Purpose. Assessment of MRI manifestation including fractional anisotropy within nucleus of destruction after focused ultrasound thalamotomy and estimation of its correlation with tremor severity.

Material and methods. 7 patients with clinically approved Parkinson's disease were included. MRI examinations of the brain were performed before FUS-thalamotomy, within 3 hours, after 24 hours, after 3 and 6 months after the operation. The study protocol included routine MR sequences; fractional anisotropy maps were generated. Before surgery, after a day, 3 and 6 months, the severity of tremor was assessed by the CRST scale; CRST values correlation with the values of fractional anisotropy, as well as the correlation of the coordinates of the destruction focus with the residual therapeutic effect of the operation was estimated using a linear regression model.

Results. The general patterns of the MRI manifestation were revealed: the appearance after the operation of the nucleus of destruction with the accumulation of paramagnetic substances in the structure and perifocal edema. The severity of the MRI-changes reached a maximum one day after the operation, regressed and were practically not visualized after 3 and 6 months. There was a high correlation between the volumes of the nucleus of destruction and perifocal edema, no correlation between the severity of tremor and the values of fractional anisotropy in the nucleus of destruction, a weak correlation between the localization of the nucleus of destruction and the value of the residual therapeutic effect of FUS-thalamotomy 6 months after surgery.

Conclusions. The MRI manifestation during 6 months after FUS-thalamotomy had a similar character in all patients, reached a maximum severity one day after the operation and had gradual regression. Fractional anisotropy values did not correlate with tremor severity. For a prolonged therapeutic effect the contribution of the localization of the focus along the sagittal axis is possible.

The purpose of the study was to evaluate the possibilities of MRI in determining the stage of hemorrhagic stroke (HS) depending on structural and perifocal changes in children.

Materials and methods. The study included 46 patients (including 19 boys and 27 girls) aged from the 29th day of life to 18 years, with a clinical picture of cerebrovascular accident and the presence of HS in the brain substance (BS) during an MRI study. For statistical analysis, patients were divided into two groups: group 1 – patients examined in the first 48 hours from the onset of neurological symptoms (21 people), group 2 – after 48 hours (26 people). Comparison in two groups was carried out according to MR signs: the presence of perifocal cytotoxic edema, the presence of perifocal hemorrhagic impregnation, the presence of a cytoplasmic rim. Intergroup comparisons on a qualitative basis were carried out using Fisher's exact test.

Results. As a result of the study, differential diagnostic criteria for the stages of HS in children were determined by analyzing the MRI semiotics of hematoma in combination with the symptom complex of perifocal changes (CPC) in the form of perifocal cytotoxic edema, perifocal hemorrhagic impregnation and cytoplasmic rim. Statistically significant differences in the frequency of occurrence of signs of perifocal cytotoxic edema and perifocal hemorrhagic impregnation in the groups were found. The presence of perifocal cytotoxic edema was statistically significant (p = 0.027) more common in group 1 (47% (n = 10), 95% CI 26–69) than in group 2 (16% (n = 4), 95% CI 5–36). The presence of perifocal hemorrhagic soaking was statistically significantly (p = 0.003) more common in group 1 (81% (n = 17), 95% CI 57–93) than in group 2 (36% (n = 9), 95% CI 18–57). In addition, a statistically significant (p = 0.005) difference was found in the incidence of CPC, which was observed in group 1 (28% (n = 6), CI 12–52) and was not observed in group 2 (0%, (n = 0), 95% CI 0–17).

Conclusions. The use of T2, T1, FLAIR, SWI and DWI modes (b = 1000) in combination with ADC in the protocol of MRI examination of children is mandatory, and only a comparison of the characteristics of the MR signal from a hematoma in combination with an analysis of perifocal changes allows us to differentiate the stage of hemorrhage. HS in the acute and early subacute stages has a similar MRI semiotics, therefore, it is necessary to assess the complex of perifocal changes, which allows to differentiate these stages, as it is determined in patients examined in the first 48 hours (p < 0.05) and is not observed after two days. SWI analysis makes it possible to differentiate the late subacute stage of hematoma from chronic due to different characteristics of the MR signal, and also allows you to establish the presence of perifocal hemorrhagic impregnation, which contributes to the differential diagnosis of hemorrhage in the early stages of the pathological process.

A rare clinical case of thrombosis of varicose superior ophthalmic vein in combination with a unilateral venous anomaly of the subcortical region of the brain with successful antithrombotic therapy is presented. Varicose veins of the superior ophthalmic vein are rare (2% of all orbital formations) and are a risk factor for thrombosis.

