The aim of the study was to compare T2*-weighted MR-perfusion (pMRI) and positron emission tomography using [¹¹C]methionine (PET-Met) in differentiating recurrent brain tumor (RT) from posttreatment radiation effect (PTRE). Material and methods. PET-Met and pMRIwere performed in 45 patients with previously treated brain tumor A total 57 lesions were analyzed. The rCBV index and [¹¹C] methionine uptake index (UI-Met) were calculated as the ratios of the highest lesion value to the that in the reference region. The diagnostic accuracy of UI-Met and rCBV for correct identification of recurrent tumor (RT) versus PTRE was evaluated by ROC-analysis using subsequent histologic analysis or clinical and radiological follow-up. Results. According to the final diagnosis patientsexhibitedthetwo typesofabnormalities: recurrent tumor (n = 33) and non-progressive lesions (n = 24). The inter-individual agreement between the both techniques was observed in 93% of cases. In 4 patients results were discordant. High [¹¹C]methionine uptake and low rCBV were detected in 2 cases of radiation necrosis. In 2 patients PET-Met was able to distinguish foci of radionecrosis and the viable tumor tissue. Conclusion. T2*-weighted MR-perfusion and PET-Met could be efficiently used for differentiation RT from PTRE. Inter-individual comparison of the both methods showed that PET-Met was more sensitive in imaging recurrent tumor, but perfusion MRI had higher specificity.

Purpose: to determine the most useful quantitative parameter of diffusion-weighted images (DWI) in the differential diagnosis of focal liver lesions. Material and methods. DWI of 69 patients with 192 focal liver lesions (145 malignant and 47 benign) were evaluated. DWI was performed with b 0, b 300, b 600 gradients at MRI 3 T. Apparent diffusion coefficient (ADC) of lesion, liver, spleen, left kidney, body of pancreas, vertebral body, back muscle were calculated. The ratio (rADC) and difference (dADC) between ADC lesion and ADC other anatomical structures were calculated. The ROC analyses were performed in order to find more useful parameters in the differentiation of malignant and benign tumors, and to determine cut-off of them. Results. Mean ADC values of benign lesions were 2.346 ± 0.683 • 10^-3 mm²/s, malignant 1.109 ± 0.383 • 10^-3 mm²/s. More useful parameters were dADC(lesion-liver), rADC(lesion/liver). The mean dADC(lesion-liver) for benign and malignant tumors was (0.989 ± 0.657) • 10^-3 mm²/s, (-0.257 ± 0.333) • 10^-3 mm²/s, respectively. The mean rADC(lesion/liver) for benign tumors was 1.729 ± 0.528, for malignant 0.819 ± 0.250. Conclusion. dADC(lesion-liver) and rADC(lesion/liver) are more useful in the differential diagnosis of focal liver lesions.

Hepatic portalvenous gas (HPVG) - rare ultrasound phenomenon, previously frequently associated with acute mesenteric ischemia and/or necrosis, and accompanied by high mortality (up to 75-90%). HPVG phenomenon was described in 1955 the baby with necrotic enterocolitis, and early studies of HPVG were based on plain abdominal radiography. Modern abdominal CT and ultrasound examination USE has resulted in the detection of HPVG in more benign conditions, and in more diverse diseases and in twenty-first century mortality when it is less than 40%. Purpose: to evaluate differents variants sonographic patterns of the HPVG-phenomenon and their diganostics value. Materials and methods. A total of 33 babies with HPVG, who visited our hospital between 2005 and 2014 were analyzed. Results. Identified 2 sonographic patterns HPVG depending on its generation. When transportal pattern the gas flow after performing manipulations on the vessels of the umbilical cord (5/33, all children 1-4 days), gas was detected only in the left branches of the portal vein, in 1 case the child had severe heart failure associated, presumably, with gas embolism of the pulmonary artery. In other cases (28/33, 25 newborns and 3 babies (7 months with enterocolitis, 9 months with midgut volvulus and 24 months with intestinal infection) occurred transportal the gas flow. The gas bubbles were detected in all parts of the liver parenchyma and in the lumen of the portal vein. In the 25 newborns 12 cases, the HPVG was observed on the background of necrotizing enterocolitis, 3 newborn - intestinal obstruction and in 10 cases of HPVG was observed on the background of deterioration in patients without a clear clinical picture. In these cases, the sonographic detection of HPVG conventionally been regarded as the risk of developing septic shock. In 1 case the child 7 months with liver cirrhosis and recanalization of the umbilical vein HPVG was complicated portosystemic gas shunting into the inferior vena cava and right heart embolism. In the article showing the various patterns of visualization HPVG. The duration of HPVG existence which only 1 case was 1 day, the remaining estimated hours. It is urgent need to differentiate HPVG from gas in the hepatic veins. Literature of this rare condition is reviewed briefly Conclusion. Sonographic representation of the HPVG depending on its origin. The transportal HPVG can be interpreted as a predictor of enterocolitis and/or sepsis. The transumbilical HPVG in newborns may be accompanied by gas embolism of the lungs.

