Modern ultrasound examination (US), unlike other modalities, allows to assess the stiffness of the lesions, with the help of a new technology named sonoelastography (SEG). According to many scientific studies, with the addition of SEG to the B-mode, the diagnostic efficiency of ultrasound of breast lesions significantly increases. According to Thomas et al. B-mode has a sensitivity of 91,8% and a specificity of 78%. When a compression SEG is added to a diagnostic study, the specificity increases to 91,5%.

The purpose of this study was to determine the diagnostic effectiveness of SEG and compare it with the effectiveness of B-mode and color Doppler mapping (CDC) in the primary diagnosis of breast tumors, as well as to identify diagnostically and statistically significant SEG signs of breast cancer (ВС).

Materials and methods. The study was performed from 2017 to 2019 on the basis of the «NMRC Oncology. named after N. N. Petrov» Ministry of Health of Russia. 277 women with complaints of lump or pain in the breast were included in the study, for all of them there was performed the multiparametric ultrasound examination with application of CDM and SEG. According to our own results, SEG is more effective at detection of malignant and benign lesions, than ultrasoumd examination in B and CDM modes.

Results: 0, 1, 2, 3 elastotypes are the highly significant diagnostic signs of benign process, and the elastotype 5 is a reliable diagnostic marker of malignant process. The effectiveness of CDM and SEG in the differential diagnosis of breast lesions showed: sensitivity — 77,6% vs. 85,5%; specificity — 51,7% vs. 84,6%; accuracy — 58,8% vs. 84,8%.

Conclusions: according to our own research results, SEG is more effective in detecting malignant and benign tumors than ultrasound in B and CDM modes.

Currently, in the world and in the Russian Federation there has been a decrease in the growth rate of cases of HIV infection and tuberculosis, however, an annual increase in the proportion of cases of a combination of these infections is noted. The method of radiation screening in the Russian Federation recognized fluorography, which reveals no more than half of HIV/TB patients, and the use of such a sensitive method as CT is only advisory in nature. WHO recommends the use of radiation diagnostics as a screening tool only if the prevalence of this combination of infections is more than 20%. Currently, it has been proven that HIV infected patients suffer from tuberculosis at least 20 more often, and with an increase in immunodeficiency, they form pathomor-phological characteristics of primary respiratory tuberculosis, while there is a rapid progression of both HIV infection and tuberculosis, often leading to death of patients. The pathomorphological characteristics recorded during computed tomography also change. A review of studies on the possibilities of detecting respiratory tuberculosis in computed tomography, including in people living with HIV infection (n=24), is presented. To compare the effectiveness of CT, a separation was used according to the psychological syndromes and the degree of suppression of immunity. The frequency of occurrence of computed tomographic patterns in this group was examined and it was found that CT is also the most sensitive method for diagnosing tuberculosis in HIV-positive individuals. And increasing the effectiveness of detection is possible when analyzing patient complaints and the severity of immunosuppression. Thus, computed tomography of the organs of the chest cavity can be used at the stage of screening for respiratory tuberculosis in HIV infected patients, taking into account the level of CD4+ lymphocytes.

Rapid development and implementation of the computed tomography (CT) in the Russian radiological practice reads to the significant increase in both the individual patient doses and collective dose of the Russian population from computed tomography.

For the successful implementation of the optimization and dose reduction techniques it is necessary to develop and implement the methods of subjective (expert) image quality assessment. The current study was focused on the development of the composite method of the CT image quality assessment using an anthropomorphic chest phantom and imitators of the nodules for the detection of the ground-glass nodules. The method includes the detection of the nodules on the CT scan series as well as the assessment of the quality of the images using 5-grade Likert scale corresponding to the designed criteria. The method was evaluated for the development of the preliminary low-dose chest CT protocols using different reconstruction algorithms. The results of the study were based on the expert opinion of ten radiologists. They indicate the possibility of the significant (up to a factor of four) reduction of the effective doses of the patients related to the reduction of mAs for the CT scans of the chest for the detection of ground-glass nodules without a reduction in image quality. The best results corresponded to the algorithm of the model iterative reconstructions. Results of the study would be further evaluated on patients within a dedicated clinical trial.

At the present time for sanatorium treatment of dorsopathies no morpho-pathogenetic principles are based on severity of degenerative spine changes. The choice of treatment modalities is provided according only to clinical signs and the fact of degenerative spine disease presence, in spite of limitations and contradictions to some resort procedures because of their mechanisms and peculiarities of therapeutic effects.

