Introduction. MRI is widely used to follow-up malignant neoplasms of the female pelvis. Aim. To optimize the use of MRI sequences for follow-up of female patients with malignant pelvic neoplasms. Materials and methods. Retrospective analysis of female pelvic MRI has been performed on 1.5 T MR scanner. This study includes 530 protocols. Results. The authors describe different protocols for assessment and differential diagnosis of recurrence, postradiation and postoperative changes. It includes applicable sequences, axis and the structure which require evaluation. In all cases, dynamic follow-up has to include analysis of patient's previous studies, anamnesis, previous treatment, as well as the end of chemotherapy and radiotherapy. All of the above, combined with the oncologist's treatment of choice determines the objective of this study. Nowadays, MRI is the method which most accurately characterizes postoperative and postradiation structural changes. MRI is useful in detection of pelvic lymph nodes. The role of MRI has high potential in assessing the effectiveness of chemotherapy and radiation therapy. Conclusion. In order to make the optimal scan protocol, follow-up of malignant neoplasms of the pelvic organs in women require the use of clinical and anamnestic data along with the results of patient's previous studies. The combined use of various sequences and techniques can improve the diagnostic significance of pelvic MRI at follow-up. Contrast enhancement has additional role in diagnostics of recurrent of pelvic organs in women. The use of different contrast enhancement techniques has proven effective in case of postradiation and postoperative complications.

Most often any kidney lesions are primary renal, but sometimes they can be secondary (metastases, lymphoma). Every year renal cell carcinoma tends to a significant increase in the incidence. Today there are many available methods of examination, however difficulties often remain in the differential diagnosis of kidney lesions. The article discusses about the modern possibilities of methods in the identification and assessment of kidney lesions, their role in determining the tactics of patient management and key approaches in imaging characterization of these masses using CT and PET, MRI and CEUS. The analysis of the modern literature has shown that the currently existing radiation diagnostic methods do not provide an absolute opportunity for differential diagnosis of rare kidney tumors. CEUS, according to various authors, demonstrates high efficiency indicators, but does not exceed these indicators in comparison with CT and MRI. Contrast-enhanced ultrasound is a potentially safe method and can be used as a method for additional examination to characterize indeterminate renal lesions.

Retino-cochleo-cerebral angiopathy or Susac syndrome is a rare autoimmune disease that selectively affects the vessels of the retina, the inner ear and the central nervous system. Differentiation of Susac syndrome and multiple sclerosis presents difficulties due to the similarity of MRI semiotics of these two diseases. This article presents two clinical cases of patients with Susac syndrome who were diagnosed with multiple sclerosis at the onset of the disease. Based on the analysis of our own clinical observations and literature data, the issues of differential diagnosis of Susac syndrome and multiple sclerosis are highlighted. For the first time a variant of the MRI picture transformation in Susac syndrome is presented.

Introduction. Multiple sclerosis is a chronic immune-mediated disease of the central nervous system with disseminated foci of demyelination and progressive neurodegeneration; it is the most common demyelinating disease and the leading cause of disability of neurological patients of a young age, characterized by a wave-like course with alternating periods of remission and relapse. Currently, there is a discussion about the participation of vascular changes in the formation of neurological disorders and about the possibility of correction of therapeutic approaches in connection with the revealed microcirculatory disorders. Perfusion MRI allows you to evaluate hemodynamics at the capillary level in vivo. Purpose. To evaluate perfusion changes in foci of demyelination in multiple sclerosis using the method of dynamic susceptibility contrast (DSC). Materials and methods. The MR study was carried out on a super-high-angle MR-scanner «Ingenia» («Philips») 3 Tesla. The study included 30 healthy volunteers and 80 patients with demyelinating disease from 18 to 48 years old (average age was 34,6±8,02 years).

Quantitative and qualitative assessment of perfusion indices in foci of demyelination was carried out. Results. In the active foci of demyelination, an increase in the speed and volume of cerebral blood flow is noted, the most pronounced changes in patients with clinically isolated syndrome. Inactive foci, marked hypoperfusion is noted. Discussion. Evaluation of cerebral perfusion allows a new look at the role of the vascular component in the formation of focal inflammatory changes in the brain in multiple sclerosis, which can determine a new direction of pathogenetic treatment. Conclusion. Perfusion data complements routine MRI and provides a comprehensive assessment of the neurovascular system.

