The purpose of this single-centre, prospective, comparative study was to evaluate the pattern and severity of the brain structural changes in patients with resistant hypertension based on MRI assessments and their changes one year after renal denervation.

Material and Methods. The study comprised 53 patients with resistant hypertension (RH), aged 52.1 ± 9.1 years, who underwent renal denervation (RDN) following the Good Clinical Practice guidelines. Patients underwent office blood pressure measurements, 24-hour blood pressure monitoring (BPM), and brain MRI scanning. Using brain MRI, the cerebrospinal fluid (CSF) system measurements, the presence and severity of periventricular white matter lesion and focal changes in the brain white matter were evaluated.

Results. Initially, patients with RH had a high incidence of the structural brain alterations: 43 (81%) patients with fine focal brain lesions, 43 (81%) patients with enlarged CSF spaces, and 48 (90%) patients with periventricular white matter lesions. After renal denervation, a significant hypotensive effect was noted. According to brain MRI, the number of patients without enlarged CSF spaces did not change significantly: 15 (25%) patients initially, and 12 (20%) patients a year later (χ² = 0.63, р = 0.43 и χ² = 0.72, р = 0.40). The incidence of periventricular white matter lesion did not significantly change one year after RDN; however, the incidence of fine focal brain lesions significantly decreased in 21 patients (81% to 60%, p = 0.02).

Conclusion. Thus, it has been revealed that patients with resistant hypertension are characterised by a high incidence of structural brain alterations based on MRI assessments. Bilateral renal denervation is followed by a significant decrease in the incidence of fine focal brain lesions, without a significant change in the cerebrospinal fluid volume one year after the procedure.

Atrial fibrillation (AF) is the most common cardiac arrhythmia, accompanied by significant morbidity and mortality among the entire population. In AF, it is the left atrium (LA) that is considered as a critical indicator of the development of adverse cardiovascular events. LA dilation followed by electrophysiological remodeling is a frequent observation in patients with AF.

Thus, echocardiography (EchoCG) is of particular interest, in particular, the use of two-dimensional and threedimensional Speckle tracking echocardiography (STE) to study the morphofunctional state of LA at the patient's bedside.

Currently, several major lecture reviews on echocardiographic assessment of LA function are presented in the domestic literature, but individual methods of radiation imaging and their correlation with each other have not been studied, there are only a couple of foreign meta-analyses on the assessment and analysis of the functional state of LA in patients with AF. This problem is relevant, since the establishment of predictors of AF at an early stage, in particular with its latent course, makes it possible to prevent the development of a number of complications associated with arrhythmia from ischemic strokes to sudden cardiac death.

The purpose of this literature review is to present the data of recent studies on the assessment of the structure and function of LA using STE to identify patients with asymptomatic AF or a high risk of its recurrence after ablation procedures.

Cardiovascular disease is one of the most frequent cause of death globally. The greatest part is occupied by ischemic heart disease. HIV patients are composed to a higher risk of coronary heart disease.

The purpose of this work is to evaluate the possibility of using molecular imaging methods in a comprehensive examination of patients with HIV infection and ischemic heart disease.

Materials and methods. The survey group includes 32 patients with HIV infection. The comparison group consists of 25 age-matched patients with coronary heart disease and without HIV Infection. All patients were underwent myocardial perfusion scintigraphy using single photon emission computed tomography. Positron emission tomography with FDG were performed if necessary to assess the viability of the myocardium. The patients of the main group undergo diagnostic coronary angiography and standard set of laboratory and institutional diagnostic methods.

Results. The results of which confirm the high efficiency of radionuclide diagnostic methods for detecting perfusion disorders, contractility and myocardial viability in patients with HIV infection even at an early stage. They can be recommended for using in a comprehensive examination of patients with HIV infection.

Purpose: to compare the indicators of elasticity of the thoracic aorta, determined by ECG-Gated-CT angiography, in patients with ascending aortic aneurysm and dilatation.

Materials and methods. The study included 20 patients with dilatation of the ascending aorta (40 mm ≤ maximum aortic diameter (D_max) < 50 mm) (group 1a), 30 patients with non-syndromic aneurysms of the ascending aorta (n = 30, D_max ≥ 50 mm) (group 1b), as well as 19 patients with normal aortic sizes (D_max < 40 mm) as controls (group 2). All patients underwent multispiral computed tomography angiography of the aorta in ECG-Gated mode (ECG-Gated -CT). Maximum systolic and diastolic aortic diameters (D_max) were measured at different levels of the thoracic aorta, followed by calculation of the difference between them and calculation of the circular deformation (CS), compliance, stiffness (Stiff), wall distensibility, longitudinal deformation (LS).

