Purpose: to study the role of lacrimal scintigraphy in estimation of drainage function of lacrimal pathways. Materials and methods. 40 lacrimal scintigraphy studies were conducted, among them 20 in healthy volunteers and 20 in patients with partial and complete nasolacrimal duct obliteration, confirmed by dacryocystography. The study was conducted with a stable у-camera of a tomographic scanner Symbia T16 (Siemens, Germany) for single photon emission tomography and computed tomography after a cul-de-sac radionuclide tracer instillation. Result. The half-life of a radionuclide tracer (T_1/2) in healthy volunteers at the region of interest, corresponding to the whole ocular surface was 24 ± 11 min, to its lateral part - 8 ± 3 min, to the lacrimal sac - 13±6 min, to the nasolacrimal duct - 11 ± 7 min. T_1/2 in patients with partial nasolacrimal duct intubation at the region of interest, corresponding to the whole ocular surface was 125 ± 90 min, to its lateral part - 90 ± 42 min, to the lacrimal sac - 43 ± 14 min, to the nasolacrimal duct - 112 ± 48 min. In patients with complete nasolacrimal duct obliteration T_1/2 was the same that a radionuclide tracer’s was. Conclusion. Lacrimal scintigrahy is the method of quantitative lacrimal drainage system function analysis, and it enables to detect minimal function in cases when routine radiographic studies do not detect it. However, lacrimal scintigraphy does not enable to localize the obliteration. It is the authors’ opinion that lacrimal scintigraphy is not informative in case of composite partial obliteration, it is not possible to diagnose partial nasolacrimal duct obstruction only on the basis of lacrimal scintigrahy data, but it is beneficial to use this method several times in one patient during the treating to detect the progress. Lacrimal scintigraphy is a useful method in a complex lacrimal drainage system abnormalities diagnostics.

The purpose: the study of the diagnostic significance of computed tomography (CT) orbital parameters - density retrobulbar fat (RBF) and extraocular muscle (EOM) - in determining the clinical activity of the Graves’ orbitopathy. Material and methods. 102 patients with the Graves’ orbitopathy (204 eye), including 72 (70.6%) women and 30 (29.4%) men, were examined. The average age of the surveyed was 48.4 ± 12,2 years. Activity and severity of the Graves’ orbitopathy was determined according to the protocol EUGOGO. The clinical significance of multi-slice computed tomography (MSCT) orbits was evaluated on the criteria of sensitivity and specificity. We expected that the value of the cut-off threshold studied attributes by constructing ROC-curve (Receiver Operating Characteristic) using a statistical analysis program MedCalc we also used an indicator AUC (Area Under Curve, the area under the ROC-curve). Results. In the group of patients with EOC sensitivity MSCT orbits to determine the activity of the process by densitometric density of RBF and EOM was 93.9% and 44.3%, respectively; for determining fibrosis - 84.6% and 67.7%, respectively. Specificity of MSCT study of RBF and EOM density for activity the Graves’ orbitopathy was 100% for both parameters, for fibrosis - 88.9% and 94.7%, respectively. Conclusion. RBF and EOM density according to MSCT of orbits can provide additional data on the activity of the process in relation to the clinical picture of the Graves’ orbitopathy. In diagnostics, edema and infiltration respective active step of the process and the formation of fibrosis in the inactive phase is the Graves’ orbitopathy, is the most sensitive parameter of the density of the RBF. In the active phase of the disease absolute specificity has both CT-parameter. In the inactive stage the Graves’ orbitopathy highly specific test is to measure the density of the EOM.

