Aim. Analysis of modern neuroimaging methods of intracranial arterial aneurysms with an emphasis on the possibilities of MR imaging of the vessel wall.

Methods. Scientific articles and clinical recommendations from the PubMed from 2012 to 2020 were included into analysis, using keywords: aneurysm, CT, MRI, CFD (computational hydrodynamics), vessel wall imaging. As a result of the search, 137 articles were selected of which 27 articles were used in the review, supplemented by 10 articles from the reference lists 1990–2012.

Results. Modern possibilities of intracranial arterial aneurysms imaging were demonstrated, with particular attention to the advantages of the method of MR imaging of the vessel wall. The main technical aspects of MR vessel wall imaging were demonstrated.

Conclusion. Modern CT and MR imaging can provide additional information about the processes occurring in the lumen of the aneurysm and its wall. This information can be a key factor in the neurosurgical patient management.

Case study. Aortic coarctation refers to well-known and well-studied congenital malformations of the cardiovascular system. The success of cardiovascular surgery significantly increased the survival rate of patients, but, unfortunately, did not reduce the risks of serious cardiovascular complications in the long-term postoperative period. One of the significant complications remains recoarctation – repeated narrowing in the area of surgery, which can initiate other complications.
The purpose of the study: to present the features of blood flow in the aorta in a patient with aortic coarctation in the long-term postoperative period on the clinical example of a complex MR examination.
Material and methods. A 12-year-old patient, at the age of 6, she underwent balloon angioplasty of aortic coarctation. Echocardiographic data revealed a residual gradient at the isthmus of the aorta and expansion of the descending aorta. To clarify the diagnosis, MRI angiography of the heart was performed with intravenous contrast and the use of a cardiopackage for 4D flow analysis (4D flow).
Results and discussion. According to the MRI study, a narrowing of the distal aortic arch with aortic dilation after the departure of the left subclavian artery was revealed, which is confirmed by the obtained absolute values of blood flow indicators. MR-angiography of the aortic arch made it possible to visually determine the “gothic” shape of the aortic arch and present 3D reconstructions. 4D flow maps showed acceleration of blood flow to the systole in the area of aortic narrowing, additional vortex flow below the area of aortic narrowing and spiral flow in the descending aorta, which persisted throughout the diastole.
One explanation for the abnormal spiral flow in the descending thoracic aorta may be the presence of a “gothic” aortic arch. Also, residual hypoplasia of the aortic arch and narrowing of the isthmus are the leading parameters affecting the pathophysiology of changes in blood pressure during exercise.
Conclusion. The 4D-flow MR package in vivo makes it possible to study the flow geometry and blood flow parameters in detail, to obtain a detailed picture of the aortic condition, which gives potential advantages in a comprehensive examination of patients with aortic coarctation under dynamic observation.

Introduction. Differential diagnosis of some pathological processes in the breast is difficult on the background of dense breast tissue. This often leads to false conclusions and to late diagnosis of breast cancer (BC) or unreasonable biopsy in a benign process. 50% of breast cancers detected less than 12 months after elective mammography were associated with high density of breast tissue. An important advantage of contrast enhanced spectral mammography (CESM) is that it does not depend on the size of the lesions and the X-ray density of the breast tissue. Objective. To compare the diagnostic performance of CESM and digital mammography (DM) in detection of breast cancer in a group of women with dense breast tissue.

Materials and methods. The data of 438 patients with suspected breast cancer examined from August 2018 to January 2021 were analyzed in the study. The mean age of women was 50 ± 11 years (from 21 to 86 years). In the study group 154 (35%) malignant and 284 (65%) benign lesions were identified. All lesions were histologically verified. Breast tissue density corresponded to types A and B in 161 patients and corresponded to C and D types in 277 patients according to the ACR classification. 154 cases of breast cancer were identified, including 49 patients with density A and B and 105 patients with density C and D types.