Results. Moderate negative correlation between the age of the patients and CS at all levels of the thoracic aorta (r_maximum = –0.33, r_minimum = –0.41) was revealed. Groups 1a and 1b did not differ significantly in all parameters. Group 1a differed from the control group (p < 0.05) in Stiff at the level of the aortic annulus (AA) (0.07 [–0.14; 0.15] vs –0.04 [–0.1; 0.06]), as well as CS at the level of AA and sinuses of Valsalva (SV ) (0.49 [–2.94; 3.36] vs –1.18 [–4.51; 3.87]), and group 1b – in CS at the level of SV (3.73 [0.24; 6.56] vs 0.13 [–1.42; 3.04]) and proximal part of the descending aorta (distal to the left subclavian artery) (5.48 [1.27; 8.40] vs 1.97 [–0.32; 6.08]), also in LS (5.96 [–8.98; 9.25] vs –2.58 [–7.75; 1.89]) at the level of the aortic arch.

Conclusion. According to ECG-Gated-CT angiography, the indicators of elasticity of the thoracic aorta in patients with ascending aortic aneurysm and dilatation did not differ. Compared with the control group, patients with aneurysm of the ascending aorta showed an increased pulse deformity of the non-dilated aortic arch.

Goal. To analyze the evolution of the myocardial contraction force through the assessment of kinetic energy in patients with aortic stenosis based on intraventricular blood flows

Material and methods. According to the selection criteria, 21 healthy volunteers (age 34 ± 3) and 105 patients with aortic stenosis (age 62 ± 4) were examined before and after surgery for 7–10 days. Transthoracic echocardiography was performed on a Vivid E9 device in 2, 3 and 4 chamber positions with registration of intraventricular blood flows, calculation of the rate of change in volume and kinetic energy depending on the left ventricular EDV, pressure gradient (ΔP) on the aortic valve with an assessment of the displacement of the left ventricular endocardium contour, based on technologies for tracking speckles of ultrasonic images in the MultiVox program.

Results. Our goal was to quantify kinetic energy (KE) during the entire cardiac cycle of the left ventricle (LV) using echocardiography. One of the main strengths identified in these studies is the high reproducibility of the assessment of LV blood flow and hemodynamics the average coefficient of variability 7 ± 2% for assessing LV function. Studies have shown increased diagnostic reliability without spending additional time. In systole, the KE before the LV operation was higher than normal values (0.62–0.78 J) after the operation, the KE approached the norm, averaging 0.55 J.

Conclusion. Changes in intraventricular blood flow in patients with pressure overload of the heart demonstrate higher systolic energy compared to the control group. Different time values of energy in systole and diastole, observed in patients before surgery, represent an objective approach to assessing the work of the heart. The energy analysis reflects earlier signs of mechanical myocardial disorders, compared with the ejection fraction and, possibly, predict the development of cardiac remodeling. Adequate correction of the defect normalizes the work of the heart already in the early postoperative period.

The aim of this study was to analyze the patterns of changes in the fat fraction of the vertebral bodies according to the modified DIXON protocol (mDixon, MRI) in patients of different age groups with densitometry data.

Materials and methods. In the course of our study, a Siemens Magnetom Verio 3T tomograph was used for diagnostics, for assessing the condition of the vertebrae of the lumbosacral spine, measuring FF, a computer program was used: “RadiAnt DICOM viewer”. DIXON (two-point) parameters of TSE pulse train with T2 type of weighting: TR 4000 ms, TE 88 ms, slice thickness 4 mm, matrix 320 × 320, NEX 1, FOV 260 × 260 mm, pixel size 0.8 × 0.8 mm, bandwidth 345 Hz/pixel. Scanning time: 3 min. 50 sec. We also used a GE Lunar Prodigy densitometer. Measurement parameters: mode – standard (13–25 cm), length 19.1 cm, width 18.0 cm. Method: mDixon.

