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V. V. Bazylev, D. V. Kokshin, T. I. Paramonova, M. G. Shmatkov
Published: 8 July 2022
Abstract:
Background. Giant coronary artery aneurysms are extremely rare findings. According to foreign authors, their prevalence as a result of autopsy ranged from 0.02 to 0.2%. Most often, they do not have specific symptoms and are detected after the development of complications, such as acute coronary syndrome, myocardial infarction. The risk of sudden complications causes an unfavorable prognosis of the disease and requires immediate surgical correction.Aim: to demonstrate the effectiveness of radiology methods in assessing coronary anatomy and the possibility of visualization before planning surgery.Materials and methods. The patient was referred to the Federal State Budgetary Institution “FCCVS” of the Ministry of Health of Russia (Penza) for additional examination and surgical treatment. Before surgery, to clarify the features of the macromorphology of the aneurysm, selective coronary angiography and CT coronary angiography were performed.Results. Before surgery, according to CT coronary angiography, a partially thrombosed fusiform aneurysm was detected in the anterior descending artery with a maximum size of 7.0 x 3.5 cm, adjacent to the pulmonary artery trunk and left atrial appendage.Conclusion. In modern conditions, the methods of radiology are successfully used to clarify the localization of aneurysms and individual topographic and anatomical features of the coronary arteries.
M. V. Lisitskaya, O. Y. Vershinina, , M. L. Plotnikova, O. S. Shlyapkina, ,
Published: 8 July 2022
Abstract:
Background. The amount of extracellular myocardial matrix is a non-invasive tool for quantitative assessment of myocardial fibrosis. MRI with late gadolinium-enhancement is considered to be the “Gold standard” of non-invasive practice. Dual Energy computed tomography is a new non-invasive approach for detection of myocardial fibrosis and its prognostic value remains unclear.The purpose of this study was to summarize all available data and to study prognostic value of DECT for the detection of fibrotic changes in myocardium.Methods. We searched MEDLINE, EMBASE, Cochrane, SCOPUS and Web of Science for cohort studies up to October 2021 that reported myocardial extracellular volume fraction quantification using contrast enhanced dual energy CT or/and MRI with delayed enhancement.Results. Eleven studies met eligibility criteria. A systematic analysis demonstrated the difference in extracellular volume fraction in patients with fibrotic and inflammation changes of the myocardium, as well as good comparability between DECT and MRI. The value of extracellular volume fraction in myocardium with fibrotic or inflammatory changes was higher than in healthy tissue, which makes it possible to use the ECV as a non-invasive marker of myocardial fibrosis.
A. Kh. Balkarov, N. S. Zagudaeva, K. V. Prusakova, V. A. Kushnarev, N. V. Boyko, P. S. Kalinin, A. V. Mishchenko
Published: 8 July 2022
Abstract:
Aim of the study: to evaluate the possibilities of differential diagnosis of cystic metastases of pancreatic cancer in the lungs and pulmonary Langerhans cell histiocytosis (PLCH)Materials and methods. Multiple cysts were visualized in the patient's lungs, which had thin and thick walls. We visualized in the patient's lung several small nodes with random distribution. These changes were located mainly in the upper and middle sections of the lungs, with the presence of several cysts and nodes near the costal-diaphragmatic angles. The differential diagnosis is formed from metastatic lung disease and pulmonary Langerhans cell histiocytosis. Morphological verification of changes in the lungs confirmed metastatic lung disease.Conclusion. A careful assessment of the thickness of the walls of cysts and the type of location of nodes in the patient's lungs made it possible to diagnose metastatic lung disease according to CT scans.
V. V. Otochkin, E. V. Rozengauz, M. D. Chernyshev, L. G. Shevkunova
Published: 8 July 2022
Abstract:
The purpose: to determine the influence of various aspects of the MR-enterography technique on the quality of the obtained images.Materials and methods. MR-enterography was performed in 634 patients for verified Crohn's disease and suspected inflammatory and tumor diseases of the small intestine. The following drugs containing polyethylene glycol (PEG) were used as an oral contrast agent in 573 patients, mannitol in 32 patients, pineapple juice in 16 patients, water in 11 patients, milk in 2 patients. Oral administration of 1500 ml of contrast agent was carried out fractional for an hour in 3 stages of 15 minutes with an interval of 10 minutes. Each patient underwent programs: T2-FIESTA mode in three planes, diffusion-weighted images with a slice thickness of 5 mm through 1 mm.Results. There were no significant differences in the severity of filling of the loops of the small and large intestine in patients taking polyethylene glycol (n = 573) and mannitol (n = 32) as an oral agent. Adequate stretching of the loops of the small intestine was achieved in 94% of patients, the expansion of the loops was considered moderate or unsatisfactory in 11 patients (4%), which is associated with poor tolerance of the contrast agent or individual characteristics of peristalsis. After coloprotectomy in 14 patients, the volume of the contrast agent was reduced to 1000 ml and the time of its administration to 30–40 minutes due to the rapid passage. MR-enterography could not be performed in 27 patients due to intolerance to PEG and mannitol drugs, which caused a pronounced gag reflex. In these cases, we resorted to alternative options in the form of water (n = 11) and pineapple juice (n = 16).Conclusions. A qualitative assessment of the condition of the small intestine is possible only with the exact observance of all aspects of the research methodology in the form of: an interval between the last meal and MR-enterography of at least 8 hours, the volume of oral contrast agent (mannitol or PEG) 1200–1500 ml, taken 60 minutes before the study. When performing MR-enterography in patients after coloprotectomy, we recommend reducing the volume of oral contrast agent to 1000 ml and the preparation time for the study to 30–40 minutes.
, M. Kadirova, V. A. Popov, E. S. Malishenko, , E. D. Strebkova, V. S. Shirokov, M. A. Novikov, E. V. Yalova, I. A. Taimasova
Published: 8 July 2022
Abstract:
Research objective: establish the impact of Left Atrium Volume Index (LAVI) on on effectiveness of Thoracoscopic Ablation (TSA) in the Treatment of Atrial Fibrillation (AF) and define the risk factors for manifestation of supraventricular arrhythmias in the long-term follow-up resultsMethods. Prospective cohort study of 121 patients with AF (from 2018 to 2021) who performed TSA. The patients were divided into two groups: patients with increased LAVI (group I), patients with normal LAVI less than 34 ml/m2 (group II).Results. According to echocardiography, the mean LAVI was 45.48 ± 9.3 ml/m2 and 28.59 ± 4.13 ml/m2 in groups I and II, respectively (p = 0.012). The mean value of left ventricular ejection fraction (LVEF) according to Teicholz in group I was 61.62 ± 7.041%, in group II 63.57 ± 6.16% (p = 0.8). Spearman's сorrelation analysis showed the relation-ship between LAVI and LVEF before surgery and in the long-term follow-up period, that is agreed with world literature data about contribution left atrial (LA) to left ventricular (LV) function. According to our study, only LAVI < 34 ml/m2 is a risk factor for arrhythmia after TSA. Effectiveness TSA in I group was 77.8%, that is lower than the II group – 88.9%. 3 months after TSA, 20 (17%) patients were required catheter ablations (CA), mainly in I group.Conclusions. Research results showed that an increase in LAVI significantly reduces the effectiveness of TSA in the long-term period by 11.1% compared with LAVI < 34 ml/m2. That are conform with other data of previously submitted works.
A. A. Karpova, P. A. Nikitin, I. A. Znamenskiy, N. V. Nudnov, V. O. Vorob`eva, N. E. Ardyukova
Published: 15 June 2022
Abstract:
Objective. To present a unique clinical case of metastatic lesions of the perirenal space, ureter and bladder in Merkel's carcinoma with the development of transverse myelitis against the background of immuno-oncological therapy.Matherial and methods. The modern states of issue in diagnose and treatment of metastatic Merkel's carcinoma within multidisciplinary approach based on the medical documentation and radiological examinations (CT, MRI) was analysed in this article.Results. The unique clinical case of metastatic Merkel's carcinoma complicated by transverse myelitis during immuno-oncological therapy according to MSCT and MRI examinations report was demonstrated.Conclusion. Radiological examinations such as MSCT, MRI, ultrasound and PET/CT needed for detection, assess the incidence of tumor (metastasis and staging) and treatment efficiency control because of the rare occurrence and insufficient knowledge of Merkel's carcinoma.
T. G. Barmina, L. T. Hamidova, P. A. Yartsev, O. A. Zabavskaya, F. A.-K. Sharifullin, I. E. Selina, I. E. Popova, P. G. Evgrafov, A. G. Lebedev, D. S. Kalimullina
Published: 15 June 2022
Abstract:
The purpose of the study. To clarify the possibilities of using radiation research methods in the framework of complex diagnostics of local peritonitis for timely recognition and treatment of intra-abdominal abscesses and infiltrates.Materials and methods. The analysis of the results of a complex radiation examination in 61 patients with local peritonitis of various etiologies who were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine was carried out. The complex of radiation diagnostics included ultrasound and X-ray examinations, computed tomography (CT). The studies were performed both initially at admission and in dynamics.Results. The diagnostic algorithm for local peritonitis is analyzed, three stages are identified with the determination of the method of choice on each of them. Ultrasound and X-ray examination methods are mainly used at the stage of primary diagnostics and for dynamic control. CT allows you to clarify the type, localization and volume of inflammatory changes, their relationship with the surrounding organs and structures. When analyzing the results of radiation diagnostics, it was determined the need to identify and evaluate the main signs of local peritonitis, both direct: the presence of voluminous formation of inflammatory genesis (infiltrate and/or abscess); and indirect: changes in the source organ of peritonitis; changes in structures adjacent to the infiltrate /abscess; the presence of reactive effusion into the thoracic and abdominal cavities.Conclusion. Comprehensive radiation diagnostics for local peritonitis makes it possible to obtain complete information about the nature of both inflammatory changes in local peritonitis and the causes of them. The obtained data of complex diagnostics help the surgeon to choose a rational treatment strategy for these patients, including minimally invasive. Diagnostic monitoring allows you to evaluate the effectiveness of treatment and carry out timely correction of tactics.
K D. Solozhentseva, , K. V. Shevchenko, I. N. Pronin
Published: 15 June 2022
Abstract:
The aim of the study: to analyze the features of the classification and diagnosis of hydrocephalus in pediatric patients.Results. Hydrocephalus is a common pathology of the CSF system, often occurring in childhood. The central place in the examination of this group of patients is taken by new neuroimaging technologies, in particular, MRI. Pediatric patients have specific features regarding classification of hydrocephalus and MRI studies. This review presents the research protocol and modern classification of hydrocephalus in children.Conclusion. Examination of pediatric patients for hydrocephalus should be based on the estimated etiology. When conducting an MRI study, the protocol must include modern MRI sequences: FIESTA, T2-CUBE, phasecontrast MRI.
A. K. Nikogosova, T. M. Rostovtseva, , ,
Published: 15 June 2022
Abstract:
Purpose: systematization of the knowledge about diffusion tensor magnetic resonance tomography; analysis of literature related to current limitations of this method and possibilities of overcoming these limitations.Materials and methods. We have analyzed 74 publications (6 Проанализировано 74 публикации (6 Russian, 68 foreign), published in the time period from 1986 to 2021years. More, than half of these articles were published in the last ten years, 19 studies-in the time period from 2016 to 2021years.[email protected] In this article we represent the physical basis of diffusion weighted techniques of magnetic resonance tomography, principles of obtaining diffusion weighted images and diffusion tensor, cover the specific features of the probabilistic and deterministic approaches of the diffusion tensor MRI data processing, describe methods of evaluation of the diffusion characteristics of tissues in clinical practice. Article provides a thorough introduction to the reasons of existing limitations of diffusion tensor MRI and systematization the main developed approaches of overcoming these limitations, such as multi-tensor model, high angular resolution diffusion imaging, diffusion kurtosis visualization. The article consistently reviews the stages of data processing of diffusion tensor magnetic resonance tomography (preprocessing, processing and post processing). We also describe the special aspects of the main approaches to the quantitative data analysis of diffusion tensor magnetic resonance tomography (such as analysis of the region of interest, analysis of the total data amount, quantitative tractography).Conclusion. Magnetic resonance tractography is a unique technique for noninvasive in vivo visualization of brain white matter tracts and assessment of the structural integrity of their constituent axons. In the meantime this technique, which has found applications in numerous pathologies of central nervous system, has a number of significant limitations, and the main of them are the inability to adequately visualize the crossing fibers and the relatively low reproducibility of the results. Standardization of the data postprocessing algorithms, further upgrading of the magnetic resonance scanners and implementation of the alternative tractography methods have the potential of partially reducing of the current limitations.
Published: 15 June 2022
Abstract:
Purpose: to study the contribution of perfusion iodine maps to diagnosis of acute pulmonary embolism (PE) and compare pulmonary perfusion defects with the main imaging biomarkers of PE.Materials and methods. 130 patients with suspected acute pulmonary thromboembolism were studied using pulmonary computed tomographic angiography with perfusion iodine map`s analysis. Pulmonary embolism was revealed in 42 cases. There were evaluated: the number and level of vessel occlusion (Qanadli index), number and grades of lung perfusion defects on perfusion iodine maps (perfusion index), signs of right heart failure, changes of lung parenchyma.Results. Analysis of the data showed a strong correlation between the index Qanadli and perfusion index, rather than signs of right failure. In 3 cases, the segmental and subsegmential pulmonary embolism was revealed form the iodine map’s analysis only.Conclusion. Thus, perfusion iodine maps improve the diagnosis of acute pulmonary embolism due to characterizing the changes of pulmonary microcirculation. From our data, the iodine maps can be employed as a prognostic tool for further therapy.
, A. A. Shadanov, D. A. Sirota, , N. T. Pak, A. M. Chernyavskiy
Published: 15 June 2022
Abstract:
Purpose. To establish the methods for estimating the volume of the true and false aortic canals applying computed tomography angiography (CTA) to a clinical case with hybrid stent-graft thoracic aorta with distal stent-graftinduced new entry associated (d-SINE) in the long-term follow-up period in comparison with a widely used technique of measuring diameters of the aorta on different levels.Materials and methods. Sequential analysis of CTA in a 7-year follow-up was performed. Aorta was divided into 3 segments, in each segment total aortic volumes (AV), volume of the true canal (TC), and volume of functional lumen of the false canal (FLFC) were calculated. The following were mathematically calculated: volume of the false canal (FC) via difference in volume between AV and TC, volume of the thrombosed lumen of FC as the difference between FC and FLFC, the coefficient of FC thrombosis, the degree of stent-graft opening. Mathematical assessment of excess volume of the graft was performed.Results. Modelling of aortic cavity, evaluation of changes in the volumes of TC and FC during a long-term follow-up, analysis of the factors inducing the development of the d-SINE syndrome were performed. When comparing the volume of the graft and the volume of the implantation zone, an excess of 234% was found, while the opening of the graft was 80%. When using the reference method based on the diameter of the true lumen of the aorta, the excess was 22% during one-year follow-up period showing no changes subsequently.Conclusion. Potentially, the method of measuring volumes based on CTA results can be used to complement the generally accepted method based on measuring diameters, since it does not require additional financial resources and has the potential to estimate effectiveness of treatment and identify complications predictors in the postoperative period to determine indications for reoperation.
I. M. Buriev, G. G. Melkonyan, P. S. Vaganova, E. B. Guzeeva, , A. N. Kuzeev, S. A. Misiano, V. V. Pchelin,
Published: 15 June 2022
Abstract:
Aim. To determine ultrasound, computed tomography and angiographic image characteristics for soft tissue hemorrhages/hematomas, the sequence of using imaging methods in patients infected with SARS-CoV-2, to study the morphology of changes in soft tissues, to determine the essence of the concept and to develop treatment tactics for this complication of COVID-19.Material and methods. During 4 months of treatment of elderly patients (+60) infected with SARS-CoV-2, 40 patients were identified with soft tissue hemorrhages/hematomas, of which 26 (65%) patients with large hematomas (>10 cm in size and > 1000 ml in volume). The analysis of clinical and laboratory parameters, methods of instrumental diagnostics (ultrasound – 26 patients, CT – 10 patients, angiography – 9 patients, punctures – 6 patients) was carried out; autopsy material was studied in 11 cases.Results. Image characteristics of hemorrhages/hematomas of soft tissue density were obtained using modern instrumental methods, and the sequence of application of visualization methods was determined. A tactic for managing a patient with stopped and ongoing bleeding has been developed. The morphological substrate of hemorrhagic complications in a new viral infection was studied. All patients were treated with conservative and minimally invasive procedures (embolization, puncture with pressure bandage). 15 patients (57.7%) recovered, 11 patients (42.3%) died from the progression of COVID-19 complications.Conclusion. Comprehensive clinical and laboratory sequential instrumental diagnosis of soft tissue hemorrhages in COVID-19. Treatment should be conservative and significantly invasive. The use of the term “soft tissue hematoma” in SARS-CoV-2 infected patients is not a natural quality of the normal pathological process and should not be observed from our point of view.
I. A. Ozerskaya, M. A. Chekalova, , G. G. Kazaryan
Published: 15 June 2022
Abstract:
Purpose: analysis of echographic signs of benign and malignant formations of the uterine appendages using the recommendations of the IOTA group.Materials and methods. 17 articles published in the journal Ultrasound in Obstetrics & Gynecology for 2007–2020 were analyzed. Each article is devoted to the histologically verified pathology of the uterine appendages, of which 431 are benign and 1205 are malignant neoplasms. When describing pathological formations, the re-searchers used a single protocol recommended by the IOTA group. 21 parameters were assessed, including the morphology of the formation, the structure of fluid inclusions and solid component, the presence of fluid in the posterior uterine pocket and ascites, as well as the degree of tumor vascularization.Results. Аll ultrasound signs of tumors were found in both groups, but the frequency of their occurrence was different. Thus, unilocular neoplasms were more often detected in benign tumors than in malignant ones (p = 0.05). Also, acoustic shadows were found significantly more frequently in benign tumors (p < 0.05). When assessing tumor morphology, attention should be paid to tendencies that are more characteristic of malignant tumors, which include a solid structure (p = 0.13) and the occurrence of ascites (p = 0.13), while a multilocular structure without a solid component was more common in benign (p = 0.10). The size of the neoplasm, uneven contour, papillary growths, hyperechoic inclusions and the nature of the internal contents of the cystic cavities are found with approximately the same frequency in both groups. When as-sessing the blood supply to a pathological formation, hypervascularization confidently indicated a malignant tumor (p < 0.05), while avascularization in such neoplasms was rare, however, the differences with benign ones were insignificant (p = 0.06).Conclusions. There are no reliable echographic signs of the nature of the neo-plasm. The set of criteria will improve the quality of preoperative ultrasound diagnostics of ovarian tumors.
Published: 15 June 2022
Abstract:
Aim. To form for viewers an actual vision of the issue of septic pulmonary embolism in the terminological, morphological and clinical aspects, as well as presentation of the methodic of medical imaging of such patients, to systematize and illustrate the main and rare CT signs of septic embolism.Materials and methods. We analyze the data of national and foreign scientific papers for 2001-2021 on the platforms PubMed, Elibrary, etc., as well as earlier "classic" publications on sepsis, infectious endocarditis and septic pulmonary embolism. Also presents own experience of practice with such patients in multidisciplinary hospitals and typical cases, taking into account more than 5 years of experience on this topic in radiology departments in cooperation with related specialists (cardiologists, therapists, purulent surgeons, morphologists).Results. 52 of the most relevant scientific papers were selected from 162 available articles. Based on the results, a review was compiled on the peculiarities of terminology, epidemiology, etiology, clinical presentations, as well as methods for diagnosis of septic pulmonary embolism, CT signs of verified cases during primary scanning, as well as follow-up images, which is extremely important in differential diagnosis. The part with the pathological anatomy of septic embolism makes it possible to better understand CT signs and the difference between this process from ordinary pneumonia.Conclusion. Due to the fact that septic embolism is a secondary process, the correct and quick interpretation of the CT images initiates the search for the primary purulent source of embolism in the body, and follow-up CT-scans (especially in infectious endocarditis) allows you to assess the effectiveness of therapy.
M. E. Mokrenko, N. A. Guseynov, Ж. Аль Хаффар, N. S. Tuturov, M. S. Sarkisyan
Published: 15 June 2022
Abstract:
Aim. This review is devoted to the analysis of available on-line services and programs using artificial neural networks (ANNs) in dentistry, especially for cephalometric analysis.Materials and methods. We searched for scientific publications in the information and analytical databases PubMed, Google Scholar and eLibrary using combinations of the following keywords: artificial intelligence, deep learning, computer vision, neural network, dentistry, orthodontics, cephalometry, cephalometric analysis. 1612 articles were analyzed, of which 23 publications were included in our review.Results. Deep machine learning based on ANN has been successfully used in various branches of medicine as an analytical tool for processing various data. ANNs are especially successfully used for image recognition in radiology and histology. In dentistry, computer vision is used to diagnose diseases of the maxillofacial region, plan surgical treatment, including dental implantation, as well as for cephalometric analysis for the needs of orthodontists and maxillofacial surgeons.Conclusion. Currently, there are many programs and on-line services for cephalometric analysis. However, only 7 of them use ANNs for automatic landmarking and image analysis. Also, there is not enough data to evaluate the accuracy of their work and convenience.
S. A. Maryashev, A. A. Poddubskiy, I. N. Pronin, G. L. Kobyakov, V. Y. Zhukov, P. V. Rodionov, D. I. Pitskhelauri
Published: 13 May 2022
Medical Visualization, Volume 26, pp 18-38; https://doi.org/10.24835/1607-0763-1046

