This study aimed to investigate and analyze data regarding the role of echocardiographic examination in assessing the diastolic function of the left ventricle and diagnosing heart failure with preserved ejection fraction (HFpEF).

Materials and methods. A search of scientific publications and clinical recommendations was conducted in the PubMed and Google Scholar information-analytical systems for the years 2016–2022, using keywords such as diastolic dysfunction, diastolic stress test, heart failure with preserved ejection fraction, and echocardiography. Additionally, literature lists were analyzed to identify articles meeting the search criteria.

Results. A total of 140 articles were analyzed, with 27 of them utilized in composing the review. Eleven additional articles from 2003–2015 were included from literature lists. The search results were organized into article blocks, within which articles were analyzed to study the role of echocardiographic examination in assessing the diastolic function of the left ventricle and diagnosing HFpEF.

Conclusion: Echocardiographic examination provides crucial information about the structure and function of the heart and is recommended for all patients with suspected HFpEF. Based on routine assessment of tissue Doppler imaging parameters, ultrasound diagnostic physicians can decide on the need to initiate the diagnostic algorithm for HFpEF using the diastolic stress test method. Results of the diastolic stress test, considering its limitations, should be interpreted in accordance with the clinical scenario or the probability of the presence of HFpEF. A reduction in diastolic reserve (E/e > 15) is a cornerstone for confirming HFpEF. The key task of upcoming clinical trials is to better differentiate various clinical phenotypes of HFpEF, thereby improving the treatment of each specific patient with HFpEF.

Objectives: 1) to evaluate the diagnostic capabilities of AT and AT/ET in determining severe AS in patients with reduced LV EF and low stroke volume.

2) to determine the threshold values for AT and AT/ET in the diagnosis of severe AS in patients with low stroke volume and low transaortic gradient.

Materials and methods. This is prospective single center study included 70 patients with low transaortic pressure gradient, reduced LV ejection fraction was and severe aortic stenosis. All patients have been examined from 2017 to 2022. Inclusion criteria for the study are: isolated AV stenosis with, reduced LV RF, low transaortic pressure gradient. Severity of AS was identified based on dobutamine stress echocardiography and aortic valve area (AVA). Severe stenosis was defined as AVA< 1 cm2.

Result. A statistically significant and high negative correlation was found between the AVA and AT/ET ratio, (r = 0.77, p < 0.001) and weak correlation with the AT indicator (r = 0.41, p = 0.01). The RoC-analysis showed the greatest predictive ability in the differential diagnosis of severe AS for the ratio AT/ET (AUC = 0.84 ± 0.54, p < 0.001) and the lower predictive ability for the indicator AT (AUC = 0.63 ± 0.72, p < 0.02). The optimal threshold value for determining severe AS for the AT / ET > 0.32 (sensitivity of 92%, specificity of 70%), for AT > 99 (sensitivity of 81%, specificity of 88%). Multiple logistic regression analysis revealed that the AT/ET ratio is the only echocardiographic parameter that has a significant impact on the differential diagnosis of severe AS in patients with reduced LV EF (OR 1.5; 95% CI 1.2–1.9, p = 0.001). There was low interobserver variability in measurements of AT score (intraclass correlation coefficient was 0.93 [95% CI, 0.80-0.97] and AT/ET ratio (intraclass correlation coefficient was 0.88 [95% CI, 0.75–0.95]).

Conclusions.

1. In patients with AS and reduced LV stroke volume the AT/ET ratio is highly sensitive and well reproducible in the diagnosis of severe AS. The AT index has a weak diagnostic ability of severe AS in that patients.
2. The threshold value of AT/ET >0.32 can diagnose severe AS with a high degree of probability in patients with reduced LV stroke volume and reduced transaortic gradients with reduced LV EF.

Objective. Comprehensive ultrasound assessment of the state complex intima-media (CIM) of brachiocephalic arteries in patients with metabolic syndrome (MS). 

Materials and methods. 82 patients were examined, including 62 patients with MS and 20 practically healthy individuals. All patients underwent biochemical blood analysis, ultrasound of the extracranial sections of the brachiocephalic arteries with an assessment of the qualitative and quantitative characteristics of CIM bifurcation of the brachiocephalic trunk (BCT), common carotid arteries (CCA) and vertebral arteries (VA).