Results. 71 patients were examined (average age is 57 years; average BMI (body mass index): 27.94). Osteopenia was diagnosed in 21 patients, osteoporosis – in 13. Bone mineral density (BMD) was obtained using X-ray densitometry, which served as a reference for detecting abnormal bone density and osteoporosis. A comparison was made of BMD values in patients with normal and patients with osteoporosis / osteopenia: the values in patients with normal were 21.85% higher than in patients with osteoporosis / osteopenia. We also compared the parameters of vertebral fat density (FF) in patients with normal and pathology – the values in patients with normal were 15.65% less than in patients with pathology. Correlation analysis revealed a relationship between BMD and FF parameters. According to the results of the morphometry of the vertebral bodies, wedge-shaped deformity of the vertebral bodies was revealed in 8% of patients with osteoporosis / osteopenia.

Conclusions. The MRI method based on the DIXON trace is of great importance in the diagnosis of changes in the spongy substance of the vertebral bodies. In the study of correlation analysis, an inverse relationship was found between the BMD and FF parameters.

Purpose: To compare the reproducibility of texture features during segmentation of CT and MR images of hepatocellular cancer (HCC) by two radiologists. Evaluate the possibility of images pre-processing to improve the reproducibility of texture features.
Material and methods. We included 66 patients with preoperative CT and MR images, followed by surgical liver resection for HCC, indicating the tumor histologic grade. Two radiologists with 3 and 6 years of abdominal imaging experience independently segmented the entire tumor volume on CT and MR images. The calculation of texture features was performed without the use of images pre-processing and using a spatial resampling with fixed voxel size of 1 mm³ (RES), a Laplace Gaussian filter, and for CT images, also with a density threshold from 0 to 300 HU (0–300 HU). The agreement between measurements of radiologists in relation to texture features was carried out using the type 2 intra-class correlation coefficient (ICC).
Results. The highest percentage of reproducible texture features with the use of image preprocessing was observed with CT in the arterial phase (0–300 HU + RES) (89.1%), and with MRI in the hepatobiliary phase (RES) (86.6%). At the same time, spatial resampling with fixed voxel size of 1 mm³ increased the percentage of reproducible texture features in the native, arterial, and delayed phases in CT, as well as in T2-WI, DWI, and in the hepatobiliary phase for MRI.
Conclusion. Thus, both techniques, CT and MRI, make it possible to extract reproducible texture features, especially with the use of spatial resampling with fixed voxel size. In this case, preference should be given to a postcontrast images, including the hepatobiliary phase. In CT, it is also advisable to use a density threshold from 0 to 300 HU for the selected area of interest, which will avoid affecting the texture features of adjacent organs and adipose tissue and increase the reproducibility of textural features. 

The purpose of the study. To study the possibilities of computed tomography (CT) in the diagnosis of spontaneous hematoma of the esophagus, including in the process of dynamic observation.

Materials and methods. A retrospective analysis of CT results in 11 patients with spontaneous esophageal hematoma treated at the N.V. Sklifosovsky Research Institute of SP in the period 2005–2020 is presented. All patients underwent a comprehensive laboratory and instrumental examination, including CT. CT studies were performed with oral and intravenous bolus contrast, primarily at admission and in dynamics.

Results. In all cases, according to CT data, acute pathology of the aorta, rupture of the esophagus were excluded and signs of spontaneous hematoma of the esophagus were revealed. CT semiotics of esophageal hematoma was analyzed with quantitative treatment of changes in density, linear dimensions and volume. CT semiotics analysis also revealed the volumetric effect of hematoma on surrounding organs and structures, accumulation of blood in the pleural cavities, and verified signs of infection of hematoma with inflammatory changes in the surrounding paraesophageal tissue. CT data served as the basis for determining the optimal treatment tactics for spontaneous esophageal hematoma. Conservative therapy was the main method of her treatment. CT examination in dynamics allowed timely detection of complications of spontaneous hematoma of the esophagus (hemothorax, perforation of the esophagus, infection of the hematoma) requiring surgical intervention.

Conclusion. CT is the method of choice in the diagnosis of spontaneous hematoma of the esophagus, which allows for a clear differential diagnosis with urgent life-threatening conditions. CT data make it possible to justify treatment tactics and assess the dynamics of the pathological process.

Purpose of the study: to determine the role of multislice computed tomography (MSCT) in the diagnostic algorithm for the management of patients with acute adhesive small bowel obstruction.

Materials and methods. The study included 168 patients undergoing inpatient treatment from 2015 to 2019 with a diagnosis of acute small bowel obstruction. The obturation form of acute adhesive small bowel obstruction (AASBO) was detected in 151 patients, while 17 patients have strangulation form of obstruction. The study compared two groups of patients who differ in the examination algorithm:

Group I – “traditional” approach – 74 patients who used X-ray (plain radiography, with passage assessment) and ultrasound to diagnose intestinal obstruction.

