultrasound diagnostics of ovarian tumors.

Annotation. Timely diagnosis of such a rare pathology as hygroma of the pubic symphysis is an urgent problem, since this disease is not always characterized by typical clinical symptoms and can occur under the guise of many urological and gynecological pathologies.

Purpose of the study: to study the possibility of radiation methods for diagnosing hygroma of the pubic symphysis on the example of clinical observation.

Materials and methods. Patient B., 63 years old, was under observation with a diagnosis of Hygroma of the pubic symphysis. Ultrasound examination was performed on a GE Voluson E10 ultrasound scanner with a RIC5-9-D transvaginal 3D probe (5–10 MHz). Magnetic resonance imaging was performed on a Siemens Magnetom Aera tomograph.

Results. According to the ultrasound examination of the urethra, between the symphysis and the anterior wall of the urethra, a volumetric formation with an even, clear contour of 43 × 33 × 40 mm was determined; urethra without focal pathology. On a series of MRI scans of the small pelvis in the retropubic fat between the posterior-lower edge of the symphysis and the anterior wall of the urethra, a heterogeneous avascular cystic-solid mass of 3.0 × 2.8 cm in size was determined that did not separate from them; a solid component of the type of multiple fibrous septa; the cystic component of the formation is associated with an unexpanded cavity of the joint space of the symphysis, containing fluid. The use of ultrasound examination of the urethra using 3D reconstruction in combination with magnetic resonance imaging of the small pelvis helped to make a diagnosis and determine further tactics for managing the patient.

Conclusion. The above clinical observation demonstrated that the complex application of various methods of radiation diagnostics helps to accurately determine the organ belonging to a volumetric formation. This allows you to choose the right tactics for managing patients in the shortest possible time.

The paper proposes a method for using the relative values of linear dimensions for spine structures, which are necessary to compare the results obtained from digital and conventional radiographs having different scales.

The purpose of the study: to develop a method for quantifying the spine structures of adult patients in relative units of measurement.

Materials and methods. Using digital spine radiographs of 141 patients (from 21 to 88 years old), with careful observance of the same magnification, it is shown that the metric length of the segment tangent to the image of the vertebral body CI lower contour – the órel standard – has no age trend.

Results and discussion. The ratio of segment tangent to the image of sacrum upper contour (segment s) and órel standard dimension also does not depend on age and is on average equal to 2.1. So the segment can be approximately calculated as órel = s/2.1. A group of 64 patients, from 21 to 88 years old, taken from the general cohort is divided into four age subgroups according to the WHO classification. It is shown that relative vertical spine size decreases with age. The difference in average relative vertical spine size for the first and the fourth age subgroups was 3.75 órels. The relative contribution of each spine part to the decrease is also demonstrated.

Conclusion. The proposed relative unit of measurement “órel” can be used as a universal measure of length, independent of the scale and method of obtaining an X-ray image for measuring and comparing the structures of the spine in adults at any age.

Objective. Quantitative assessment of Dixon two-point and three-point technologies operation using phantom modeling in the range from 0 to 70%.

Materials and methods. To simulate substances with different concentrations of the fat phase we chose direct oil-in-water emulsions. Tubes with ready-made emulsions were placed in a phantom. Emulsions based on vegetable oils were presented in the range from 0–70%. The phantom was scanned on an Optima MR450w MRI tomograph (GE, USA) in two Dixon modes: the accelerated two-point method “Lava-Flex” and the three-point method “IDEAL IQ”. A scan was performed on a GEM Flex LG Full RF coil. We calculated fat fraction (FF) using two formulas.

Results. There is a linear relationship of the determined values when calculating the fat concentration in “IDEAL IQ” mode and using the formula based on Water and Fat. The accuracy of body fat percentage measurement in “IDEAL IQ” mode is higher than in “Lava-Flex” mode. According to the MR-sequence “Lava-Flex” draws attention to the overestimation of the measured values of the concentration of fat in relation to the specified values by an average of 57.6% over the entire range, with an average absolute difference of 17.2%.

Conclusion. Using the “IDEAL IQ” sequence, the results of the quantitative determination of fractions by formulas were demonstrated, which are more consistent with the specified values in the phantom. In order to correctly quantify the fat fraction, it is preferable to calculate from the Water and Fat images using Equation 2. Calculations from the In-phase and Out-phase images provide ambiguous results. Phantom modeling with direct emulsions allowed us to detect the shift of the measured fat fraction.