Objective of the study. To develop and evaluate the effectiveness of a technology for  segmenting the pancreatic parenchyma and its hyper- and hypovascular lesions on abdominal computed tomography (CT) scans using deep machine learning.

Materials and methods. CT scans from the database of the A.V. Vishnevsky National Medical Research Center of Surgery were used for training and testing the algorithms – a total number of approximately 150 studies (arterial and venous phases). A test dataset of 46 anonymized CT scans (arterial and venous phases) was prepared for validation of the obtained algorithms, independently assessed by expert physicians. The primary segmentation neural network used is nn-UNet (M. Antonelli et al., 2022).

Results. The average accuracy of the test dataset for the model determining segmentation masks of the pancreas on CT images had an AUC of 0.8 for the venous phase and 0.85 for the arterial phase. The segmentation masks of pancreatic formations had an AUC of 0.6.

Conclusion. Automated segmentation of the pancreatic parenchyma structure using deep machine learning technologies demonstrated high accuracy. However, the segmentation of hypo- and hypervascular pancreatic lesions requires improvement. The overlap of the masks showed a rather low result, but in all cases, the location of the pathological formation was correctly identified by the algorithm. Enhancing the training dataset and the algorithm used could increase the accuracy of the algorithm.

No false negative results were obtained when detecting pancreatic formations; in all cases, the INS detected “suspicious” areas of the pancreatic parenchyma. This can help reduce the omission of pancreatic pathologies in CT scans, and their further assessment can be carried out by the radiologist himself.

Introduction. Artificial intelligence (AI) is an effective tool for automating routine tasks in radiology. The diagnostic accuracy of AI in detecting various pathologies on medical images has generated considerable interest in the scientific community: the number of studies and meta-analyses has been constantly growing. The abundance of published evidence and the diversity of outcomes necessitate the need to systematize the available publications. The aim of this paper is to conduct an umbrella systematic review of contemporary meta-analyses on the use of AI in radiology.

Materials and methods. PubMed was searched for studies published in the English language. Thirty-eight systematic reviews with meta-analyses published between 2021 and 2023 were selected for full-text analysis. The extracted data included the goal, study design, imaging modality, sample size, quality assessment of the included studies, AI diagnostic accuracy estimates, reference method parameters, and clinical efficacy metrics of AI implementation. The methodological quality of included systematic reviews was assessed using the AMSTAR-2 tool.

Results. Nearly half (47%) of the included meta-analyses focused on the diagnosis, staging and segmentation of malignancies. Four meta-analyses were related to detection of maxillofacial structures in dentistry, while another four meta-analyses addressed the diagnosis of brain lesions. The diagnosis of COVID-19 and the diagnosis of bone fractures were each covered in three meta-analyses. One meta-analysis was reviewed for each of the following fields: colorectal polyps, pneumothorax, pulmonary embolism, osteoporosis, aneurysms, multiple sclerosis, acute cerebrovascular accident, intracranial hemorrhage, burns, and the risk of intrauterine growth restriction. Thirty-five (92%) meta-analyses assessed the risk of bias. Twenty-eight (80%) meta-analyses utilized QUADAS-2 to assess the risk of bias. 14 out of 28 papers reported low risk of bias (50%); 4 (14%) – moderate; 10 (36%) – high. The major risks were associated with samples that were unbalanced in terms of size and composition, a lack of details about the methods, a low number of prospective studies, and a lack of external validation of the outcomes. The overall results indicate that the diagnostic accuracy of AI is comparable to or even greater than that of radiologists. The mean sensitivity, specificity and area under the ROC curve for AI and radiologists were 85.2%, 89.5%, 93.5% and 84.4%, 90.0%, 92.8%, respectively. However, many studies that compared the diagnostic accuracy of AI and radiologists lack the data on the number and experience of the latter. Only one paper presented results of implementing AI into routine clinical diagnosis.