Abstract:
Цель исследования: оценить влияние совмещения МР- и интраоперационных КТ-последовательностей, выполненных при планировании стереотаксической биопсии, на результативность гистологического диагноза и безопасность стереотаксической биопсии. Материал и методы. В работу включены данные 170 пациентов (95 мужчин и 75 женщин), которым по различным причинам в 2019 г. выполнена стереотаксическая биопсия на аппарате Cosman–Roberts– Wells® (CRW®) фирмы Integra LifeSciences Corporation. Возраст пациентов 7–69 лет. В 80 наблюдениях для совмещения изображений интраоперационной КТ головного мозга с данными предоперационной МРТ в различных режимах, для выбора точки мишени, траектории забора материала и места входного отверстия использовали программу NeuroSight Arc®. Результаты. Из 80 пациентов, у которых мы использовали совмещение КТ и МРТ, только у 1 пациента не удалось получить гистологический диагноз. В группе из 90 пациентов, которым для расчетов проводилась только интраоперационная КТ, в 3 случаях не удалось получить гистологический диагноз. В группе из 80 пациентов не отмечалось геморрагических осложнений. В группе из 90 пациентов, которым выполнялась только интраоперационная КТ, в 3 случаях были выявлены внутричерепные гематомы, потребовавшие хирургического вмешательства. Заключение. Использование современных методов нейровизуализации, таких как МРТ и ПЭТ-КТ, в планировании и проведении стереотаксической биопсии повышает ее информативность и снижает риск развития постоперационных осложнений.
A. G. Shandra, O. V. Astaph’Eva, V. E. Gazhonova, R. V. Morozova
Published: 13 May 2022
Medical Visualization, Volume 26, pp 125-129; https://doi.org/10.24835/1607-0763-1083

