Aim: to analyze the latest research in the field of CT diagnostics of pulmonary aspergillosis in patients with COVID-19 according to domestic and foreign literature.

Results. Pulmonary aspergillosis is one of the most common life-threatening fungal diseases that is caused by inhalation of Aspergillus mold spores and affects all parts of the respiratory system. In recent years, there has been a sharp increase in cases of invasive mycotic processes. During the COVID-19 pandemic, according to a number of authors, the incidence of pulmonary aspergillosis reached 34.4%, and the mortality rate was 74%. The World Health Organization calls for “minimizing the disproportionate use of corticosteroids and antibiotics for mild and moderate cases”. She explained that corticosteroids in severe cases do save lives, but their massive use can cause fungal infections. This complication is increasingly common in patients after corticosteroid and antibiotic therapy, with immunodeficiency states, as well as those treated in intensive care units. The COVID-19 pandemic has created additional challenges in the diagnosis, treatment and prevention of fungal complications. The clinical and radiographic features of fungal infections are largely similar to typical pulmonary manifestations of COVID-19. A comparative analysis of CT signs of various forms of pulmonary aspergillosis before and during the COVID-19 pandemic was carried out according to the literature. The main CT symptoms of mycotic lung lesions among patients who have undergone COVID-19 have been identified. Currently, computed tomography is crucial, first of all, to detect and monitor complications of COVID-19, including the addition of a secondary fungal infection.

Conclusion. To make a conclusion about mycosis in the early stages, special vigilance and high qualification of the radiologist are required, which in turn will contribute to the timely appointment of antifungal therapy, which will reduce morbidity and mortality.

Objective. The purpose of this study was to determine the association between preoperative myocardial perfusion data (obtained by SPECT) with transit time blood flow characteristics in left internal mammary artery (LIMA) to left anterior descending artery (LAD) grafts in patients with ischemic cardiomyopathy.

Methods. The study group consisted of 57 patients with ischemic cardiomyopathy. Intraoperative transit-time flow measurement (TTFM) of LIMA-LAD grafts were performed in all patients. All patients were also examined with preoperative stress and rest myocardial perfusion SPECT with ^99m Tc-MIBI. Anastomotic patency was considered satisfactory with a normal waveform of blood flow, diastolic-dominant blood filling, and a mean flow value greater than 11.5 ml/min.

Results. All 57 patients with LIMA-LAD grafts were divided into two groups; those with graft satisfactory patency (n = 40) and those with unsatisfactory patency (n = 17) as determined by TTFM. We found differences among these groups in values of global summed rest score (20.7 ± 7.5 vs. 29.8 ± 4.0; p = 0.002), global total perfusion deficit (TPD) at rest (32.0 ± 11.4 vs. 43.0 ± 7.2; p = 0.01), and regional TPD at rest in the LAD territory (20.7 ± 7.5 vs. 29.8 ± 4.0; p = 0.002). Additionally, the flow characteristics were different in patients with and without surgical left ventricle reconstruction (Q (ml/min): 17 (11.5, 40.8) vs. 47 (25, 69.5), p = 0.013; PI: 3.9 (3.2, 7.4) vs. 2.4 (2.0, 3.6), p = 0.001; DF (%): 63.5 (44.5, 70.8) vs. 74 (66.0, 79.7), p = 0.019). TPD at rest was the best predictor of the LIMA-LAD graft satisfactory: area under curve = 0.771, cut-off value = 26.85 with 83.3% sensitivity and 78.1% specificity.

Conclusions. Preoperative myocardial perfusion characteristics are associated with blood flow in LIMA-LAD graft in patients with ischemic cardiomyopathy. TPD at rest (assessed globally and in the LAD region) as well as global SRS value are potential predictors of early graft failure.

Aim. To study changes in the size and linear velocities of the blood flow of internal jugular veins in patients with high degree stenosis of the extracranial carotid artery.