Results. 100% of patients with MS, changes in the echostructure of CIM were recorded in the form of pathological layering, 9 (14.5%) patients – in the form of hyperechogenic inclusions. Thickness of CIM in the bifurcation of BCT and CCA in patients with MS statistically significantly exceeds the same indicator in practically healthy persons and demonstrates direct correlation between the components of MS. The modified Carnegan index patients with MS is statistically significantly higher than the same indicator in practically healthy individuals and demonstrates direct correlation with the thickness of CIM estimated in different segments of the brachiocephalic arteries (BCT k 0.356, RCCA k 0.718, LCCA k 0.846, in the bifurcation of CCA on the right k 0.431, on the left k 0.519).

Conclusion. Comprehensive ultrasound assessment of the state brachiocephalic arteries in patients with MS allows us to obtain complex of qualitative and quantitative signs characteristic of metabolic angiopathy.

The aim of our study is a comprehensive echo assessment of the LV  function using the speckle tracking technique in children with abnormal origin of the left coronary artery from the pulmonary artery in the late postoperative period аnd a comparative analysis segmental longitudinal and circumferential LV deformation with cardiac magnetic resonance late enhancement of myocardium.  

Methods. The search is a prospective observational study. We examined and analyzed 25 children with AOLCA from PA in late postoperative period. Obtained morphofunctional LV and RV echo parameters were compared with LV ejection fraction and dimensions, the grade of mitral insufficiency and age at the time of operation. CMR was performed in 15 patients (60%; n = 15/25) using Avanto 1.5T. The average age of children at the time of the study was 8.8 ± 3.5 years.

Results. 1) Reduce of LV segmental longitudinal deformation is unique in each patient’s case. The largest number of segments with reduced longitudinal deformation was detected in the 2d (anteroseptal basal); in 4th (inferior basal); 5th (inferolateral basal), 6th (anterolateral basal),  11th (inferolateral middle) segments of LV myocardium. 2) There is no relationship between LV global longitudinal and circumferential deformation in children in the late postoperative period after correction of AOLCA from PA and initial LV morphological and functional echo data (at the time of defect correction). 3) Segmental LV longitudinal deformation Area Under the Curve is 0.64 (0.56–0.72) with “cut-off” 9.5% with a sensitivity of 92% and a specificity of 85% and circumferential segmental deformity Area Under the Curve is 0.48 (0.40–0.56) in the predicting of fibrosis according to CMR data.

The objective of our study was to disclosed efficiency of  ultrasound for the  prediction of the severity of acute pancreatitis (AP).

Material and Methods. Our study included 322 hospitalized patients with AP. We studied and compare the efficacy of clinical scoring systems and radiologic data.

Results. Ultrasound findings showed sensitivity (Se) 72,9%, and specificity (Sp) 89,3% compared with the clinical scoring systems (Se from 27,1% to 48,6%, Sp from 80,3% to 100%, AUC from 0,538 to 0,645) and computed tomography (Se 85,4%, Sp 89,5%). Ultrasound showed a trend of a higher AUC in the prediction of severe AP (0.811) compared with the clinical scoring systems (0,538 до 0,645) and computed tomography (AUC 0,854).

Conclusions. Abdominal ultrasound examination is a useful method for early prediction of the severity of acute pancreatitis.

