Purpose. The aim of the study was to investigate changes in iron distribution in the brain of patients with multiple sclerosis (MS) using magnetic resonance imaging (MRI) technique – quantitative susceptibility mapping (QSM) – in comparison with clinical data.

Materials and methods. Three groups of patients were included in this prospective study: 47 patients with relapsing-remitting MS (RRMS), 20 patients with secondary progressive MS (SPMS) and 39 healthy controls. For all patients we collected clinical data, including history of present illness (H&P) and disability degree, and performed brain MRI followed by QSM maps obtaining and assessing relative magnetic susceptibility in subcortical structures.

Results. We found an increase in magnetic susceptibility in the heads of the caudate nuclei and in putamen in patients with SPMS as compared to RRMS. At the same time, a decrease in magnetic susceptibility in the thalamic pulvinar was detected in patients with MS in the long term, but a sharp hyperintensity in conjunction with decreasing volume was observed in some patients.

Conclusion. Increased magnetic susceptibility on the QSM in subcortical structures of the brain, reflecting iron content, is more typical for patients with SPMS, which may indicate the prognostic value of these changes.

Purpose. To analyze the publications related to the technique of MRI mapping of cerebrovascular reactivity.

Materials and methods. We have analyzed 75 publications (4 Russian, 71 foreign), published in the period from 1960 to 2021 years. More than half of these articles were published in the last ten years, with 26 studies – in the period from 2016 to 2021 years.

Results. The article systematizes methods for assessing cerebrovascular reactivity and approaches to assessing cerebrovascular reactivity by MRI. The technique of non-enhanced MRI mapping of cerebrovascular reactivity with a hypercapnic challenge is described in detail; alternative vasoactive stimuli are also considered. Issues related to data processing and evaluation of research results were discussed.

Conclusion. Impairment of cerebrovascular reactivity plays an important role in the pathogenesis of cerebrovascular diseases. Over the past decades, various radionuclide and ultrasound methods have been widely used to assess cerebrovascular reactivity. In recent years the interest of researchers in MRI as a method of mapping cerebrovascular reactivity has increased significantly. Noninvasiveness, safety, absence of radiation exposure, and good tolerability are the absolute advantages of MRI mapping over other methods of assessing cerebrovascular reactivity. However, the variety of methodological approaches to MRI mapping of cerebrovascular reactivity causes significant variability in the results of the study. Standardization of the procedure should be the first step toward the introduction of MRI mapping of cerebrovascular reactivity into clinical practice.

Non-lactational mastitis is an inflammatory process in the breast tissue that is not associated with lactation. The detection of a malignant transformation during inflammation process is often difficult, because it has similar clinical manifestations. Medical approach depends on the characteristics of the processes which are received from the data obtained from radiation diagnostic methods: whether or not there is a nodular formation or infiltrate, cystic cavities, dilatation of the ducts, how the axillary lymph nodes are changed. Diagnostic errors in inflammatory breast diseases are quite common; according to the literature, errors in the interpretation of clinical, mammographic, and ultrasound signs of cancer during inflammation account for up to 53.1% of cases. Inflammation, as well as cancer, in majority of cases is accompanied by a visually detectable increase in blood flow due to proliferation and neoangiogenesis. Magnetic resonance imaging with dynamic contrast enhancement (MRI) is highly sensitive in detecting areas with increased vascularization and makes it possible to assess their nature with a high degree of probability during any changes in the structure of the breast tissue, including edema and inflammatory infiltration. MR signs that allow to make differential diagnosis are a combination of pathological accumulation and lymphadenopathy, which are coded by the BIRADS system as category 4 and only the absence of contrast agent accumulation may suggest an inflammatory nature of the changes. According to the literature, MRI-DCE is a highly sensitive diagnostic method of identifying cancer during inflammation processes. The results of 85 MR studies with clinical manifestations of non-lactational mastitis were analyzed.

The purpose of study: is to evaluate the possibilities of magnetic resonance mammography in making a differential diagnosis of non-lactational mastitis and breast cancer.

Purpose of the study: to study the possibilities of computed tomographic pericardiography in assessing the invasion of a mediastinal tumor into the myocardium.

Materials and methods. Traditional computed tomography with intravenous contrasting and direct contrasting of the pericardial cavity (computed tomographic pericardiography) were compared in a 19-year-old patient with mediastinal germ cell tumor.

Results. Due to the introduction of a contrast agent under manual pressure into the pericardial cavity, it became possible to exclude tumor invasion into the myocardium at the level of the atria. This made it possible to assess the technical feasibility of tumor removal at the preoperative stage.

