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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">ldt</journal-id><journal-title-group><journal-title xml:lang="ru">Лучевая диагностика и терапия</journal-title><trans-title-group xml:lang="en"><trans-title>Diagnostic radiology and radiotherapy</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2079-5343</issn><publisher><publisher-name>Baltic Medical Education Center</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.22328/2079-5343-2023-14-3-82-92</article-id><article-id custom-type="elpub" pub-id-type="custom">ldt-909</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОРИГИНАЛЬНЫЕ СТАТЬИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ORIGINAL RESEARCH</subject></subj-group></article-categories><title-group><article-title>Компьютерная томография и магнитно-резонансная томография диффузных аксональных повреждений  при черепно-мозговой травме у детей младшего возраста: ретроспективное исследование</article-title><trans-title-group xml:lang="en"><trans-title>Computed tomography and magnetic resonance imaging of diffuse axonal injury in brain trauma in young children: retrospective  study</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6124-5410</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Зайцева</surname><given-names>Е. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Zaitseva</surname><given-names>E. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Зайцева Екатерина Сергеевна  — врач-рентгенолог отдела лучевых методов диагностики</p><p>119180, Москва, ул. Большая Полянка, д. 22</p></bio><bio xml:lang="en"><p>Ekaterina S. Zaitseva — radiologist of Radiology Department </p><p>119180, Moscow, st. B. Polyanka, 22</p></bio><email xlink:type="simple">katarina0594@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3235-8854</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ахадов</surname><given-names>Т. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Akhadov</surname><given-names>T. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Ахадов Толибджон Абдуллаевич — доктор медицинских наук, профессор, руководитель отдела лучевых методов диагностики</p><p>119180, Москва, ул. Большая Полянка, д. 22  </p></bio><bio xml:lang="en"><p>Tolibjon A. Akhadov — Dr. of Sci. (Med.), Professor, Head of Radiology Department</p><p>119180, Moscow, st. B. Polyanka, 22</p></bio><email xlink:type="simple">akhadov@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6349-5739</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Маматкулов</surname><given-names>А. Д.</given-names></name><name name-style="western" xml:lang="en"><surname>Mamatkulov</surname><given-names>A. D.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Маматкулов Алишер Джахангирович  — аспирант отделения нейрохирургии </p><p>119180, Москва, ул. Большая Полянка, д. 22 </p></bio><bio xml:lang="en"><p>Alisher D.  Mamatkulov — postgraduate student of Neurosurgery Department</p><p>119180, Moscow, st. B. Polyanka, 22</p></bio><email xlink:type="simple">md-uz7@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4709-9461</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Божко</surname><given-names>О. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Bozhko</surname><given-names>O. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Божко Ольга Васильевна — кандидат медицинских наук, ведущий научный сотрудник отдела лучевых методов диагностики</p><p>119180, Москва, ул. Большая Полянка, д. 22 </p></bio><bio xml:lang="en"><p>Olga V. Bozhko — Cand. of Sci. (Med.), Leading Researcher of Radiology Department</p><p>119180, Moscow, st. B. Polyanka, 22</p></bio><email xlink:type="simple">bozhko_olga@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4627-9874</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ублинский</surname><given-names>М. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Ublinsky</surname><given-names>M. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Ублинский Максим Вадимович — кандидат биологических наук, старший научный сотрудник</p><p>119180, Москва, ул. Большая Полянка, д. 22</p><p> </p></bio><bio xml:lang="en"><p>Maxim V. Ublinsky — Cand. of Sci. (Biol.), Senior researcher of Radiology Department</p><p>119180, Moscow, st. B. Polyanka, 22</p></bio><email xlink:type="simple">maxublinsk@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-2258-2913</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Новосёлова</surname><given-names>И. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Novoselova</surname><given-names>I. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Новосёлова Ирина Наумовна — кандидат биологических наук, старший научный сотрудник отделения реабилитации </p><p>119180, Москва, ул. Большая Полянка, д. 20 </p></bio><bio xml:lang="en"><p>Irina N. Novoselova  — Cand. of Sci. (Biol.), Senior Researcher of Radiology Department</p><p>119180, Moscow, st. B. Polyanka, 20</p></bio><email xlink:type="simple">i.n.novoselova@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0060-7895</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Понина</surname><given-names>И. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Ponina</surname><given-names>I. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Понина Ирина Витальевна — врач-педиатр </p><p>119180, Москва, ул. Большая Полянка, д. 20</p></bio><bio xml:lang="en"><p>Irina V. Ponina — pediatrician</p><p>119180, Moscow, st. B. Polyanka, 20</p></bio><email xlink:type="simple">ponina.irina@mail.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2910-3711</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Мельников</surname><given-names>И. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Melnikov</surname><given-names>I. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Мельников Илья Андреевич — кандидат медицинских наук, заведующий отделением КТ и МРТ отдела лучевых методов диагностики</p><p> 119180, Москва, ул. Большая Полянка, д. 20 </p></bio><bio xml:lang="en"><p>Ilya A. Melnikov — Cand. of Sci. (Med.), Head of CT and MRI Department</p><p>119180, Moscow, st. B. Polyanka, 20</p></bio><email xlink:type="simple">ilyamed@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1698-0547</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Хусаинова</surname><given-names>Д. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Khusainova</surname><given-names>D. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Хусаинова Дарья Николаевна — научный сотрудник отдела IT </p><p>119180, Москва, ул. Большая Полянка, д. 20 </p></bio><bio xml:lang="en"><p>Daria N. Khusainova — researcher at the IT department</p><p>119180, Moscow, st. B. Polyanka, 20</p></bio><email xlink:type="simple">dsavina@yandex.ru</email><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Научно-исследовательский институт неотложной детской хирургии и  травматологии</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Clinical and Research Institute of Emergency Pediatric Surgery and Trauma</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Научно-исследовательский институт неотложной детской хирургии и травматологии</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Clinical and Research Institute of Emergency Pediatric Surgery and Trauma</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Научно-исследовательский институт неотложной детской хирургии и  травматологии</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Clinical and Research Institute of Emergency Pediatric Surgery and Trauma</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2023</year></pub-date><pub-date pub-type="epub"><day>05</day><month>10</month><year>2023</year></pub-date><volume>14</volume><issue>3</issue><fpage>82</fpage><lpage>92</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Зайцева Е.С., Ахадов Т.А., Маматкулов А.Д., Божко О.В., Ублинский М.В., Новосёлова И.Н., Понина И.В., Мельников И.А., Хусаинова Д.Н., 2023</copyright-statement><copyright-year>2023</copyright-year><copyright-holder xml:lang="ru">Зайцева Е.С., Ахадов Т.А., Маматкулов А.Д., Божко О.В., Ублинский М.В., Новосёлова И.Н., Понина И.В., Мельников И.А., Хусаинова Д.Н.</copyright-holder><copyright-holder xml:lang="en">Zaitseva E.S., Akhadov T.A., Mamatkulov A.D., Bozhko O.V., Ublinsky M.V., Novoselova I.N., Ponina I.V., Melnikov I.A., Khusainova D.N.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://radiag.bmoc-spb.ru/jour/article/view/909">https://radiag.bmoc-spb.ru/jour/article/view/909</self-uri><abstract><sec><title> ВВЕДЕНИЕ</title><p> ВВЕДЕНИЕ: Черепно-мозговая травма (ЧМТ) является ведущей причиной смерти и инвалидности у детей. Детская ЧМТ связана с  рядом характеристик, отличающих ее от  взрослых. Хотя уровень смертности, связанной с  ЧМТ, снизился за  последние два десятилетия, инвалидность детей, переживших ЧМТ, продолжает оказывать значительное влияние на экономику и общественное здравоохранение общества в целом.