Objective. To evaluate the value of multislice computed tomography in the diagnosis, assessment of severity and prognosis of acute pancreatitis and its complications, and the choice of an appropriate method of treatment. Materials and Methods. A computer tomography (CT) study of 75 patients with acute pancreatitis. Computer-tomographic study was performed on devices Siemens Somatom Sensation, Siemens Emotion Duo, slice thickness 5 mm, followed by reconstruction of 1 mm with an oral contrast intestine (Urografin) and contrast enhancement (Ultravist, Omnipaque). Results. Diagnostic efficacy of computed tomography in acute pancreatitis was determined. The association of CT severity index with clinical severity and complications were found. Using of the results of multislice computed tomography (MSCT) as a prognostic criterion of the severity of acute pancreatitis was proposed. Conclusion. Complex assessment of pathological changes identified during the initial computer-tomographic study predicts the nature of the subsequent course of the disease in most patients.

The purpose: to evaluate the benefits of targeted prostate biopsy under navigation of the histoscanning technology. Material and methods. During the period from mid- September to December 2013 according to the histoscanning procedure with targeted biopsies were examined 27 patients aged from 47 to 98 years with suspected prostate cancer, aimed at the urology department of “Clinical Hospital №1” of the Presidential Administration of the Russian Federation to perform transrectal prostate multifocal biopsies. All patients underwent complex clinical examination and ultrasound examination, which included: a study in grayscale using ultrasonic angiography, sonoelastography and histoscanning. Results. The sensitivity of histoscanning technology was 81,8%, specificity - 75%, accuracy - 77,7%, PPV - 69,2%, NPV - 85,7% respectively. Conclusion. We can get closer to the new standard of performing prostate biopsy - biopsy of suspicious areas only today.

Teratomas are the most widespread among the germinal tumors. They are found from the youngest age and represent group of tumors, very various on the fabrics which were their part which come from germinal leaves of various degree. The clinical case illustrates an example of cystic teratoma diagnostics. Ultrasound, as well as CT, owing to the considerable amount of lesion, at the first stage didn't allow to tell with confidence, about an ovary, as about lesion source. MRI was the method of the diagnostic choice which has allowed accurately to define its source.

Aim. To estimate possibilities of the color duplex scanning in evaluation of a shank artery status. Duplex scanning was used as an updating method required for planning of revasularizing operations on the lower extimities arteries. A study of haemodynamic in patients after femoral-tibial bypass combined with formation of arterio-venous fistula was used as prognostic criteria of bypass functioning. Materials and methods. 9 patients with occluding aterosclerotic lesions of femoral-popliteal-tibial segments were studied. 10 revascularing operations were performed: 6 external femoral-tibial bypasses and 4 femoral-tibial bypasses with formation of unloading arterio-venous fistula and application of a “Sent-Mary boot” cuff on a distal anastomosis level. Color duplex scanning and computer angiography were performed for all patients before operation and after distal arterial reconstructions. Results. Possibilities of both methods in evaluations of the status of lower extrimities arterial bed were compared and 70% coincidence were revealed. Prognostic useful factor of the bypass functioning was a volume blood velocity in bypass at middle third of leg which is equal to a sum of volume blood velocity in donor artery distal to anastomosis and volume blood velocity in unload vein proximal to anastomosis. Conclusion. Precise performance of method and duplex scanning protocol allow to evaluate not only an anatomic state of the outflow pathway but also to determine functional status of the invaded extrimity. These data may serve as a prognostic criteria of bypass functioning.

