Introduction: The growing importance of the MSCT method in the case of acute massive pulmonary embolism forms new diagnostic directions  — the determination of objective MSCT markers of right ventricular dysfunction and the search for new, previously ignored, MSCT parameters of angiographic severity of embolic load.
The purpose of the study: to evaluate the prognostic role and predictivity of the results of MSCT angiopulmonography in the case of choosing a surgical method for the treatment of pulmonary embolism.
Research objectives. Тo analyze the influence of the volume of preserved peripheral arterial pulmonary blood flow on the results of surgical treatment of acute massive PE and the dependence of the average pressure in the pulmonary artery on the MSCT parameters.
Materials and methods: this work examines the surgical approach to the treatment and possibilities of preoperative MSCT diagnosis of acute massive pulmonary embolism. The 7-year analysis included the analysis of more than 1,200 MSCT studies for acute massive pulmonary embolism. 147 patients were selected for surgical treatment and successfully operated on, the remaining patients received conservative therapy with dynamic MSCT observation. According to international classifiers, the analysis of classes and categories of intraoperative and postoperative complications of emergency surgical treatment was performed in comparison with the initial MSCT parameters of acute massive PE.
Results. The smaller the number of segmental branches of the pulmonary artery is determined at the preoperative stage, the higher the risks of mortality and complications of emergency surgical treatment of acute massive PE (p<0,001). A direct relationship between the average pressure in the pulmonary artery and the MSCT parameter-the diameter of the unpaired vein (p<0,001) was confirmed. An increase in the number of visualized bronchial arteries corresponds to an increase in the average pressure in the pulmonary artery (p<0,05).
Discussion. The lightning speed of the course of pulmonary embolism dictates an exceptional approach to the completeness of the diagnosis of the disease, and the change in treatment tactics due to the increasing demand for surgical methods of treatment changes the diagnostic approach to acute pulmonary embolism in general. The success of surgical treatment of PE directly depends on the completeness and speed of preoperative MSCT diagnostics, in particular, on the quality of analysis of intra-pulmonary and intracardiac hemodynamics.
Conclusion: For acute massive PE with obstruction at the level of the trunk and / or main branches of the pulmonary artery, with a sharp and often uncontrolled progression of right ventricular failure, risk stratification in «real time» becomes the most relevant, the time factor becomes of paramount importance for determining treatment tactics. The inclusion of previously ignored MSCT parameters in the algorithm of preoperative diagnosis allows us to modify the algorithm of preoperative diagnosis, to form and introduce the concept of the reference MSCT status of a patient with acute massive PE. 

Introduction: Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumor, usually developing in the context of chronic liver disease, most commonly associated with hepatitis B (HBV) or C (HCV) infection, alcohol use, or metabolic syndrome. Hepatocellular carcinoma is a very heterogeneous cancer, both at the histological and molecular level. According to recent scientific studies based on gene expression profiling, regardless of the nomenclature used by different authors, HCC can be divided into 2 main subgroups: the non-proliferative type and the proliferative type.
Purpose. A review and analysis of the available foreign literature on the textural analysis of magnetic resonance imaging in noninvasive prediction of molecular classification and molecular structure of hepatocellular carcinoma.
Material and methods. We searched for scientific publications and clinical guidelines in the PubMed information and analytical system for 2016–2021 using the keywords: «MRI», «radiomics», «texture analysis», «radiogenomics», «HCC», «proliferative», «nonproliferative», «molecular». After excluding studies devoted to technical aspects and the description of individual clinical observations, 16 articles were selected for analyzes.
Results. The presented review has demonstrated the broad possibilities and prospects of the use of texture analysis of magnetic resonance imaging in the study of hepatocellular cancer, including the first results in the study of molecular characteristics (signatures) of this tumor. Correlation of textural characteristics with the expression of genes of immunotherapeutic targets CTLA-4 and PD-1 was shown, and a correlation was also shown between ring enhancement of a tumor in the arterial phase by MRI with gadoxetic acid (hepatospecific contrast agent) and proliferative HCC. Texture analysis scores were the predominant independent predictor of microvascular invasion, which was the main independent risk factor for postoperative recurrence.
Conclusion. Although texture analysis in the study of HCC is an actively developing field, further study of the structure of this tumor at the molecular level is necessary to develop an personalized treatment, supplement or replace tumor biopsy, as well as to develop new prognostic biomarkers in patients with HCC.