Discussion. AI is capable of reducing the turnaround time for non-urgent examinations. When used to verify the primary interpretation, AI was effective in detecting false-negative results from radiologists. However, the efficacy of detecting false-positive results was inadequate. Our assessment of the quality of systematic reviews with AMSTAR-2 show that the methods of searching, selecting and analyzing literature must be improved and brought to a common standard. The development of a specialized tool for assessing the quality of systematic reviews in the AI implementation is also necessary. Due to high diagnostic accuracy, AI is currently considered a promising tool for optimizing the turnaround time. However, more evidence is needed to study the AI outcomes in routine clinical practice. Furthermore, it is necessary to standardize and improve the quality of research methodology.

The purpose of the study was to investigate the possibility of applying first-reader and second-reader modes in the implementation of an automatic detection program for MCA ischemic stroke in the diagnostic process of radiologists with less than 3 years of experience and varying expertise in emergency neuroradiology.

Material and methods. The study included a software product based on artificial intelligence technologies, as well as seven doctors with less than 3 years of experience and varying expertise in the diagnosis of ischemic stroke. Complementary evaluation was performed based on a cohort of 100 patients admitted to the regional vascular center in Saint Petersburg with clinical presentation of ischemic stroke in the territory of the middle cerebral artery, who underwent native CT brain studies. Ischemic stroke was confirmed in half of the patients based on clinical data, as well as CT angiography of the cerebral vessels and CT perfusion. The diagnosis was ruled out in the other half. Two variants of implementing the artificial intelligence algorithm as a decision support system in the diagnostic process of a radiologist were simulated: the first (parallel) and second reader modes.

Results. The results of the study showed that the application of the complementary evaluation parallel- reader mode leads to an increase in diagnostic efficiency indicators and interobserver agreement in assessing ASPECTS scale among young specialists, regardless of their experience with urgent pathology.

Background. Obesity is a chronic disease characterized by excessive accumulation of adipose tissue in the body, manifested by an increase in body weight by 20 percent or more of the average values. Obesity is becoming an increasingly significant public health problem. Assessment of the functional pathology of the brain provides more information about the pathogenetic changes leading to metabolic disorders. Modern methods of neuroimaging make it possible to obtain information about the initial functional changes in the brain according to the data of intracerebral connectivity - functional connectivity between its individual structures.

Objective. The study of modern literature data on functional disorders of brain connectivity in patients with obesity, including those with eating disorders.

Materials and methods. A systematic review of studies published in foreign and domestic literature has been carried out. Articles were searched using the PubMed database and Elibrary.

Results. The problem of functional and microstructural studies of the brain in obesity is covered in sufficient detail in Western English-language literature. Nevertheless, it must be stated that at the moment there are practically no articles on the subject under study in domestic scientific publications. However, it should be noted that in the foreign literature there are rare data on neuroimaging of the brain in the aspect of neural network connectivity, studies in obesity with concomitant somatic pathology, for example, in type II diabetes, and other disorders of the endocrine system. There are relatively few data where correlations would be made with the age and gender of patients, concomitant mental disorders, which emphasizes the relevance of the issue.

At the subsequent stages of the joint development of endocrinology, psychiatry and radiation diagnostics, the use of modern MRI techniques will help with the choice of target structures for stereotaxic correction of the described pathology. The clinical application of functional MRI will help to reveal the pathogenesis of various types of obesity at the neurofunctional  levels with further prediction and analysis of the development of the disease, while the inconsistency and inconsistency of the currently obtained results of studies of the pathogenesis of alimentary obesity in terms of the pathology of functional connectivity based on fMRI,  the absence clinical application of special MRI techniques substantiate the need to continue scientific research in this direction

Cerebrovascular disease (CVD) was detected in 87% of the examined liquidators of accidents at the Chernobyl Nuclear Power Plant 7–8 years after participating in emergency recovery work with a radiation dose of ≤0.3 Gy. Analysis of the conducted studies shows that the results of structural methods of radiation diagnostics do not always correlate with the severity of the clinical picture. The use of an extended MRI examination of the brain to assess the correlation of anatomical and functional indicators of various observation groups in people with chronic cerebrovascular insufficiency seems promising.