Abstract:
Атипичная дуктальная гиперплазия это пролиферация мономорфных, расположенных на одном уровне клеток, включая терминальную дольково-протоковую единицу. Термин “атипичная дуктальная гиперплазия” определяет группу образований с комбинацией определенных специфических структурных и цитологических особенностей, которые предполагают высокий риск последующего рака молочной железы. Описан случай визуализации атипичной дуктальной гиперплазии молочной железы с нарушением тканевой архитектоники в виде симптома “лучистости” у пациентки с отягощенным акушерско-гинекологическим анамнезом на ультразвуковой системе Siemens Acuson S2000 с помощью автоматизированного объемного сканера для молочной железы ABVS (Automated Breast Volume Scanner).
S. V. Asriyants, , , , I. N. Pronin
Published: 13 May 2022
Medical Visualization, Volume 26, pp 10-17; https://doi.org/10.24835/1607-0763-1073

Abstract:
Введение. Электростимуляция субталамического ядра (STN) считается общепризнанным эффективным и безопасным методом лечения развернутых стадий болезни Паркинсона. Классическим методом интраоперационной верификации цели является сочетание микроэлектродной регистрации (МЭР) с интраоперационной стимуляцией. Появление высокопольных томографов, новых последовательностей и способов компьютерной обработки полученных изображений ставит вопрос о возможности проведения операции, основываясь только на данных нейровизуализации без использования интраоперационной верификации структуры-мишени. Цель исследования: анализ сопоставимости данных 3Т МРТ и МЭР в определении границ STN у пациентов с болезнью Паркинсона. Материал и методы. В исследование было включено 20 пациентов, которым проводилась 3Т МРТ для предоперационных расчетов для проведения имплантации электродов для хронической электростимуляции в STN. Мы определили верхнюю и нижнюю границы 40 субталамических ядер в режимах Т2 с высоким пространственным разрешением и SWAN и сравнили эти данные с результатами, полученными во время операции с помощью МЭР. Результаты. Расхождение между данными МЭР и 3Т МРТ при определении верхней границы STN составило 1,2 мм в режиме SWAN и 1 мм в режиме Т2. Нижнюю границу STN удавалось определить с точностью 0,85 в режиме SWAN и 0,75 мм в режиме Т2. Группы не отличались между собой статистически достоверно (Wilcoxon sign-rank test, p > 0,05). Заключение. 3Т МРТ с высоким пространственным разрешением демонстрировала высокую сопоставимость с данными МЭР в определении верхней границы, нижней границы и середины STN, что позволяет использовать ее в качестве метода прямой визуализации STN.
A. V. Arablinskii, M. Y. Titov
Published: 29 March 2022
Medical Visualization, Volume 26, pp 139-153; https://doi.org/10.24835/1607-0763-1110

Abstract:
Острый панкреатит является одним из самых часто встречающихся острых заболеваний органов брюшной полости с широким спектром симптомов, которые варьируются по тяжести от легкого интерстициального воспаления железы до тяжелых форм со значительными региональными и системными осложнениями. Несмотря на улучшения в лечении и оказании неотложной помощи, тяжелый острый панкреатит по-прежнему связан с высокими показателями смертности. “Золотым стандартом” его диагностики уже долгое время является компьютерная томография (КТ) с внутривенным контрастированием. Несмотря на это, в современной литературе и методических рекомендациях сохраняются неточности в терминологии выявляемых изменений, часто влияющих на выбор метода лечения и прогноз заболевания. В нашей работе рассматривается рентгенологический аспект терминологии и классификации характерных проявлений острого панкреатита и панкреонекроза. Обсуждены рекомендации и показания к проведению КТ- и МРТ-исследований, а также их методология. Положения обзора проиллюстрированы КТ- и МРТ-изображениями наиболее ярких и значимых изменений в рамках заболевания из архива авторов для большей наглядности. Цель данного исследования – структурировать различные данные отечественной и зарубежной литературы для формирования более полной и четкой картины различных фаз течения острого панкреатита, главным образом, за счет характеристики их проявлений и осложнений с помощью лучевых методов исследования.
A. A. Korotkevich, , O. V. Maleva, O. A. Trubnikova
Published: 13 May 2022
Medical Visualization, Volume 26, pp 101-112; https://doi.org/10.24835/1607-0763-1048