</p></sec><sec><title>ЦЕЛЬ</title><p>ЦЕЛЬ: Показать возможности компьютерной и магнитно-резонансной томографии в диагностике травматических диффузных аксональных повреждений у младенцев и детей младшего возраста.</p></sec><sec><title>МАТЕРИАЛЫ И МЕТОДЫ</title><p>МАТЕРИАЛЫ И МЕТОДЫ: В данной работе мы проанализировали данные КТ и МРТ 1334 детей до 3 лет с острой ЧМТ, лечившихся в НИИ неотложной детской хирургии и травматологии (730 мальчиков и 604 девочек). Возраст детей был от 23 дней до 3 лет, средний возраст составил 1 год 6 месяцев. Компьютерная томография выполнена на 128-срезовом томографе Ingenuity Elite (Philips). Сканирование зоны интереса (голова+шейный отдел позвоночника) проводилось с максимально возможным снижением показателей для минимизации дозы облучения, включая программу iDose4. МРТ проведена на томографе Phillips Achieva 3 Тл с получением мультипланарных T1- и T2-ВИ, 2D- и 3D-изотропных изображений, FLAIR, SWI, ДВИ/ДТИ, магнитно-резонансной ангиографии (МРА). Контрастное усиление не применялось.</p></sec><sec><title>Статистика</title><p>Статистика: проводилась с помощью компьютерной программы GraphPad Prism 9. Использовались вычислительные и графические возможности редактора электронных таблиц Excel. Для сравнения средних значений выборок данных применялся дисперсионный анализ ANOVA, различия считались достоверными на уровне значимости р&lt;0,05.</p></sec><sec><title>РЕЗУЛЬТАТЫ</title><p>РЕЗУЛЬТАТЫ: У 824 (61,8%) из 1334 детей было сотрясение головного мозга, у 510 (38,2%) выявлены травматические повреждения черепа и головного мозга от неосложненных кефалогематом и линейных переломов до массивных внутричерепных гематом и тотального отека мозга. ДАП I и II типа при КТ, в дальнейшем подтвержденные при МРТ, выявлены у 32 (6,27%) детей из всех 510 с ЧМТ. У 19 из 32 было сочетание с ушибами головного мозга, 13 с эпи- и/или субдуральными гематомами небольшого объема. МРТ выполнена у 89 из 510 детей до 3 лет с интракраниальными повреждениями, у которых первично произведена КТ. Диффузные аксональные повреждения (ДАП) различного типа с помощью МРТ выявлены у 92,13% (82/89) пострадавших.</p></sec><sec><title>ОБСУЖДЕНИЕ</title><p>ОБСУЖДЕНИЕ: ДАП является одним из наиболее частых видов ЧМТ и встречается как при легкой, так и при тяжелой степени, представляет собой повреждение головного мозга, характеризующееся разрывом аксонов, в результате чего возникают поражениями трактов белого вещества в большом пространстве. С учетом поступления в институт детей с ЧМТ со значительным разбросом (от 1 часа до 7 суток), первичную КТ проводили не позднее чем через один час после поступления и дополняли МРТ. Критерием назначения КТ и МРТ после ЧМТ служил клинический и неврологический статус на время поступления. КТ имеет низкую чувствительность обнаружения ДАП, так как выявляется только крупные геморрагические (гиперденсные) очаги ДАП. Использование мультипланарной реконструкции, а также различных опций, таких как 3D-реконструкция, MIP и  MinIP (проекция максимально и  минимальной интенсивности) и  другие, позволяют детально оценить паренхиму головного мозга и повысить выявляемость ДАП. В нашем исследовании ДАП с помощью МРТ выявлены у 92,13% пациентов, а наиболее критичный тип ДАП III — у 100% детей с тяжелой ЧМТ с плохим исходом и смертью пациентов.</p></sec><sec><title>ЗАКЛЮЧЕНИЕ</title><p>ЗАКЛЮЧЕНИЕ: КТ головы является предпочтительным методом для неотложной радиологии пациентов с ЧМТ из-за ее доступности, скорости получения данных и способности обнаруживать поражения, требующие срочного нейрохирургического вмешательства. В острых случаях МРТ назначается пациентам с тяжелыми неврологическими нарушениями, несмотря на отсутствие структурных повреждений головного мозга на КТ. МРТ является методом выбора при подострой и хронической ЧМТ.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>INTRODUCTION</title><p>INTRODUCTION: Traumatic brain injury (TBI) is the leading cause of death and disability in children. Children’s TBI is associated with a number of characteristics that distinguish it from adults. Although the death rate associated with TBI has decreased over the past 2 decades, the disability of children who survived TBI continues to have a significant impact on the economy and public health of society as a whole.