Results. Sensitivity, specificity and overall accuracy of DM were 85.7%, 87.3%, 86.8%, respectively. Diagnostic performance of CESM significantly higher than of DM with sensitivity, specificity and accuracy of 96.8% (p < 0.001), 93.3% (p = 0.015), 94.5% (p < 0.001), respectively. CESM had high positive and negative predictive values of 88.7% (p = 0.012) and 98.1% (p < 0.001), which exceeded those of DM – 78.6% and 91.9%, respectively. The diagnostic performance of DM and CESM were comparable in women with normal breast density (types A and B according to ACR), but in patients with high breast density (types C and D according to ACR), CESM was significantly more sensitive in detecting breast cancer.

Conclusion. Thus, diagnostic efficiency of CESM in detecting breast cancer significantly higher in comparison with digital mammography.

Abstract. Breast cancer is one of the most common malignant neoplasms among women nowadays. Timely diagnosis is the basis for effective and successful treatment of this disease. The existing classical methods of X-ray examination (MG, ultrasound, MRI) play a major role in the detection of breast cancer, but in some cases, the diagnosis of breast cancer can be difficult. Therefore, diagnostic performance of scintimammography with specialized gamma camera called molecular breast imaging (MBI) is now of particular clinical interest.
Materials and methods. 312 patients with a preliminary clinical diagnosis of breast cancer were examined in the department of radionuclide diagnostics of N.N. Petrov Research Center of Oncology. They underwent scintimammography (MBI) with a specialized gamma camera manufactured by GE (Discovery 750b). Images of both breasts were obtained 15 min after intravenous injection of 500 MBq activity of 99mTc-MIBI. The foci of moderate and intensive radiopharmaceutical accumulation in breast were considered as a sign of a tumor. The diagnostic performance of MBI and the sensitivity in detection of various biological subtypes of cancer were calculated by comparing with the results of morphological and immunohistochemically studies.
Results. The sensitivity, specificity and accuracy of the MBI in the diagnostics of breast cancer were 88, 75 and 87%, respectively. Sensitivity of this method in detection of different biological subtypes ranged from 89% to 95% with lowest performance found in luminal A subtype.
Conclusion. Scintimammography (MBI) is an informative way of breast cancer diagnostics. The revealed differences in the sensitivity of the method in patients with different biological subtypes of breast cancer confirm the need for further study of this topic.

One of the actual problems of oncology is the early diagnosis of breast cancer. However, there are some difficulties not only in diagnostic but also in the verification of lesions. Image-guided cor-biopsy nowadays became the gold standard for verification of non-palpable breast lesions. The main issue is to choose the method of visualization. According to up-to-date recommendations, there is no universal method with all requirements (high visualization quality, convenience, and accessibility for biopsy). Fusion-biopsy or virtual real-time sonography can combine MRI diagnostic potential and facility of US

Aim: to leverage the technique of fusion biopsy under combined ultrasound/MR control for verification of breast lesions identified only on MRI and occult on MG and US.

Methods. 30 high-risk patients, who had pathological breast lesions detected by diagnostic CE-MRI, classified as BI-RADS 4, 5 yet occult on the other visualization methods were enrolled in the study. All patients underwent supine MRI prebiopsy examination, real-time virtual sonography of the lesions, image-guided biopsy or excisional biopsy, histopathologic examination.

Results. The breast fusion-biopsy method was developed based on up-to-date scientific publications and optimized for the technical equipment of N.N. Petrov National Medicine Research Center of Oncology. According to the designed protocol of examination, there were the following steps: interpretation of breast CE-MRI in the standard prone position for breast lesion detection, prebiopsy CE-MRI performed in the supine position, real-time virtual sonography for comparison of breast MRI and US, histopathologic examination.

Conclusion. Being one of the perspectives methodic of morphological verification Fusion-biopsy might become a more common procedure in breast lesions diagnostics. The simplicity of US-guided biopsy and high MRI breast diagnostic sensitivity are combined in fusion-biopsy technology.

