Idiopathic normal pressure hydrocephalus (Hakim-Adams syndrome, iNPH) is a chronic neurodegenerative disease of elderly associated with ventricular expansion, and characterized by gait disturbance, mental deterioration, and urinary incontinence. It becomes more important with increasing of elderly part of population. Important feature of iNPH is it’s reversibility in case of early surgical treatment. One of the main problem is the differential diagnosis between iNPH and other neurodegenerative diseases and detection of patients which would be most benefit with shunting. In this purpose a number of radiological symptoms and signs have been proposed. Assessment of MR symptoms of iNPH increases the accuracy of diagnosis and allows in some cases to avoid the necessity of invasive diagnostic procedures (e.g. tap-test, infusion test, external lumbar drainage, ICP monitoring etc.) with lower risk of complications, less duration of treatment and minimizing negative personal experience. At the same time, assessing of most sensitive iNPH radiological symptoms allows to evolve candidates for shunting at prehospital stage and reduce the duration of treatment.

Background and purpose: systematization and synthesis of data on radiological symptoms of iNPH in order to identify most simple and at the same time significant diagnostic and prognostic criteria.

Matherials and methods. The search was performed in PubMed, Google Scholar and Cochrane Library by key words «normal pressure hydrocephalus», «neuroimaging», «magnetic resonance imaging», «computed tomography, radiological symptoms». In addition, data from references were used.

Results. Most specific and sensitive radiological criteria for diagnosis of iNPH are following: Evans index, DESH, temporal horns dilation, callosal angle, periventricular edema, perivascular spaces dilation and local sulci dilation. Complex assessment of this symptoms increases diagnostic accuracy and in some cases allows to avoid the necessity of invasive diagnostic procedures. 

Timely and accurate diagnosis of focal lesions of the liver, despite the existing arsenal of of radiation examination modalities, still remains a challenge. Particular difficulty is caused by foci of small diameter, an atypical character of contrasting; a combination of multiple formations of different genesis; focus against the background of diffuse liver damage; liver damage, mimicking tumors. DECT method givesnew analysis algorithms that are different from traditional CT. The article presents a review of the literature on the use of qualitative and quantitative parameters of spectral scanning in different phases of contrast enhancement in the differential diagnosis of liver focal lesions. The use of low-energy monochromatic images and the quantitative analysis of iodine content contribute to a better detection of liver foci and greater confidence in differential diagnosis.

With improved treatment for cerebral gliomas leading to longer survival, late rare complications of radiation therapy on the brain are more frequently observed. The paper presents the results of positron emission tomography (PET) with [11C]methionine in 4 patients with malignant cerebral glioma, in whom the phenomenon of transient diffuse high [11C]methionine uptake in the cerebral cortex was detected during treatment monitoring. The unilateral high [11C]methionine uptake in the posterior portion of the cerebral hemisphere was stereotyped and easy to recognize. Nevertheless high amino acid uptake on PET did not match with structural abnormalities on MRI and was not accompanied by aggravation of neurological symptoms or by epileptic seizures. The results of the follow-up examinations excluded tumor recurrence. The control PET/CT scans showed complete resolution of the abnormal [11C]methionine uptake. The clinical and instrumental similarity of the presented cases allowed to establish the diagnostic criteria for the phenomenon of metabolic pseudoprogression and to compare them with the criteria of the SMART syndrome (stroke-like migraine attacks after radiation therapy). Two cases with SMART syndrome are presented as a comparison group. The similarities and discrepancies of unusual metabolic hyperfunction with previously known phenomena and possible mechanisms for their development are discussed. It is important for clinicians and radiologists to be aware of the characteristic imaging findings of the metabolic pseudoprogression on PET with [11C] methionine to avoid overdiagnosis of the brain tumor recurrence and aggressive treatment approach.

Approximately 30% of patients with symptomatic epilepsy have pharmacoresistant seizures refractory to medical therapy. The most effective treatment modality is microsurgical resection of whole epileptogenic zone, not only visible on MRI lesion. However, in some cases patients still have seizures after operation. We provide a method of simultaneous EEG-fMRI to more accurate localization of epileptogenic zone after failed surgery. Here we present our experience of gamma knife stereotactic radiosurgery for patient harboring mesial temporal lobe epilepsy using EEG-fMRI for confirmation of residual epileptogenic zone.

PET study of cerebral glucose metabolism was performed in 73 children with epilepsy and mental retardation. Expressive speech disorders were associated with decrease of cerebral metabolism rate of glucose (CMRglu) in the upper frontal gyrus, caudate nucleus and thalamus of the left and right hemispheres. In the group with combined expressive and impressive speech disorders the significant CMRglu reduction in the middle temporal and supramarginal gyrus of the left hemisphere was observed. The obtained results confirm that the brain structures associated with the executive functions and complex association processes have a great significance in the speech development.