Materials and methods. Comparison of complex imaging examination and sanatorium resort intensity regimen medical appointments of 952 patients with dorsopathies was provided depending on morphological pattern and severity of degenerative spine changes. Case histories, sanatorium medical outpatient cards and the results of radiologic imaging (computed tomography, magnetic resonance imaging, spondylography and osteodensitom-etry) were analyzed.

Results. Three groups of sanatorium resort therapeutic action intensity (maximal, 376 patients; limited, 493 patients; and minimal, 83 patients) for patients with dorsopathies were established. The most significant morphological criteria of patient distribution into appropriate groups were established, such as bone mineral density state, the presence and severity of spinal osteoarthrosis and spondylolisthesis, vertebral-motor segment stability or instability, vertebral body hemangiomas. The size of intervertebral disc extrusions and grade of disc height decreasing played a secondary role. The value of spondylography, computed tomography, magnetic resonance imaging and dual-energy radioabsorptiometry in determination of these criteria is presented, as far as in imaging algorithm of examination of patients with dorsopathies on the pre-sanatorium stage, with calculation of computed tomography and magnetic resonance imaging sensitivity, specificity and accuracy.

Discussion. Forming morpho-pathogenetic approach to sanatorium resort treatment of dorsopathy demands essential application of modern radiologic imaging modalities. The presence, type and severity of degenerative spine morphological changes must be as fundamental as clinical and neurological pattern, affecting sanatorium resort intensity regimen selection and treatment modalities and schemes. In basic cases most advisable radiologic imaging pre-sanatorium examination modality should be computed tomography, but others are also necessary to use when concretely indicated.

Introduction. The purpose of the investigation is to systematize MRI protocols for primarily identified malignant masses in women’s pelvis.

Materials and methods. The retrospective analysis included 1.5 T MRI of 530 women’s pelvis. The analysis included uterine cervical cancer, uterine corpus malignancy, ovarian cancer and rectal cancer. Three MRI oncology experts, with over 5 years of experience, have performed a retrospective analysis of scanning protocols and their significance in identifying local extent of metastatic lesion.

Results and discussion. In rectum cancer, corpus uteri or uterine cervical cancer MRI is used as a method to assess local extent, pelvic lymph nodes and, in some cases, paraaortic lymph nodes. The authors have suggested MRI protocols to solve these problems. The authors discuss the MRI scanning protocol for primarily identified neoplasms in rectum, uterus, uterine cervix and ovaries. It also considers the application of necessary sequences, details of useful axis with indication of evaluated structures.

Conclusions. The complex application of different methods improves diagnostic significance for multiparametric pelvic MRI in female patients. In experts’ opinion, the complex implementation of diffusion methods and dynamic contrast enhancement significantly improve the results of traditional MRi scanning for ovarian neoplasms and uterine corpus cancer. Different contrast methods do not provide necessary information for primarily identified colorectal cancer and cervical uterine cancer.

Introduction. Modern treatment strategies of colorectal cancer determine the need for a personalized approach not only in administration of neoadjuvant therapy, but also in correction after its completion, depending on the tumor local extent and taking into account the risk of relapse. Objective. To incrise the diagnostic performance of multiparametric MRI (mpMRI) in assessing the effectiveness of treatment and predicting the clinical course of locally advanced rectal cancer (LARC) after neoadjuvant treatment.

Materials and methods. 112 patients with LARC who received preoperative chemoradiotherapy (CRT) (85 patients) and CRT supplemented with neoadjuvant polychemotherapy (27 patients) followed by surgery were enrolled in retrospective study. All the patients underwent mpMRI before neoadjuvant treatment and 8-10 weeks (median 8,4 weeks) after its completion in order to evaluate the tumor response. The parameters examined included circumferential resection margin (CRM), extramural venous invasion (EMVI), T stage (T) and N stage (N), TRG (TRG). To determine the diagnostic performance of mpMRI, obtained data are compared with pathomorphology.

Results. The MRI parameters with the highest diagnostic performance, in comparison with pathomorphological results, were: N stage (sensitivity 81,2%, specificity 95,6%, accuracy 91,6%), CRM (sensitivity 84%, specificity 83,9%, accuracy 83,9%) and EMVI (sensitivity 75%, specificity 85,4%, accuracy 83,9%). The diagnostic performance of T staging (sensitivity 95%, specificity 59,6%, accuracy 78,6%) and TRG (sensitivity 46%, specificity 86,3%, accuracy 72,3%) were not high enough.

Conclusions. Multiparametric MRI has high sensitivity and specificity in assessing the effectiveness of neoadjuvant treatment of locally advanced rectal cancer, and that allows to choose proper patient management.