Purpose: to evaluate retrospectively the MR data of the breast phyllodes tumors and to perform comparative analysis of the MR signs and the histological grade of the phyllodes tumors.
Materials and methods. The analyses enrolled 27 pathologically confirmed phyllodes tumors (mean age of patient 37.8 y.o.). Following features were evaluated: tumor shape and structure, margins, size, type of contrast enhancement, foci of high signal intensity on the T1-WI, foci of hypo- or isointense signal on the T2-WI comparing with intact breast tissue, presence of cystic inclusions and the type of their margins.
Results. The study included 18 benign, 4 borderline and 5 malignant phyllodes tumors. The following features showed significant correlation with the tumor grade: irregular margins of the cystic foci (p = 0.003), foci of hypoor isointense signal on the T2-WI compared with intact breast tissue (p = 0.005). Foci of high signal intensity on the T1-WI were often revealed in the malignant (3/5) and borderline tumors (2/4), but this dependence was not significant (p = 0.021). According to pathomorphological correlation the foci of the high signal intensity on the T1-WI corresponded to hemorrhages, while cystic foci with irregular margins were revealed to be foci of necrosis. The foci of hypo- or isointense signal on the T2-WI compared with intact breast tissue corresponded to the hypercellular stroma.
Conclusion. Specific features of phyllodes tumors are useful in differentiation of their histological types; furthermore the MR mammography provides accurate data for planning the point of biopsy.

Aim: Studying, statistical processing and classification of complications that arose after breast augmentation with silicone gel implants.
Material and methods. Complex clinic-radiological examination of 590 women after a breast augmentation with silicone gel implants was performed. Various complications after breast augmentation were diagnosed in 223 (37.8%) cases. Radiology examination included X-ray mammography, ultrasound and magnetic resonance imaging (X-ray, US and MRI).
Results. The analysis of the data obtained allowed us to divide all the identified complications of breast augmentation into 3 groups depending on the etiology and pathogenesis of their occurrence.
Conclusion. The proposed classification of complications of breast augmentation using silicone gel implants, based on their etiology and pathogenesis, will allow to choose the optimal treatment method predicting its efficiency.

Introduction. Currently, CT and MRI do not reliably differentiate oncocytoma, angiomyolipoma with minimal fat and renal cell carcinoma, and therefore most patients with localized solid renal tumors undergo surgical treatment. Identification of differential signs of benign formations according to imaging methods would make it possible to change the therapeutic tactics in more than a third of cases in patients with newly diagnosed small renal masses (less than 4 cm).
Purpose. The aim of the study was to evaluate the diagnostic efficacy of diffusion-weighted MRI (DWI) in the differential diagnosis of solid renal masses.
Materials and methods. А prospective study, which included 90 patients aged 34 to 79 years with primary solid renal masses who were examined and treated at the Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation was conducted in the period from February 2019 to October 2021. Before surgery, all patients underwent MRI of the retroperitoneal organs using DWI with b-factors of 0–800 s/mm2 and 0–1000 s/mm2. The diffusion coefficient was quantified on two ADC maps for renal masses of various histological types and the obtained values were compared with each other.
Results. According to the results of the statistical analysis, the values of the diffusion coefficient for benign tumors were significantly higher than for RCC (p < 0.05). There was no statistically significant difference between clear cell, chromophobe and papillary types of RCC in terms of diffusion coefficient both at b-factors of 0–800 s/mm2 and at 0–1000 s/mm2.
Conclusion. Using DWI we can suggest a benign genesis of a solid renal mass. Differential signs for RCC of various histological types according to diffusion-weighted images were not identified.