Objective: to determine the diagnostic effectiveness of computed tomography (CT) in predicting the course of the disease in patients with chronic inflammatory complications of diverticular disease (DD).
Material and methods. The study included 70 patients with a complicated course of colon diverticular disease in the phase of exacerbation of the chronic inflammatory process. All patients underwent CT of the abdominal cavity with intravenous contrast to assess the type and severity of inflammatory changes in the colon and surrounding tissues in the area of localization of diverticula. All patients received conservative treatment and were monitored as part of the ongoing study for 12 months from the moment of initial treatment at the Center. Surgical intervention due to the ineffectiveness of conservative therapy or the recurrence of the inflammatory process during the established follow-up period was considered as an unfavorable outcome of the disease (42/60%). The positive effect of drug therapy without signs of a return of the clinical picture of inflammation within 12 months was considered as a favorable outcome (28/40%). A statistical analysis of CT signs of inflammatory changes in various DD outcomes was performed to identify prognostic CT parameters.
Results. Statistically significant differences were revealed between the severity of inflammatory changes according to CT data for different outcomes of the disease. In the favorable outcome group, the main part (23/28.82%) were patients with diverticulitis, in the unfavorable outcome group, 2/3 of patients (29/42.64%) were diagnosed with pericolic infiltrates, including abscesses/cavities, and colon fistulas. It was found that the thickness of the intestinal wall, the extent of inflammatory changes in the intestinal wall, the extent of inflammatory infiltration of pericolic fiber, the symptom of “centipede”, the accumulation of fluid in the pericolic region statistically significantly differed with different outcomes of chronic inflammatory complications of diverticular disease. Мultivariate Cox proportional hazard model revealed two main predictors of the onset of an unfavorable outcome – thickening of the intestinal wall and the presence of fluid in the pericolic region. Thickening of the intestinal wall at values equal to or greater than 0,6 cm increased the risk of an unfavorable outcome by 4.69 times, and the presence of fluid by 4.52 times.
Conclusion. The use in clinical practice of the revealed CT predictors of the onset of an unfavorable outcome in chronic inflammatory complications of DB can serve as one of the factors for deciding on elective surgery in this category of patients. 

Aim: study of the effectiveness of endoscopic interventions in complicated celiac disease.
Material and methods. An electronic literature search was performed using databases: PubMed, Medline, Cochrane Library. A clinical case of a patient with small intestinal bleeding and celiac disease is described.
Results. This literature review includes case reports, retrospective studies, and literature reviews. Presented is a clinical case of a patient who noted periodic discharge of blood from the anal canal for 2 years. According to esophagogastroduodenoscopy, erosive gastritis was detected, complicated by bleeding (the source was not identified) with suspected celiac disease. According to the histological conclusion, celiac disease is excluded. During hospitalization, it was decided to perform capsule endoscopy with balloon-assisted enteroscopy followed by a biopsy. According to the data of a comprehensive endoscopic examination of the small intestine, various defects of the mucous membrane with signs of ongoing bleeding were revealed. Endoscopic clipping of the identified defects was performed and a biopsy was taken. According to the results of histological examination, celiac disease complicated by small intestinal bleeding was diagnosed.
Conclusions. The use of endoscopic therapeutic techniques avoids surgical interventions, and preserves the quality of life of the patient.

Aim. Analysis of the literature and comparative evaluation of data on the effectiveness of instrumental radiological diagnostic methods in patients with suspected OA.

Material and methods. A search was made for scientific publications, clinical recommendations, reports of congresses and scientific conferences in the information and analytical systems PubMed, Google Scholar and ELibrary for 2013–2022. by the following keywords: acute appendicitis, diagnosis of acute appendicitis, intestinal ultrasound, computed tomography in the diagnosis of acute appendicitis, CT and acute appendicitis, MRI for acute appendicitis, radiodiagnosis of appendicitis, radiodiagnosis of intestinal pathology, diagnosis of acute appendicitis, ultrasound, CT, MRI in the diagnosis of acute appendicitis. In addition, the literature lists were analyzed to find articles that match the search criteria.

Results. 264 articles were analyzed, including publications of scientific conferences and congresses, 50 of which were used to compile the review. From the lists of references, 9 articles for 2020–2022 were additionally included. Search results – blocks of articles were created, within which the material was analyzed to study the questions posed.

Conclusion. Each of the radiological methods in the diagnosis of OA has strengths and weaknesses. Knowledge of these features, as well as the equipment of the hospital, can determine the choice of the method of radiation diagnostics in case of suspected OA. An analysis of the literature data on the comparison of the effectiveness of ray methods and the sequence of their application dictates the need to continue research in this direction.

