Objective: To evaluate the outcomes of balloon mitral valvuloplasty (BMV) for mitral valve stenosis (MVS) performed under ultrasound guidance, and to summarize the role of echocardiography (EchoCG) in the diagnosis and treatment of rheumatic mitral stenosis (MS).

Materials and Methods: This study included 47 patients with MS who underwent BMV using the Inoue technique, with echocardiography employed as an auxiliary method for procedural guidance. The majority of patients were women—39 (82.9%). The mean age was 49.8 ± 6.14 years. Sinus rhythm was present in 35 (74.5%) patients, while atrial fibrillation (AF) was observed in 12 (25.5%).

Results: The mean duration of the procedure (from venous puncture to catheter removal) was 48.76 ± 6.48 minutes. The average size of the balloon catheter was 26.3 ± 0.91 mm. The mean transmitral pressure gradient decreased significantly from 14.15 ± 2.75 mmHg to 6.1 ± 1.15 mmHg (p < 0.05). The mean pulmonary artery pressure (PAP) was reduced from 28.48 ± 2.26 mmHg to 15.2 ± 3.68 mmHg (p < 0.05). Left atrial (LA) pressure dropped from 27.86 ± 3.87 mmHg to 13.4 ± 2.75 mmHg (p < 0.05) after BMV. The mitral valve area (MVA) increased from 0.95 ± 0.14 cm² to 1.89 ± 0.25 cm² (p < 0.05). No intraoperative or postoperative complications were observed. The mean follow-up duration was 11.35 ± 1.14 months.

Conclusion: BMV is an effective and safe treatment option for selected patients with MS. Echocardiography not only plays a central role in diagnosing MS but should also be integrated into all stages of the BMV procedure. Enhancing the use of echocardiographic guidance during endovascular intervention can significantly reduce radiation exposure, and potentially eliminate its need altogether in the future.

SARS-CoV-2 infection continues to circulate in the population and to play a role of immunological trigger. Polyserositis, described as a marker of immunoinflammatory diseases, today can often be found in patients who have had COVID-19, even irrespective of respiratory infection.

Objective: to study the incidence of pericardial and pleural effusion based on lung CT scans in patients with moderate to severe acute COVID-19 pneumonia and to compare findings with mortality rates.

Materials and methods. The incidence of exudation >5 mm according to data from a chest CT scan performed upon admission to a Covid hospital in patients with acute pneumonia from the database for the period from February 1 to April 30, 2020 and 2022. Criteria non-inclusion: presence of previous pericarditis or pleurisy, hydropericardium, hydrothorax, CHF with NYHA class ≥3, immunoinflammatory disease.

Results. Over the 3 months studied in 2020 and 2022, 390 cases were included, of which 58 ended in death. Pleural effusion visible on CT of the lungs in the group of survivors were recorded in 15%, in the group of deceased – in 50% of patients (OR 3.9; 95%CI 2.5–6.2), pericardial effusion – 12 and 57%, respectively (OR 5.6; 95%CI 3.6–8.9). The maximum thickness of the effusion was also twice as large in the second group: 13 vs 29 mm in the cavity pleura, 6 vs 11 mm in the pericardial cavity. When comparing the frequency of serous membranes involvement by year, in 2020 effusion into the pleural cavity was recorded in 16%, in 2022 – in 22%, in the pericardial cavity in 2020 – in 14%, in 2022 – in 20% respectively. At the same time the groups were comparable in age Me 59 [95%CI: 49 to 86] years in 2020 and 60 [95%CI: 49 to 87] years in 2022 (p = 0.6), as well as by the severity of pneumonia according to CT 1.65 ± 0.2 vs 1.55 ± 0.2 (p = 0.2) respectively.

Conclusions. 1/5 of inpatients with COVID-19 pneumonia have a small effusion in the serous cavities of the chest. The exudation into the pleural or pericardial cavities are associated with a 4- and 6-fold increased risk of death in these patients. The incidence of serous effusion >5 mm increased 1.5 times over 3 years, which may indicate patient sensitization.

Lung cancer is one of the most common cancers. Bronchoscopy and transthoracic lung biopsy under the control of computed tomography (CT) are used for morphological verification of the tumor. Both of these technologies are invasive with certain risks and high costs. The accuracy of the morphologically verified diagnosis of lung cancer in Russia reaches an average of 88.2%. Treatment tactics, progression and prognosis of the disease depends on the histological type of lung cancer. The gold standard for lung cancer diagnosis is computed tomography of the chest. A developing area of CT image processing is radiomics, a mathematical analysis of data from radiation research methods that allows the detection of tissue texture features at a level inaccessible to the eye of a radiologist. The use of radiomics methods can contribute to the determination of the histotype of lung cancer even at the stage of diagnostic search.