Thanks to a method of a transillumination it is possible to estimate accurately safety of a blood-groove in a transplant at reconstruction of a digestive tract after a gastrectomy. The venous thrombosis is a specific complication of jejunal interposition. Knowledge of them allowes to minimize risk of intra- and postoperative complications. During a surgery a transillumination can clearly assess the bloodstream in order to detect venous thrombosis and to assess the viability of the transplant at whole. Objective: to evaluate the possibility of MDCT diagnosis in order to plan of jejunal transplant formation before surgery based on a created of new classification of jejunal angioarchitectonics. Material and methods. Research conducted in two stages. First stage. Research included 30 patients with a cancer of a stomach who were on treatment from June, 2012 to December, 2013 in A.V. Vishnevsky Institute of Surgery. MDCT with contrast enhancement carried out to all patients to operation for the purpose of an assessment prevalence of oncological process and an assessment of blood supply and anatomic features of the vascular cource and possibility of vessels of a jejunum. Gastrectomy with one-stage jejunal interposition executed to all patients with the estimation of angioarchitectonics jejunum. Intraoperative data on angioarchitectonics jejunum, received by means of transillumination, compared to results of the MSCT-angiography. Second stage. As groups of comparison and for confirmation of frequency of occurrence of various options of angioarchitectonics jejunum carried out the analysis of section data in casual selection of 30 corpses of adults and results of 30 casual angiography of abdominal aorta. Results. The defined types and variants of angioarchitectonics arteries jejunum were following: stem type - 23.3%, arcuate type - 41.1%, branchy type - 18.9%, scattered type - 16.7%. The sensitivity of MdCt in evaluation of angioarchitectonics jejunum is 93.3%, specificity - 100%, general accuracy - 93.8%. An arcuate type of angioarchitectonics was detected in 2 patients by MDCT-angiography, while intraoperatively they were interpreted as scattered. Conclusion. First we determined two anatomic types and four variants of jejunal angioarchitectonics as the significant criterion for the formation of segmental transplant. A preoperative MDCT with bolus contrast enhancement preliminary makes it possible to model a jejunal transplant.

Purpose. Determination of criterions of efficiency, duration and expediency for only minimally invasive techniques treatment of purulent necrotic complications of acute severe pancreatitis. Material and methods. The research is based on results of 115 treatment cases of purulent necrotic complications of acute severe pancreatitis. Patients were divided into 2 groups: first - 33 (28,7%) patients which had received traditional operation; second - 82 (71,3%) patients received surgical treatment started with minimally invasive interventions. The Mumbai 2008 classification based on imaging diagnostics was used for comparative evaluation. Each group was divided into subgroups depending on severity of the disease. The classification of Filin-Tolstoy was used for the sub-division. Results. 6 (18%) patients from the first group had the following postsurgical complications: arrosive hemorrhage (5 cases), colic fistula (1 case). The hospital stay duration averages: 30,2±5,4 days for the mild cases group, 51,1 ± 9,2 for the severe cases group. Lethality averages 39,3% (13 cases). There was 1 lethal case in mild cases group as result of postsurgical arrosive hemorrhage. The lethality in severe disease group averages 36,3% (12 cases): as result of postsurgical arrosive hemorrhage (2 cases) and as result of developing multi-system organ failure (10 cases). There were 19 (23%) complications in second group: arrosive hemorrhage (5 cases), colic fistula (11 cases), pancreas fistula (14 cases). The hospital stay duration averages: 55,3±4,2 days for the mild severity group, 70,9±6,7 for severe disease group. It was discovered that lethality for second group were 2 times less and hospital stay duration were 1,5 times longer than for the first group. Conclusion. It is always possible to start with minimally invasive techniques under control of ultrasonic and X-ray imaging in cases of purulent necrotic complications of acute severe pancreatitis. However in case of intoxication syndrome retention it is necessary to take decision on corresponding necrosequestrectomy by means of laparothomy or imaging endosurgery.

Purpose. To evaluate the capabilities of modern minimally invasive interventions under the beam guidance in the surgical treatment of pancreatic cysts. Materials and Methods. The results of the examination and surgical treatment of 82 patients with pancreatic cysts. Percutaneous puncture drainage under ultrasonographic guidance holds 56 (68.3 %) patients, endoscopic transpapillary intervention in 19 (23.2%) patients, endoscopic transmural drainage of cysts by ultrasonography - in 7 (8.5%). Results. After performing percutaneous drainage of cysts positive results were observed in 51 (91.1%) patients. In 14 (25.0%) patients in the control studies showed preservation of the residual cystic cavity is not more than 3 cm in diameter, without clinical manifestations, that is not regarded as a relapse. Relapses cystic formations were observed in 5 (8.9%) patients. Positive results transpapillary stenting of the main pancreatic duct was observed in 16 patients. In 3 cases, endoscopic stenting GLP was not effective. Subsequently, the patients underwent percutaneous drainage of puncture with a positive result. Endoscopic transmural drainage under ultrasonography noted one intraoperative complication - perforation of the stomach wall. 6 patients had a good result. Term follow up of patients ranged from 10 months to 3 years. Conclusion. Integrated use of modern percutaneous endoscopic and minimally invasive interventions under the beam guidance in 82 patients with pancreatic cysts, yielded positive results in 79 (96.3%) cases, which confirms the efficiency and the prospects for further study and application of these minimally invasive procedures.