Introduction. This study is determined with the high prevalence of encephalitis in children, as well as the severe course and the possible disability. Herpes encephalitis occurs in almost half of cases of viral encephalitis in children. It is known that changes on the brain magnetic resonance imaging (MRI) in the acute stage of the disease are detected more often than on brain computed tomography (CT), but the clarification of this brain MRI changes is needed.
Objectives of the study. To assess the features of brain multiparametric MRI changes in herpes encephalitis in children.
Materials and methods. Two groups of children were examined, the first group included 25 children aged 6,0±4,8 years with laboratory-confirmed acute EH, the second group (control) — 23 children without signs of central nervous system damage at the comparable gender and age. Structural changes were assessed using MRI of the brain in T1-WI, T2-WI, Flair, T1-WI modes post contrast, DWI, DTI and MR spectroscopy.
Results. In 40% of cases revealed panencephalitis, 36% — leukoencephalitis, 24% — polioencephalitis. Most often, the process involved the cerebral hemispheres — 72%, the brain stem — 44%, the thalamus — 40% and basal nuclei — 36%. In 52% of cases changes in DWI were found, in 20% of cases the lesions accumulated contrast agent. There was a statistically significant decrease of FA both in the focus and in the intact area in children with EH compared with the control group.
Conclusion. The application of multiparametric MRI using DWI, DTI, and MR spectroscopy methods are statistically significant for the detection and assessment of focal brain lesions in children with herpes encephalitis.

Introduction. Classical trigeminal neuralgia (TN) is a common disease, largely diagnosed by measuring the anatomical parameters of the trigeminal nerve and the adjacent artery using MRI. For an adequate assessment the significance of the identified changes, it may be necessary to adjust for the individual characteristics of the patient, such as gender, age, duration of the TN, and clinical severity of TN.
The aim of the study was to identify the relationship of anatomical changes in the intercisternal portions of the trigeminal nerves and adjacent arteries with the clinical and anamnestic data of patients with classic trigeminal neuralgia.
Materials and methods. The FIESTA MR sequences of 133 patients were analyzed: 86 patients with verified trigeminal neuralgia (55±11 years) and 47 patients of the control group (51±16 years). The cross-sectional areas (CSA) and diameter ratio of nerves, diameters of adjacent arteries and neurovascular distances were measured in the context of gender, age, duration and therapy of neuralgia.
Results. After dividing the group of TN patients into three conditional age groups (up to 50 years old, 50–65 years old, and over 65 years old), the ANOVA analysis revealed a decrease in the CSA in older age groups (medians 3,2 mm²; 2,15 mm²; 1,85 mm²; p=0,0193) and an increase in the diameter of the adjacent artery (median 1 mm; 1,3 mm; 1,2 mm; p=0,018). At the same time, on the opposite sides of the TN, only a tendency towards a decrease in the CSA remained (median 4,45 mm2; 3,45 mm²; 3,05 mm²; p=0,0016). The CSA of the nerves in the operated patients were less than ones in the patients with conservative treatment (median 2,9  mm² and 2  mm²; p<0,05). In patients with TN, right-sided lesion prevailed. The duration of the TN was 9±7,8 years (from 1 year to 33 years) for patients who had an accurately documented date of manifestation of TN (N=56), no direct correlations of the MR-parameters with the duration of TN were found. A simple correlation analysis between MR-parameters and the patients age revealed a linear relationship only for the decrease of the CSA: on the right side (p=0,014) in patients with TN and on both sides in control patients (р=0,005–0,013).
Conclusion. Theas data make it possible to more clearly distinguish significant MR changes in TN, taking into account the clinical and anamnestic data of patients.The revealed MR patterns of an increase in the caliber of the adjacent artery and a decrease in the CSA, which are pathognomonic for a clinically significant neurovascular conflict, are often asymptomatic age-related changes in elderly patients, which reduces their potential diagnostic value. In connection with this circumstance, the comparison of seemingly significant anatomical changes with similar ones on the opposite side of the lesion is of exceptional importance. 

Introduction. In the postoperative period after total mastectomy, patients develop postmastectomy syndrome, including upper limb lymphedema and a number of neuropsychiatric disorders that affect the functional state of the brain and reduce the quality of life.
Purpose of the study. Evaluation of changes in functional connectivity of the default mode network in patients with post-mastectomy syndrome using resting state functional MRI.
Materials and methods. Resting state functional MRI was performed to 46 patients aged 30 to 50 years with neurological disorders in the late postoperative period (>6 months) after radical mastectomy for breast cancer, as well as 20 healthy women from the control group.
Results. According to the intergroup statistical analysis, there were differences in functional connectivity of the default mode network in all 46 patients with post-mastectomy syndrome, compared to the control group (p<0,01).
Conclusion. The revealed changes in the functional connectivity of the default mode network of the brain indicate the functional reorganization of the brain connectome in patients with neurological manifestations of post-mastectomy syndrome. 