Methods. The study included 28 patients: 14 patients with high degree stenoses of the internal carotid arteries (70% and more by NASCET criteria) constituted group 1, 14 patients with “small” stenoses of the ICA (less than 30%) – group 2. The state of blood flow in the extracranial sections of the main arteries of the head were evaluated using ultrasound.

Results. When studying the features of venous blood flow, the following was found: in the group with unilateral hemodynamically significant stenosis, in contrast to the group of patients with “small” stenoses, the venous pressure measured on the arm was statistically significantly lower, and therefore the calculated central venous pressure, while the linear velocities of the peaks S and T were statistically significantly higher by 1 the group on the side of hemodynamically significant stenosis. On the side of contralateral stenosis in group 1, there was statistically significantly less area of VAV, and the ratio S₁/S₂, than in patients of group 2. Intra-group analysis revealed a statistically significant difference in almost all indicators in patients with hemodynamically significant stenosis compared with the contralateral side: the diameters of the vein and its area were larger, and the linear rates of the A, S and T peaks were higher. Whereas there were no statistically significant differences in the group of “small” stenoses.

Conclusion. Changes in venous blood flow in the jugular veins are interrelated with the development of high degree carotid stenosis and have diagnostic significance, can be used as an additional sign of the hemodynamic significance of carotid stenosis.

The study group included 147 patients at the stage of preparation for emergency surgical treatment of acute massive PE in the period from March 2012 to December 2019 inclusive. As CT indicators of overload of the right chambers of the heart, the usual CT indicators that do not require the use of expert – class computed tomographs were taken – they were the superior vena cava, inferior vena cava, unpaired vein; reflux of the contrast drug into the inferior vena cava; reflux of the contrast drug into the hepatic veins. In the course of the study, a comparative analysis of the average pressure in the pulmonary artery with the above CT indicators was performed. The most stable statistical relationship with the indicators of mean pressure in the pulmonary artery was demonstrated by CT parameters – the diameter of the unpaired vein and the reflux of the contrast agent into the hepatic veins. Based on the results of the work, a method for calculating the actual values of the average pressure in the pulmonary artery based on the CT parameter of the diameter of the unpaired vein is proposed.

Objective. Evaluation of diagnostic value of modern imaging modalities: trans-thoracic echocardiography (TTE), CT-angiography (CTA) and cardio-MRI in diagnosis and preoperative planning of aortic coarctation correction (CoA) in in infants and young age group children.

Materials and methods. 101 pediatric patients (aged 0 to 5 years) with CoA underwent TTE, 98 of them underwent CT, 30 – cardio MRI. On TTE, CTA and cardio-MRI aorta morphometry was performed. The most common anomalies associated with CoA (ventricular septal defect (VSD), patent ductus arteriosus (PDA), aberrant right subclavian artery (ARSA), hypoplastic arch and brachiocephalic vessels anomalies) were assessed.

Results. The overall diagnostic accuracy of TTE, CT and cardiac-MRI in diagnosis of CoA were 89.1%, 95.9%, 86.7% respectively. There was no significant difference in the accuracy in detecting CoA between TTE, CT and MRI (p > 0.05). The accuracy of TTE in determining the brachiocephalic vessels anomalies, ARSA and arch hypoplasia was 84%, 93% and 85.3%, respectively. The accuracy of CT in determining the brachiocephalic vessels anomalies, ARSA and arch hypoplasia was 100%, 100% and 98% and cardio-MRI: 97.1%, 98.4% and 96.8%, respectively.

Conclusion. TTE is a widely available and safe method, it has a high diagnostic value in determining CoA. Due to limitations in visualization of all parts of the aortic arch and the detection of concomitant anomalies, TTE cannot be the final method in planning the CoA correction. CT and MRI of the heart, as a TTE, are effective methods in the diagnosis of CoA, however, in the assessment of extracardiac anomalies, they equally show a significantly more accurate result.