Objective. To evaluate neurovascularization using contrast and non-contrast magnetic resonance perfusion. Materials and methods. 140 patients with type 2 diabetes with and without cognitive impairment were included in the study. We assessed the variability of glycemia, magnetic resonance imaging (MRI): contrast and non-contrast. Results: brain neurovascularization change is associated with glycemia variability, with contrast advantage revealed in the contrast study. Microcirculation disorder occurs in both cortical (grey matter area) and subcortical structures. The greatest influence on brain vascularization disturbance in type 2 diabetes was revealed in terms of age, body mass index, arterial hypertension. Hyperglycemia and its duration, as well as hypoglycemia, control quality, average amplitude of oscillation, average time in the target range determined the change of vascularization. Conclusions. Understanding the pathogenesis of microcirculation disorders and the role of glycemia variability in the brain in type 2 diabetes, it is possible to correct the glycemic curve in time and eliminate modifiable risk factors (body mass index, arterial hypertension) affecting the development of cognitive disorders.

Introduction. The radiotracer L-[methyl-¹¹C]methionine (Met) has long been considered the tracer of choice in CNS tumors diagnosis using positron emission tomography, combined with computed tomography (PET/CT). However, there are more and more logistic arguments for the introduction of fluorinated amino acids into diagnostics, in particular, O-2-[¹⁸F]fluoroethyl-L-tyrosine (FET), for which our institute has developed its own method of radiochemical synthesis. The aim of the study was to compare amino acid radiotracers L-[methyl-¹¹C]methionine (Met) and O-2-[¹⁸F]fluoroethyl-L-tyrosine (FET) in the imaging of cerebral gliomasusing PET/CT. Materials and methods. PET/CT studies using Met and FET were performed in 36 patients (15 men and 21 women) aged 28 to 73 years with suspected intracerebral tumor before surgery of biopsy. Pathohistologicalstudy verified gliomas(n-31) or other tumors (n=3), inflammatory process (n=2). The analysis of results included visual comparison of images, calculation of the tumor-to-brainratio (TBR) and metabolic tumor volume for Met and PET. Results. Visual and quantitative analysis of the scans revealed that tumor uptake pattern of FET was similar to those of Met. No significant differences were found in the TBR of both radiotracers in tumors of different grades of malignancy. A strong significant correlation (r=0,9) was revealed between the TBR of Met and FET in gliomas. There were no significant differences between tumor metabolic volumes when using the same cutoff values for both radiotracers. The ROC analysis established the same diagnostic value of Met and FET in differentiating low and high grade gliomas (area under curve 0,884 and 0,881, respectively). Conclusion. Amino acid radiotracers provide comparable diagnostic information in preoperative imaging of gliomas using PET/CT, which makes it possible to recommend FET as an adequate alternative to Met for PET centers without on-site cyclotron.

Introduction. Computed tomography is a non-invasive technique for examining patients and is helps to study the structures of the paranasal sinuses before endonasal interventions. The purpose of the study: to develop the criteria for assessing the architectonics of the ethmoid bone using computed tomography to determine the anatomical and topographic features of its structure, for endonasal surgical treatment planning. Tasks: to study variants of the anatomical structure of the nasal cavity, ethmoid bone, using the method of x-ray computed tomography and determine their role in planning tactics of endonasal surgical interventions. Materials and methods: 130 patients were examined, two groups of patients were formed — the first 65 people with cerebrospinal fluid lick, and the other 65 people with inflammatory diseases of the paranasal sinuses. All the patients underwent computed tomography, after which we studied the anatomical structure of the ethmoid plate of the ethmoid bone and cells of the ethmoid labyrinth and the contents of the paranasal sinuses were evaluated. Research results. The study revealed 6 basic anatomical and topographic types of the structure of the ethmoid bone. We evaluating the position of the plane of the ethmoid plate, a conclusion was made about the location of the roof of the nasal cavity: high, medium or low. The deeper the olfactory fossa is, the lower the general nasal passage is. Conclusions. The revealed low location of the roof of the nasal cavity was regarded as a predisposing factor to the development of iatrogenic cerebrospinal fluid lick with endoscopic endonasal intervention.