Objective: to determine the most common histological types of lung cancer based on the textural analysis of CT-scans of the chest organs.

Materials and methods. The study included data from 200 patients treated at the RSCRR with histologically confirmed lung cancer, including 100 patients with small-cell lung cancer, 100 patients with non-small cell lung cancer (50 of them with adenocarcinoma and 50 with squamous cell carcinoma). 107 radiomic features were calculated for each tumor. Machine learning models were built in the Python 3.10 programming language using specialized libraries. To select the most effective models, standard machine learning metrics were used: precision, recall, accuracy, f1-measure and the area under the receiver operating characteristic curve (ROC-AUC).

Results. Several machine learning models were developed, the best metrics were gradient boosting for differentiating non-small cell lung cancer and small-cell lung cancer with ROC-AUC 0.973 and a random forest based on three trees for differentiating adenocarcinoma and squamous cell carcinoma with ROC-AUC 0.833.

Conclusion. Classification models developed by us have high metrics of diagnostic accuracy, which allows us to discourse about the applicability of radiomics features for differentiating various types of lung cancer at the stage of diagnostic search, as well as in situations where it is impossible to obtain material for histological examination.

Purpose of the study: to determine ultrasound signs of severe course and prognostic criteria for recurrence of Clostridioides difficile (Cl. difficile) colitis and the possibility of separating clinically negligible antibiotic-associated diarrhea from its case related with Clostridial infection. In order to fulfill the aim the study involved patients with and without COVID-19.

Material and Methods. A continuous random sample consisted of 253 patients with antibiotic-associated diarrhea. We used standard, recommended by international and Russian agreements methods of the intestinal wall ultrasound examination and diagnostics of SARS-CoV-2 and Cl. difficile infection.

Results. It was found that in antibiotic-associated diarrhea widespread intestinal wall thickening greater than 3.2 mm by ultrasonography is observed in Cl. difficile colitis. In case of diarrhea in patients with COVID-19, the detection of intestinal wall thickness of more than 4.0 mm indicates the presence of pseudomembranous colitis when intestinal pathology of ischemic genesis is excluded. Severe course of Сlostridial colitis is characterized by widespread increase in the colonic wall thickness with a maximum value of more than 7.2 mm at echography. Furthermore, there may be additional ultrasound signs of severe course of Cl. difficile colitis: the presence of paracolic free fluid and/or ascitic fluid in various regions of the abdominal cavity; increased echogenicity of adipose tissue adjacent to the inflamed intestine (omentum) and “increase” in its volume; impaired stratification of the colonic wall; thickening of the small intestine wall more than 3.0 mm; paresis of the colon; toxic megacolon. When thickening of the intestinal wall detected by ultrasound in patients with Cl. difficile colitis is more than 6.0 mm after the standard course of treatment with the achievement of clinical target results (absence of diarrhea, normalization of temperature and laboratory parameters) it is a predictor of recurrence of the disease. The described ultrasound diagnostic criteria for pseudomembranous colitis can be used for establishing its severe course and high probability of recurrence in the case of the combination of Cl. difficile colitis with COVID-19.

Conclusion: the use of ultrasound examination of the intestinal wall and surrounding structures allows to detail the diagnosis of Cl. difficile colitis.

Aim: to demonstrate the difficulties of assessing the local prevalence of pancreatic ductal adenocarcinoma using computed tomography (CT) after neoadjuvant chemotherapeutic treatment using the example of a series of clinical observations.

Materials and methods. A search was conducted for scientific publications and clinical recommendations in the PubMed information and analytical system using the keywords “pancreatic ductal adenocarcinoma”, “resectable and borderline resectable”, “locally advanced cancer”, “neoadjuvant therapy response”, “post-chemotherapy computed tomography”, “radiomics” over the past 10 years.

Results. From 30 sources found, 23 were selected for review.

Conclusion. Computed tomography remains the main method of assessing the local prevalence of ductal adenocarcinoma of the pancreas, however, in some cases it does not allow differentiating tumor, fibrous and inflammatory changes after neoadjuvant chemotherapeutic treatment.

The aim of the study was to study the characteristic CT and MRI features of phosphaturic mesenchymal tumors.

Material and methods. CT and MRI images of 13 patients with phosphaturic mesenchymal tumors were analyzed. The size, localization, shape, contours, structure of the tumor, accumulation of contrast agent, a position relative to the cortical layer, and size of the lymph nodes were assessed.

Results. Eight bone tumors (average size 23 ± 9.6 mm) and 5 soft tissue tumors (36.2 ± 47.5 mm) were detected.

