Introduction. The Alberta stroke programme early CT score (ASPECTS) was developed for a unified approach to the diagnosis of Acute Ischemic Stroke. ASPECTS is currently used as a standard method for assessment of ischemic volumes in the anterior cerebral circulation. However, the scale is not fully standardized, which is a source of intersubject variability.

The purpose of the review is to gain an understanding the advantages and limitations of the ASPECTS scale, as well as the level of inter-expert and intra-expert agreement.

Results. A literary analysis demonstrates most researchers have identified many factors that affect both the interpretation and assessment of the distribution of ischemic changes by ASPECTS. These signs are diverse and include a wide range of parameters: from methodological standardization to personal factors of experts. Also, studies on the effectiveness of the ASPECTS scale showed quite heterogeneous results, which reflect a wide degree of variability in inter-expert agreement.

Conclusion. The ASPECTS is a systematic, reliable and practical method that is widely used in modern clinical practice. However, the possibility of variability of expert assessments is the main limitation of its application. The pronounced variety of results and the heterogeneity of intrasubject variability does not currently allow us to consider this scale as a truly reliable version of a standardized assessment and may affect the further treatment process. To solve this problem, it looks promising to introduce into clinical practice the methods of semi-automatic and automatic processing of CT images using artificial intelligence systems. But for the full acceptance of such systems into clinical practice, their wide clinical approbation on independent sets of different data is necessary. 

Tuberculosis remains one of the most dangerous and socially significant diseases in the world. Diagnostic imaging of pulmonary tuberculosis is being improved every year, new algorithms, technologies and methods are being introduced, what create a positive effect on the detection of tuberculosis. However, the diagnosis of tuberculosis remains a challenge. Digital fluorography remains the primary screening method, and computed tomography (CT) is used for more detailed analysis. This should be noted that there is a positive trend towards the application of low-dose computed tomography (LDCT), which is invaluable for screening studies. The leading place among radiopaque studies is CT with bolus enhancement, which helps to differentiate tuberculosis with other lung diseases. Such diagnostic methods as single-photon emission computed tomography, magnetic resonance imaging (MRI), and diffusion-weighted MRI are used individually as an additional source of information. 

Gangliogliomas are known to be rare and mainly slow-growing benign primary central nervous system tumors, most frequently occurring in children and young adults. They are the most common epilepsy-associated tumors, which frequent location is the temporal lobe. Surgery often seems to be the best approach in controlling seizures in such patients. This paper deals with a rare case of ganglioglioma in a young adult patient with a temporal lobe tumor associated with neuronal heterotopy of white matter, but without epilepsy. Long-term dynamic observation including in-depth clinical, electroencephalographic, radiologic, and postsurgical histologic examination confirmed the documented neoplastic process without any manifestation of seizures over ten years. Surgical intervention was based on the results of a multimodal radiological examination, which demonstrated the presence of neoplasm in the structure of the pathological substrate of unclear etiology. 

Introduction. According to studies on the treatment of emphysema, the absence of CT signs of collateral ventilation correlates with the results of valvular blocking procedure, but there is not any data on the relationship between the signs of collateral ventilation and the results of bronchial valve treatment in destructive forms of pulmonary tuberculosis.

Study goals: to study the effect of CT features of collateral ventilation in combination with other factors on the results of valvular bronchial blocking in patients with destructivepulmonary pathology in tuberculosis.

Materials and methods. Тhe study is based on the results of evaluation of chest CT data of patients with various pathology of pulmonary tuberculosis before and after valvular blocking procedure.

Results. Сorrelations between such characteristics as collateral ventilation, additional factors and valvular treatment effects have been determined, and prognostic models estimating the success of valve therapy have been constructed.

Conclusion. Positive pleural integrity symptom is a predictor of lobe volume reduction after bronchial valve treatment. Lobe volume reduction during valve therapy is a prognostic factor for cavity’s closure. 

Introduction. A new coronavirus infection (COVID-19) is a pathogenetically complex disease characterized by the involvement of the main human organs and systems in the pathological process, including the organs of the gastrointestinal tract (gastrointestinal tract).