Introduction. In the literature, the insufficient attention is paid to preoperative planning of access to adrenal masses using modern computed tomographic navigation capabilities. The purpose. To demonstrate the possibilities of designing a safe access for adrenalectomy with the appliation of three-dimensional printed models based on the integral assessment of preoperative computed tomographic data. Materials and methods. The possibilities of preoperative design of access for adrenalectomy were studied in 362 patients with adrenal tumors, for whom computed tomography was performed on an Aquillion 64 (Toshiba, Japan). Results. Reliable anthropometric (BMI, body shape) and CT criteria for designing surgical access to the right and left NP were determined. Three patients with a borderline number of risk criteria for the development of vascular complications associated with technical difficulties of adrenalectomy (for the right AP, ≥4, for the left AP, ≥3) underwent CT-segmentation of images followed by the creation of three-dimensional plates — a model of the AP tumor with adjacent organs and vessels. Conclusion. Preoperative computed tomographic access design, taking into account the criteria of the risk of complications and the application of three-dimensional printed models, make it possible to reasonably use endoscopic and open adrenalectomy options, significantly improving the immediate results of patient treatment.

Introduction. The report is devoted to the peculiarities of residual brucellosis expert examination and its relationship to occupation. The purpose. To determine the radiological manifestations of residual brucellosis for objectification of clinical data at the examination of the relation of brucellosis with professional activity. Materials and methods. The results of clinical and radiological studies of 11 patients are performed at the examination of the relationship of brucellosis with the profession according to the submitted medical documents and x-ray images. Results. Pathognomonic changes in bone and joint system as sacroiliitis — 55%, spondylitis — 64%, severe changers in clavicular-acromial joints — 63%, of the knee 72%, and hip joints 64% were reported. The lesion of large joints with relative safety of small joints was unilateral. Osteoporosis was revealed in 82% of cases. Conclusion. During the examination to establish the relationship of residual brucellosis with occupation, there is necessary to take into account the results of specific serological tests, the data from x-ray examination of all parts of the spine, large and small joints.

Purpose. To study the possibilities of CT perfusion (CTP) in detecting periampullary tumors depending on the anatomical localization, to compare the diagnostic efficiency with the standard CT protocol. Materials and methods. CT scan of the abdominal organs according to the standard protocol and CTP were performed in 229 patients with periampullary tumors. Results. In adenocarcinoma of the pancreas, compared with adenocarcinoma of the major duodenal papilla, BF, BV, MSI (p<0,005) were statistically significantly lower, there were no differences in MTT, TTP, and PS (p>0,005). In distal cholangiocarcinoma, compared with adenocarcinomas of the pancreas and the major duodenal papilla (MDP), the BF, BV and MSI values were statistically significantly higher, the TTP values were lower (p<0,005), there were no differences in the MTT and PS values (p>0,005). Conclusion. CT perfusion is a highly informative method for detecting and determining the anatomical affiliation of periampullary tumors with a sensitivity of 98,7%, a specificity of 98%, and a diagnostic accuracy of 98,4%.

Introduction. The most common complication of the vascular access for hemodialysis, that can lead to its loss, is thrombosis. The method of choice in diagnosing fistula thrombosis is duplex ultrasound. Purpose: to study the ultrasound signs and changes in hemodynamics data in thrombosed fistulas and to determine the risk factors contributing to its development. Materials and methods. Duplex ultrasound was performed in 550 patients with vascular access for hemodialysis. Access thrombosis was detected in 12,0%, non-occlusive thrombosis was observed in 60,6%, occlusive thrombosis — in 39,4%. Thrombosis was significantly more common in women than in men (p=0,025). In patients with graft, thrombosis was more common (24,2%) than in those with arteriovenous fistula (11,2%), p=0,026. A correlation was found between the presence of significant vascular access stenosis, aneurysm of the outflow vein or graft, and the development of thrombosis (p<0,02). Duplex ultrasound allows to diagnose vascular access thrombosis and to determine the causes of its development.

Pelvic tumors are quite common. Of these, angiofibromas are very rare. It is causes difficulties in differential diagnosis. But getting the right diagnosis is important, given the great similarity with other, often malignant tumors. According to the literature, the average size of angiofibromas does not exceed 12 cm. We present the case of a patient with an unusually large angiofibroma.