In patients with soft tissue tumors, the oval shape was predominant. The contours of all tumors were smooth, the tumors were adjacent to the cortical bone layer according to CT data in 75% of cases. According to MRI data, in all cases the tumors were adjacent to the cortical bone layer. In half of cases, calcifications were determined in the tumor structure. The structure of the tumor according to CT data was homogeneous, while in half of the cases, septa were visualized on MRI images. Soft tissue tumors intensively enhanced on CT and MRI. In patients with bone tumor, rounded shapes predominated. In one case, a large sacral tumor (measuring about 40 mm) prolapsed into the spinal canal. The tumors were predominantly osteolytic with sclerotic contours and were located subcortically. Osteoid or chondroid matrix in the form of calcifications was determined in the structure. According to CT data, in 3 cases the tumors intensively enhanced, in 3 cases they did not enhance, and in 1 observation there was a weak enhancement. In MRI, all lesions intensively enhanced.

Conclusion. Phosphaturic mesenchymal tumor can occur in bones and soft tissues. CT and MRI allow to identify them and determine the boundaries of surgical resection, but should be used as second-line diagnostic methods after radioisotope methods. The use of a new diagnostic feature: the adjacency of bone and soft tissue formations to the cortical layer, and focusing attention by radiologists on this area may reduce the risk of “missing” the tumor.

Relevance. Over the past 5 years, the incidence of soft tissue liposarcomas, including their localization in the extremities, has remained at the same level and amounts to 1 case per 100 thousand people per year. Despite this, liposarcoma is characterized by a high risk of recurrence and metastasis, which necessitates multidisciplinary treatment for each of them. The diagnosis of these malignant neoplasms remains complex due to their morphological diversity and pronounced similarity to benign lipomas, even with the improvement of radiation imaging methods.

The aim: To identify the semiotic characteristics of lipomas and liposarcomas according to multi-parametric magnetic resonance imaging, allowing these histological types of tumors to be differentiated from each other.

Materials and methods. The study included 75 patients with histologically verified lipomatous tumors of soft tissues (28 men and 47 women) aged from 30 to 82 years (average age 58 years). All patients underwent multiparametric MRI of soft tissues before treatment on a tomograph with a magnetic field strength of 1.5 T.

Results. The study included 32 patients with histologically verified liposarcoma and 43 patients with soft tissue lipoma. Morphologically, liposarcoma was represented by the following types: atypical lipomatous tumor (ALT/WDLS), dedifferentiated liposarcoma (DDLPS), myxoid liposarcoma (MLPS), pleomorphic liposarcoma (PLPS). The study identified a number of MR criteria that distinguish lipomas and liposarcomas from each other (tumor shape, location of the tumor relative to the compartment, number and thickness of septa, presence of solid tissue, MR signal on IP with suppression of the signal from adipose tissue (p < 0.05).

Conclusion. MRI allows not only to detect lipomatous tumors, but also to differentiate benign lipomas from malignant liposarcomas based on their morphological characteristics. This makes MRI an indispensable tool in the diagnosis and treatment planning of such tumors.

Introduction. To clarify the radiological criteria for determining the prescription of fractures of the bones of the nose, based on the data of a forensic medical examination performed using CT. Special attention is paid to the comparative analysis of X-ray signs that make it possible to differentiate an acute fracture from a consolidated injury, as well as to the assessment of the impact of these data on the objectivity of forensic conclusions.

Materials and methods. The study analyzed data from 259 victims with fractures of the nose bones. The patients were examined using radiography and CT with 3D reconstruction. The studies were conducted on the day of admission, 10–14 days, 21 days and 1 month after the injury. The majority of injuries (83.3%) occurred in people aged 21–38 years, more often in men (82.9%). Domestic and street incidents caused 79.3% of injuries, car accidents – 15.2%, falls from heights – 5.5%. Radiological signs included the condition of the soft tissues, the shape and structure of the fracture edges, the presence of hemosinus, the nature of the line of illumination between the fragments, and signs of bone remodeling.

Results. Analysis of CT scans has shown that acute fractures (one day or 3–4 days after injury) have uneven edges and pointed corners, with a clear and contrasting line of illumination up to 1 mm. After 10–14 days, the illumination persists, but becomes less clear and contrasting, and the soft tissue edema regresses. On days 20–21, signs of callus formation appear: smoothing of the edges, blunting of the ends of the fragments and an increase in the width of the lumen to more than 1 mm. By 4–5 weeks, bone callus, sclerotic changes and a local decrease in mineral density are clearly visualized.

Discussion.  Establishing the limitation period of a mechanical injury is important for a forensic medical examination. The problem of diagnosing the prescription of nasal fractures in living persons has not been solved. Traditional radiography is not always accurate, especially 21 days after an injury. CT with 3D reconstruction is more reliable, revealing subtle changes in bone structure and the stage of regeneration. CT distinguishes between acute and consolidated fractures, confirming changes in radiological signs by repair stages. Regulations do not take into account modern methods of radiation diagnostics, which leads to errors. The integration of CT improves the accuracy of the assessment and the objectivity of the conclusions.