Taking into account the difficulties in conducting MRI of the heart in children under one year and younger age group, the need for a longer stay in anesthesia, the lack of additional diagnostically significant information in comparison with CT of the heart, cardio-MRI is not the method of choice in the primary diagnosis and preoperative planning of correction of CoA in children under one year and younger age group requiring the use of an anesthetic aid for the duration of the scan. Cardio-MRI may be the method of choice in preoperative planning of CoA in small children with absolute contraindications to the radiocontrast agent.

In the 90s of the last century, the first isolated cases of the occurrence of T-cell non-Hodgkin's lymphoma of the breast after augmentation mammoplasty with silicone endoprostheses were identified. For many years, this disease was considered very rare and was not associated with the presence of implants. In the future, the number of patients with this pathology began to increase. In 2012, the FDA identified an association between anaplastic large cell T lymphoma and breast implants and introduced the term Breast Implant-Associatad Anaplastic Large Cell Lymphoma (BIA-ALCL), which is now recognized as a new disease by the WHO. Active study of BIA-ALCL continues today. An increase in the estimated risk of developing this severe complication of plastic surgery was noted.

Purpose: to present a literature review of materials covering the problems associated with the most severe complication of augmentation mammoplasty – BIA-ALCL; to determine the place and tasks of ultrasound in the proposed diagnostic instrumental algorithm for patients with suspected BIA-ALCL based on a set of ultrasound criteria.

Materials and methods. The analysis of literary sources on the topic "BIA-ALCL" was carried out. With the accumulation of experience in the diagnosis and treatment of patients with BIA-ALCL, the number of papers presenting clinical observations on this topic has increased in the available literature. From 2013 to December 2022, PUBmed found 324 search results in the BIA-ALCL section. The vast majority of English-language papers – about 200 – were published in 2020 and 2021. Single publications are presented in Russian.

Based on world experience in 2016, recommendations for the diagnosis and treatment of patients with BIAALCL were developed and updated in 2019. According to the literature, three criteria have been formulated that should be paid special attention in order not to miss this disease: the accumulation of a significant amount of fluid in the periprosthetic space (occurs in 60% of cases), the presence of additional masses in this fluid (8–24%), and axillary pathological lymphadenopathy (4–12%). Instrumental examination of patients with suspected BIA-ALCL is recommended to begin with ultrasound or MRI. The prevalence of the process is assessed by PET/CT.

It is necessary to raise the awareness of doctors and patients about the possibility of developing this complication of plastic surgery, to actively continue the study and search for diagnostic criteria for BIA-ALCL to identify the process in the early stages of the disease.

Objective: to assess the benefits of using contrast-enhancer spectral mammography in patients with an established category of BI-RADS 4a, 4b according to the results of a standard examination (digital mammography and ultrasound).
Materials and methods. The date of 425 patients with a suspicious category of BI-RADS in the period from 2018 to 2021 were analyzed. As part of the additional examination, all patients underwent contrast-enhanced spectral mammography follow by histological verification of the identified changes. The sensitivity and specificity of the methods were evaluated. 
Results. The final diagnosis of breast cancer was established in 247 (58.1%) patients out of 425 women. Multicenter and multifocal growth was diagnosed in 17 (6.8%) patients out of 247, and primary multiple synchronous cancer was detected in 6 (2.4%) patients out of 247. False-positive cases when assessing CESM mainly consisted of: typical and atypical ductal hyperplasia, fibroadenoma, intraductal papilloma.
Conclusion. Contrast-enhancer spectral mammography is a highly sensitive and highly specific method in the detection of malignant tumors of the breast. The method also allows minimizing the number of unwanted interventions in suspicious BI-RADS categories.

The purpose of the study is to improve the accuracy of CT diagnostics of pulmonary ACTH-Secreting Tumor.