Conclusion. Extragonadal germ cell tumors of the mediastinum often have an asymptomatic course, which leads to the detection of tumors that are already large in size, with signs of spread to neighboring organs and structures. Traditional computed tomography with intravenous contrast does not always allow to exclude invasion of the myocardium, pericardium and large vessels. This article demonstrates a clinical case of performing direct contrasting of the pericardial cavity (computed tomographic pericardography) in a 19-year-old patient with a germ cell tumor of the mediastinum, which made it possible to exclude myocardial invasion and subsequently successfully operate the patient.

Granulomatosis with polyangiitis (GPA) is a rare systemic disease characterized by two parallel processes: necrotizing granulomatous inflammation and low-immune vasculitis predominantly affecting small vessels. Differential diagnosis of lung lesions on CT in patients with an established diagnosis of granulomatosis with polyangiitis can be very difficult.

Purpose. Developing computed tomography criteria for the differential diagnosis of infiltrative changes in the lungs in patients with GPA and community-acquired bacterial pneumonia.

Materials and methods. 67 CT examinations of the chest by 24 patients with verified GPA with infiltrative lung lesions and 36 CT examinations by 30 patients with bacterial pneumonia without concomitant pulmonary pathology, a comparative analysis of the following characteristics of ground glass opacity symptom was performed: “location", “craniocaudal distribution”, “uniformity”, “localization”, “quantity”, “association with consolidation”, “association with pleural effusion”. CT was performed natively on a Toshiba Aquilion Prime CT scanner according to a standard examination protocol with a slice thickness of 1 mm. Statistical processing of the obtained results was carried out

using the software application RStudio, version 1.3.1093 for mac OS (RStudio, PBC). To study the relationships between two categorical variables, the χ2 independence test and the principal component method for categorical

variables were used.

Results. GPA is characterized by multiple bilateral areas of ground glass opacity compaction, often with a central location, without a statistically significant craniocaudal dependence in the lung regions. In community-acquired pneumonia, this sign is more likely to be unilateral with a peripheral location in the lower lobes of the lung. Statistically significant differences in the degree of homogeneity, combination with consolidation, pleural effusion have not been established.

Conclusion. CT reveals the characteristic features of the ground glass opacity CT sign in GPA and pneumonia, which, together with clinical and laboratory data, increase the accuracy of radiodiagnosis of these diseases.

During laparoscopic surgery for colorectal cancer, vascular structures may be incorrectly identified and damaged due to ignorance of the variant anatomy of the inferior mesenteric artery (IMA), lack of tactile sensations, narrowed field of vision, which leads to complications such as massive bleeding and intestinal ischemia. Therefore, the preoperative study of the variant anatomy of the IMA is of paramount importance. Knowing the variant anatomy of the vessels before surgery, you can make an operation plan in advance, which will ensure fast and safe vascular ligation at the required level and lymph dissection.

Aim: To develop a classification of IMA variability for practical use in operations for colorectal cancer. Optimize the standard abdominal scanning protocol to improve the accuracy of MSCT and the best visualization of the IMA and its branches.

Material and methods. From February 2013 to March 2022, 214 computed tomograms (CT) of abdominal organs with intravenous contrast were analyzed. We studied the variant anatomy of the IMA. The abdominal cavity scanning protocol was optimized using a 100 kV tube voltage, the contrast density of the NBA and its branches was compared using standard and optimized scanning protocols during a retrospective analysis of 105 CT studies of abdominal organs.

Results. We proposed the classification of structure of the IMA and its branches. This is especially important when the safe lymph node dissection along the IMA is necessary. I type – several colonic branches derivate from the IMA by independent trunks (54%); II type – all colon branches derivate from the IMA in one point like a “goose paw” (25%); III type – one colon branch departs from the IMA by a single trunk; then it divides into colonic branches (21%).

The accuracy of MSCT of the abdominal organs with intravenous contrast, which was determined by comparing the results of studies with intraoperative data, was 97.9%. The sensitivity of the method is 95.8%, the specificity of the method is 100%.

The use of a scanning protocol with a tube voltage of 100 kV makes it possible to simplify and speed up the determination of the anatomical type of structure, improve the visualization of the IMA and its branches.

Conclusion. CT with 3D-reconstruction of vessels allows the surgeon to perform an extended LND for colorectal cancer with a minimal risk of complications.

Purpose. To analyze the literature data on the use of CT perfusion in kidney diseases and to assess the future prospects of using the technique in clinical practice.

Materials and methods. In electronic databases (PubMed, E-library, Web of Science, Google Scholar), a search was conducted for published studies evaluating the possibilities of using CT perfusion in both neoplastic and non-neoplastic kidney diseases. The article analyzes the results of 40 most relevant works of Russian and foreign researchers devoted to this topic.