Objective: to evaluate the effectiveness and capabilities of multiparametric ultrasound (mpUS) with contrast enhanced in the assessment of renal cystic lesions and compare data with the results of computed tomography (CT).
Patients and Methods. The study included 61 patients with cystic kidney tumors (category Bosniak ≥ II). Cysts of categories Bosniak ≥ III were morphologically verified, the rest (categories II-IIF) were under long-term dynamic control. All patients underwent mpUS including greyscale mode, color doppler imaging (CDI) and contrastenhanced ultrasound (CEUS), as well as contrast-enhanced CT.
Results. Contrast-enhanced mpUS with CEUS demonstrated high efficiency of the method: sensitivity (Se) – 97.2%; specificity (Sp) – 91.6%; accuracy (A) – 95.1%. The effectiveness of CT with contrast in the study group was 91.7%; 84.0%; 88.5% respectively. Also, mpUS showed a more accurate assessment of cystic tumors according to the Bosniak classification, in comparison with contrast-enhanced CT.
Conclusions. Contrast-enhanced mpUS with CEUS demonstrated a significant increase in the effectiveness of the method as a whole, as well as higher rates in comparison with CT in the assessment of cystic formations of the kidneys. This technique should be considered as the method of choice in cases where CT is not possible, and it is recommended to include it in the algorithm for examining patients with cystic kidney tumors.

The aim: to evaluate the own direct results of the RFA of kidney tumors in A.V. Vishnevsky National Medical Research Center of Surgery.
Materials and methods. The study included the results of examination and treatment of 22 patients with kidney tumors treated at A.V. Vishnevsky National Medical Center of Surgery (16 men and 6 women aged 40 to 81, mean age 61.5 years). All patients underwent preoperative ultrasound, MSCT with contrast enhancement., Patients underwent RFA of kidney tumors using the Radionics Cool-Tip ® Ablation System (USA) at various stages of treatment In the postoperative period, all patients underwent MSCT monitoring with contrast enhancement and ultrasound with duplex scanning, as well as ultrasound with contrast enhancement – in 7 patients and MRI with contrast enhancement on the first day after the intervention – in 5 patients. Dynamic follow-up was performed in the postoperative period from 3 to 60 months (median 17.8 months).
Results. Depending on the surgical tactics, the patients were divided into two groups: the first (16 patients) – RFA was performed as the first independent stage of treatment; the second (6 patients) – RFA was performed as a staged treatment for kidney resection.
The tumor was solitary in 19 patients of both groups, multiple – in 3. In tumors of the first group, with sizes exceeding 30.0 mm in diameter, a positive effect was obtained from the manipulation: no progression of the tumor was detected during dynamic observation. These patients underwent 2 to 3 RFA sessions. In tumors of the second group, the size did not exceed 30.0 mm, 2 to 4 sessions (on average 3 sessions) of RFA were performed, which was due to multiple lesions in 3 cases.
The use of RFA in the treatment of patients with small kidney cancer in patients with concomitant diseases that do not allow for radical treatment, made it possible to obtain a relapse-free period of an average of 16.5 months. The use of RFA, as a stage in the treatment of primary multiple kidney cancer, showed a relapse-free period of an average of 21.2 months.
Conclusion. The use of radiofrequency ablation in the treatment of kidney cancer patients can significantly expand the scope of surgical care, both in the case of patients with concomitant diseases that do not allow a significant amount of surgical intervention, and in the treatment of patients with primary multiple cancer of both kidneys as a stage treatment.

The twinkling artifact has been known to specialists in ultrasound diagnostics since 1996. However, until now there is no understanding of the reasons for its appearance, and the place of its application in diagnostics.

Material and methods. Electronic databases (PubMed, E-library, Web of Science) were searched studies using the keyword – “twinkling artifact”. The scientific publications on the Doppler twinkling artifact from the moment of the first reports about its existence is systematized and analyzed. The authors' own developments on this topic are presented. Modern views on this phenomenon and its place in ultrasound diagnostics are described. An explanation of the physical mechanisms of this phenomenon is given.

Results. Recommendations are formulated for practitioners on changing the settings of an ultrasound scanner in order to increase twinkling artifact detectability. The directions of using the artifact to obtain additional diagnostic signs of pathological changes, which currently include the diagnosis of nephro-, uretero- and choledocholithiasis, are determined.