Purpose: to determine the role of multislice computed tomography (MSCT) in assessment of popliteal artery aneurysm and to estimate the quality of reconstructive operations, as well. Materials and Methods. 37 patients with popliteal artery ane urysm were investigated and treated surgically from 2006 to 2013. Patients age ranged from 20 to 71 years. Tactics of surgical treatment was based on Collor Doppler ultrasound, MSCT and in some cases on digital subtraction angiography datas. Results. 52 aneurysms of popliteal arteries were revealed in 37 patients. Aneurysms were unilateral in 22 (59.4%) cases and bilateral in 15 (40.6%). They were associated with aneurysms in other locations in 15 cases: with abdominal aorta - in 8 (21.6%) cases, with iliac arteries - in 3 (8.1%) cases, with femoral arteries - in 4 (10.8%) cases. Ligation of afferent and efferent vessels of aneurysm with autovenous grafting was performed in 12 (32.4%) cases; resection of aneurysm with autovenous grafting in 8 (21.6%) cases, dissection of aneurysm with autovenous grafting and coverage with duplication from aneurysmatic walls in 5 (13.5%) cases, endovascular grafting of aneurysm in 4 (10.8%) cases, ligation of afferent vessel of aneurysm in 1 (2.7%) case. Conclusion. As the standard method of diagnosis for all patients at revealing the popliteal artery aneurism, it is necessary to perform CD of aorta and the arteries of lower extremities on the whole length that helps to reveal accompanying aneurysms of abdominal aorta and of ilio-femoral segment. The advantage of MSCT to CD is the possibility of performing three dimentional (3D) images and enhanced images of tissues. This gives the opportunity for more detailed and precise study of topography of aneurism, involving vessels and tissues around it, also reveal the severity of lesions of the peripheral vascular bed and choosing optimal surgical treatment. The evaluation of efficiency of the surgical treatment and the adequacy of performed angioplasty or reconstruction of vessels is preferable to be assessed with CD. In case of some disorders, for more accurate evaluation of the vessels’ pathologies, examination should be added with MSCT.

The aim: assessment of short-term and long-term outcomes of surgical treatment of branches of aortic arch in patients who suffer from nonspecific arteritis (Takayasu’s arteritis). Materials and methods. Duplex ultrasonographic imaging was conducted in 27 patients with nonspecific arteritis who had 30 different kinds of surgical repairs of the branches of aortic arch performed, (carotid and subclavian arteries), 31 shunts were imposed (one patient put two shunt). The average postoperative follow-up period was 8.4 ± 5.4 years. Results. In late postoperative period 15 (48%) of the repaired arteries remained unobstructed. The absence of variations in the surgery area was registered after the performance of reconstruction of carotid arteries (aorta carotid or carotid subclavian prosthesis) more often (80%). Complications in the area of the reconstructed artery (thrombosis, stenosis at the distal anastomosis) were more common after transthoracic surgeries - 69%, while the percentage of complications after extrathoracic surgeries was 27%. In 62.5% of the observed cases, the connection was found between the development of the bypass thrombosis with the progression of inflammatory process in the arteries of the distal arterial bed. The permeability of the reconstructed carotid arteries in 5 years and over was 83.3%. according to the duplex ultrasonographic imaging. After the reconstruction of subclavian arteries, the bypass patency in 5 years was 63.6%, in 10 years - 36.3%. Conclusion. Accurate diagnosis of changes in the vessels of medium and large caliber in patients with nonspecific arteritis is a topical issue of radiology. The use of duplex scanning at various stages of treatment of this complex group of patients allows high accuracy to evaluate the results of surgical and medical treatment to prevent the development of life-threatening complications, and its non-invasiveness, safety and relative affordability make duplex scanning priority diagnostic method of control.