Abstract:
Введение. Уровень перфузии головного мозга у пациентов с мультифокальным атеросклерозом зависит не только от ограничения кровотока по каротидным артериям, но и от степени изменений миокарда. Цель исследования: определить наличие связи между показателями регионарного мозгового кровотока по данным ОФЭКТ и эхокардиографическими параметрами сердечной деятельности и проанализировать механизм их взаимоотношений. Материал и методы. Обследовано 22 пациента (18 мужчин и 4 женщины в возрасте 64 ± 6,5 года) с признаками хронической сердечной недостаточности (ХСН) и мультифокальным атеросклерозом с поражением каротидных и коронарных артерий, подвергшихся симультанному хирургическому вмешательству. Всем пациентам выполнялось эхокардиографическое исследование сердца и ОФЭКТ головного мозга. Результаты. Выявлены умеренные прямые корреляционные связи между показателями регионарного мозгового кровотока (рМК) и фракцией выброса (ФВ) (p = 0,009307), УО/КДО (p = 0,012431); умеренные обратные корреляционные связи между показателями рМК и УО (p = 0,002913), КДО (p = 0,031737), КСО (p = 0,016483), КСО/КДО (p = 0,010645), КСО/УО (p = 0,007255). В послеоперационном периоде выявлена умеренная прямая корреляционная связь показателей когнитивного статуса и показателей перфузии головного мозга в правой затылочной, теменной и лобной доле (p = 0,021162, R = 0,511475). Заключение. Изученные нами эхокардиографические параметры у пациентов с ХСН кореллируют с показателями регионарного мозгового кровотока, причем эта связь в большей степени выражена не для ФВ, а прослеживается между параметрами КДО, КСО и их соотношением по принципу “золотой пропорции”. Полученные данные по перфузии головного мозга методом ОФЭКТ связаны с показателями сердечной деятельности и отражают тяжесть ХСН.
, Y. V. Sidorova, E. V. Novoselova
Published: 29 March 2022
Medical Visualization, Volume 26, pp 130-138; https://doi.org/10.24835/1607-0763-1145

Abstract:
Цель исследования: найти типичные компьютерно-томографические признаки пиелосинусных рефлюксов при небольшом объеме экстравазации мочи. Материал и методы. Проанализированы 8 наблюдений, в которых имела место экстравазация мочи в почечный синус, выявленная при КТ. Результаты. В 6 случаях изменения были справа, в 2 – слева. Причиной острой обструкции мочевых путей в 4 наблюдениях были камни мочеточников, в 2 наблюдениях имело место сдавление мочеточника извне опухолью малого таза. В 2 случаях уже через сутки после разрешения почечной обструкции контрастированная моча за пределами чашечно-лоханочной системы не определялась. Дополнительными находками были: перегиб мочеточника в 2 случаях, кисты почечного синуса в 4 случаях. В 4 наблюдениях обращала на себя внимание картина “диссекции” лоханки почки в выделительную фазу, которая заключалась в наличии тонкой прослойки, “делящей” контрастированное содержимое лоханки на две части. Выводы. 1. Выявление картины “псевдодиссекции” лоханки является практически патогномоничным компьютерно-томографическим симптомом экстравазации мочи в результате пиелосинусного рефлюкса и разрыва чашек или лоханки. 2. Разрешение мочеточниковой обструкции может приводить к полной нормализации компьютерно-томографической картины в течение суток. 3. Перегиб мочеточника, кисты синуса почки, возможно, являются провоцирующими факторами экстравазации мочи при острой мочеточниковой обструкции, однако это требует дальнейшего изучения.
M. V. Malakhova, T. N. Galyan, A. V. Khovrina, E. R. Сharchyan, V. V. Khovrin
Published: 13 May 2022
Medical Visualization, Volume 26, pp 81-90; https://doi.org/10.24835/1607-0763-1149

Abstract:
Цель исследования: cравнение протоколов МСКТ-аортографии с кардиосинхронизацией и их модификация для снижения лучевой и йодной нагрузки на пациента. Материал и методы. В ФГБНУ “Российский научный центр хирургии им. акад. Б.В. Петровского” была выполнена МСКТ-аортография 95 пациентам (57 мужчин и 38 женщин, средний возраст составил 61,4 ± 15,6 года) с использованием протоколов двух- и трехзонного сканирования и выбором значения напряжения на рентгеновской трубке (80 и 100 kV) в зависимости от антропометрических характеристик пациента, а именно индекса массы тела (ИМТ). Были проведены сравнение параметров DLP (Dose Length Product, произведение дозы на длину) – поглощенная доза за все МСКТ-исследование с учетом протяженности области сканирования и количества повторных сканирований), эффективной дозы (Е), времени и протяженности сканирования, а также подсчет количества вводимого контрастного препарата между группами, обследованными с применением двух- и трехзонного протокола при напряжении на рентгеновской трубке 80 и 100 kV. Результаты. Анализ полученных данных показал, что значения DLP и E были статистически достоверно ниже при использовании протокола МСКТ-аортографии, состоящего из трех зон сканирования (при 80 kV p = 0,008, при 100 kV р < 0,001). При этом отсутствовала достоверная разница протяженности области исследования в группах с одинаковым напряжением на рентгеновской трубке (р = 0,55), в группе с трехзонным протоколом время сканирования было достоверно ниже (р < 0,001) и составляло 9,4 ± 0,5 с / 10,24 ± 0,9 с (80 kV / 100 kV), что позволило существенно снизить лучевую нагрузку (до 40%) и объем вводимого контрастного препарата (на 20%). Заключение. Использование трехзонного протокола МСКТ-аортографии с индивидуальным выбором напряжения на рентгеновской трубке оправданно и позволяет значительно снизить лучевую и йодную нагрузку в сравнении с двухзонным cканированием при сохранении высокого качества получаемых изображений.
N. M. Kosyanchuk, A. V. Korobov
Published: 13 May 2022
Medical Visualization, Volume 26, pp 58-65; https://doi.org/10.24835/1607-0763-1108

Abstract:
В статье приводится опыт применения классификации TI-RADS (2020) при проведении мультипараметрического ультразвукового исследования щитовидной железы 60 пациентов с последующей морфологической верификацией путем тонкоигольной аспирационной биопсии. Освещены проблемы и трудности, которые могут возникнуть у врача ультразвуковой диагностики при стратификации узлового образования при использовании данной классификации и возможные пути их решения.
V. V. Bazylev, R. M. Babukov, F. L. Bartosh, A. V. Levina
Published: 13 May 2022
Medical Visualization, Volume 26, pp 91-100; https://doi.org/10.24835/1607-0763-1006

Abstract:
Цель исследования: 1. Сравнить эхокардиографические показатели времени ускорения (АТ), соотношения времени ускорения к общему времени выброса левого желудочка (AT/ET) и общего времени выброса левого желудочка (ЕТ) с данными прямой катетеризации сердца и оценить предсказательную способность тяжелого аортального стеноза (АС) у пациентов с сохраненным ударным объемом ЛЖ и высокими трансаортальными градиентами. 2. Определить пороговые значения для показателей АТ и АТ/ЕТ в диагностике тяжелого АС. Материал и методы. Проспективно собраны данные 75 пациентов, средний возраст 72 ± 6 лет, которым планировалась транскатетерная имплантация аортального клапана (АК). Критерии включения: изолированный стеноз АК с эхокардиографическими характеристиками, соответствующими тяжелому стенозу с сохраненным ударным объемом ЛЖ и высокими трансаортальными градиентами. Всем исследуемым перед транскатетерной имплантацией АК проводили катетеризацию сердца с измерением показателей, необходимых для оценки тяжести АС. Результаты. Анализ линейной регрессии продемонстрировал статистически значимую корреляционную связь между показателями АT и AT/ET, р < 0,05. Кривая ROC-анализа продемонстрировала наибольшую диагностическую способность в оценке тяжести АС для показателя AT/ET, значение площади под кривой AUC 87 (р < 0,001), несколько меньшую диагностическую способность для показателя АТ, значение под кривой АUC 0,8 (р < 0,001). Чувствительность и специфичность показателя AT/ET в определении тяжелого АС составили 84 и 79% соответственно, для показателя АТ чувствительность – 82% и специфичность – 46%. Были выявлены пороговые значения для показателя АТ и АТ/ЕТ в определении тяжелого стеноза АК – 105 и 0,35 мс соответственно. Выводы. 1. Эхокардиографические показатели АТ и АТ/ЕТ обладают сильной корреляционной связью с данными катетеризации и высокой предсказательной способностью тяжелого АС у пациентов с сохраненным ударным объемом ЛЖ и высокими трансаортальными градиентами. 2. Пороговые значения показателей АТ 105 мс и АТ/ЕТ 0,35 мс могут с высокой долей вероятности диагностировать тяжелый АС.
, O. S. Puchkova, , , L. I. Dyachuk, N. A. Karanadze, Y. E. Arutyunova, R. M. Gorbunov,
Published: 13 May 2022
Medical Visualization, Volume 26, pp 113-124; https://doi.org/10.24835/1607-0763-986