Introduction. Тhe application of the volume ultrasound expands opportunities of prenatal diagnosis and increases the detection of brain abnormalities.
Objective: to assess diagnostic capabilities of ultrasound in prenatal diagnosis of the cerebral midline structures abnormalities in the second trimester of pregnancy.
Materials and methods. 39 women, who had fetuses with cerebral midline structures abnormalities, were included into the study.
Results. Abnormal image or absence of the septum pellucidum are informative signs of the cerebral midline structures abnormalities. Agenesis of the corpus callosum always has indirect ultrasound signs.
Conclusion. The volume ultrasound improves the multiplane fetal brain assessment, prenatal diagnosis of brain abnormalities.

Introduction. The possible formation of persistent residual changes in the lung after a COVID-19 began to be reported after the first wave of the pandemic, but their extent and prevalence have not been fully assessed.
Purpose of the study. Evaluate CT patterns of residual changes in COVID-19 lung lesions. 
Materials and methods. We analyzed the clinical and radiation data of 868 patients (f/m — 441/427) who underwent COVID-19 and were observed in the clinics of First St.-Petersburg State Medical University n.a. academician I.  P. Pavlov since 2020 until 2021. The average age of the patients was 33,4±17,2 years. All patients underwent high-resolution computed tomography in dynamics — after 6 months or more. Statistical data processing was performed using the Statistika 16.0 software/statistical package.
Results. Analysis of the results of CT examination revealed the following patterns of residual changes after a new coronavirus infection: ILAs (interstitial lung abnormalities) in 0,7%, the formation of fibrotic changes (NsIP, OIP) in 0,2% of patients, CT signs of constrictive bronchiolitis in 0,3% of patients, CT signs of persistence in 0,1% of patients, CT signs of the formation of pulmonary hypertension, identified in 0.3% of patients.
Conclusions. CT allows to identify a variety of residual changes in COVID-19 lung lesions, which is important for assessing the prognosis of the disease and the tactics of its treatment. 

Introduction. The most striking manifestations of the disease caused by the SARS-CoV-2 virus are manifested in the microvasculature of the lungs. The study of the residual manifestations of the disease seems to be relevant, since it can affect the development of complications and its outcome.
Purpose of the work. To assess changes in the microvasculature of the lungs of patients who have undergone COVID infection at different times from the onset of the disease, and who have not previously had respiratory diseases.
Material and methods. SPECT data were analyzed in 96 patients with proven coronavirus infection from May 2020 to April 2021 of varying severity. The results of SPECT, MSCT, FVD and coagulation hemostasis (D-dimer, fibrinogen, prothrombin index) were compared.
Results. All patients were found to have changes in microcirculation in the lungs in the postcoid period. The severity of microcirculation disorders had a significant dependence (p<0,05, r=0,71) on the degree of damage to the pulmonary parenchyma and an average correlation dependence (r=0,48) on the timing of the postcoid period. Signs of PE/microthrombosis/post-thromboembolic changes were significantly more frequent (p<0,05, r=0.8) in patients with a more severe course of the disease.
Conclusion. Disorders of microcirculation in the lungs are detected in patients, regardless of the severity of the pathological process. The method of automatic processing of the results of radiological studies of the lungs in comparison with the norm made it possible to quantitatively assess the degree of changes in microcirculation after pneumonia caused by the SARS-CoV-2 virus.

Introduction. Today, we have a lot of difficulties in the focal kidney lesions diagnosis, despite the many available radiation methods of examination. Computed tomography (CT) is the «gold standard» of radiological diagnosis of kidney cancer (KC), which over the years of its existence has proven to be highly effectiveness. Ultrasound examination (US) is the best method for the primary diagnosis of solid kidney lesions. Multiparameter ultrasound (mpUS) with using contrast significantly supplements the information obtained in traditional scanning, significantly expanding the range of tasks to be solved. The article discusses the modern possibilities of radiology methods in the detection and assessment of kidney lesions, their role in determining the patient management tactics.
Objective. Тo explore the possibilities and compare the effectiveness of individual multiparameter ultrasound techniques (Bmode, CDI and PDI, ultrasoundcontrast) in assessing solid kidney formations with each other and computed tomography (CT), as a reference method of radiation diagnostics.
Material and methods. Мultiparametric ultrasound examination (mpUS) using B-mode, doppler mapping and contrast enhancement (1,0 ml Sonovue) was performed in 79 patients with solid kidney lesions. Most of the detected lesions (n=65) were histologically verified, the rest (n=14) with signs of benign changes were subjected to dynamic control. All patients underwent contrast-enhanced computed tomography as a control method.
Results. Тhe effectiveness of the B-mode was: sensitivity (Se) — 76,9%; specificity (Sp) — 29,6%; accuracy (A) — 60,7%, for the CDI mode, these indicators were Se — 80,7%; Sp — 37,1%; A — 65,8%. The use of contrast enhancement significantly increased the overall efficiency of multiparameter ultrasound: Se — 92,1%; Sp — 93,7%; A — 92,4% and showed comparable efficiency with CT: Sp — 94,9%; Se — 85,0%; A — 92,4%.
Conclusions. CT to this day remains the «gold standard» in the assessment of kidney lesions, however, ultrasound with contrast enhancement due to comparable efficiency, as well as taking into account the absence of radiation exposure, wide availability of equipment, high resolution, in the presence of contraindications to CT in a number of cases can act as a method of choice.