Purpose. To compare structural MRI data of the brain and indicators of cerebral hemodynamic perfusion in LPA and patients in the control group.

Materials and methods: 147 patients aged from 55 to 87 years old with a diagnosis of chronic cerebrovascular disease were examined. The main group – 93 patients, the comparison group – 54 patients who were not exposed to radiation. The identified changes were assessed by the degree of atrophy of white and gray matter, by the degree of gliosis changes, and were compared with the data of perfusion parameters.

Results. Signs of the atrophic process of the brain were detected in 93.9% of the main group and in 76.7% of patients from the comparison group, microangiopathy – in 100.0 and 83.4%. The risk of developing atrophy and microangiopathy in LPA is 1.24 (p = 0.041) and 1.14 (p = 0.008), respectively. When comparing MRI perfusion parameters (CBV, CBF and MTT) between the cortex and glia in patients of the main and control groups, it was found that the cortex/glia ratio between CBV and CBF in the OG is lower than in the GS by 13.9 and 24.2, respectively %. A comparative analysis of MRI perfusion parameters showed that in LPA the ratio between CBV in the glia and cortex of the right hemisphere is lower, by 0.3 and 11.7%, and in the left hemisphere – by 19.3 and 22.9%. CBF in the glia of the right hemisphere of the LPA is increased by 6.9%, and in the cortex it is decreased by 14.2%, in the left hemisphere – by respectively 9.8 and 13.4%.

Conclusions. The study showed the high efficiency of contrast MRI perfusion and made it possible to identify the correlation of structural and perfusion changes in different research groups.

Purpose: to determine the frequency of various ultrasound signs of dissections of the extracranial parts of the brachiocephalic arteries, as well as to compare the results of ultrasound and neuroimaging methods in the diagnostics of dissections.

Materials and methods. The study included data on 108 patients, among them 44 (40.7%) women, 64 (59.3%) men, mean age was 56 ± 14 years. All patients underwent duplex scanning of the brachiocephalic arteries, 53 patients underwent CT-angiography, and 99 patients underwent MRI.

Results. The sensitivity of duplex scanning in the primary diagnosis of dissections in our study was 97.2%. In 40 patients (37%) with dissections according to duplex scanning the presence of dissection was also confirmed on CT-angiography or MRI. Expansion of the vessel diameter and the presence of intramural hematoma (IMH), as well as their combination, were the most common ultrasound signs of dissections in our study. In cases where dissection was not confirmed by CT-angiography or MRI data moderate echogenicity of IMH was noted significantly more often (p = 0.018). Of all the ultrasound signs of dissections, the highest share of coincidence with the signs obtained with neuroimaging diagnostic methods occurred with IMG.

Conclusion. The most frequently recorded ultrasound signs of dissections were the expansion of the vessel diameter and the presence of IMG, as well as their combination. The results of the study showed a high sensitivity of the ultrasound method in detecting dissections, especially in the subacute and chronic stages, as well as to determine the causes of ischemic stroke in the differential diagnosis of brachiocephalic artery pathologies.

Objective. To study indices of right ventricular (RV) longitudinal deformation at transthoracic echocardiography (TTE) in patients with acute pulmonary embolism (APE), to determine their threshold values; to study indices of right ventricular-arterial coupling (RVAC) in patients with APE, to determine their threshold values.