Material and methods. During the period from 2010 to 2022 at the Endocrinology Research Centre and the National Medical Research Center of Surgery named after A. Vishnevsky of the Ministry of Health of Russia 23 patients with pulmonary ACTH-Secreting Tumor were examined and treated. CT-features were analyzed: localization, shape, contours, connection of the formation with the bronchus, connection of the formation with the vessel, adherence to the vessel and bronchus along the long axis, structure of the neoplasm. We also analyzed the largest size of the formation, the size of the largest regional lymph node, the density of the tumor on axial sections in the native, arterial, venous and delayed phases of the study.

Results. In the study, we identified a new phenotypic CT sign – the relationship with the bronchovascular bundle. The connection with the bronchus and vessel was assessed in detail. In the majority of patients, the connection with the pulmonary vessels (in most cases with small bronchial arteries) was especially clearly noted: an intimate attachment of the tumor along its long axis to the vessel. Less often it was possible to trace the connection with the bronchus.

Conclusion. ACTH-producing NET of the lung is most often a peripherally located oval-shaped formation with even/ lobulated contours, adjacent to the bronchovascular bundle along the long axis of the tumor, intensively enchancing (increase of density parameters by more than 40 HU compared with the unenhanced phase) in the venous, less often the arterial phase of bolus contrast enhancement.

Objective. Our goal was to establish common bile duct (CBD) diameter reference levels for abdominal ultrasound and percutaneous transhepatic cholecysto-cholangiography (PTCC) measurements with relevance to age and gender across the cohort of patients with underlying gallbladder disease excluding any intra- or extrahepatic bile ducts lesions.

Materials and methods. 251 symptomatic patients with gallbladder disease and no signs of choledocholithiasis or biliary obstruction presenting to Liver and Pancreas Surgery Department, Sklifosovsky Research Institute for Emergency Medicine from January 2019 to June 2023 were reviewed. All the selected subjects underwent transabdominal ultrasound examination of hepato-biliary zone and PTCC. Common bile duct diameter, if not obscured, was measured at its widest visible portion by means of electronic calipers. The relationship between CBD size, age and gender was examined by nonparametric tests across stratified groups.

Results. Mean sonographic CBD diameter was as high as 4.99 ± 1.17 mm with no evidence of correlation with age or gender. Mean cholecysto-cholangiography CBD diameter made up 6.49 ± 1.52 mm and reflected a considerable increase with age only: patients under 60 had CBD diameter significantly narrower, then those over 60. Basing upon the 95-percentile, we derived upper reference limit of 6.0 mm for US measurements without age and sex association, and for PTCC measurements regarding distinct age groups (8.0 mm in subjects < 60 years and 9.0 mm in subjects ≥ 60 years). Diameter of common bile duct was substantially higher on cholangiograms versus sonograms.

Conclusion. Present study displayed notable common bile duct diameter discrepancies not only between ultrasound and cholangiography measurements, but also throughout age-dependent groups on cholangiograms. We imply those variations to be taken in consideration in case of contrasting various radiological evaluations of common bile duct, and in case of ruling out the diagnosis of choledocholithiasis or bile flow abnormality.

Purpose of the study: to show the significance of ultrasound diagnostics in assessing the dynamics of the spleen mass coefficient in children of various age against the background of a chronic form of EBV virus.

Materials and methods. The study was performed on 146 children aged 3 to 18 years suffering from chronic EBV virus. Depending on age, the children were divided into 3 groups. Group 1 included 63 patients aged 3 to 7 years; Group 2 consisted of 28 children aged 8 to 11 years; Group 3 included 55 children aged 12 to 18 years. The clinical, laboratory and ultrasound examination was conducted including ultrasound of the spleen with the further determination of its mass coefficient (SMC).

Results. In the acute period of EBV virus, children of all age groups revealed an increase in SMC, while the maximum increase was observed in children aged 3 to 7 years and amounted to 6,88. Against the background of a complete clinical and laboratory recovery in this age group, the SMC remained at the level of 4.66 and did not reach the average values of healthy children of the same age. The follow-up dynamics for 15–18 months demonstrated the normalization of the SMC to the average values of healthy patients in accordance with their age (in children aged 12 years and older).