This article investigates the value of early diagnosis and prognostic evaluation of Doppler ultrasound for preterm neonates very low birth weight in early neonatal life. The results showed that cerebral hemodynamic disturbance of intracranial carotid arterials would be associated with later brain impairments (intraventricular hemorrhage, lesions of periventricular white matter) detected by MRI.

Fim of the study. We attempted to select a complex of signs for prognosis of early post-intervention stroke in patients referred for extensive invasive cardiovascular surgery or intravascular procedures, from the data of routine MRI of the brain.

Material and methods. Basing on the histories of 540 patients underwent non-carotid cadiosurgical or invasive intravascular procedures we selected ten in whom the post-operation early stroke was diagnosed and who also underwent pre-surgically the MRI study of the brain. The control comparative group comprised twelve persons in whom no post-intervention stroke was observed and also pre-intervention MRI was present. At the admission before surgery or intervention in everybody the T2-weighted MRI has been carried out in T2-weighted and T1-weighted thin slice (1,5– 3 mm) modes with subsequent quantification of cerebral ischemic preconditioning from quantitatification of T2-w. Imaged and with measurement of cortex’thickness.

Results. In patients of both post-surgical stroke and control groups the coexistance of critical carotid stenosis or carotid occlusion with contralateral subcritical or mild/minimal contralateral carotid stenosis was detected. The post-operation ishemic stroke was detected in those persons obly, in whom pre-surgically the region of ishaemic leucodystrophy (unilateral leucoarayosis) was detected as signal-enhanced region on T2-weighted MRI scans on the side of carotid occlusion/critical stenosis, simultaneously with cortical thinning on the side. The index of physical volume of the T2-w.hyperintence region was in patients in whom post-surgically the ischemic stroke occurred as high as 18–51 сm3, whereas the volume of irreversibly damaged tissue diffusely distributed over the T2-w.hyperintensive leucoarayosis area 3,9–14,7 сm3. The ratio of volumes of irreversibly damaged tissue to the physical volume of damage was 0,17–0,29. Simultaneously in these persons in the middle cerebral artery perfusion region ipsilaterally the relative thinning of the cortex was seen with no cerebral stroke in the personal history. The cortex was in these patients on the side of ICA critical stenosis/ ICA occlusion 1,7–3,1 mm, and contralaterally 2,5–3,2 mm, with asimmetry index 0,65–0,82. This syndrome of «ischemic preconditioning of the brain» seen as combination {T2-hyperintensity & cortical dystrophy} was also detected in hree patients in whom the ishaemic stroke after cardiovascular surgery did not occur, and all these persons were treated befor the operation with high — up to 750 mg daily — doses ethylmethyl hydroxypiridine succinate (mexidol). The sensitivity of MRI syndrome {T2-hyperintensity & cortical dystrophy} in prognosis of post-operation ischemic stroke was as high as 100%, whereas specificity 75%, and diagnostic accuracy 86%.

Conclusion. Thus, the detection of extensive unilateral area of T2-hyperintensity in the internal carotid artery region (unilateral leucoarayosis) concomitant with thinning of cortex in the region, on the side of occlusion or critical stenosis of internal carotid artery can be accepted as factor of high risk of ishemic stroke early after extensive vascular surgery or intervention. It is necessary to carry out the MRI study of the brain in every patient before and after extensive cardiovascular intervention, for scoring of stroke risk early after procedure. 

The work testifies to the possibilities of ultrasound, magnetic resonance imaging (MRI) and multispiral computed tomography (MSCT) in revealing the formation of parotid salivary glands. Evaluation of the results of MRI and MSCT facilitates preoperative planning and minimizes postoperative complications in operations in the side of the face. Modern methods of radiation diagnosis are indispensable for the dynamic control of possible recurrences of tumors of the parotid salivary glands. The purpose of this study was to improve radiation methods of examination in the complex preoperative preparation and intraoperative management of patients with pathology of the side facial.

The aim of the study was to evaluate the role of virtual bronchoscopy (VB) in traumatic rupture of the main bronchus Material and methods. Тhe data of virtual bronchoscopy of multispiral computed tomography (MSCT) with multiplanar and 3D reconstructions of 10 patients with traumatic separation of the main bronchus were analyzed. MSCT was carried out by the computer tomograph AquilionONE (320-slice) according to the previously described technique. Results of the study. VB MSCT allowed to determine the presence of a complete or partial rupture of the main bronchus, its distance to the bifurcation of the trachea, the state of the collapsed lung, the presence of fluid in the hemithorax, secondary changes in the bone structures of the chest. The World Bank played an important role in monitoring the adequacy of reconstructive measures on the damaged bronchus, excluding the occurrence of postoperative stenosis. The conclusion. Virtual bronchoscopy of multispiral computed tomography with the capabilities of multiplanar and volumetric reconstructions, postprocessing image processing is an optimal non-invasive method for determining the traumatic lesion of the main bronchi and monitoring the success of the reconstructive surgical manual.