Purpose: to study the gastroenterological manifestations of COVID-19 in patients of mild and moderate severity based on the analysis of complex data, including computed tomography examination.

Material and methods. The study included 80 patients hospitalized with a confirmed diagnosis of COVID-19 (19 patients with mild and 61 with moderate severity) who underwent a comprehensive original examination upon admission to the hospital and outpatient at week 8 of dynamic follow-up. In the complex therapy of 41 patients, the drug rebamipid was used. The scope of the examination included questionnaires, traditional clinical, clinical and laboratory, biochemical, instrumental and radiation studies, unique methods for studying microbiota and intestinal permeability. All patients also underwent computed tomography (CT) of the chest organs, followed by analysis and postprocessing of images of the upper abdominal cavity. The study also included a group of 43 inpatient patients with moderate severity of the disease, a group of 17 practically healthy patients was used as a control.

Results and conclusions. A method of qualitative and quantitative assessment of the state of parenchymal and hollow organs of the upper abdominal cavity according to CT data is proposed. It was found that with moderate severity of COVID-19, quantitative criteria (attenuation coefficient of the liver, pancreas, bile) were subject to more pronounced deviations, as was the diameter of the colon. Additional diagnostic capabilities of the standard chest CT protocol in patients with COVID-19 are associated with postprocessor analysis of images of abdominal organs. 

Introduction. Continuous improvement and increased availability of high-tech research methods, such as computed X-ray tomography (CT) and magnetic resonance imaging (MRI) with contrast enhancement, qualitatively change the diagnostic search for combined vascular pathology, including when conducting studies of other organs and systems, even in the absence of any clinical manifestations.

The purpose of the study: to evaluate the possibilities and determine the indications for CT diagnosis of arteriovenous conflicts of the abdominal cavity, retroperitoneal space.

Research objectives: to determine CT parameters and the algorithm of CT analysis of upper-level arteriovenous conflicts in modern radiation and urological aspects.

Materials and methods. The study included 34 patients with arteriovenous conflicts of the abdominal cavity and retroperitoneal space detected by computer X-ray tomography. The average age of patients is 39±11.0 years; the number of male patients is 19 (55.9%), female — 15 (44.1%). Children’s patients accounted for 23.5% (8 people; average age 11±7 years). The preoperative diagnostic algorithm included a clinical examination, ultrasound diagnostics, a comprehensive study of laboratory parameters, CT-arterio/venography.

The results of the study. Among the upper—level arteriovenous conflicts, superior mesenteric artery syndrome prevailed — it was observed in 23 patients (67.6%), of which aortomesenteric duodenal compression (Wilkie syndrome) was detected in 12 patients (52.2%); aortomesenteric venous compression (Nutcracker syndrome) — in 11 patients (47.8%). Among children’s patients, aortomesenteric tweezers prevailed (5 patients — 62.5%). A combination of upper-level syndromes was detected in 6 patients (17.6%). Compression syndrome of the left renal vein (aortovertebral venous compression, posterior nutcracker syndrome), or Nutcracker syndrome was detected in 11 patients (32.4%), which in all cases (100%) was a «random finding» of CT diagnostics.

Conclusions. It is recommended to perform CT-, MR-studies with contrast enhancement (in angiography mode) in patients with a suspected diagnosis of arteriovenous conflict with the expansion of the scanning zone to the level of the abdominal cavity, retroperitoneal space and pelvis in order to exclude combined multi-level vascular pathology. Mandatory for radiation analysis are the magnitude of the aortomesenteric angle, the magnitude of the aortomesenteric distance for the left renal artery, the magnitude of the aortovertebral distance for the left renal artery, the magnitude of the aortomesenteric distance for the duodenum; analysis of concomitant variant vascular pathology at the levels studied. 

Introduction. An urgent problem of oncogynecology is the diagnosis and treatment of patients with endometrial cancer, the steady growth of which is noted in most developed countries of the world and at the present stage occupies the 2nd place among neoplasms of the reproductive system of women.

Purpose. To evaluate the informativity of complex ultrasound examination for diagnostics of endometrial cancer.