Objectives: to specify the main ultrasonic signs of hilar cholangiocarcinoma in order to enhance the efficiency of its diagnosis; to create a volume of ultrasonic examination techniques of patients with hilar cholangiocarcinoma. Materials and methods. The analysis of the results of clinical-instrumental tests on 99 patients suffering from tumors or benign damages of proximal bile ducts has been carried out. The patients have been allocated to the following groups in accordance with the final diagnosis: group 1 - patients with hilar cholangiocarcinoma (n = 38; 38,4%), group 2 - patients with primary hepatic and gallbladder tumors (n = 31; 31,3%), group 3 - patients with benign damages of proximal bile ducts (n = 30; 30,3%). All the patients have undergone complex clinical-instrumental tests. Results. The analysis of the frequency of the following echo-signs in the group of patients with hilar cholangiocarcinoma as well as tumor affection and benign damages of the liver and gallbladder has been carried out: dilatation of intrahepatic bile ducts, alterations of bile duct walls (the absence of differentiation or thickening), hyperechoic periductal tissues, tissue alterations of hepatoduodenal ligament, focal hepatic formations in the portal fissure region and dimensional changes of the gallbladder. Conclusion. A symptom complex typical of hilar cholangiocarcinoma has been singled out which helped to enhance the informative value of ultrasound techniques for tumor diagnosis with the susceptibility of 73%, specificity of 94% and accuracy of 87%. It also optimized the results of detaching the morphotype of tumor growth and the extension of the local disease in order to frame the appropriate therapeutic approach.

Objective. To determine the causes of misdiagnosis of gallbladder cancer (GBC). Materials and Methods. The results of examination and treatment of 34 patients GBC. Results. GBC was diagnosed in the majority of patients (92,8%) with stage T4, had spread to the liver from 78.9%, the liver metastases in 32.1%, the metastases in the lymph nodes in 39.2%. Sensitivity and specificity in the diagnosis GBC were 73.7% and 16.7% for ultrasound; 64.3% and 33.3% for X-ray CT; 69.2% and 0% for MRI; 71.4 % and 66.7% for CA -199; 94.1 % and 50% for the surgical evaluation. Lack of true positive MRI results are not possible to calculate the specificity. Low specificity of the methods due to the large number of false positives results - in (29.4%) patients. False positive results associated with inflammatory changes in the gallbladder and surrounding liver. False-negative results associated with the rapid spread of GBC on the liver, which is taken as primary liver cancer involving the gallbladder. Conclusion. Diagnosis GBC is a difficult task, even in advanced stages. Nevertheless, requires a comprehensive diagnosis using ultrasound, X-ray CT, MRI, determination of the level of CA 19-9 and biopsy

Presents the data of literature on frequency of occurrence and features of diaphragmatic hernia beam diagnostics in the fetus and newborn. Presented own observation of application of magnetic resonance imaging (MRI) to analyze the fetus and newborn with congenital diaphragmatic hernia. Positive aspects and difficulties in conducting postmortem MRI were noted. It is concluded, expediency of carrying out postmortem MRI as additions to autopsy studies in certain cases.