The aim of the study is to reveal early echocardiography signs of cardiac remodeling in arterial hypertension patients with Doppler study of transmitral diastolic flow at rest as well as in exercise test (Valsalva’s test and an isometric exercise test) (stress echocardiography). Material and methods. The study involved 92 teens (49 boys and 43 girls, 53% and 47%, relatively) aged 12-18 (mean age 14.9 ± 1.71). The patient (basic group) included 36 adolescents with clinically confirmed hypertension (39%). The second (comparison) group involved 28 healthy adolescents with normal arterial pressure and risk factors of cardiac illnesses (30.5%). The third group included 28 healthy adolescents (30.5%) with normal arterial pressure and without any cardiac risk factors. There were no gender and age differences between the groups. Clinical study of the groups with standard techniques was performed and involved family history taking to detect risk factors of any cardiac diseases, cardiac rhythm assessment and measurement of arterial pressure. Echocardiography was made in accordance with standards techniques with a Japanese ultrasound diagnostic device “Nemio XG” manufactures by Toshiba. Parameters of diastolic filling of the left ventricle at rest and at the pick of exercise tests (Valsalva’s test and isometric test) were assessed. Program SPSS 19.0 for Windows was used for statistic analysis of the obtained data. . Results. Healthy adolescents with increased cardiovascular risks as well as adolescents with arterial hypertension can demonstrate inadequate response of the cardiovascular system to exercises. In both groups of adolescents a decrease in the diastolic reserve has been revealed (as a change of the cardiac function as a response to post-exercise). Conclusions. The detected patterns of early left ventricular remodeling provide an opportunity to consider that hemodynamic disturbances specific for arterial hypertension start their development long before clear and evident clinical manifestation of the arterial pressure appear. The condition requires certain preventive measures to decrease the risk of a cardiovascular disease development. Assessment of diastolic left ventricular filling and control of arterial pressure both at rest and in exercises are recommended to be performed for the early diagnostics of the condition.

Cardiac resynchronization therapy is an effective treatment for patients with congestive heart failure which improves systolic function and clinical status. One third of patients have isolated diastolic form of mechanical dyssynchrony but the effect of resynchronization therapy on diastolic function is not well described. In this clinical case we will try to analyze the effect of resynchronization therapy in patient with heart failure and isolated diastolic dysfunction.

Studying of opportunities of the Cone Beam Computed Tomography (CBCT) in an assessment of bone structure and of a tooth formula was an objective for aging of a paleoanthropological finding. Remains of the child of the Stone Age from a cave Staroselye (Crimea) are subjected to examination. Beam research was carried out when using CBCT with individual selection of laying, physics and technology conditions and modes of scanning depending on anatomic accessory and the size of fragments. The images received as a result of CBCT differ in high informational content (from 7.5 to 10.6 pixels/mm), optimum spatial permission, clearness and contrast. The software of CBCT includes parameters and possibility of post-processor processing of images (creation of panoramic, multiplanar and 3D reconstruction). The method allows carrying out the analysis of anthropological material without the need for their destruction that is the extremely important for work with samples of museum collections. Use of a high-informative beam method of CBCT is perspective for the paleoantropological researches.

Inflammatory breast cancer (IBC) is characterized by an aggressive course and high metastatic potential, therefore timely diagnosis affects outcome of the treatment. In the basis of instrumental diagnosis of IBC, standard imaging methods include - mammography and ultrasonography (USG) additional test and modern techniques such as magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) can also be used. Ultrasound is the most highly sensitive technique that allows in terms of any clinic to identify tumor component in suspected IBC in 93% of cases, and determines the possibility for morphological diagnosis. Mammography is the least sensitive method for diagnosing IBC as tumor tissue on the background of tissue edema are difficult to identify (16-80%, depending on the method of mammography), but the method is still required. MRI allows to defect and pinpoint the tumor changes of the breast tissue in the presence of tissue edema in almost all of the patient with IBC. PET/CT during IBC remains the most accurate in staging the tumor process, and the significance of the method includes a visual ization of the tumor in the breast itself. The use of Single-Photon Emission Computed Tomography in the diagnosis of IBC remains to be established. In the diagnostic algorithm of IBC, combination of all the above methods of research should be used, in order to obtain the most complete picture of the disease, which is extremely important in treatment planning.

Introduction. Thyroid diseases occupy the first place in the overall structure of endocrine diseases in children and adolescents. A problem is the objectification of the results of the subsidiary methods. One of the ways to improve ultrasound techniques - development of elastography. Purpose. Determine the velocity of the shear wave propagation (ARFI-elastography) in the parenchyma of the thyroid in children and adolescents without endocrine pathology. Material and methods. Ultrasound researches of the thyroid gland were made in 195 children and adolescents. Results. For children up to 1.5 years the average value of ARFI was 1.3 m/s (range 0.9-2.3), increasing to 2.3 (1.7-3.6) in people aged 22 years and older. Age dynamics in the shear wave velocity consistent with the morphological changes. Conclusion. Shear wave velocity (ARFI-elastography) can be used as normative. Increasing the speed of the shear wave propagation in older people reflects age-related changes of the thyroid gland parenchyma.