Material and methods. A 41-year-old patient with verified thrombosis of unilateral orbital venous varicose veins was observed for 9 months. Initially, MSCT of the brain and MSCT angiography were performed, then dynamic monitoring was carried out by performing MRI of the brain and MR venography, and finally an ultrasound examination of the orbit was performed.

Description of a clinical case. The clinical presentation consisted of a slight non-pulsatile unilateral exophthalmos, mild ptosis, periorbital soft tissue edema, subconjunctival hemorrhage, paraorbital hematoma, and venous dysfunction in the fundus. MSCT and MSCT angiography revealed a thrombus inside the sac of orbital venous varicose veins. The disease was probably secondary in nature, given that it was combined with venous angioma of the subcortical region on the same side. During 9 months of observation, to monitor the effectiveness of therapy, MRI was performed three times before and after contrast enhancement, which showed a gradual decrease in exophthalmos, the size of the thrombus and the varicocele sac, which was accompanied by a gradual improvement in the clinical picture until subjective recovery.

Conclusion. MRI was as good an imaging modality as MSCT, and, in our opinion, more preferable due to the absence of radiation exposure and the need for iodine contrast agent.

Objective: To assess the possibilities of various methods for analyzing the functional integration of large-scale brain neural networks in healthy subjects according to functional MRI resting state.

Material and methods. Functional MRI at rest was performed on 28 healthy male subjects aged 27.4 ± 5.1 years, without bad habits and craniocerebral injuries. A functional evaluation of large-scale neural networks included in the triple network model was carried out: default mode network, salience network, executive control network.

Results. The analysis of independent components made it possible to fully identify the default mode network and the salience network, however, the executive control network were partially identified, and this mainly concerned structures with a bilateral location. Graph analysis has identified structures of greatest value for neurofunctional research. Almost all structures that have the highest graph indicators are related to the executive control network. The results of the Roi-analysis showed the interaction between all large-scale networks, which indicates their joint work in providing important brain functions. It was also determined that in healthy people, all structures within large-scale networks are functionally interconnected.

Conclusion. Different methods of resting functional MRI data analysis reveal different aspects of connectivity in the brain, completely different principles are involved in the processing of each method, and the final quantification parameters also vary depending on the preferred method. Currently, there is no single method that in itself would be considered the standard of analysis. Applying multiple methods to the same dataset can produce more informative results.

Purpose of the study: to identify diagnostic effectiveness of the CT perfusion method in diagnosing squamous cell carcinoma of the oropharynx and in assessing dynamic changes in the affected area after chemoradiotherapy.

Materials and methods. The results of CT perfusion and CT with intravenous contrast were analyzed in 27 patients aged 40 to 76 years, who were divided into three groups: 1) a control group of patients with suspected oropharyngeal tumors – 9 people (33.4%); 2) group of primary (untreated) patients – 8 people. (29.6%) with a verified diagnosis of squamous cell carcinoma; 3) a group of patients with this diagnosis only after chemoradiotherapy – 10 people (37.0%).

Results. Our own algorithm for CT perfusion of the oropharynx region was developed. Digital indicators characterizing the presence of tumor tissue in the tissues of the oropharynx were determined: arterial blood flow (AF) and blood volume (BV). When studying CT perfusion indicators, the following was established: in the group of untreated patients, in contrast to the control group of patients, the values of equivalent blood volume (BV), arterial blood flow velocity (AF) and permeability (FE) were statistically significantly increased. Whereas in patients after chemoradiation treatment, compared with the group of untreated patients, CT perfusion indices were statistically significantly reduced in the following parameters: equivalent blood volume (BV), arterial blood flow velocity (AF). The vascular permeability indicator (FE) is only of secondary importance in identifying the tumor process. Analysis of the results of CT perfusion in patients after chemoradiation treatment revealed an almost complete restoration of tissue perfusion indices in terms of AF and BV relative to perfusion indices in patients in the control group.

Conclusion. The results of our study indicate the diagnostic effectiveness of CT perfusion in detecting oropharyngeal cancer and in assessing the corresponding changes in the affected area that occur after chemoradiotherapy. Changes in CT perfusion parameters are associated with microcirculation in the tumor area, which is confirmed by a statistically significant decrease in BV and AF parameters after chemoradiotherapy. 