Abstract:
Сердечно-сосудистые заболевания (ССЗ) относятся к социально значимым заболеваниям и являются одной из основных причин смертности среди женщин. Отсутствие эффективных и унифицированных методов скрининга препятствует уменьшению заболеваемости и распространенности ССЗ и смертности от них. Сосудистые кальцинаты в молочной железе могут стать одним из доступных инструментов страти фикации риска ССЗ. Патогенез кальциноза средней оболочки артерий, известный как артериокальциноз Менкеберга, отличается от патогенеза атеросклероза интимы, возникающего в коронарных артериях. Тем не менее исследования подтверждают корреляцию между сосудистыми кальцинатами в молочной железе и факторами риска ССЗ. К таким факторам относится атеросклероз коронарных артерий, выявляемый с помощью КТ-коронарографии. Цель работы: изучение связи сосудистых кальцинатов в молочной железе с факторами риска сердечно-сосудистых заболеваний, атеросклерозом коронарных артерий, брахиоцефальных артерий и висцеральных ветвей брюшной аорты. Материал и методы. 21 пациентка, находящаяся на стационарном лечении в отделении кардиологии, была обследована на наличие сосудистых кальцинатов в молочных железах с помощью цифровой маммографии. Также всем пациенткам была выполнена КТ-коронарография с ангиографией брюшной аорты. Результаты. Применение W-критерия Уилкоксона–Манна–Уитни при ненормальном распределении показало взаимосвязь между наличием сосудистых кальцинатов в молочной железе и кальциевым индексом (р = 0,0028), стенозами коронарных артерий (р = 0,040), кальцинозом стенки грудной аорты (р = 0,035) и стенозами висцеральных ветвей брюшной аорты (р = 0,037). Заключение. Наличие кальцинатов в стенках сосудов молочных желез коррелирует с более частым выявлением кальцинатов в стенках коронарных артерий и более высоким кальциевым индексом.
E. S. Zaitceva, A. D. Mamatkulov,
Published: 13 May 2022
Medical Visualization, Volume 26, pp 39-57; https://doi.org/10.24835/1607-0763-1116

Abstract:
Цель исследования: проанализировать последние исследования, относящиеся к вопросам применения компьютерной томографии (КТ) при черепно-мозговой травме (ЧМТ) у детей раннего возраста. Результаты. ЧМТ – одна из частых причин смерти и инвалидности у детей. Детская ЧМТ связана с рядом характеристик, отличающих ее от взрослых. Это обусловлено возрастными анатомо-физиологические различиями, зависящими от физического состояния ребенка и трудностями с неврологической оценкой у детей. Дети раннего возраста проявляют специфические патологические реакции на ЧМТ с четкими сопутствующими неврологическими проявлениями. В этом обзоре представлена важная информация о текущих аспектах использования КТ при всех видах изолированной тупой ЧМТ у детей в возрасте от рождения до 3 лет с учетом особенностей, соответствующих возрасту в условиях неотложной помощи. Хотя механизмы ЧМТ у раннего возраста аналогичны взрослым, визуальные проявления травм головы у детей имеют свои особенности из-за развивающегося мозга и свода черепа. Основная роль радиолога – определить и охарактеризовать тип и степень тяжести травмы головы, чтобы помочь правильному ведению пациента. Исходя из информации, полученной при КТ, зная механизм ЧМТ у младенцев и детей раннего возраста, радиологи играют ключевую роль как в диагностике, так и в выборе эффективного лечения и улучшении результатов лечения и исходов. Заключение. КТ головы с многоплановыми и 3D-реконструкциями в настоящее время заменила рентгенографию черепа при подозрения на ЧМТ и стала важнейшим диагностическим методом у пациентов с ЧМТ в условиях неотложной помощи. Рентгенограммы не добавляют дополнительной диагностической информации и могут быть исключены из исследования в случае проведения КТ с 3D-реконструкцией.
Published: 13 May 2022
Medical Visualization, Volume 26, pp 66-80; https://doi.org/10.24835/1607-0763-1062

Abstract:
Классификация опухолей легкого, плевры, тимуса и сердца опубликована Всемирной организации здравоохранения (ВОЗ) в 2015 г. В ней представлен совершенно иной подход к аденокарциноме по сравнению с классификацией ВОЗ 2004 г. Аденокарцинома – наиболее распространенный гистологический тип рака легких. Междисциплинарная классификация основана на консенсусе между онкологами, торакальными хирургами, пульмонологами, патологами, молекулярными биологами, рентгенологами, радиологами и определяет широкий спектр типов аденокарциномы и подтипов с различным прогнозом и лечением. Они сопровождаются разнообразными проявлениями и особенностями при компьютерной томографии, которые обычно коррелируют с гистопатологическими данными, подчеркивая одну из ключевых ролей врача-рентгенолога в диагностике и лечении таких пациентов. Целью работы является ознакомление врачей-рентгенологов с классификацией ВОЗ 2015, терминологией и компьютерно-томографическими диагностическими критериями различных типов аденокарциномы легкого.
A. N. Katrich, S. V. Polshikov, E. P. Fisenko
Published: 5 March 2022
Medical Visualization, Volume 26, pp 104-118; https://doi.org/10.24835/10.24835/1607-0763-1020

Abstract:
Aim. To study the features of contrast enhancement of malignant neoplasms of the liver in patients with and without cirrhosis (LC), to study the differences in the dynamics of contrast enhancement of liver are metastatic lesions (MTS) and hepatocellular carcinoma (HCC).Material and methods. A retrospective analysis results 58 patients with HCC (group 1) and 51 patients with liver metastases (group 2) was carried out based on morphological data. According to the criterion for the presence of LC, group 1 was divided into two subgroups. The main method of radiological diagnostics was contrast enhancement ultrasound (CEUS).Results. The indicators of the dynamics of the Wash-in of an ultrasound contrast agent into the HCC node and the dynamics of the drug WASH-OUT from the focus in patients with LC did not significantly differ from those in patients without cirrhosis. HCC is characterized by the onset of leaching of the ultrasound contrast agent after 62 seconds from the beginning of the study, which significantly differs from MTS (p <0.05). The parameters in predicting the G3 stage of the tumor were as follows: the parameter “onset of WASH-OUT” of the from the focus <79 sec, the parameter “time of maximum WASH-OUT” of the ultrasound contrast agent <270 seconds. In our opinion, certain difficulties are presented by the diagnosis of highly differentiated carcinomas due to the absence of the WASH-OUT phenomenon in 50% of patients. Differential diagnosis of metastases should be based on a combination of a number of signs, the most important of which, in our opinion, are: early onset of elution of ultrasound contrast agent, “black hole” symptom, peripheral ring-shaped enhancement in arterial phase.Conclusion. The data obtained with the help of CEUS confirm the effect of “arterialization of hepatic blood flow” in patients with LC. Differences in the parameters of contrasting HCC nodes in subgroups of patients with and without LC are not statistically significant. The polymorphism of the signs detected in MTS in the liver is due to the morphology of the primary tumor and the size of the neoplasms. Differential diagnosis should be based on a combination of signs of the dynamics of ultrasound contrast agents.
E. I. Zyablova, ,
Published: 5 March 2022
Medical Visualization, Volume 26, pp 15-20; https://doi.org/10.24835/10.24835/1607-0763-1084

Abstract:
The review provides information on the possibilities and significance of computed tomography (CT) angiography as a method of postoperative control of cerebral aneurysms after treatment (surgical clipping or endovascular embolization). The comparison of the diagnostic value of CT and cerebral angiography as a routine method of postoperative control is shown. The possibilities of improving the methods of scanning and post-processing in the framework of CT angiography are described for better visualization of the completeness of aneurysm shutdown, as well as minimizing artifacts from surgical clips and coils.
, , O. S. Puchkova, I. S. Sennikov,
Published: 5 March 2022
Medical Visualization, Volume 26, pp 40-47; https://doi.org/10.24835/10.24835/1607-0763-1090

Abstract:
The article discusses the latest achievements of radiation diagnostics in the examination of patients with suspected breast cancer at various stages. The possibilities of dual-energy contrast spectral mammography, magnetic resonance imaging in the primary diagnosis of the disease and in assessing the prevalence of the process, the involvement of the contralateral breast, the optimal methodology of the study and the principles of interpretation of the data obtained in daily practice are discussed.
G. B. Nazarova, , M. V. Lisitskaya, M. L. Plotnikova, , P. S. Malakhov
Published: 5 March 2022
Medical Visualization, Volume 26, pp 78-83; https://doi.org/10.24835/10.24835/1607-0763-1086

Abstract:
Spontaneous pneumomediastinum, pneumothorax, pneumoperitoneum, and soft tissue emphysema have been recently described in several sources as possible complications in patients with severe COVID-19 and lung damage. This clinical case is dedicated to demonstrarte the development of these lesions in 3 male patients with comorbid conditions. The putative pathophysiological mechanism of these complications is air leakage due to extensive diffuse alveolar damage followed by rupture of the alveoli. All presented patients had a favorable outcome of the disease without lethal cases, their laboratory data and clinical dynamics were described.It should be noted that such conditions are not rare complications of COVID-19, and are observed mainly in male patients with severe form of the disease and the presence of comorbid conditions. Such complications are associated with long hospitalization and a severe prognosis. In some cases, with a mild course of the disease and positive dynamics in a decrease of the percentage of pulmonary lesions, the outcome is favorable, not requiring additional invasive interventions.
M. A. Sungatullin, I. V. Abdulianov, I. I. Vagizov, S. Yu. Akhunova
Published: 5 March 2022
Medical Visualization, Volume 26, pp 94-103; https://doi.org/10.24835/10.24835/1607-0763-1000