Purpose was the evaluation of possibility of using monocular motion parallax (MTD) in navigation during percutaneous transhepatic cholangiostomy. Materials and Methods. To study the MTD the phantom of bile ducts was created. It consists of two plastic tubes, upper tube marked with radiopaque marker and the needle installed between the tubes. Interventions were performed on 155 patients in 3.5 years. Drainage of left lobe ducts was performed on 15 (9.6%) patients, drainage of right lobe ducts was performed on 84 (54.2%), drainage of both right and left lobes was performed on 56 (36.2%) patients. Results. Application of MTD in navigation during percutaneous transhepatic cholangiostomy allowed to increase the number of simultaneous multiple drainage ducts of both left and right hepatic lobes from 2 patients in 2011 to 12 patients in 2012. Conclusions. Monocular motion parallax allows quickly get an idea of needle position in bile ducts on different types of C-arms and, if necessary, make corrections of puncture direction, reduce the time and traumatism of this manipulation.

The aim of the study was to evaluate the efficiency of uterine artery embolization (UAE) by means of MRI, depending on their location, structure type and the presence of accompanying endometriosis Methods and materials. MRI (1.5 T) was performed in 20 women with leiomyomas (107 nodes) at the age of 41-46 years, presented for consideration for UAE before and 1 month after the manipulation. MRI was also performed in 6 months after the UAE in 8 women and in 12 months in 4 women. Results. Submucosal nodes were determined in 25% of cases, intramural - in 32% and subserosal - in 30.7%. Hyalinization of the nodes was noted in 44% of cases, the second most frequent type was node without signs of degeneration - 36%. The most prominent dynamics was noted in cellular leiomyoma type - the volume decrease was up to 50% in one month, 64% in 6 months and 75% in 12 months after UAE. In leiomyomas with hyaline, cystic or myxoid type of degeneration volume shrinkage was less prominent - 44%, 50% and 65% accordingly. Conclusion. MRI can provide us with precise information about location, size, structure and vascularization of leiomyomas before and after UAE. UAE efficiency depends on accompanying endometriosis and node structure.

Aim. Identify opportunities for cardiac MRI with contrast in predicting the dynamics of coronary artery disease after revascularization with pre-operative assessment morphological and functional state of LV in patients with ischemic cardiomyopathy (ICM). Material and methods. The study involved 28 people with ICM. After spiroveloergometry formed two groups of patients with improvement and deterioration of left ventricular function after revascularization. Before surgery, patients underwent MRI of the heart with the calculation of LV EDV and ESV and the proportion of viable LV myocardium. Comparing the values of these parameters in groups. Combined effects of functional performance and the percentage of viable myocardium in the postoperative prognosis LV estimates of multivariate discriminant analysis. Results. When the value of preoperative LV EDV 192 (186; 275) ml, LV ESV to 136 (124; 188) ml and the number of viable myocardium over 67 (59; 73) % LV mass a year after cardiovascular surgery should expect positive dynamics. When LV EDV more than 244 (209; 282) ml, LV ESV more than 187 (156; 215) ml and a content of less than viable myocardium 58 (52; 72) % in LV mass may imply the expression of remodeling and small opportunities myocardial reserve improve left ventricular function after cardiovascular surgery. Discriminant analysis formula Z = 0.56 · X (EDV) + 0.47 · X (ESV) - 0.54 · X (viab.) allows the calculation of index prediction Z, and get information about the type of dynamics of ICM after revascularization. Conclusions. With the help of cardiac MRI with contrast agent defined criteria for evaluating the state of LV morphology and function in patients with ICM, allowing preoperative examination to assess the possibility of myocardial reserve and predict the nature of ICM after revascularization.

Purpose. Compare the characteristics of MRI techniques and whole-body bone scintigraphy in the detection of bone metastases in primary malignant tumors of the most frequent sites. Materials and methods. 29 patients with malignant tumors of different localization and suspected secondary bone lesions were examined at “RNTSRR”. All patients underwent bone scan to gamma camera Nucline DHW using mono-and diphosphates of Tc-99m activity of 370-600 MBq, as well as MRI “whole body” for magnetic resonance imaging “Atlas” 1.5 T, and “Signa” 1.5 T The diagnosis of secondary bone lesions was further confirmed by the data MSCT or supervision for 6 months. Results. Metastatic bone lesions were present in 21 (72.4%) patients, benign nature were identified at 8 patients (27.6%) patients. According to the results of the use of MRI techniques “whole body” was placed 1 false-negative and false-positive diagnosis 2, the sensitivity of techniques was 95.2% (20/21), specificity of 75% (6.8). According to bone scan were mentioned 3 false-negative results, and 3 falsepositive, the sensitivity was 85.7% technique (18/21), specificity - 62.5% (8.5). The accuracy of the technique of the whole body MRI was 89.6% (26/29), bone scintigraphy - 79.3% (23/29). Conclusions. MRI “whole body” is a more objective procedure than bone scan, due to a more accurate visualization of anatomical zones. Using MRI “whole body” for suspected secondary bone disease can reduce the need for additional diagnostic studies. MRI “whole body” is no-radiation procedure, but it is technically difficult and may not be performed at all equipment, which leads to increased cost of study.