The purpose of the study is to evaluate the results of ultrasound examination, generalize the criteria for differential diagnosis of various types of paragangliomas in neck area and the development of a standard ultrasound protocol that provides information about the resectability of formations.

Material and methods. 91 patients (100 tumors) with a clinical diagnosis of neurogenic neck tumor were examined, of which 71 (71%) were carotid paragangliomas, 18 (18%) – vagal paragangliomas, 10 (10%) – neurinomas and 1 (1%) – neurofibroma. All patients underwent ultrasound examination, including examination of the tumor structure in B-mode, assessment of the size and prevalence formations relative to the base of the skull and color Doppler mapping to assess the degree of intra-tumor blood flow and the relationship of formations with carotid arteries.
The study allowed us to systematize the main ultrasound signs characteristic of various neurogenic neck tumors, among which we identified: clear, even contours; the presence of a capsule; a heterogeneous, predominantly hypoechoic structure with hyperechoic inclusions resembling “salt–pepper”. The following parameters played a crucial role in differential diagnosis: localization of formation, features of intra-tumor blood flow and the relationship of paragangliomas with carotid arteries.

Results. Evaluation of the structural features of the tumor in the B-mode did not show significant differences between various paragangliomas, neurinomas and neurofibromas, all formations had clear, even contours, their capsule was clearly visualized. For carotid paragangliomas in all 71 (100%) observations, the characteristic feature was the location in the bifurcation area of the common carotid artery, with the mouths of the internal and external carotid arteries moving apart, which was 100% the diagnostic criterion of this group of formations. Vagal paragangliomas or neurinomas in all cases were located outside the bifurcation of the carotid artery, although in close proximity to the carotid arteries. The nature and degree of intra–tumor vasularization is another argument in the differential diagnosis of paragangliomas, which, unlike other neurogenic tumors, are highly vascularized tumors. The study of the nature of the intracellular blood flow showed that arterial paragangliomas predominate vessels, unlike neurinomas and neurofibromas, have significantly poorer vascularization with a predominance of venous vessels in the structure of the tumor. In 8 (44%) cases, vagal paragangliomas sprouted into the adventitia of the carotid arteries, which was characterized by a local increase in blood flow in this area in combination with turbulence during ultrasound.

Conclusion. The proposed algorithm of ultrasound examination of neurogenic formations in the neck area makes it possible already at the primary stage instrumental diagnostics to identify volumetric formations, differentiate them between themselves and with other neck formations and to assume the degree of traumatism of the proposed surgical intervention.

Objectives: to compare the consistency of echocardiographic Vmr and FR obtained by PISA and volumetric methods with Vmr and FR obtained by MRI in patients with secondary MR with reduced LV EF.

Materials and methods. The analysis included data from 433 patients with secondary mitral regurgitation with reduced LV EF (less than 35%). The patients were divided into 2 groups: Group 1 – 286 patients with an average age of 64 ± 10 years, in whom the calculation of R_vol and RF was carried out by the PISA method. Group 2 – 147 patients with an average age of 63 ± 11 years, in whom the calculation of R_vol and RF was carried out by the volumetric method.

Results. A moderate correlation was found between the indicators obtained by MRI and echocardiography, regardless of the method used, volumetric method R_vol r = 0.54 p = 0.01 and RF r = 0.56, p = 0.01, PISA method R_vol, r = 0.36, p = 0.01 and RF, r = 0.3, p = 0.01. The agreement in MR severity categorical scores between PISA and MRI was 27% in the diagnosis of severe mitral regurgitation and 50% in the diagnosis of moderate MR. The consistency in categorical MR severity scores between volumetric and MRI was 46% in the diagnosis of severe mitral regurgitation and 65% in the diagnosis of moderate MR. In the Bland–Altman analysis, the average difference in R_vol between PISA and MRI was 7.6 ± 13 ml with coincidence limits (30; –25 ml), the average difference in R_vol between volumetric and MRI was –2.5 ± 7.3 ml with coincidence limits (–12; 17 ml).

Conclusions. MRI and echocardiography regardless of the method used have only a moderate correlation in the assessment of Rvol and RF in patients with secondary MR with reduced EF. The volumetric method may be the method of choice when calculating quantitative indicators of MR severity, as it has better agreement with MRI data compared to the PISA method.

Annotation. Pulmonary sequestration is one of the most common malformations of this organ in clinical practice. But there may be difficulties in interpreting of radiology studies, which leads to a violation of the methodology of the study in such patients, and consequently – the lack of success of the therapy and the correct routing.