Results. According to the analysis of the data obtained, perfusion CT is an effective diagnostic tool in oncology: the technique allows noninvasively assessing the nature of the tumour, including differentiating benign nodes (fat-poor angiomyolipoma and oncocytoma) from renal cell carcinoma; to establish the histological variant of renal cell carcinoma and Fuhrman grade, to characterize the effectiveness of ablative techniques and systemic treatment of renal cell carcinoma. Based on the correlation of CT kidney perfusion data and the results of various methods for determining organ function, the possibility of using perfusion CT as one of the prognostic factors for determining the tactics of treatment of patients with obstructive uropathies, aortomesenteric compression, and also shows the potential of using the technique in transplantology both in patients after surgery and during the examination of donors.

Conclusions. Despite the fact that the role of CT kidney perfusion in various fields of urology and nephrology has been sufficiently studied, some important aspects of the likely application of this technique remain underestimated. Taking into account the high incidence rates and a significant percentage of localized forms of tumors, the study of the role of CT perfusion in planning and evaluating the results of nephron-sparing treatment of renal cell carcinoma may open up new prospects in optimizing surgical tactics.

Early detection of cervical (CC) and endometrial (EC) cancer recurrence in previously irradiated areas remains a difficult task for clinicians and radiologists. 18F-FDG PET-CT scope and limits in this matter are not clear yet.

Purpose. To determine ¹⁸F-FDG PET-CT significance and diagnostic value in differential diagnosis of locoregional recurrence and post-radiation tissue changes in CC and EC patients with suspected relapse in preirradiated zones.

Materials and methods. Follow-up data, including multiparametric MRI (T1-WI, T2-WI, DWI, DCE) and ¹⁸FFDG PET-CT full descriptions, were studied in 51pts., in 25(49%) CC and 26 (51%) EC Ia–IIIc FIGO, with suspected loco-regional recurrence in pre-irradiated area, 4–96 months after the end of treatment.

Adjuvant combined radiotherapy (conformal pelvic EBRT – 3D-CRT, IMRT, VMAT, endovaginal ¹⁹²Ir HDR brachytherapy) was performed in 33 (64,7%) pts. after radical surgery, adjuvant chemoradiation with Cisplatin 40 mg/m² or Carboplatin AUC2 weekly – in 8 (24.2%) of them. 18 (35,3%) pts. were treated with definitive chemoradiation, median EQD2 for HR-CTV D90 81.6 ± 4.4 Gy (CI 95% 72.4 Gy – 93.7 Gy) and 54.6 ± 3.3 Gy (CI 95% 48.8–64.2 Gy) for metastatic pelvic and paraaortic lymph nodes.

Indications for ¹⁸F-FDG PET-CT (Biograph True64, Siemens, 3.8–4.7 MBq/kg, total 169–356 MBq) in all pts. were suspicious clinical, cytological, complex ultrasound, and multiparametric MRI findings in pre-irradiated zones. Any areas of ¹⁸F-FDG pathologically increased uptake were considered hypermetabolic lesions, positive for cancer recurrence.

Results. No evidence of loco-regional recurrence in pre-irradiated zones was confirmed in 32 (62.7%) pts. Clinical, morphological and radiological signs of progression were obtained in 16 (31.3%) ¹⁸F-FDG PET-CTpositive patients, with SUV_max 2.86–8.8 in this subgroup. 18F-FDG PET-CT false-positive results were obtained in 6 (11.8%) patients, false-negative – in 1 (1.9%) heavy pre-treated CC patient. ¹⁸F-FDG PET-CT sensitivity was 94.1%, specificity – 84.2%, positive predictive value – 72.7%, negative predictive value – 96.9%.

Conclusions. ¹⁸F-FDG-PET-CT has a high diagnostic value in the differential diagnosis of loco-regional relapses and post-radiation tissue changes in CC and EC patients with suspected progression in pre-irradiated zones. But ¹8F-FDG-PET-CT findings evaluation and interpretation requires a multidisciplinary discussion and consensus for this cohort of patients.

Objective: to identify the characteristic echographic features of benign ovarian tumors using the recommendations of the IOTA group.

Materials and methods. Five articles published in the journal Ultrasound in Obstetrics & Gynecology for 2008–2019 were analyzed. Each article is devoted to a histologically verified pathology of the ovaries, representing four morphological variants of an ovarian tumor (strum, fibroma/fibrothecoma, uroepithelial tumor (Brenner's tumor) and cystadenofibroma, as well as endometrioma in pregnancy. The total number was 380 women. When describing pathological formations, the researchers used a single protocol recommended by the IOTA group. Evaluated twentyone parameters, including the morphology of the formation, the structure of fluid inclusions and the solid component, the presence of fluid in the retrouterine space and ascites, as well as the degree of tumor vascularization.