The present paper reports available modern data about the safety of medical visualization, including US, MRI, CT, PET and scintigraphy. In all accessed papers, objects are pregnant women and fetuses – the most vulnerable of all groups of patients. We summarize data concerning exposure to radiodiagnostic procedures during pregnancy and approaches to diminish the potential risk. We analyzed articles published between 2003 and 2023 using PubMed and Google Scholar. Keywords included: MR-safety, pregnancy, CT, MRI, US, scintigraphy. The list of found articles consisted of more the 2000 items. We analyzed more than 100 articles in Russian and English and included 63 items in the current review. Primarily we dealt with clinical guidelines based on randomized trials on the safety of radiological methods during pregnancy. Hopefully, presented information, including the latest international recommendations, will help clinicians and patients pursue realistic and informed approaches and minimize anxiety. 

The aim of the study was to evaluate the clinical significance of the new urinary tract dilation classification (UTD-2014) in predicting outcomes of the calyx-pelvic system dilation detected by ultrasound (US) in children in the perinatal center.

Materials and methods. A retrospective analysis of the urinary system ultrasound protocols and the outcomes of 152 children with dilated calyx-pelvic system due to various causes examined at the National Medical Research Center for Obstetrics, Gynecology and Perinatology for the period from 2017 to 2022 was carried out.

Results. The median age of patients at the time of the first ultrasound was 2 days, the median duration of follow -up was 10 months. The decrease in the UTD category during the observation period occurred in –/35/29/10% of patients in groups with the primary established UTD category 0/I/II/III, respectively. The UTD category remained the same in 42%, an increase in the category occurred in 32/26/4/-% of patients with UTD 0/I/II/III, respectively. The age at the time of the first ultrasound of patients who had an increase in the UTD category (median – 2 (1; 3.5) days) was significantly less than in other children (with the exception of operated patients). Surgical intervention was performed by 0/2/31/60% of patients with UTD category 0/I/II/III (only 18%), respectively.

Conclusions. UTD classification correlates well with outcomes of the calyx-pelvic system dilation due to various causes in children – the larger the category according to primary ultrasound, the less often its decrease or lack of dynamics is noted during follow-up, surgical treatment is more often necessary. When using the UTD classification in the perinatal center, there is a high risk of underestimating the degree of dilatation due to the early conduct of the first ultrasound in the first two days of life.

Purpose. To evaluate the quality of filling DICOM tags responsible for the orientation, scanning area and photometric interpretation of the image, as well as to develop and test algorithms for automatically determining the true values of these tags for chest x-rays and fluorograms.

Materials and methods. To assess the quality of filling DICOM tags, were used 1885 studies obtained from the Unified Radiological Information Service of the Unified Medical Information and Analysis System (ERIS EMIAS). For training and validation of algorithms for automatic determination of the true values of tags, were used datasets of radiographs in standard frontal and lateral projections, from open databases and from ERIS EMIAS (12,920 studies in total). The deep neural network architecture VGG 19 was chosen as the basis for creating algorithms.

Results. We found that the frequency of missing values in DICOM tags can range from 6 to 75%, depending on the tag. At the same time, up to 70% of filled tag values have errors. We obtained next models: a model for determining the anatomical area of x-ray examination, a model for determining the projection on the chest x-ray, a model for determining the photometric interpretation of the image. All of the obtained algorithms have high classification quality indicators. The AUC for each of the obtained models was more than 0.99.

Conclusions. Our study shows that a large number of studies in diagnostic practice contain incorrect values of DICOM tags, which can critically affect the implementation of software based on artificial intelligence technology in clinical practice. Our obtained algorithms can be integrated into the development process of such software and used in the preprocessing of images before their analysis.

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

Purpose. The aim of this review is to provide an insight into newly developed perfusion measurement techniques based on MRI and CT comparing their accuracy with the “gold standard” H₂¹⁵O PET measurements and describing their role in today’s clinical practice.

Materials and methods. More than 200 Pubmed publications were analyzed for the keywords “perfusion, MRI, CT, ASL, oxygen metabolism”. Relevant publications that do not contain these keywords or contain them in a different wording were also studied.

Results. This review selected 49 publications describing CT and MR perfusion using contrast agents and MR ASL perfusion. Examples of the use of the described methods in fundamental research and applied medicine are given.

Conclusion. The quantitative results obtained using novel non-invasive molecular imaging techniques are in most cases comparable to H₂¹⁵O PET data, which opens the way for broad use of MRI and CT perfusion and oxygen metabolism measurements in clinical practice.