Purpose of the study. To present a literature review of current data related to lung sequestration, to discuss important clinical aspects of this abnormality and features of tactics. The review also describes the radiology patterns of sequestration with an emphasis on CT signs; typical images and methodological specificity of scanning in these patients are present and based on own practice experience.

Materials and methods. Both “classical” and modern local and foreign scientific papers about lung sequestration in adults and children are considered with a description of the morphology of the lesion, the clinical symptoms and the actual CXR and CT imaging; modern features of surgical treatment of such patients are presented.

Results. Often, lung sequestration manifests itself already in adulthood, without creating the impression of a congenital anomaly, hiding under the “masks” of abscessing pneumonia, neoplasm. The clinical course of lung sequestration is not specific and is characteristic of many respiratory complaints, but at the same time – the anomaly requires a different management tactics than ordinary inflammatory processes and is associated with the need to consult a thoracic surgeon. Due to the limited differentiation of the sequestration structure in CXR, in current time, if sequestration is suspected, CT with angiography is indicated. An aberrant vessel can trace not only from the thoracic, but also from the abdominal aorta, its branches.

Conclusion. The correct interpretation of the revealed CT-signs allowed routing patients to a hospital with thoracic surgery department because in the majority of cases, to prevent repeated episodes of sequestr inflammation, it is necessary to remove it. The expansion of the scanning area below the diaphragm can be useful because some of the sequesters are supplied with blood from the abdominal aorta and its visceral branches – this will prevent repeated CT-angiography studies because information about the source of blood supply is extremely important for surgeons.

Purpose of the study. The purpose of this literature review is to determine the radiographic features in the diagnosis of non-tuberculous mycobacteriosis (NTMB) and to assess the possibility of radiological diagnosis of a combination of tuberculosis and non-tuberculous mycobacteriosis of the lungs in a patient with HIV infection.

Materials and methods. A review of the literature on the bases of scientific articles PubMed, ELibrary and Google Scholar. Attention was focused on full-text articles. The article presents a clinical observation of a patient being treated at the Clinical TB Dispensary in Omsk from 2019 to 2022 with a diagnosis of disseminated pulmonary tuberculosis, bilateral, in the infiltration phase, tuberculous spondylitis Th_VII–IX, complicated by a paravertebral abscess.

Results. The radiological changes characteristic of NTMB are: lesion of the right middle and lingual lobes of the lungs with the presence of diffuse bronchiectasis, changes in the type of “tree in the kidneys”, compaction of lung tissue by the type of “frosted glass” with the presence of centrilobular nodules, asymmetric small dense foci with peribronchial location, apical location of thin-walled cavities with thickening of the costal pleura, as well as foci of inflammatory infiltration. The absence of specific symptoms for this pathology requires further research in this area. The identification of characteristic radiological features will speed up the diagnosis of infection and determine the correct management tactics for patients.

Conclusion. The radiosemiotics of NTMB is characterized by a large variability of manifestations. The most informative method of radiation diagnosis of NTMB is multispiral computed tomography (MSCT). Thanks to MSCT, a radiologist has the opportunity to accurately assess the localization and nature of foci, as well as assess the dynamics and prevalence of the process. The most characteristic radiological symptoms are the defeat of the right middle and lingual lobes of the lungs with the presence of diffuse bronchiectasis, changes in the type of “tree in the kidneys”, compaction of lung tissue by the type of “frosted glass” and the presence of centrilobular nodules, asymmetric small dense foci with peribronchial arrangement, apical arrangement of thin-walled cavities with thickening of the costal pleura, as well as foci inflammatory infiltration. The absence of specific symptoms for this pathology requires further research in this area. The identification of characteristic radiological features will speed up the diagnosis of infection and determine the correct management tactics for patients.

Annotation. Gastric varicose veins are one of the common causes of gastrointestinal bleeding in patients with portal hypertension. Bleeding of this localization has a greater percentage of death and difficulty in achieving hemostasis than bleeding from esophageal varices. This paper discusses the etiology and main aspects of the pathophysiology of portal hypertension, the mechanisms of bleeding, which play an important role in the prevention of complications prevention. The venous outflow from the stomach, variants of porto-systemic collateral anastomoses and types of varicose veins of the stomach itself are presented in sufficient detail. The advantages and disadvantages of diagnostic imaging in the assessment of gastric varicose veins and the possible prediction of the risk of bleeding are demonstrated.