Purpose: to develop methodological aspects of CT navigation and control of tumor cryoablation.

Methods and materials. The study included 38 patients with malignant neoplasms of different localization, who underwent 58 cryoablation procedures with CT navigation. CT control was performed in sequential mode, in the mode of CT fluoroscopy or as an part of robot-assisted operations. The accuracy of cryoprobe positioning and the possibility of visual control of the ice-ball propagation were evaluated.

Results: in all cases of cryoablation the use of CT made it possible to install accurately cryoprobes in the tumor and visually control the formation of the ice-sphere.

Conclusion: CT is the optimal method of image guidance for cryoablation, which allows to control both the positioning of cryoprobes in the tumor and the process of ice front propagation. Depending on the characteristics of the tumor, technical equipment and experience of the operator, one or another method of CT navigation of instruments can be chosen.

The purpose of our study is to study the current approaches of radiation therapy at somatotropinomas and to evaluate neuroimaging indices in long term periods of therapy. The object of the study was 50 patients who underwent radiotherapy. The patients were divided into 3 groups: the 1st group a 1 year after the radiation therapy 7 persons, the 2nd group 1-5 years — 19, the 3rd group 5-10 years — 24 patients. The results of determining the average daily levels of growth hormone at various times after the radiation therapy show that at the time of the first examination, all patients had active acromegaly, which was estimated by the level of growth hormone. Evaluation of the condition of patients in all groups after radiation therapy showed a decrease in growth hormone levels (p<0,01). A significant decrease was observed in group III, the average level of growth hormone was 7,8±1,2 mMe/l. The result of the dynamics of neuroimaging studies at various times after radiation therapy showed a significant decrease in the size of pituitary adenomas in all respects.

Conclusion. In the long-term period after radiation therapy, 10% of patients had a decrease in the size of the pituitary gland, 54% had normal pituitary sizes, 16% had no effect and in 20% of cases there was an empty turkish saddle. It has been established that radiation therapy, followed by medical treatment with dopamine agonists, both in the immediate and long term periods after it, contributes to the stabilization of the pathological process of acromegaly.

The aim of the study was the comparative analysis of morphological changes dynamics for gonarthritis 0-2 stages by symptomatic therapy (Symptomatic slow acting drugs for osteoarthritis — SYSADOA) in combination with orthovoltage x-ray therapy (OVRT) using magnetic resonance imaging (MRI) on WORMS criteria.

Material and methods. The study included the patients with clinically confirmed gonarthritis. All the patients were randomly divided into 2 groups, each received a combined SYSADOA glucosamine (500 mg) and chondroitin (400 mg) sulfate, OVRT was performed for patients of the group 2 performed on Xstrahl-200 equipment, a single dose of 0,45 Gy, in 10 sessions to a total dose of 4,5 Gy. Evaluation of morphological MR-changes was carried out by WORMS in 15 conditional areas calculating of the average value for each anatomical zone before, after 12 and 36 months.

Results. There were selected 300 patients, 150 in each group, eight people were lost. The difference in meniscus status was statistically significant before treatment. After 12-36 months a statistically significant advantage of OVRT in cartilage thickness (8,6 vs 1,9; p=0,009), the degree of prevalence of bone marrow edema (5,7 vs 0,6; p=0,024), thinning of articular surfaces (1,6 vs 0,3; p=0,042; t=2,11, df=34), the presence of marginal osteophytes (4,4 vs 1,8; p=0,042) and synovitis (1,1 vs 0,5; p=0,022).

Conclusion. Complex MR-evaluation of the results of treatment of gonarthritis according to the WORMS criteria showed a significantly lower rate of progression of pathological changes in patients who received SYSADOA in combination with OVRT compared with patients who were prescribed monotherapy with SYSADOA, the effect remains for at least three years.

Purpose. To create a model of pharmacokinetics of thyroid-stimulating radiopharmaceuticals (Na131I), to determine the transport constants of thyroid metabolism and excretion by comparing the model results with quantitative radiometric data of patients with thyroid cancer, as well as to calculate the threshold and therapeutic absorbed doses in the thyroid gland on the basis of this model taking into account the effects of ablation.

Materials and methods. The principles and methods of pharmacokinetics (compartment simulation), method of Hooke-Jeeves for finding the minimum of function of several variables when determining the values of the parameters of communications between compartments using quantitative data radiometry of the thyroid tissue of five patients entered radiopharmaceutical, methods of calculation of absorbed doses was found through the process of modeling the cumulative activity of the radiopharmaceutical in the thyroid gland.