Abstract:
Material and methods. A prospective, randomized, single-center study was conducted. It included 166 patients with mitral valve disease divided into three groups depending on types of AF: with paroxysmal AF at 14 (8.4%) patients, with persistent AF at 63 (37, 9%) patients and with long-term persistent AF at 89 (53.6%) patients hospitalized at the Interregional Clinic and Diagnostic Center Kazan from 2011 to 2018. An average age of patients was 57 ± 5 years old, mainly females amounted to 97 (58.4%).Results. Surgical isolation of the pulmonary vein ostia and the left atrium by RFA at mitral valve replacement significantly improves the contractile function of the left atrium, which allows us to judge about the improvement of the transport function of the left heart chambers as a whole.
G. A. Stashuk, , D. Ya. Smirnova, O. V. Sumtsova
Published: 5 March 2022
Medical Visualization, Volume 26, pp 119-129; https://doi.org/10.24835/10.24835/1607-0763-1092

Abstract:
Portal vein thrombosis is one of the most common complications of liver cirrhosis, the risk factors for which are still not fully understood.Purpose: to develop a prognostic model to determine the likelihood of portal vein thrombosis based on anamnestic, etiological factors, the presence of hepatocellular carcinoma, as well as parameters of CT perfusion of liver tissue.Material and methods. 43 patients with compensated liver cirrhosis (58.1% of men) and 38 patients with subcompensated liver cirrhosis (50% of men) were included in the prospective study. The age of patients in the first group was 52.56 ± 9.62 years, in the second group - 50.95 ± 9.94 years. The number of patients with 1 etiological factor of liver cirrhosis in the study groups was 62.8% and 81.5%, respectively. Type 2 diabetes mellitus was exhibited in 23.3% of patients with compensated liver cirrhosis and in 15.8% of patients with subcompensated liver cirrhosis. The diagnosis of hepatocellular carcinoma was established in 27.9% of patients with compensated liver cirrhosis and in 18.4% of patients with subcompensated liver cirrhosis. All patients, after the native study, underwent CT perfusion of the liver using a 256-slice Philips ICT apparatus. As a result of postprocessing, the values of arterial, portal, total perfusion and perfusion index of liver tissue were determined. Statistical analysis of the data was carried out using the binary logistic regression method and the construction of ROC curves.Results. A logistic stepwise multivariate analysis showed that an increase in arterial perfusion (p = 0.002) and a decrease in portal perfusion (p = 0.004) were independently associated with portal vein thrombosis in patients with compensated liver cirrhosis, and a history of primary liver cancer (p < 0.001) was a dependent factor in this model. In patients with subcompensated liver cirrhosis, a history of hepatocellular carcinoma (p < 0.001) and a decrease in portal perfusion (p = 0.001) became independent predictors of portal vein thrombosis, male gender (p = 0.029) was a dependent factor in the developed model.Conclusion. CT-perfusion of the liver makes it possible to determine predictors that can be used together with such factors as the presence of hepatocellular carcinoma and gender in the construction of prognostic models to determine the likelihood of portal vein thrombosis in patients with compensated and subcompensated liver cirrhosis. Age, etiological factor and the presence of type 2 diabetes mellitus in the developed models were not statistically significant.
M. V. Lisitskaya, , , M. L. Plotnikova, O. S. Shlyapkina
Published: 5 March 2022
Medical Visualization, Volume 26, pp 70-77; https://doi.org/10.24835/10.24835/1607-0763-983

Abstract:
MSCT is known for its extremely high diagnostic accuracy in coronary artery stenosis detection and quantification. However, there are still questions about physiological assessment of myocardial ischemia, since the degree of arterial stenosis and clinical outcomes do not always correlate. It is also noted that the exclusive use of functional non-invasive tests to assess the grade of stenosis can lead to false-negative results and worsen the long-term prognosis of cardiovascular events. Thus, the combined use of anatomical and functional tests can improve the prognosis in coronary heart disease patient. MSCT coronary angiography, combined with stress perfusion and/or CT derived fractional flow reserve, could be used as an all-in-one approach. This review describes new applications of cardiac MSCT.
Published: 5 March 2022
Medical Visualization, Volume 26, pp 27-39; https://doi.org/10.24835/10.24835/1607-0763-1088

Abstract:
The concept of “contrast-induced acute renal injury” (CI-AKI) is an increase in the level of plasma creatinine, recorded within 48 hours after contrast drug administration. This condition is the third most common cause of chronic renal failure occurring in a hospital. Despite the rather frequent occurrence of this phenomenon, it is not completely clear whether all such cases can really be explained by the exceptionally wide spread of procedures with contrast agent administration, because a decrease in kidney function is often found in inpatient patients. Since there is no treatment for CI-AKI, many groups of scientists have attempted to develop a prevention regimen. However, such measures are fraught with a number of difficulties: possible consequences for patients, logistical difficulties in a medical institution, costs of funds. The effectiveness of these measures has also not been unequivocally proven. In particular, in the course of a large AMACING study, it was shown that hydration does not reduce the likelihood of developing CI-AKI, but significantly increases the patient's treatment costs and can cause specific complications. In addition, there is a lot of literature evidence in favor of the fact that the hydration technique is effective for preventing a decrease in kidney function only in patients who have undergone intra-arterial administration of a contrast agent. Thus, the need for drug prevention of CI-AKI is currently being questioned, research in this area is actively continuing.
Published: 5 March 2022
Medical Visualization, Volume 26, pp 130-139; https://doi.org/10.24835/10.24835/1607-0763-1114

Abstract:
The aim of the study is to determine the influence of liver shapes on the accuracy of estimating the organ volume and assessment of hepatomegaly on CT. To develop approaches to improve the accuracy of calculations for various forms of liver.Material and methods. The work is based on the analysis of the results of 603 abdominal CT examinations available in the radiological information systems of the city of Moscow. Six dimensions of the liver were measured: transverse, vertical and anteroposterior dimensions of the right and left lobes. Using automatic segmentation, performed in special software systems IntelliSpase Portal (Philips) and Synapse 3D (Fuji), the maximum close to the true liver volume was calculated. This made it possible to carry out a mathematical analysis to obtain various formulas for calculating the liver volume, depending on its shape. A comparative assessment of the sensitivity and specificity of the developed formulas and the standard one, which does not take into account the shape of the liver, was carried out in relation to the diagnosis of hepatomegaly.Results. During the study, the four most common types of liver forms were identified, for each of which, based on mathematical approaches, formulas for calculating the organ volume were developed. Comparative analysis of these formulas and the previously developed by us standard one showed that the root-mean-square error decreases using the formula for a certain type of liver shape. However, the sensitivity and specificity of the diagnosis of hepatomegaly in the differential approach do not change compared with the standard formula.Conclusion. The existing difference in the forms of the patients’ liver does not significantly affect the approaches to determine the organ volume and establishing the fact of hepatomegaly during CT. Therefore, the standard formula for determining liver can be used in clinical practice: V = (HRL+TRL)3/21, (V – volume, HRL – high of right lobe, TRL – thickness of right lobe).
O. Yu. Borodin, E. N. Karpov, , V. S. Skuridin, I. A. Ignatovich, V. Yu. Ussov
Published: 5 March 2022
Medical Visualization, Volume 26, pp 84-93; https://doi.org/10.24835/10.24835/1607-0763-1016

Abstract:
Introduction. The development and improvement of new tomographic technologies for highly sensitive imaging of lung cancer (LC) is crucial for the early detection of this disease, accurate staging and control of complex therapyThe purpose of the study. To study the possibility of using the radiopharmaceutical (rp) 199TlCl for SPECT-CT imaging of LC.Material and methods.199TlCl in solution was obtained at the U-120 cyclotron (Efremov Institute of Physics and Technology, Rosatom, St. Petersburg) of the TPU Institute of Physics and Technology by the reaction of irradiation of a metal gold target with alpha particles 197Au(α,2n)199Tl, at an alpha particle energy of 28 MeV, with a 199Tl yield of over 95%, in saline solution. The injected dose of rp was 180–185 MBq in all cases, and the scan was performed in 12–20 minutes after the injection of 199TlCl. The chest SPECT was acquired as 64 planar scans per 360° rotation of the two-detector system, in a 64 × 64 matrix, with a field of view size of 40 × 40 cm, with acquisition of more than 50,000 pulses per frame, with a high-energy high-resolution collimator installed, with an energy peak of 70 keV set at a window width of 20% of the differential discriminator. The axial sections were reconstructed using the back-projection method, taking into account the depth absorption with an absorption constant of 0.12 1 / cm. The contour of the patient's body for this purpose was imported from the CT. CT of chest was carried out immediately after the SPECT, ro the 512 × 512 matrix, with a spatial resolution of 1 mm. No X-ray contrast enhancement was carried-out. All studies were performed using a combined SPECT-CT scanner Simbia T16 (Siemens Medical).We recruited 12 patients with an established diagnosis of non-small cell LC, in everybody the SPECT-CT with 199Tl-chloride was employed to stage the disease. The control group comprised 7 patients who underwent a study with 199Tl-chloride for non-oncological pathology, but the diagnosis was finally rejected.Results. Visually, in SPECT-CT with 199TlCl in patients without tumor pathology, the accumulation in the lungs was close to background, and the image of the mediastinum was due to the normal accumulation of rp to the heart muscle. Ratio “healthy lung/myocardium” was 0.23 ± 0.05 in the control group. For the primary node of LC, this index was 0.62 ± 0.14 (p < 0.02), and for metastatically involved lymph nodes, 0.59 ± 0.16 (p < 0.05). According to the results of the individual picture of SPECT-CT with 199TlCl in LC, 6 patients out of 12 had expanded radiation areas during external gamma therapy.Conclusion.199TlCl has a high affinity to the LC tumor tissue and shows high accumulation both to the primary and to metastatic LC foci. Routine use of SPECT-CT with 199TlCl in LC makes sence, both in the primary diagnosis and for the staging of the disease. It is necessary to continue the study of 199TlCl as rp for both ptimary diafnostic imagung of LC and also for the follow-up control of therapy.
Published: 5 March 2022
Medical Visualization, Volume 26, pp 140-154; https://doi.org/10.24835/10.24835/1607-0763-1068