Material and methods. There were examined 28 patients aged from 45 to 70 y.o. (23 menopausal women — 82,1% and 5 in reproductive status — 17,9%). The diagnosis of endometrial cancer was verified by morphologic and histologic methods. For all the patients there was performed the ultrasound examination including energy Doppler mode, ultrasound elastography, Doppler imaging of uterine and intratumoral vessels, evaluation of M-echo thickness, invasive growth index and rate of myometrial invasion. Studies were performed with ultrasound scanners «ACUSON 2000» by SIEMENS and «Aixplorer» by «SuperSonic Imagine S.A.».

Results. Highly and moderately differentiated adenocarcinoma was revealed mostly in patients with Ia and Ib stages while low differentiated adenocarcinoma was revealed mostly in the III stage. The investigation performed ascertained that a complex ultrasound examination with application of dopplerography, sonoelastography, contrast enhanced sonography is highly informative for determination, staging and prediction of endometrial cancer.

Conclusion. The results obtained indicate the high efficiency of the diagnostic complex used in identifying the characteristic features of intraorgan and tumor blood flow, as well as tissue stiffness, which play an important role in specifying the stage and prognosis of the disease.

Introduction. The problem of differential diagnostics of diabetic osteoarthropathy (DOAP) and osteomyelitis (OM) of the foot bones for patients with diabetes mellitus is still not finally solved, even with the use of MR imaging.

The aim of the study. To find the MR signs that most accurately indicate the development of osteomyelitis (OM) of the foot bones in patients with diabetic osteoarthropathy (DOAP).

Materials and methods. The study included 62 patientswho successfully completed treatment of uncomplicated or complicated DOAP and had the whole set of diagnostic criteria. They were divided into three groups: acute form of DOAP (n=31), DOAP+soft tissue infection (STI) (n=11) and DOAP+OM (n=20). There were identified6 MR-signs, which could become significant independent classifiers for the differential diagnostics of complicated and uncomplicated forms of DOAP. The diagnostic significance of MR symptoms was assessed in several steps with the use of various methods of statistical analysis.

Results. There was revealed that the groups differ among themselves by 4 MR signs: characteristics of bone marrow edema (p=0.003); swelling of the supporting surfaces (p=0.006); restriction of diffusion in the bone marrow (p=0.001); fistulous course (p=0.001). Points were assigned to these MR criteria. According to the total MR score, groups 1 and 3 (p<0.001); 2 and 3 (p=0.001) differed among themselves. With the use of logistic regression and ROC analysis, we determined the significance of the total MR score for the diagnostics of osteomyelitis. Conclusion. The use of the MR-score summation system helped in the diagnosis of OM. The sum of MR scores ≥3 in the developed scoring system allowsto diagnose OM with high sensitivity (94.1%) and specificity (83.3%). >˂0.001); 2 and 3 (p=0.001) differed among themselves. With the use of logistic regression and ROC analysis, we determined the significance of the total MR score for the diagnostics of osteomyelitis.

Conclusion. The use of the MR-score summation system helped in the diagnosis of OM. The sum of MR scores ≥3 in the developed scoring system allowsto diagnose OM with high sensitivity (94.1%) and specificity (83.3%).

Introduction. This report of Listeria monocytogenes infection with the involvment of central nervous system is important due to the increased frequency either in adults or children as well as the usually severe course and high mortality in generalized forms, especially with the CNS involvement. The demonstration of this clinical case, especialy the features of structural changes in the CNS with MRI in the disease’s dynamics, reflects the complexity of differential diagnosis and the evaluation of therapy effectiveness.

Purpose of the study. To present a clinical case of CNS lesion in a 7-year-old child, the causative factor of which was listeria infection, with a detailed description of structural changes in the CNS using MRI studies.

Material and methods. There is a clinical observation of a patient (child) with a diagnosis of listeriosis, secondary generalized form, extremely severe clinical course, with lesions of the central nervous system (meningoencephalitis). A series of magnetic resonance imaging studies of the brain in dynamics against the background of treatment are analyzed. Structural changes were assessed using multiparameter MRI of the brain using the following modes: T1-weighted, T2-weighted, Flair, T1-weighted with contrast, diffusionweighted and diffusion tensor imaging (DWI / DTI), susceptibility weighted imaging (SWI), MR perfusion, MR angiography.