Aim: to analyze the data of foreign and domestic literature on varicose veins of the stomach, to identify criteria that determine the risks of bleeding according to the methods of diagnostic imaging.

Results. Analysis of foreign and domestic literature showed that the problem of diagnosing gastric varicose veins is extremely relevant and requires special consideration of all its various aspects. There are many diagnostic methods with certain advantages and disadvantages. But, in our opinion, the possibilities of non-invasive methods, especially computed tomography, in the diagnosis of varicose veins of the stomach and the prognosis of bleeding from them are underestimated and require further study.

Glomus tumors usually occur in areas rich in glomus bodies, such as the subungual areas of the fingers or the deep dermis of the palm, wrist, and forearm, but they can also occur in deep visceral sites throughout the body, including the lungs, stomach, pancreas, liver, gastrointestinal and urinary tracts. They are thought to have originated from modified smooth muscle cells of the neuromyoarterial glomus, commonly referred to as the glomus body, whose function is to regulate temperature through arteriovenous shunting of the blood. Important during the pathological process for these tumors are pain that persists for a long time, which is often necessary for their detection and the possibility of relapse.

The purpose: to analyze and evaluate our own clinical cases of glomus angioma of various localization.

Materials and methods. 6 patients with a morphologically verified diagnosis of glomus angioma (5 women and 1 man aged 23 to 50 years, mean age 34.5 years) were treated at A.V. Vishnevsky National Medical Research Center of Surgery for the period from 2004 to 2023. All patients were operated on. Lesions localization: limbs soft tissues – 3, retroperitoneal space – 2, lung – 1.

Results. The term of the lesions detection varied from 2 months to congenital. In 2 of 3 cases of the limbs soft tissues tumors localization they were congenital. Limbs soft tissues glomus tumors: the leions ranged in size from 40.0 × 28.65 mm to a large lesion, consisting of multiple foci ranging in size from 20.0 to 60.0 mm in diameter, all tumors were multinodular. Retroperitoneal glomus tumors: the lesions were rather large (a multinodular lesion from 6.0 to 48.0 mm in diameter and a single-nodular multi-chamber lesion of a polycyclic form, 150.0 × 100.0 × 80.0 mm in size). The lung glomus tumor was single-nodular and had a diameter of 12.5 mm. In the vast majority of cases (5/6), the lesions manifested with the pain and discomfort. Only the lung lesion was detected by chance and during a routine examination.

The criteria for ultrasound and MSCT signs of the lesions of various localizations are given. The data are compared with literature data.

Conclusion. Given the rarity of glomus angioma and the lack of publications on glomus angiomas of soft tissues of the extremities and deep-seated tumors in the domestic literature, the presented analysis of a series of our own cases will increase the awareness of clinicians and diagnosticians about these tumors and, thereby, increase their detection, which will allow for earlier surgery.

The article offers the latest view on possibilities of diagnostic algorithm to identify cervical cancer (CC), one of the most incidental 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 cervical cancer therapies. The article sets forth the principal trends in using imaging methods, their role and possibilities for staging CC, planning and assessing the efficacy of applied therapy, on-going surveillance over patients, who have undergone specialized anti-cancer treatment.

Objectives. Analysis of possibilities of radiomics as a source of additional diagnostic information about the structural maturity of the lungs

Materials and methods. A retrospective study included 72 pregnant women: 35 with congenital fetal diaphragmatic hernia (group 1) and 37 without fetal lung pathology (group 2). Frontal or co-frontal T2 images (T2 FSE) were obtained. Segmentation of regions of interest at the fetal lung level was performed manually with ITK-Snap. A total of 107 radiomic features were extracted using pyradiomics. The statistical analysis was performed using the STATISTICA 10 statistical analysis package (USA) to detect correlation between trait values and the target variable (presence of lung pathology in CDH), and to show differences in the comparison groups according to the detected parameters.

Results. Statistically significant features were identified for 2D and 3D segmentations (p < 0.05). For 2D and 3D segmentations, the number of significant features was 14 and 73, respectively. After exclusion of features with cross-correlations, their number decreased to 6 and 8 for single slices and 3D images, respectively. Correlation coefficients between the features and the presence of lung pathology were also calculated. In the case of 3D images, the number of features with significant correlation coefficients (r > 0.4, p < 0.05) equaled 20, while for single-slice images this number was 3.

Conclusion. The data obtained allow to conclude that it is reasonable to use texture analysis of the 3D MRI images as a source of additional diagnostic information concerning the structural maturity of the lungs.