Conclusions. The high efficiency of the use of the twinkling artifact for the diagnosis of small kidney stones, comparable with the capabilities of computed tomography, has been shown.  

Purpose. To study the incidence of anomalies and malformations of visceral arteries and evaluate their role in the treatment of extrahepatic portal vein obstruction (EHPVO) in children
Material and Methods. The study included 155 previously not operated children with EHPVO. A retrospective analysis of the results of three-phase multislice computed tomography with angiography (MSCTA) of visceral vessels was performed. Frequency of visceral arteries anomalies of the abdominal aorta, aortomesenteric angle, the structure of the hepatic, splenic and superior mesenteric arteries (SMA) were assessed. The size of visceral arteries depending on the prevalence of portal vein thrombosis was also assessed.
Results. According to analysis 35 (22.6%) children with EHPVO had abnormalities of visceral arteries. Of them, 14 (11.7%) patients presented with signs of aortomesenteric compression of the left renal vein (LRV). Coeliacomesenteric trunk was detected in 4 (2.5%) children. In one (0.64%) case there was sign of saccular splenic artery (SA) aneurysm. According to data, there was a significant correlation of the diameter of SA and SMA with the age of children (r = 0.58; p = 0.001). According to the study, diameter of arteria hepatica propria in children with portal vein thrombosis (PVT) with extension into superior mesenteric vein (SMV) was significantly lower than in PVT and its branches (2.48 ± 0.23 mm vs 3.15 ± 0.08 mm, p = 0.01). The diameter of SA in children with PVT extended into splenic vein was significantly smaller (4.26 ± 0.19 mm) in comparison to children with PVT and its branches (4.9 ± 0.12 mm, p = 0.01), and children with widespread thrombosis of portal vein system (5.45 ± 0.41 mm, p = 0.05).
Conclusion. Multiple aberrations of the anatomical structures of visceral arteries make any hepatobiliary surgery challenging to surgeons. The study data suggest that MSCTA is an informative method for evaluation of associated anomalies of visceral arteries in children with EHPH.

Purpose: to consider the modern possibilities of positron emission tomography combined with computed tomography (PET/CT) with FDG in the diagnosis of oncological formations in gynecology.

Materials and methods. Search, selection and evaluation of existing foreign and domestic research included in the peer-reviewed E-library, PubMed, GoogleScholar, Scopus.

Results. This article summarizes the existing evidence base to establish the clinical relevance and new possibilities for the use of FDG PET/CT in common gynecological malignancies.

Conclusion. The use of FDG PET/CT can have a significant impact on patient management by improving cancer staging, influencing patient choice for treatment, and detecting early disease recurrence.

Purpose. To develop and test algorithms for determining the projection and searching for common technical defects on chest -rays using transfer learning with various neural network architectures.
Materials and methods. Algorithms have been created to search for technical remarks such as incorrect choice of study boundaries and errors of patient positioning. Transfer learning of neural network architectures VGG19 and ResNet152V2 was chosen as the basis for creating algorithms. To train and test the algorithms, we used radiographs from open databases (over 230,000 studies in total). To validate the obtained algorithms, a test dataset was prepared from 150 anonymized chest x-rays unloaded from the Unified Radiological Information Service of the Moscow city (URIS) and evaluated by expert doctors and technicians.
Results. All obtained algorithms have high classification quality indicators. The maximum accuracy on the test dataset was obtained for the model that determines the projection, AUC was 1.0, the minimum accuracy: AUC 0.968 was obtained for the model that determines the rotation of the chest on the lateral X-ray. On the validation dataset maximum accuracy was obtained for the model that determines the projection, AUC was 0.996, the minimum accuracy: AUC 0.898 was obtained for the model that determines the rotation of the chest on the lateral x-ray.
Conclusions. All of diagnostic accuracy metrics for each of the models exceeded the threshold value of 0.81 and can be recommended for practical use.