Findings. Children in the age group from 3 to 7 years old had the maximum value of the spleen mass coefficient, both in the acute period and after complete clinical and laboratory recovery. The use of ultrasound technique with the assessment of the spleen mass coefficient in the chronic course of EBV virus allows expanding and determining the children contingent for further dynamic monitoring for prevention of possible complications.

The article offers the latest view on possibilities of diagnostic algorithm to identify vaginal cancer (VC), rare tumor of the woman’s reproductive system. The algorithm is described as a consensus of leading expert in imaging diagnostics, as well as oncogynecologysts, investigating diagnostic challenges and vaginal cancer therapies. The article sets forth the principal trends in using imaging methods, their role and possibilities for staging VC, planning and assessing the efficacy of applied therapy, on-going surveillance over patients, who have undergone specialized anti-cancer treatment

Oxygen metabolism is a key factor in the life of a living organism. The article is the first part of a review of methods for measuring oxygen metabolism.

Purpose. The aim of this review is to present an insight into the evolution of methods for measuring oxygen metabolism in a way from global to local measurement of brain perfusion. The role of the ¹⁵O isotope as the “gold standard” for measuring oxygen metabolism using positron emission tomography (PET) is described. We also provide a case report of brain tumor perfusion measurements from our clinic.

Materials and methods. More than 200 Pubmed publications were studied with the keywords “positron emission tomography + O-15”. Relevant publications that do not contain these keywords or contain them in a different wording were also analyzed. A clinical case of a brain tumor perfusion using CT perfusion, MR-ASL and PET with H₂¹⁵O is provided.

Results. The evolution of methods for measuring perfusion, oxygen extraction, and oxygen metabolism, is described. More than 50 papers are cited depicting key advances in measurement technologies. Examples of the use of PET with H₂¹⁵O in fundamental research and clinical practice are given.

Conclusion. The obvious value of oxygen-isotope PET data is combined with the invasiveness (in some cases), technical complexity and high cost of the procedure. The second part of the review will be devoted to alternative methods for measuring oxygen metabolism, which are developing in the 21st century and which are intended for wide clinical use.

The aim of the study is to develop a method for detecting areas of text with private data on medical diagnostic images using the Tesseract module and the modified Levenshtein distance.

Materials and methods. For threshold filtering, the brightness of the points belonging to the text characters in the images is determined at the initial stage. The dynamic threshold is calculated from the histogram of the brightness of the pixels of the image. Next, the Tesseract module is used for primary text recognition. Based on the tag values from DICOM files, a set of strings was formed to search for them in the recognized text. A modified Levenshtein distance was used to search for these strings. A set of DICOM files of the “Dose Report” type was used to test the algorithm. The accuracy was assessed by experts marking up blocks of private information on images.

Results. A tool has been developed with a set of metrics and optimal thresholds for choosing decisive rules in finding matches that allow detecting areas of text with private data on medical images. For this tool, the accuracy of localization of areas with personal data on a set of 1131 medical images was determined in comparison with expert markup, which is 99.86%.

Conclusion. The tool developed within the framework of this study allows identifying personal data on digital medical images with high accuracy, which indicates the possibility of its practical application in the preparation of data sets.

Background. To evaluate the diagnostic accuracy of radiologists with a wide range of experience and training in emergency neuroradiology and other specialty hospitals, as well as the level of inter-experts’ agreement regarding CT signs of ischemic stroke.

Material and methods. Our study included a retrospective cohort of 100 patients who underwent NCCT, CT angiography (mCTA) and CT perfusion in St. Petersburg clinical hospital. Fifty patients had confirmed middle cerebral artery ischemic stroke. The study also randomly included fifty patients in whom this diagnosis was excluded, including on the basis of dynamic follow-up as part of further clinical evaluation and follow-up CT scan of the brain. All 100 CT were reviewed by 21 radiologists who independently assessed each study for CT evidence of ischemic stroke. Statistical analysis included the Kappa-Fleiss coefficient ( ) calculation of agreement for each sign of ischemic stroke, specificity, sensitivity, and accuracy of detection of these changes.