Group II – “proposed” algorithm, included 94 patients whose diagnostic complex, in addition to the methods described above, was supplemented with MSCT with enterography.

Results. In the group of "proposed" algorithm, the sensitivity, specificity and accuracy of MSCT was 99.7%, 86.6%, 97.8%, respectively, in the diagnosis of the obturation AASBO, and the resolution of the obstruction was detected significantly earlier than in the "traditional" group (p = 0.0081).

Conclusion. Computed tomography is the most accurate method of diagnosing the presence, cause and level of intestinal obstruction; in addition, it is the most effective way to evaluate the efficacy of conservative therapy.

Introduction. Survival rates and treatment algorithms for patients with bladder cancer (BC) depend on the depth of tumor invasion, in particular on the presence of the bladder muscle layer invasion and extraorganic spread. To assess the depth of bladder invasion, the VI-RADS system was developed in 2018, which is based on multiparametric MRI (mpMRI). According to published studies on the VI-RADS effectiveness, there is a high diagnostic accuracy for identifying formations with probable invasion into the muscle layer. The data on BC extraorganic spread are limited and the issue of assessing the sensitivity and specificity of this system requires further study.

Aim of the study. To evaluate the diagnostic performance of mpMRI using the VI-RADS system in detecting muscle invasion and BC extraorganic growth.

Materials and methods. A prospective study was conducted in the clinics of the National Medical Research Radiological Centre and included 75 patients aged 19 to 85 years, of which 39 (52%) had been newly diagnosed with BC, 36 (48%) had a relapse or continuous tumor growth. All patients underwent pelvic organs mpMRI on a tomograph with a magnetic field induction of 1.5T, followed by transurethral resection (TUR), TUR-biopsy of the bladder or cystectomy no later than 6 weeks after scanning.. The description of the bladder tumor included its measurements, localization and VI-RADS scale assessment. The data obtained by mpMRI were compared with the results of the morphological study using statistical analysis.

Results. According to the results of the study, the overall VI-RADS scale sensitivity for categories above 3 (the presence of muscle invasion is equivocal) was 95.15% [90.11%; 99.95%], above 4 (muscle invasion is likely) – 92.59% [82.11%; 97.94%], specificity was determined at the level of 47.62% [25.71%; 70.22%] and 80.95% [58.09%; 94.55%] respectively. When assessing extraorganic spread in 30 patients, the sensitivity was 83.33% [62.62%; 95.26%], specificity – 83.33% [35.88%; 99.58%]. The accuracy and positive predictive value also had high levels from 80 to 95%, in contrast to the negative predictive value (55.56%).

Conclusion. The scale for BC invasion depth assessing VI-RADS is characterized by high rates of sensitivity, specificity and accuracy, in particular when used in determining extraorganic spread.

Research objective. To study the features of visualization of ischemic stroke in children at the early stages of the formation of the pathological process using magnetic resonance imaging.

Material and methods. The results of magnetic resonance imaging (MRI) examination of 34 children with clinical manifestations of ischemic stroke (IS) were analyzed. The analyzed group included patients aged from the 29th day of life to 18 years who had focal changes in the brain substance (BS) during an MRI examination within a period of not more than 48 hours from the onset of neurological symptoms.

Results. MRI makes it possible to establish in the early stages of the development of the pathological process the ischemic lesion of the BS in 100% of cases, as well as to evaluate the time indicators of the occurrence of focal changes, based on the analysis and comparison of pulsed MRI sequences, which allow characterizing the severity of the process.

Discussion. The analysis of data obtained confirms the results of studies described earlier in the foreign and domestic literature. Moreover, there is a difference in the MR signal specifications from the IS focus during the first 6 hours upon occurrence of the neurological symptoms.

Conclusions/findings. The MRI studies in children are important and necessary to determine the IS formation, evaluate the onset and dynamics of the pathological process that contribute to the timely detection of focal changes in the brain structures at the early stages. 

Aim: to present a new method for assessing glucose catabolism in brain tissues of healthy volunteers and neurooncology patients. This method is MR spectroscopy with resonance frequency of deuterium (hydrogen isotope) called deuterium metabolic imaging - DMI.

Material and methods. We searched scientific papers in PubMed and Google Scholar indexing systems for 2017–2022 publicatioin years. Keywords used: deuterium spectroscopy, DMI, DMV, PET, non-proton spectroscopy, brain tumor metabolism, Warburg effect in brain tumor, glucose/glucolytic flux/metabolism.