Hypertrophic cardiomyopathy affects about 0,2% of the adult population of the Earth. This disease is one of the main causes of sudden death, and can also lead to disability in patients of all age groups, which determines the high medical and social significance of the disease. Echocardiography and magnetic resonance imaging are the most informative methods of radiological diagnostics of hypertrophic cardiomyopathy.

Aim. To evaluate the effectiveness of the mathematical model for determining the probability of osteopenic syndrome in patients with multifocal atherosclerosis.

Materials and methods. The study included 251 male patients with verified atherosclerosis of the coronary and carotid arteries. The average age of the patients was 60,56±8,7 years. All patients included in the study performed multispiral computed tomography of coronary and carotid arteries with a quantitative evaluation of calcification by the method of Agatston (calcium index and equivalent weight of calcium deposits), color duplex scanning of carotid arteries, densitometry. The obtained data were used to calculate the probability of having an osteopenic syndrome (р) using a mathematical model. Criterion for the risk of osteopenic syndrome in the patient is the value р>0,688. The results of the analysis were compared with the densitometry data chosen as the reference method.

Results. According to the quantitative assessment of coronary artery calcification in patients with osteopenia and osteoporosis, significantly higher values of the calcium index and equivalent weight of calcium deposits were observed than in patients with normal bone mineral density. Regardless of the presence of bone mineralization, more than half of the respondents (66,7% of patients with normal bone mineral density and 59,6% of patients with osteopenic syndrome) had coronary artery stenoses up to 50%. Calcification and presence of stenosis more than 30% of carotid arteries prevailed in the group of patients with osteopenic syndrome. The results of calculating the probability of having an osteopenic syndrome using a mathematical model indicate that it is highly prevalent in the sample (69,3%) and does not differ significantly from the densitometry data (70,1%). The sensitivity of the mathematical model was 89,8%, the specificity was 78,7%, the prognostic value of the positive result was 90,8%, the prognostic value of the negative result was 76,6%.

Conclusion. The mathematical model for assessing the probability of osteopenic syndrome is highly diagnostic in men with multifocal atherosclerosis. 

Complex clinical and radiological examination has a great value for control of the patients with traumatic lesions of hip joint before and after endoprosthesis replacement. The high risk of possible complications due to mineral metabolism disorders which must be detected before and controlled after operations.

The aim of the study. Compare the efficiency of the use of dual-energy x-ray absorptiometry (DRA) and bioimpedansometry (BIM) in the evaluation of the body composition of hemodialysis patients.

Patients and methods. 67 patients on hemodialysis, among which 23 men and 44 women aged 54±14,4 years. BIM and DRA were used to evaluate the body composition.

Results. The results of determining the total muscle mass of the body obtained by the results of DFA and BIM were compared with the use of the Bland-Altman method. The correlation coefficient between the indices was R=0,994, p<0,0001, delta (M±s) was –0,48±0,91 kg, CI 95% (–0,71)…(–0,26) kg.

Conclusion. DRA does not have significant advantages over tetrapolar multifrequency BIM when assessing the body composition in hemodialysis patients. 

Low-level laser therapy as a method for correcting the mucositis caused by ionizing radiation of the oral mucosa is used in clinical practice for various exposure parameters: radiation power not less than 10 mW, laser doses not less than 2 J/cm2. The purpose of this study was to compare the efficacy of low-level laser therapyred and infrared laser radiation for the correction of mucositis of the oral mucosa in patients receiving radiation and chemoradiotherapy for oral and pharyngeal cancer, with laser doses of less than 1 J/cm2. The study included 106 patients who received radiation and chemoradiotherapy for cancer of the oral cavity and pharynx, which were randomly divided into three groups. In the first (37 patients), mucositis was prevented and corrected in accordance with the standards of the clinic, in the second (36 patients) and the third (33 patients), patients were additionally exposed to the oral cavity with Low-level laser therapy (LLLT) at 635 nm and 780 nm at powers of 5 mW and 20 mW, respectively. The effect of LLLT on the wavelength of 635 nm significantly reduced the frequency and severity of mucositis, increased the time until the appearance of the first symptoms of mucositis of the oral mucosa, shortened the duration of severe mucositis (grade 3), and reduced the need for painkillers, including narcotic analgesics compared with the group who received standard prophylaxis and correction of mucositis.