Results. The staff radiologist’s mean experience in emergency neuroradiology affects both diagnostic performance and consistency for detection of most CT features of ischemic stroke. At the same time, experience does not affect the diagnostic efficiency of radiologists with no experience in stroke assessment. The most highly specific and reproducible sign of ischemic stroke was the hyperdense middle cerebral artery sign, and the most ambiguous diagnostic sign was the gyral effacement. At the same time, all radiologists, regardless of length of service record and experience in emergency neuroradiology, are prone to over-diagnosis.

Conclusion. Further search for tools and solutions is needed to level out interexpert variability regarding assessment of ischemic CT signs, since this problem has high clinical importance.

Goal of research. Evaluation of MRI, CT parameters after chelation and hemoexfusion therapy in patients with iron overload, identification of the prognostic value of CT indicators in the assessment of moderate and severe iron overload.

Materials and methods. The design of the study is prospective. The study included 43 patients with hereditary hemochromatosis (HH), secondary transfusion-dependent hemochromatosis (TDH) receiving regular hemotransfusions, iron chelators. We evaluated age, frequency of hemotransfusions, chelating drug used. CT was performed on a two-energy computer tomograph Siemens Somatom Definition 128. 27 patients (62.8%) reached repeated CT. MRI was performed on a Siemens Magnetom Espee high-field tomograph with a magnetic field induction of 1.5 T.

Results. The median age was 34.00 [33.00; 53.50] for HH and 52 [36.00; 62.00] for TDH. After therapy in the general group, T2* values increased by 26%, LIC decreased by 21.2%, DEDHU 140 and 80 mean by 17.6%, DERHU 140 and 80 mean by 3%, DEIHU 140 and 80 mean by 92.8%, 80 max by 3%, DEDHU 140 and 80 max by 19%, DERHU 140 and 80 max by 2.5% after therapy. In patients with HH, liver T2* increased by 4.6 times, LIC decreased by 5.5 times, DEDHU 140 and 80 mean by 35.1%, DERHU 140 and 80 mean by 7.8%, DEIHU 140 and 80 mean by 93.6%, DEDHU 140 and 80 max by 29.3%, DEIHU 140 and 80 max by 21.6%. In patients with TDH, LIC decreased by 18.9%, DEIHU 140 and 80 mean by 92.2%. A value of 80 mean ≥ 85.5, 140 mean ≥ 71.5, M0.3 mean ≥ 76, DEIHU 140 and 80 mean ≥ 0.007996 and DEDHU 140 and 80 mean ≥ 18.5 predict the probability of severe iron overload.

Conclusion. In patients after chelation therapy and hemoexfusion therapy, MRI and CT indicators decrease. The values of CT 80 mean ≥ 85.5, 140 mean ≥ 71.5, M0.3 mean ≥ 76, DEIHU 140 and 80 mean ≥ 0.007996, DEDHU 140 and 80 mean ≥ 18.5 can predict LIC values of more than 11 mg/g.

Contrast-free MR-perfusion of "labeled arterial blood spins" ("ASL-perfusion") is an MR-technology for qualitative and quantitative assessment of tissue perfusion properties based on of arterial blood proton spins labeling by radiofrequency pulses and their subsequent measurement when passing through the area of interest. The most of ASL-perfusion application clinical data referred to central nervous system diseases diagnostics, but some works showing the effectiveness of this technique in assessment of skeletal muscle perfusion and diagnostics of soft tissue tumors appeared recently.

Two presented clinical cases (soft tissue tumor and post-traumatic benign changes) demonstrate the possibility of this technique usage to assess vascularization of pathological changes in hip soft tissues.