Introduction. Color processing of X-ray images has a long history and initially was directed for improvement of analysis of medical diagnostic images. Purpose — to evaluate the results of clinical application of the method for color contrast enhancement of digital radiographs.
Material and methods. The study was carried out in the X-ray department of the city Mariinsky hospital in St. Petersburg, having installed a computer program on the workstations of the radiologists for carrying out color contrasting of digital radiographs (CCDR). The CCDR program allowed the radiologist to select one of 63 trajectories in 8 colors. Choosing options for coloring, we settled on a warm, cold, full scale, as well as 4 combinations of one color from cold and warm scales with a saturation from 0 to 100%. The CCDR performed 100 digital radiographs of various anatomical areas.We analyzed a variety of colors and their percentage of saturation in terms of optimal transmission of pathological signs of anatomical areas. 27 radiologists assessed the possibilities of CCDR in X-ray diagnostics.
Results. Clinical application of CCDR showed that thanks to this method, tissues of different densities were distinguished in more detail on the X-ray image, since their contours were more expressively emphasized. Pathological symptoms, indistinctly expressed on a black-and-white radiograph, were convincingly reflected in the colorized image, which increased the sensitivity and specificity of the diagnosis. Thanks to color post-processing, it was possible to optimize subtle radiological signs of structural bone changes, traumatic injuries of the ribs, impaired pneumatization of the lungs (infiltration, hypoventilation), pneumo-, hydrothorax, and others. Of the radiologists, 77% considered it important to use CCDR in X-ray diagnostics.
Conclusion. A digital radiograph, contrasted with a color of optimal saturation, has distinct advantages over a traditional blackand-white X-ray image, since it reveals hidden or subtle diagnostic information. The diagnostic efficiency of the method of color contrasting of radiographs is higher than the analysis of black-and-white images up to 13%.To increase the diagnostic capabilities of X-ray diagnostics, it is advisable to include the method of color contrasting in the package of computer post-processing of images, using at least three gamuts in the standard, the saturation of which is 25–50%.The colorized image does not replace black and white, but complements it, resolving the diagnostic doubts of the radiologist.

Introduction. Crohn’s disease is a recurrent inflammatory disease that can affect any part of the gastrointestinal tract with transmural manifestations. Extraintestinal manifestations occur in 21–47% of all cases. Radiology techniques play a significant role in diagnosis, assessment and observation by means of computed tomography and magnetic resonance imaging.
Materials and methods. Clinical data, laboratory and instrumental studies, surgical procedures done in the children’s hospital were collected and analyzed during the study.
Results. A 4-year-old girl was urgently presented to the hospital with non-productive cough and tachypnea that had lasted for two days. Inhalation therapy with Berodual® and Pulmicort® was initiated with a minor effect. Chest multidetector computed tomography (MDCT) showed signs of larynx edema, regular bilateral infiltrates with a volume decrease of the lung on the right side, left-sided tension pneumothorax. It was known that Crohn’s disease had been diagnosed in 7 months. The condition of the child was assessed as a serious case of Crohn’s disease. The condition of patient became stable after 7 days of treatment. The child has been observed by a gastroenterologist and a pulmonologist later.
Conclusion. It is highly recommended to take into account the possibility of respiratory system involvement in patients with diagnosed inflammatory bowel diseases. A thorough anamnestic data research and multidisciplinary approach while evaluating the results of the chest MDCT would help clinicians to optimize clinical management at the early stage of the disease and prevent the development of possible complications.

Review of a patient with HIV infection and generalized tuberculosis against the background of progression of neurological deficit complicated by irregular therapy. Features of diagnosis and differential diagnosis of brain lesions in immunosuppression.  

The article presents statistical data on the state of Saint-Petersburg radiology as of 2020.