Results. The revealed structural changes in the brain during dynamic MRI examination, as well as their correlation with the data of anamnesis and clinical and laboratory data, made it possible to confirm meningoencephalitis, as well as to evaluate and make adjustments to the treatment.

Conclusion. The described clinical case, the features of the course of the disease and MRI changes, suggest that dynamic MRI research is of great importance in identifying and assessing (including dynamics) structural changes in the brain substance in patients with neurological disorders in infectious diseases. The obtained data can be used by the attending physicians to assess and correct the ongoing therapy, to determine the required amount of rehabilitation. 

Introduction. Stomach doubling is one of the rarest types of gastrointestinal doubling in the system of pathology of abdominal organs in children. Stomach doubling occurs in 4–8% of cases of gastrointestinal doubling. To a greater extent, it is diagnosed in girls. The rarest localization of doubling is a small curvature of the stomach — 7%.

The purpose of the study: to present the informative value of radiation methods in the diagnosis of gastric doubling by the example of a clinical case.

Material and methods. The work is based on the analysis of clinical data, instrumental, histological studies performed in a children’s hospital in St. Petersburg.

Results: An 8-year-old patient was hospitalized for further examination for cystic formation of the abdominal cavity, detected antenatally at 36 weeks of gestation. At the age of 2 years, MSCT angiography of the abdominal cavity was performed and a differential series between a liver cyst and a doubling of the stomach was exposed. At the control ultrasound, further negative dynamics in size. An MRI revealed that the picture most likely corresponds to a cystic doubling of the stomach. Indications for surgical treatment are exposed. Histologically confirmed variant of stomach doubling.

Conclusion. The multimodal approach allows timely diagnosis of the presented pathology, differential diagnosis of gastric doubling with rare localization and determination of indications for surgical treatment. 

The aim of this study was to evaluate the immediate results of the stereotactic radiosurgery (SRS) application in patients with choroid melanoma.

Material and methods. The prospective study included 43 patients who were diagnosed with choroidal melanoma cT1–3N0M0.SRS was performed on a Gamma Knife gamma therapeutic unit, Perfexion (Elekta, Sweden). Under local anesthesia, the eyeball was immobilized using frenulum sutures on the rectus muscles. The median prescribed dose per tumor margin at 50% isodose was 30 Gy. The immediate effect of the treatment was assessed as positive (local control) in all cases, except increased blood flow according to Doppler ultrasound, an increase in tumor size by more than 20% of the previously determined lesion according to MRI.

Results. During the follow-up period (median follow-up — 16 months), there were no cases of negative outcome in terms of local tumor control.A statistically significant gradual decrease in tumor thickness was revealed during the entire observation period (6.6±2.1 mm before treatment, 5.3±2.1 mm 12 months after treatment, p<0.001), stabilization of the tumor base (12.25±3.26 mm before treatment, 11.4±2.5 mm 12 months after treatment, p=0.355). Contrast-enhanced MRI also showed a progressive statistically significant decrease in tumor volume (635.21±328.32 mm3 before treatment, 376.0±267.6 mm3 15 months after treatment, p><0.001). The eyeball was saved in 90.1%. Post-radiation optical retinopathy developed in 9.3% of >˂0.001), stabilization of the tumor base (12.25±3.26 mm before treatment, 11.4±2.5 mm 12 months after treatment, p=0.355). Contrast-enhanced MRI also showed a progressive statistically significant decrease in tumor volume (635.21±328.32 mm3 before treatment, 376.0±267.6 mm3 15 months after treatment, p<0.001). The eyeball was saved in 90.1%. Post-radiation optical retinopathy developed in 9.3% of>˂0.001). The eyeball was saved in 90.1%. Post-radiation optical retinopathy developed in 9.3% of cases, progression of retinal detachment was registered in 13.9% of cases. The one-year metastatic-free survival rate was 96.3±3.6%, the two-year survival rate was 81.3±8.6%.

Conclusions. In the present study, the use of stereotactic radiosurgery with a prescribed marginal dose of up to 35 Gy allowed achieving sustainable local control of primary choroidal melanoma cT1–3 in 100% of cases over a median follow-up period of 16 months.