Results. A two-compartment model of the kinetics of a thyroid-stimulating radiopharmaceutical was developed taking into account the radiation damage of thyroid tissue residual after thyroidectomy as a result of internal irradiation during radionuclide therapy. Kinetic curves of changes in radiopharmaceutical activity (time-activity curves) in the model compartments for five patients with thyroid cancer were obtained. On the basis of this model calculations of individual threshold and total absorbed doses in thyroid tissue are carried out.

Conclusion. The developed pharmacokinetic model allows to describe the kinetics of radiopharmaceuticals in patients with thyroid cancer. On the Activity-time curves for thyroid tissue there is a characteristic fracture at the time of reaching the threshold dose and then a sharp decline due to the destruction of thyroid tissue as a result of the effects of ablation.

Summary. The article observes the possibilities of high-technologic radiologic methods for diagnostics of laryngeal malignancy. Despite of large amount of publications, dedicated to the question of different radiologic imaging modalities application for laryngeal tumors the aspects of complex radiological examination and highly differentiated laryngeal tumors detection are not well described.

Materials and methods. In our article there is the case of diagnostic process in 56-years old male patient complained on voice changes with the right vocal fold neoplasm detected in laryngeal videoendoscopy, which had ambiguous pattern in autofluorescence. The results of laryngeal videoendoscopy included differently colored zones from white ones, which corresponded to benign tissue, to blue and violet ones, which corresponded to malignancy. The patient was examined with contrast-enhanced computed tomography, contrast-enhanced magnetic resonance imaging with diffusion-weighted protocol and combined positron-emission and computed tomography with ¹⁸F-fluorodeoxyglucose.

Results. Computed tomography data showed the right vocal fold thickening without contrast agent uptake, on magnetic resonance images there was detected the irregular thickening of the same fold, also without contrast medium agent uptake. In positron-emission and computed tomography with ¹⁸F-fluorodeoxyglucose a focal radiotracer hypermetabolism with highly increased standard uptake value was detected, which indicated malignancy. In addition distant metastases in thoracic lymph nodes were found. Pathomorphologic diagnosis of high-differentiated laryngeal cancer was established.

Discussion. Highly differentiated laryngeal malignant tumors can imitate benign process on computed tomography and magnetic resonance imaging because of peculiar cell composition, but they are characterized with ¹⁸F-fluorodeoxyglucose hyperfixation conditioned by glycolytical activity of malignant cells. Negative computed tomography and magnetic resonance imaging data in combination with positive positron-emission and computed tomography results may correspond to highly differentiated laryngeal tumor.

Background. Pneumothorax is the most common surgical complication of bullous emphysema, and extremely rare in patients with a single lung. We present our clinical study of a patient with bilateral pneumothorax and bullous emphysema of the single lung and mediastinal hernia diagnosed 40 years after pneumonectomy.

Methods. A case report of a patient with bilateral pneumothorax is presented. Patient F., 44 years old, was admitted with complaints on thoracic pain syndrome and respiratory failure. In the previous history of the patient there were mentions of surgery on the left lung without documentary clarification. Routine radiography of the lungs made it possible to diagnose bilateral pneumothorax and postoperative changes of the left hemithorax. Further examination, including computed tomography of the chest and fiber-bronchoscopy, revealed that the patient has emphysematous single right lung, mediastinal pulmonary hernia with the formation of a single pleural cavity, bilateral pneumothorax as a complication and consequence of two previous conditions and due to pneumonectomy in the childhood. The patient underwent a re-draining of the pleural cavity with the elimination of pneumothorax and clinical recovery. The patient refused of antirelapse surgery. Subsequently, he was at the dispensary observation.

Results. The most frequent and regular evolution of the residual pleural cavity after pneumonectomy is to fill it with an effusion with subsequent obliteration. The formation of a mediastinal hernia is an extremely rare phenomenon, that has not yet been studied. The tactics of treatment of such patients should be individual, taking into account the revealed changes, the functional state of the respiratory and cardiovascular systems, and the dynamic of the disease.

Conlusions. Our study demonstrated a rare clinical case of mediastinal pulmonary hernia after pneumonectomy and the development of bilateral pneumothorax after the rupture of a single lung bull. Modern image diagnostics make it possible to identify the nature of existing changes and clarify their nature even in the absence of accurate anamnestic data.

Today magnetic resonance enterography is one of the most informative and safe methods of identification of the manifistations and complications of Crohn’s disease among children and adults. Receipt of the high-informaitive MR-enterograms directly depends on the right preparation of the patient and the competent research. The article deals with semiotics of the small bowel lesions in Crohn’s disease. The qualitative and quantitative analysis of the images are also represented.