Methods. We examined 34 patients with acute massive and submassive pulmonary embolism. The diagnosis was made on the basis of computed-tomography pulmonary angiogram. The mean age was 61 ±13 years. Of these, 16 were women (47,1%) and 18 were men (52,9%). As a control group, 30 healthy individuals were examined: 14 males and 16 females. The mean age of the healthy individuals was 39±9,8 years. Echocardiography was performed on Vivid E95 (GE HealthCare, USA) with data postprocessing on EchoPak workstation. The indices of right ventricular (RV) systolic and diastolic function, the magnitude of global longitudinal deformation of the right ventricle (GLS RV) and longitudinal deformation of the right ventricular free wall (RVFWLS) were studied using two-dimensional speckle-tracking echocardiography. We studied indices of right ventricular-arterial coupling (RVAC). We determined the relationship of longitudinal deformation of RV and RVAC with other indices of its systolic function. 

Results. Mean values of traditional parameters of RV contractile function were within normal limits, whereas mean values of longitudinal strain in APE were significantly lower than normal. There was also a significant decrease ( P < 0,0001) of all measured parameters of right ventricular-arterial coupling in patients with APE in comparison with the control group.

Conclusions. When longitudinal deformation parameters are included in the criteria of RV dysfunction in APE, its detectability increases from 26,47% to 61,77%. The revealed decrease of right ventricular-arterial coupling parameters in APE indicates a more frequent disturbance of the connection between RV and the small circle of blood circulation

Aim: evaluation of the intracardiac hemodynamics and determination indications for early correction of the atrial septal defect in children before 1 year age.

Methods. The study included patients observed from 2010 to 2021. The first group was formed from children under the age of 12 months with ASD and were observed for the next 4 years until its interventional or surgical elimination. The second group included healthy children of the appropriate age. All patients underwent an echocardiographic (ECHO) study with assessment of the main parameters of hemodynamics and intracardial structures.

Results. The first group included 887 children with ASD, the control group included 887 healthy children. The age of the patients included in the study was 6 ± 2.6 months. for group I and 6 ± 2.5 months. for the second one. It was found that in young children with ASD, the first manifestation of hemodynamic changes was dilatation of the right ventricle, then the right atrium and finally dilatation of the pulmonary trunk, which was accompanied by an increase in pressure in the pulmonary circulation and weight loss. In 11% of patients, spontaneous closure of the ASD occurs within the first year of life. Almost 20% of patients are younger than 6 months. have clinical and hemodynamic indications for surgical treatment of ASD.

Conclusions. Indications for the atrial septal defect closure should be determined taking into account clinical, anatomical and hemodynamic parameters.

Introduction. Cardioembolic stroke (CE) is one of the main etiopathogenetic subtypes of ischemic stroke and accounts for approximately 17% of all patients with ischemic stroke. Currently, there is a search for widely accessible radiological diagnostic methods that allow for the accurate diagnosis of left atrial (LA) dysfunction. Among these methods is transthoracic strain echocardiography (EchoCG), which provides additional information about the degree of deformation and change in shape of the LA during the cardiac cycle. To date, the association between strain EchoCG parameters and the severity of fibrotic changes in the LA among patients with CE remains unstudied.

Objective. To evaluate the relationship between myocardial deformation parameters of the left atrium and the degree of fibrosis in patients with CE, as well as the impact of LA myocardial deformation changes on the prognosis of patients with CE.

Materials and Methods. A prospective cross-sectional study included 132 patients who underwent evaluation and treatment in the Department of Emergency Neurology at the N.V. Sklifosovsky Research Institute for Emergency Medicine from 2020 to 2022. Group 1 consisted of 12 patients who died during hospitalization, while Group 2 comprised 120 patients who were discharged from the department after receiving treatment.

Results. Deceased patients, compared to survivors, were characterized by the presence of LA myocardial remodeling. Statistically significant differences in LA myocardial deformation parameters were found between the study groups. Correlation analysis revealed statistically significant associations between LA myocardial deformation parameters and the severity of fibrotic changes. In the multifactorial logistic regression model, significant effects on the prognosis of patients were observed for LA strain peak systolic circumferential strain rate (LA-Scs) and LA strain peak systolic longitudinal strain rate (LA-Sls), with each 1% increase in the parameter associated with a 1.128-fold and 1.075-fold increase in the odds of a lethal outcome, respectively (OR: 1.128, 95% CI: 1.021–1.25, p = 0.017, and OR: 1.075, 95% CI: 1.009–1.15, p = 0.025).