Results. The analysis of the struma, fibroma (fibrothecoma), Brenner tumor, cystadenofibroma and endometrioma of pregnant women indicates that there are no reliable criteria for diagnosing the histological structure of the tumor, both by the age of the patients, the size of the formation, and by ultrasound signs. Hyperechoic inclusions, which are noted only in Brenner tumors, both benign and malignant, can serve as the only marker among the pathology under consideration. In the study of the listed benign neoplasms of the ovaries, no features of the blood supply were revealed. All neoplasms had vascularization from the complete absence of vessels (1 point) to their moderate number (3 points). Hypervascularization (4 points) occurred in struma, fibroma (fibrotecoma), and cystadenofibroma.

Conclusions. The task of ultrasound examination is the timely detection of an ovarian tumor with a presumptive conclusion of the probability of malignancy, based on standardized protocols of the IOTA group, which is important for the correct routing of the patient. 

Goal: To develop a method for automated assessment of the volumetric bone mineral density (BMD) of the vertebral bodies using an artificial intelligence (AI) algorithm and a phantom modeling method.

Materials and Methods: Evaluation of the effectiveness of the AI algorithm designed to assess BMD of the vertebral bodies based on chest CT data. The test data set contains 100 patients aged over 50 y.o.; the ratio between the subjects with/without compression fractures (Сfr) is 48/52. The X-ray density (XRD) of vertebral bodies at T₁₁-L₃ was measured by experts and the AI algorithm for 83 patients (205 vertebrae). We used a recently developed QCT PK (Quantitative Computed Tomography Phantom Kalium) method to convert XRD into BMD followed by building calibration lines for seven 64-slice CT scanners. Images were taken from 1853 patients and then processed by the AI algorithm after the calibration. The male to female ratio was 718/1135.

Results: The experts and the AI algorithm reached a strong agreement when comparing the measurements of the XRD. The coefficient of determination was R2=0.945 for individual vertebrae (T₁₁-L₃) and 0.943 for patients (p=0.000). Once the subjects from the test sample had been separated into groups with/without Сfr, the XRD data yielded similar ROC AUC values for both the experts – 0.880, and the AI algorithm – 0.875. When calibrating CT scanners using a phantom containing BMD samples made of potassium hydrogen phosphate, the following averaged dependence formula BMD =0.77*HU-1.343 was obtained. Taking into account the American College Radiology criteria for osteoporosis, the cut-off value of BMD<80 mg/ml was 105.6HU; for osteopenia BMD<120 mg/ml was 157.6HU. During the opportunistic assessment of BMD in patients aged above 50 years using the AI algorithm, osteoporosis was detected in 31.72% of female and 18.66% of male subjects.

Conclusions: This paper demonstrates good comparability for the measurements of the vertebral bodies’ XRD performed by the AI morphometric algorithm and the experts. We presented a method and demonstrated great effectiveness of opportunistic assessment of vertebral bodies’ BMD based on computed tomography data using the AI algorithm and the phantom modeling.

The purpose of the study. To analyze the possibility of using artificial intelligence as a decision support system for radiologists for pulmonary nodules detection on Chest CT before and during the COVID-19 pandemic on the example of the system Botkin.AI.

Materials and methods. Two groups of Chest CT studies were identified: those performed before (group 1) and during the COVID-19 pandemic (group 2). Each group contains anonymized CT data of 150 patients. Chest CT scans for group 2 were selected based on the percentage of coronavirus lung damage from 0 to 25%. The research was analyzed by the artificial intelligence system Botkin. AI for the presence of peripheral pulmonary nodes up to 6 mm, followed by a “blind” check of the analysis results by three radiologists.

Results. In group 1, the sensitivity of the method was 1.0; specificity – 0.88 and AUC – 0.94. In the 2nd group 0.93; 0.81 and 0.86, respectively.

In group 2, a slight decrease in specificity is mainly associated with an increase in false positive results in the pulmonary opcities, as manifestations of coronavirus lung damage, taken by the AI model for pulmonary nodes.

Conclusion. The platform has a high accuracy of detecting pulmonary nodules on computed tomography of the chest both in studies conducted before and during the COVID-19 pandemic. It can be useful to prevent possible omissions of important findings in conditions of increased workload for radiologists.

The increase in the incidence of endometrial cancer is noted not only in postmenopausal women, but also in a socially active group of women of reproductive age, starting from 25 years. Ultrasound and magnetic resonance imaging (MRI) are the main methods of non-invasive diagnosis of endometrial cancer. Our study included 69 patients with endometrial cancer stages I–IV aged 30 to 79 years. The diagnostic informativeness of the MRI method in detecting tumor invasion into the myometrium for all groups was: sensitivity – 82.30%, specificity – 6.6%, PPV – 93.30%, NPV – 40%. The diagnostic informativeness of the ultrasound method in detecting tumor invasion into the myometrium for all groups was: sensitivity – 91.3%, specificity – 88.4%. The peculiarity of this study was to evaluate the possibilities of radiation methods (ultrasound, MRI) in the staging of endometrial cancer.