Introduction. It wasregistered while studying peculiarities of reparative osteogenesis in experimental conditions that stable fixation of bone fragments in correct position and conservation of intraosseousblood supplywere the most important for successful regeneration. Use of such visual control methods as X-ray imaging and tomography with densitometry doesn’t allow to estimate degree of vascularization of the regenerate. High response and simplicity of radionuclide researchesat the diagnostics of regenerated maturity, duration of fixation periodallows to describe functional state of an extremity when replacing bone defect depending on individual qualities of an organism that allows to decrease percentage of complications connected with vessels injury or other regenerate’s trophism disorders. Aim of the research: to estimate in experiment vascularization of distraction bone regenerate when lengthening an extremity with use of gamma-scintigraphy. Results. The dynamics of vascularization when restructuring distraction regenerate of forearm bones was estimated with use of gamma-scintigraphy. By the 10^th day of fixation of bone fragments with external fixation deviceblood flow in the area of the regenerate begins to increase which is proved by digital results of gamma-scintigraphy onthe 2^nd stage of blood supply and alsogrowth of bone tissues becomes faster which is proved by delta parameter during skeletal stage of the research. However by the 20^th day of fixationbone tissue growth during the stages of blood circulation is 2 times slower than in intact bone, and its digital characteristics can testify about incomplete formation of vessels in the area of the regenerate. During skeletal stage by the end of the experiment delta parameter is larger, but it is 25% lower than that one of intact extremity, which is also an evidence of incomplete bone formation. Conclusion. Obtained results of experimental research of vascularization of distraction bone regenerate by the method of gamma-scintigraphy show structural changes of the regenerate and of quantity characteristic of the degree of blood supply on different stages of restructuring.

The paper presents five stages of standardized technique of compression elastography, which is clearly structured for gray-scale images phasing evaluation as qualitative so and semi-quantitative elastography. The examples of conclusions are shown with the help of conventional classifications and categories of BI-RADS for breast cancer Comparative data on the diagnostic efficiency and reproducibility standard and the proposed methods of elastography in 2741 people with focal formations breast, thyroid and lymph nodes are presented. The advantage standardized methodology is proved. The ways of nationwide discussion of these Recommendation sare suggested.

Aim. To study the opportunities of the magnetic resonance tomography (MRl) in diagnostics of seromas of a bed of silicone gel implants after endoprosthesis replacement of mammary glands. Material and methods. Complex kliniko-radiological examination of 630 women with 1260 implants after a breast augmentation of mammary glands is conducted. Various complications after endoprosthesis replacement of mammary glands were diagnosed at 127 (20.1%) women. Thus, seromas around of breast silicone implants were revealed in 21.3% cases and developed in terms from 1 year to 16 years after endoprosthesis replacement of mammary glands. Results. Sensitivity of mammography in diagnostics of seromas round implants of mammary glands made 37%, specificity - 78.7%. Sensitivity of ultrasonography in diagnostics of seromas in a bed of implants of mammary glands made 87%, specificity - 99%. Sensitivity and specificity of MRI in diagnostics of seromas of implants of mammary glands made 100%. Conclusion. MRI, is the most informative method in diagnostics of seromas around of an endoprosthesis. Application of MRI is shown for specification of nature of changes of mammary glands and the endoprosthesis revealed at sonography, and also in cases of existence of pain, feeling of a pressure from in and a dyscomfort in mammary glands if at ultrasonography of pathological changes it is not revealed.