Abstract:
Purpose. Improving the efficiency of CT in the differential diagnosis of mass-forming pancreatitis (MFP) and pancreatic ductal adenocarcinoma (PDAC) making a diagnostic model based using a combination of texture features and contrast enhancement features.Methods and materials. 45 patients with histologically confirmed non-metastatic locally advanced PDAC and 13 patients with MFP where underwent CT examination with contrast enhancement. For each group, the ratio of the densities of intact pancreatic tissue and tumors, the relative tumor enhancement ratio (RTE) in all enhanced phases of CT, 94 texture features for each phase of the study were calculated and compared. The selection of predictors in the logistic model was carried out in 2 stages: 1) selection of predictors based on one-factor logistic models, the selection criterion was padj <0.2; 2) selection of predictors using LASSO-regression after standardization of variables. The selected predictors were included in a logistic regression model without interactions.Results. There were statistically significant differences in 14, 17, 4 out of 94 for the unenhanced, arterial, and venous phases of the study, respectively (p < 0.05). After selection, the final diagnostic model included the texture features CONVENTIONAL HUQ2 and DISCRETIZED HUQ1 for the unenhanced phase, DISCRETIZED HUQ1 and GLRLM RLNU for the arterial phase, DISCRETIZED Skewness for the venous phase, RTE for the delayed CT phase. The diagnostic model was built showed an accuracy of 81% in the diagnosis of MFP.Conclusion. We have developed a diagnostic model, including textural parameters and contrast enhancement features, which allows preoperatively distinguish MFP and PDAC, the developed model will increase the accuracy of preoperative diagnosis.
, N. A. Rucheva,
Published: 5 March 2022
Medical Visualization, Volume 26, pp 21-26; https://doi.org/10.24835/10.24835/1607-0763-1087

Abstract:
Introduction. Cancer metastases from an unknown primary origin (CUP) in the head and neck area include a large heterogeneous group of tumor formations, the primary localization of which could not be established even after a thorough diagnostic search. Combined positron emission computed tomography (PET-CT) with 18F-FDG has a high level of detection of primary neoplasms as a result of simultaneous acquisition of precisely combined anatomical and functional images of the entire body.Objectives. 1. To evaluate the possibility of using PET-CT (positron emission tomography in combination with computed tomography) with 18F-FDG (18-fluorodeoxyglucose) in patients with metastases from the CUP (carcinoma unknown primary) in the head and neck.2. To determine the effectiveness of PET-CT for the detection of primary tumor focus in patients with histologically verified diagnosis of CUP in the head and neck.3. To evaluate the contribution of the PET-CT technique in assessing the prevalence of the disease in patients diagnosed with head and neck cancer.Materials and methods. 134 patients diagnosed with CUP in the head and neck from September 2018 to March 2019 were included to this retrospective study: 35(26.1%) women and 99(73.9%) men, with the mean age of 61.9 ± 7.5 years. All patients underwent a biopsy from at least one metastatic lesion, and the malignant nature of the neoplasm was histologically verified. Before PET-CT with 18F-FDG, standard oncological evaluation was carried out to detect primary tumor.Results. Among 134 patients comprised the study, initial histological diagnoses were: squamous cell cancer (n = 82, 61.2%), melanoma (n = 5, 3.7%), undifferentiated carcinoma (n = 20, 15%), adenocarcinoma (n = 21, 15.6%) and undifferentiated malignant neoplasm (n = 6, 4.5%).With PET-CT with 18F-FDG, primary tumor location was revealed in 72 (54%) of the patients. New metastatic lesions were found in 60 (44.7%) of the patients.Change in the TNM stage was observed in 95(71%) of all cases after PET-CT with 18F-FDG. It was associated both with the detection of the primary tumor and the identification of new metastatic foci.Conclusions. Use of PET-CT with 18F-FDG allows to carry out oncological evaluation more precisely than the standard procedures in the majority of patients with CUP in the head and neck region. In a significant quota of cases, this method is in a position also to help to identify the primary tumor lesion, which, in turn, influences on strategy of treatment and also on the prognosis of disease. PET-CT with 18F-FDG should be included to the protocol of radiological examination in patients with CUP in the head and neck anatomic area.
Published: 5 March 2022
Medical Visualization, Volume 26, pp 48-69; https://doi.org/10.24835/10.24835/1607-0763-1094