</p></sec><sec><title>OBJECTIVE</title><p>OBJECTIVE: To show the possibilities of computed tomography and magnetic resonance imaging in the diagnosis of traumatic diffuse axonal injuries in infants and young children.</p></sec><sec><title>MATERIALS AND METHODS</title><p>MATERIALS AND METHODS: In this work, we analyzed the CT and MRI data of 1334 children under 3 years of age with acute TBI who were treated at the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (730 boys, 604 girls). The age of the children was from 23 days to 3 years, the average age was 1 year 6 months. Computed tomography scans were performed on a 128-slice Ingenuity Elite scanner (Philips). Scanning of the area of interest (head + cervical spine) was carried out with the maximum possible reduction in indicators to minimize the radiation dose, including the iDose4 program. MRI was performed on a Phillips Achieva 3 T scanner with multiplanar T1- and T2WI, 2D and 3D isotropic images, FLAIR, SWI, DWI/DTI, and magnetic resonance angiography (MRA). No contrast enhancement was applied. Statistics: data processing was carried out using the GraphPad Prism 9 software package. The computing and graphic capabilities of the Excel spreadsheet editor were used. To compare the mean values of the data samples, ANOVA analysis of variance wasused; differences were considered significant at a significance level of p&lt;0.05.</p></sec><sec><title>RESULTS</title><p>RESULTS: 824 (61.8%) of 1334 children had a concussion, 510 (38.2%) had traumatic injuries of skull and brain from uncomplicated cephalohematomas and linear fractures to massive intracranial hematomas and total brain edema. Diffuse axonal injuries(DAI) type I and II on CT, further confirmed by MRI, were detected in 32 (6.27%) of all 510 children with TBI. 19 out of 32 hada combination with brain contusions, 13 with epi — and / or subdural hematomas of a small volume. MRI was performed in 89 out of 510 children under 3 years of age with intracranial injuries, in whom CT was initially performed. DAI of various types were detected by MRI in 92.13% (82/89) of the patients.</p></sec><sec><title>DISCUSSION</title><p>DISCUSSION: DAI is one of the most common types of TBI, occurring in both mild and severe forms, and is a brain injury characterized by axonal disruption, resulting in lesions of white matter tracts over a wide area. Taking into account the fact that children with TBI were admitted to the institute with a significant spread (from 1 hour to 7 days), the initial CT scan was performed no later than one hour after admission and was supplemented by MRI. The criteria for CT and MRI prescribements after TBI were: clinical and neurological status at the time of admission. CT has low sensitivity for detecting DAI, as only large hemorrhagic (hyperdense) lesions of DAI are detected. The use of multiplanar reconstruction, as well as various options, such as 3D reconstruction, MIP and MinIP (maximum and minimum intensity projection) and others, allows for a detailed assessment of the brain parenchyma and increases the detection of DAI. In our study, DAI using MRI was detected in 92.13% of patients, and the most critical type of DAI III was detected in 100% of children with severe TBI with poor outcome and death of patients.</p></sec><sec><title>CONCLUSION</title><p>CONCLUSION: Head CT is the preferred method for emergency radiology of TBI patients due to its affordability, speed of data acquisition, and ability to detect lesions requiring urgent neurosurgical intervention. In acute cases, MRI is chosen for patients with severe neurological impairment despite the absence of structural brain damage on CT. MRI is the method of choice for subacute and chronic TBI</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>младенцы</kwd><kwd>дети младшего возраста</kwd><kwd>магнитно-резонансная томография</kwd><kwd>черепно-мозговая травма</kwd><kwd>дети</kwd><kwd>изображения</kwd><kwd>взвешенные по магнитной восприимчивости</kwd></kwd-group><kwd-group xml:lang="en"><kwd>infants</kwd><kwd>young children</kwd><kwd>magnetic resonance imaging</kwd><kwd>traumatic brain injury</kwd><kwd>children</kwd><kwd>susceptibility-weighted images</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Лихтерман Л.Б. Диффузное аксональное повреждение головного мозга // Consilium Medicum. Неврология и ревматология (Прил.). 2016. Т. 1. 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