Conclusions. The conducted study established a strong correlation between LA myocardial deformation and LA fibrosis and the degree of fibrosis in the LA. LA myocardial deformation parameters can be used in risk stratification for the development of a lethal outcome in patients with CE. 

Early diagnosis of eye blood supply disorders in patients with type 1 diabetes mellitus in childhood is an urgent task.

Determination of ultrasound changes in the hemodynamics of retrobulbar vessels under the influence of risk factors will have a beneficial effect on the dynamic monitoring of children and adolescents with type 1 diabetes mellitus.

Purpose of the study: to evaluate the variability of ultrasound indicators of retrobulbar blood flow in patients with type 1 diabetes mellitus in childhood and adolescence, depending on the duration of the disease, indicators of lipid metabolism and the level of glycated hemoglobin.

Material and methods. The study included data from 186 children aged 5–17 years, of which 148 had type 1 diabetes and 38 children in the control group. The analysis took into account the duration of type 1 diabetes mellitus, laboratory, ultrasound indicators and ophthalmological examination data.

Results. The results of the study confirm the presence of changes in the hemodynamics of retrobulbar vessels in type 1 diabetes mellitus in children in response to the influence of risk factors, and create conditions for the use of ultrasound studies in the assessment of disorders of the blood supply to the eye.

A clinical case of epithelioid hemangioendothelioma (EHEL) in combination with atypical lung carcinoid (AC) is presented. According to computed tomography (CT), magnetic resonance imaging (MRI) in the lower lobe of the right, a solid-fluid formation was easily identified, associated with the lower lobe artery, slightly accumulating ¹⁸F-FDG. CT and PET monitoring for 6 years did not reveal any negative dynamics of the lesion. After suffering from Covid-19 associated pneumonia, the patient developed episodes of hemoptysis and shortness of breath. CT and PET scans revealed an increase in the size of a focal formation in C6 of the right lung, a significant increase in metabolic activity, and accumulation of radionuclide in the mediastinal lymph nodes and the spinous process of the Th_II vertebral body. Lower bilobectomy revealed EHEL and a previously unrecognized atypical carcinoid with metastases to the bifurcation lymph nodes.

Purpose: to define the new criteria for contrast-free ASL perfusion using for the management of diffuse liver diseases (DLD).

Material and methods. Clinical and laboratory data, results of MRI with non-contrast MR perfusion (ASL-perfusion) of the liver  were estimated in a group of patients with DLD (three-year research).

Results. Potentials of assessment of liver ASL perfusion for patients with DLD (including complicated cases) are described in the article. It was established that ASL liver perfusion is useful for DLD clinical forms differential diagnosis,  predicting the risk of liver cirrhosis, as well as complications (hepatic encephalopathy, sialoadenitis) and DLD exacerbation. The strategy of contrast-free MR perfusion using  in patients with DLD management algorithm was developed.

Conclusion. Liver ASL perfusion is a promising for the study and application method for the management of DLD.

Aim. Gastrointestinal occult bleeding (OGB) is defined as persistent or recurrent bleeding from the gastrointestinal tract in which the source has not been identified endoscopically. New advances in small bowel diagnostics and the ability to successfully perform endoscopic therapy have largely replaced surgical procedures and have led to a trend towards non-invasive diagnosis and endoscopic treatment of OGB. The purpose of this literature review is to study the current state of diagnosis and treatment of occult gastrointestinal bleeding.

Materials and methods. An electronic literature search was carried out using databases: PubMed, Medline, Cochrane Library.

Results. This literature review includes systematic reviews and meta-analyses, prospective and retrospective studies, and literature reviews.

Conclusion. The introduction of new methods of imaging and endoscopy has contributed to a significant improvement in the effectiveness of methods for diagnosing and treating occult bleeding.