Abstract:
Presurgical brain mapping of language-eloquent cortex aims to minimize its injury during neurosurgery in patients with brain tumors and drug-resistant epilepsy, and thereby, to preserve their quality of life. Two main goals of language mapping are to identify the localization and lateralization of brain regions involved in language. Gold standards for them are the intraoperative mapping and Wada test, respectively; however, due to some limitations of these techniques, non-invasive preliminary language mapping becomes reasonable. During the last years, fMRI has been widely applied for such purposes. Our literature review focuses on innovations and actual tendencies which spread in the field of language mapping via fMRI in the last decade. State-of-the-art knowledge on brain organization of language, which underpins brain mapping of language processing via fMRI, is briefly described in the article. Contemporary studies of fMRI validity in localization and lateralization of language brain regions are considered. Strategies of presurgical language mapping, such as application of tractography in addition to fMRI, combined analysis of fMRI tasks as well as resting-state fMRI are also discussed. Well-established fMRI tasks for brain mapping of language production and comprehension, as well as new experimental developments in this field, are listed and described.
Published: 7 February 2022
Abstract:
The concept of “contrast-induced acute renal injury” (CI-AKI) is an increase in the level of plasma creatinine, recorded within 48 hours after contrast drug administration. This condition is the third most common cause of chronic renal failure occurring in a hospital. Despite the rather frequent occurrence of this phenomenon, it is not completely clear whether all such cases can really be explained by the exceptionally wide spread of procedures with contrast agent administration, because a decrease in kidney function is often found in inpatient patients. Since there is no treatment for CI-AKI, many groups of scientists have attempted to develop a prevention regimen. However, such measures are fraught with a number of difficulties: possible consequences for patients, logistical difficulties in a medical institution, costs of funds. The effectiveness of these measures has also not been unequivocally proven. In particular, in the course of a large AMACING study, it was shown that hydration does not reduce the likelihood of developing CI-AKI, but significantly increases the patient's treatment costs and can cause specific complications. In addition, there is a lot of literature evidence in favor of the fact that the hydration technique is effective for preventing a decrease in kidney function only in patients who have undergone intra-arterial administration of a contrast agent. Thus, the need for drug prevention of CI-AKI is currently being questioned, research in this area is actively continuing.
E. I. Zyablova, ,
Published: 7 February 2022
Abstract:
The review provides information on the possibilities and significance of computed tomography (CT) angiography as a method of postoperative control of cerebral aneurysms after treatment (surgical clipping or endovascular embolization). The comparison of the diagnostic value of CT and cerebral angiography as a routine method of postoperative control is shown. The possibilities of improving the methods of scanning and post-processing in the framework of CT angiography are described for better visualization of the completeness of aneurysm shutdown, as well as minimizing artifacts from surgical clips and coils.
M. V. Lisitskaya, , , M. L. Plotnikova, O. S. Shlyapkina
Published: 7 February 2022
Abstract:
MSCT is known for its extremely high diagnostic accuracy in coronary artery stenosis detection and quantification. However, there are still questions about physiological assessment of myocardial ischemia, since the degree of arterial stenosis and clinical outcomes do not always correlate. It is also noted that the exclusive use of functional non-invasive tests to assess the grade of stenosis can lead to false-negative results and worsen the long-term prognosis of cardiovascular events. Thus, the combined use of anatomical and functional tests can improve the prognosis in coronary heart disease patient. MSCT coronary angiography, combined with stress perfusion and/or CT derived fractional flow reserve, could be used as an all-in-one approach. This review describes new applications of cardiac MSCT.
Published: 3 February 2022
Abstract:
Purpose. Improving the efficiency of CT in the differential diagnosis of mass-forming pancreatitis (MFP) and pancreatic ductal adenocarcinoma (PDAC) making a diagnostic model based using a combination of texture features and contrast enhancement features.Methods and materials. 45 patients with histologically confirmed non-metastatic locally advanced PDAC and 13 patients with MFP where underwent CT examination with contrast enhancement. For each group, the ratio of the densities of intact pancreatic tissue and tumors, the relative tumor enhancement ratio (RTE) in all enhanced phases of CT, 94 texture features for each phase of the study were calculated and compared. The selection of predictors in the logistic model was carried out in 2 stages: 1) selection of predictors based on one-factor logistic models, the selection criterion was [email protected] Results. There were statistically significant differences in 14, 17, 4 out of 94 for the unenhanced, arterial, and venous phases of the study, respectively (p < 0.05). After selection, the final diagnostic model included the texture features CONVENTIONAL HUQ2 and DISCRETIZED HUQ1 for the unenhanced phase, DISCRETIZED HUQ1 and GLRLM RLNU for the arterial phase, DISCRETIZED Skewness for the venous phase, RTE for the delayed CT phase. The diagnostic model was built showed an accuracy of 81% in the diagnosis of MFP.Conclusion. We have developed a diagnostic model, including textural parameters and contrast enhancement features, which allows preoperatively distinguish MFP and PDAC, the developed model will increase the accuracy of preoperative diagnosis.
, , O. S. Puchkova, I. S. Sennikov,
Published: 7 February 2022
Abstract:
The article discusses the latest achievements of radiation diagnostics in the examination of patients with suspected breast cancer at various stages. The possibilities of dual-energy contrast spectral mammography, magnetic resonance imaging in the primary diagnosis of the disease and in assessing the prevalence of the process, the involvement of the contralateral breast, the optimal methodology of the study and the principles of interpretation of the data obtained in daily practice are discussed.
G. B. Nazarova, , M. V. Lisitskaya, M. L. Plotnikova, , P. S. Malakhov
Published: 7 February 2022
Abstract:
Spontaneous pneumomediastinum, pneumothorax, pneumoperitoneum, and soft tissue emphysema have been recently described in several sources as possible complications in patients with severe COVID-19 and lung damage. This clinical case is dedicated to demonstrarte the development of these lesions in 3 male patients with comorbid conditions. The putative pathophysiological mechanism of these complications is air leakage due to extensive diffuse alveolar damage followed by rupture of the alveoli. All presented patients had a favorable outcome of the disease without lethal cases, their laboratory data and clinical dynamics were described.It should be noted that such conditions are not rare complications of COVID-19, and are observed mainly in male patients with severe form of the disease and the presence of comorbid conditions. Such complications are associated with long hospitalization and a severe prognosis. In some cases, with a mild course of the disease and positive dynamics in a decrease of the percentage of pulmonary lesions, the outcome is favorable, not requiring additional invasive interventions.
O. Yu. Borodin, E. N. Karpov, , V. S. Skuridin, I. A. Ignatovich, W. Yu. Ussov
Published: 3 February 2022
Abstract:
Introduction. The development and improvement of new tomographic technologies for highly sensitive imaging of lung cancer (LC) is crucial for the early detection of this disease, accurate staging and control of complex therapy.The purpose of the study. To study the possibility of using the radiopharmaceutical (rp) 199TlCl for SPECT-CT imaging of LC.Material and methods.199TlCl in solution was obtained at the U-120 cyclotron (Efremov Institute of Physics and Technology, Rosatom, St. Petersburg) of the TPU Institute of Physics and Technology by the reaction of irradiation of a metal gold target with alpha particles 197Au(α,2n)199Tl, at an alpha particle energy of 28 MeV, with a 199Tl yield of over 95%, in saline solution. The injected dose of rp was 180–185 MBq in all cases, and the scan was performed in 12–20 minutes after the injection of 199TlCl. The chest SPECT was acquired as 64 planar scans per 360° rotation of the two-detector system, in a 64 × 64 matrix, with a field of view size of 40 × 40 cm, with acquisition of more than 50,000 pulses per frame, with a high-energy high-resolution collimator installed, with an energy peak of 70 keV set at a window width of 20% of the differential discriminator. The axial sections were reconstructed using the back-projection method, taking into account the depth absorption with an absorption constant of 0.12 1 / cm. The contour of the patient's body for this purpose was imported from the CT. CT of chest was carried out immediately after the SPECT, ro the 512 × 512 matrix, with a spatial resolution of 1 mm. No X-ray contrast enhancement was carried-out. All studies were performed using a combined SPECT-CT scanner Simbia T16 (Siemens Medical).We recruited 12 patients with an established diagnosis of non-small cell LC, in everybody the SPECT-CT with 199Tl-chloride was employed to stage the disease. The control group comprised 7 patients who underwent a study with 199Tl-chloride for non-oncological pathology, but the diagnosis was finally rejected.Results. Visually, in SPECT-CT with 199TlCl in patients without tumor pathology, the accumulation in the lungs was close to background, and the image of the mediastinum was due to the normal accumulation of rp to the heart muscle. Ratio “healthy lung/myocardium” was 0.23 ± 0.05 in the control group. For the primary node of LC, this index was 0.62 ± 0.14 (p < 0.02), and for metastatically involved lymph nodes, 0.59 ± 0.16 (p < 0.05). According to the results of the individual picture of SPECT-CT with 199TlCl in LC, 6 patients out of 12 had expanded radiation areas during external gamma therapy.Conclusion. 199TlCl has a high affinity to the LC tumor tissue and shows high accumulation both to the primary and to metastatic LC foci. Routine use of SPECT-CT with 199TlCl in LC makes sence, both in the primary diagnosis and for the staging of the disease. It is necessary to continue the study of 199TlCl as rp for both ptimary diafnostic imagung of LC and also for the follow-up control of therapy.
Published: 7 February 2022
Abstract:
Presurgical brain mapping of language-eloquent cortex aims to minimize its injury during neurosurgery in patients with brain tumors and drug-resistant epilepsy, and thereby, to preserve their quality of life. Two main goals of language mapping are to identify the localization and lateralization of brain regions involved in language. Gold standards for them are the intraoperative mapping and Wada test, respectively; however, due to some limitations of these techniques, non-invasive preliminary language mapping becomes reasonable. During the last years, fMRI has been widely applied for such purposes. Our literature review focuses on innovations and actual tendencies which spread in the field of language mapping via fMRI in the last decade. State-of-the-art knowledge on brain organization of language, which underpins brain mapping of language processing via fMRI, is briefly described in the article. Contemporary studies of fMRI validity in localization and lateralization of language brain regions are considered. Strategies of presurgical language mapping, such as application of tractography in addition to fMRI, combined analysis of fMRI tasks as well as resting-state fMRI are also discussed. Well-established fMRI tasks for brain mapping of language production and comprehension, as well as new experimental developments in this field, are listed and described.
G. A. Stashuk, , D. Ya. Smirnova, O. V. Sumtsova
Published: 7 February 2022
Abstract:
Portal vein thrombosis is one of the most common complications of liver cirrhosis, the risk factors for which are still not fully understood.Purpose: to develop a prognostic model to determine the likelihood of portal vein thrombosis based on anamnestic, etiological factors, the presence of hepatocellular carcinoma, as well as parameters of CT perfusion of liver tissue.Material and methods. 43 patients with compensated liver cirrhosis (58.1% of men) and 38 patients with subcompensated liver cirrhosis (50% of men) were included in the prospective study. The age of patients in the first group was 52.56 ± 9.62 years, in the second group - 50.95 ± 9.94 years. The number of patients with 1 etiological factor of liver cirrhosis in the study groups was 62.8% and 81.5%, respectively. Type 2 diabetes mellitus was exhibited in 23.3% of patients with compensated liver cirrhosis and in 15.8% of patients with subcompensated liver cirrhosis. The diagnosis of hepatocellular carcinoma was established in 27.9% of patients with compensated liver cirrhosis and in 18.4% of patients with subcompensated liver cirrhosis. All patients, after the native study, underwent CT perfusion of the liver using a 256-slice Philips ICT apparatus. As a result of postprocessing, the values of arterial, portal, total perfusion and perfusion index of liver tissue were determined. Statistical analysis of the data was carried out using the binary logistic regression method and the construction of ROC curves.Results. A logistic stepwise multivariate analysis showed that an increase in arterial perfusion (p = 0.002) and a decrease in portal perfusion (p = 0.004) were independently associated with portal vein thrombosis in patients with compensated liver cirrhosis, and a history of primary liver cancer (p < 0.001) was a dependent factor in this model. In patients with subcompensated liver cirrhosis, a history of hepatocellular carcinoma (p < 0.001) and a decrease in portal perfusion (p = 0.001) became independent predictors of portal vein thrombosis, male gender (p = 0.029) was a dependent factor in the developed model.Conclusion. CT-perfusion of the liver makes it possible to determine predictors that can be used together with such factors as the presence of hepatocellular carcinoma and gender in the construction of prognostic models to determine the likelihood of portal vein thrombosis in patients with compensated and subcompensated liver cirrhosis. Age, etiological factor and the presence of type 2 diabetes mellitus in the developed models were not statistically significant.
A. N. Katrich, S. V. Polshikov, E. P. Fisenko
Published: 3 February 2022
Abstract:
Aim. To study the features of contrast enhancement of malignant neoplasms of the liver in patients with and without cirrhosis (LC), to study the differences in the dynamics of contrast enhancement of liver are metastatic lesions (MTS) and hepatocellular carcinoma (HCC).Material and methods. A retrospective analysis results 58 patients with HCC (group 1) and 51 patients with liver metastases (group 2) was carried out based on morphological data. According to the criterion for the presence of LC, group 1 was divided into two subgroups. The main method of radiological diagnostics was contrast enhancement ultrasound (CEUS).Results. The indicators of the dynamics of the Wash-in of an ultrasound contrast agent into the HCC node and the dynamics of the drug WASH-OUT from the focus in patients with LC did not significantly differ from those in patients without cirrhosis. HCC is characterized by the onset of leaching of the ultrasound contrast agent after 62 seconds from the beginning of the study, which significantly differs from MTS (p Conclusion. The data obtained with the help of CEUS confirm the effect of “arterialization of hepatic blood flow” in patients with LC. Differences in the parameters of contrasting HCC nodes in subgroups of patients with and without LC are not statistically significant. The polymorphism of the signs detected in MTS in the liver is due to the morphology of the primary tumor and the size of the neoplasms. Differential diagnosis should be based on a combination of signs of the dynamics of ultrasound contrast agents.
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