CT allows you to dynamically evaluate changes by determining the timing of repair. Radiological signs of fractures correlate with physiological processes. Without these signs, the expert cannot establish a connection with recent exposure.

Conclusion. Computed tomography (CT) improves diagnostic accuracy by differentiating between acute and consolidated fractures. Radiological signs, such as changes in the structure of the edges of fragments and the formation of bone marrow, correlate with the physiological processes of repair. This allows for more accurate dating of injuries, which is important for the legal assessment of incidents. The integration of CT into forensic practice improves the diagnosis and methodology of research. Further developments, including the improvement of the regulatory framework and the introduction of quantitative analysis methods, are promising.

Diabetic polyneuropathy (DPN) is a common complication of diabetes mellitus. It is characterized by damage to peripheral nerves with changes in perfusion and intraneural pressure. The search for new diagnostic tools is an urgent task.

The aim of the study is to assess perfusion and intraneural pressure of the sciatic nerves in adolescents with type 1 diabetes mellitus using a multimodal approach (ultrasound, MRI).

Materials and methods. Patients with type 1 diabetes mellitus aged 13–17 years (n = 50). All patients underwent ultrasound examination of the peripheral nerves of the lower extremities twice dynamically, using a greyscale mode, Dopplerography, and shear wave elastography. MRI of the sciatic nerve was performed in patients (n = 20) using diffusion tensor tractography and perfusion methods once.

Conclusions. A multimodal approach (ultrasound, MRI) allows us to characterize sciatic nerve perfusion and intraneural pressure in adolescents with type 1 diabetes mellitus. Increased MR perfusion of the sciatic nerves is accompanied by an increase in ultrasonic stiffness and the coefficient of ultrasound assessment of peripheral nerves in adolescents with type 1 diabetes mellitus.

In the field of pediatric trauma, the question of the optimal approach to diagnosing the volume of hemoperitoneum and calculating blood loss in injuries to the abdominal organs is of important clinical significance.

Aim. To develop an ultrasound diagnostic method to accurately determine the volume of free fluid in the abdominal cavity and study its informative value in children with hemoperitoneum.

Material and methods. To calculate the volume of free fluid during echosonography, an experiment was conducted on cadaver material (10 victims). To simulate hydroperitoneum, a drainage was installed in the epigastrium using a puncture method, through which an isotonic solution was injected into the peritoneal cavity in portions. Subsequently, ultrasound was performed and correction factors were calculated. The assessment of the informativeness of the ultrasound diagnostic method was carried out based on the results of a one-time analysis of 47 case histories of patients with splenic rupture and hemoperitoneum who were treated from January 1997 to September 2009.

Results. In an experiment on cadaver material, a comparison between the true volume and the obtained volume according to echosonography revealed a significant (p = 0.008) difference of 400 (100; 600) ml and 139 (21; 355) ml, respectively. To optimize the calculation of the volume of free fluid according to ultrasound data, correction factors were calculated, which were 2.36 for low hydroperitoneum (up to 11 ml/kg); 1.37 for moderate (11–22 ml/kg) and 1.04 for large (more than 22 ml/kg). In the clinical group, the information content of ultrasound was assessed using the obtained correction factors and body surface area. It was revealed that the resulting formula has high diagnostic tests (sensitivity 93–100%; specificity 88.2–97.7%) for the true calculation of hemoperitoneum volume in children.

Conclusion. In children, when performing abdominal echosonography using correction factors, it is possible to calculate with high accuracy the true volume of bloodshed, which is necessary for assessing blood loss. Our results allow us to contribute to the optimization of diagnostic procedures and improve our understanding in assessing the exact volume of hemoperitoneum in the context of abdominal injuries.

The fusion of artificial intelligence with medical imaging is undoubtedly a progressive innovative process in the modern development of domestic healthcare, which allows for unprecedented accuracy and efficiency in the diagnosis and planning of special treatment of various diseases, including malignant tumors. At the same time, artificial intelligence approaches, especially in the field of clinical application of radiotherapy techniques, are spreading more widely and moving from the field of specialized research to the field of already accepted traditional clinical practice.

Purpose of the study: to analyze the approaches of artificial intelligence in the field of clinical application of radiotherapy techniques for the antitumor treatment of malignant tumors.

Conclusion. The further development of artificial intelligence provides for the provision of options for the prevention, diagnosis and treatment of cancer patients against the background of a constant increase in accuracy in their implementation, including assistance in optimizing radiotherapeutic treatment of malignant neoplasms.