Results. 474 articles were analyzed, 21 of which were used for this review. The references list additionaly includes 9 articles for 1924–2014 pyublication years. The review covers the history of proton and multinuclear MR spectroscopy (phosphorus, carbon, deuterium) development of and PET diagnostics. We described DMI applicability in visual and quantitative assessment of tissue metabolism disorders in brain tumors and discussed its future use in clinical practice.

Conclusion. Compared to fluorodeoxyglucose (FDG) PET, the DMI method provides additional information on metabolic disorders during anaerobic glycolysis in a tumor. DMI can be implemented and performed on clinical MRI scanners.

Purpose: To analyse the prognostic value of the initial volumetric PET biomarkers – the total metabolic tumor volume (MTV) and the total lesion glycolysis (TLG) – in classic Hodgkin's lymphoma (cHL) and determine their optimal threshold values for prognosis.

Material and methods. This retrospective study included 62 cHL patients with different stages who underwent staging with ¹⁸F-FGD PET/CT. The follow-up period was from 6 to 61 months after the baseline PET/CT, 41 patients remained in remission, 10 patients had refractory course, 11 relapsed. The examinations were processed with automatic (multi-foci segmentation – MFS) method to obtain MTV and TLG using two fixed absolute thresholds (SUV_max ≥ 2.5 and SUV_max ≥ 4.0) and one relative threshold (41% of SUVmax).

Results. In subgroups with disease remission (n = 41) and refractory course or relapse (n = 21), statistically significant differences between MTV and TLG with the two thresholds were found – SUV_max ≥ 2.5 and 41% of SUV_max (p < 0.05). When using threshold of SUV_max ≥ 4.0 statistically differences between the mean of MTV and TLG were no detected.

Univariate analysis revealed correlation between progression-free survival and volumetric PET biomarkers (MTV and TLG) with three thresholds (SUV_max ≥ 2.5, SUV_max ≥ 4.0, and 41% of SUV_max).

Conclusion. In cHL high values of initial volumetric PET biomarkers – MTV and TLG – calculated with three thresholds (SUV_max ≥ 2.5, SUV_max ≥ 4.0, and 41% of SUV_max) are associated with unfavourable prognosis – a high probability of refractory disease course or relapse.

The optimal prognostic thresholds values of MTV and TLG in the analysed group were determined respectively: SUV_max ≥ 2.5 – 204 cm³ and 961, at 41% of SUVmax – 105 cm³ and 620.

Purpose of the study: To determine the possibility of a non-invasive evaluation of the biologically active substances (BAS) effect on the rate of a pH level restoration in a muscle after a maximum load using 1H magnetic resonance spectroscopy (MRS).

Materials and methods. Creatine monohydrate and beta-alanine were taken as tested biologically active substances, used according to the manufacturer's recommendations. At the first stage, calibration curves of a pH dependence on the magnitude of chemical shifts were plotted during assigning 1H spectra of model carnosine dipeptide solutions for non-invasive determination of intramuscular pH. Further experiments were carried out on laboratory animals (mice) using a 9 T NMR spectrometer Bruker Advance III WB 400MHz WB (Bruker, Germany). In experiments on volunteers the functional test pwc170 was used for assessing the ergogenic effects of biologically active substances on rectus quadriceps femoris. The test allows to achieve the level of myocytes cytoplasm acidification with lactate, and the effectiveness of functional biologically active substances on endurance, and also the function of aerobic systems by the muscle pH rate of recovery. Detection was performed using a high-field magnetic resonance imaging scanner (Philips Healthcare, Achieva 3.0T, North Braband, The Netherlands) and two SENSE Flex-L surface ring radiofrequency coils.

Results. The effect of oral intake of creatine and beta-alanine on the restoration of rectus quadriceps femoris muscle pH after an acidification of the myocytes cytoplasm with lactate was evaluated using the 1H MRS method. Reproducible results with optimal signal-to-noise ratios and width of carnosine spectral peaks were achieved in volunteers using individual protocols and 1H MRS at 3T in the quadriceps femoris. Animal experiments have highlighted the need to develop and use more accurate techniques for voxel extraction and fat suppression during in vivo 1H spectroscopy to reliably capture the chemical shifts of carnosine peaks.

Conclusion. The data obtained using 1H MRS on volunteers allow us to conclude that the developed method makes it possible to non-invasively assess the effect of biologically active substances on the rate of restoration of pH level in a muscle after a critical load in real time in vivo.