INTRODUCTION: Members of the coronavirus family can affect the human central nervous system, causing various neurological complications in patients with SARS-CoV-2. Proton magnetic resonance spectroscopy (1H-MRS) seems to be a promising technique for assessing the prognosis of persistent neurological manifestations and complications, determining the completeness of a patient’s recovery during long-term follow-up. O

BJECTIVE: To study changes in the metabolites profile in the brain with relation to cognitive impairment in patients with COVID-19.

MATERIALS AND METHODS: 68 patients with verified COVID-19 and neurological complaints underwent a diagnostic workup, including a psychoneurological assessment and MRI of the brain with multivoxel proton magnetic resonance spectroscopy (1H-MRS), starting in the first 2 weeks from the onset of the disease. In 11 patients, a complex examination was repeated 7–8 months after the onset of the disease. The exclusion criteria were acute severe neurological symptoms, age over 65 years, artificial lung ventilation, lung CT score III–IV, as well as information about pre-Covid neuropsychiatric disorders. As a control group, earlier collected data of 10 healthy volunteers (age 30–67 years) were taken from a local database. Statistics: Intergroup differences in the ratios of metabolites peak areas determined by the 1H-MPC method were assessed using the nonparametric Mann-Whitney test with Bonferroni’s correction for multiple comparisons. Values were considered statistically significant at p<0.05. RESULTS: According to 1H-MRS, all patients with COVID-19 showed metabolic changes in the brain: a statistically significant increase in mI/Cr in the white and gray matter and a diffuse decrease in the levels of Cho/Cr in the supraventricular white matter, even in the absence of any changes in structural MRI. DISCUSSOIN: Patients were divided into three subgroups according to the severity of neurological symptoms that arose with the onset of the coronavirus infection. The most pronounced metabolic changes were found in the group with severe neurological manifestations (NM). At follow-up, a gradual recovery of the metabolite profile was noted, but in our sample group complete normalization was not achieved within the specified time frame. CONCLUSION: The obtained data indicate metabolic changes associated with SARS-CoV-2 infection, as well as the prospects for using the 1H-MPC technique in the diagnosis of neurological complications of the new coronavirus infection, including manifestations of a psychoneurological syndrome associated with COVID-19.><0.05.

RESULTS: According to 1H-MRS, all patients with COVID-19 showed metabolic changes in the brain: a statistically significant increase in mI/Cr in the white and gray matter and a diffuse decrease in the levels of Cho/Cr in the supraventricular white matter, even in the absence of any changes in structural MRI.

DISCUSSOIN: Patients were divided into three subgroups according to the severity of neurological symptoms that arose with the onset of the coronavirus infection. The most pronounced metabolic changes were found in the group with severe neurological manifestations (NM). At follow-up, a gradual recovery of the metabolite profile was noted, but in our sample group complete normalization was not achieved within the specified time frame.

CONCLUSION: The obtained data indicate metabolic changes associated with SARS-CoV-2 infection, as well as the prospects for using the 1H-MPC technique in the diagnosis of neurological complications of the new coronavirus infection, including manifestations of a psychoneurological syndrome associated with COVID-19.

INTRODUCTION: This paper analyzes local and foreign literature on functional magnetic resonance imaging (fMRI) in patients with anorexia nervosa. Resting state fMRI results of the brain of patients with anorexia nervosa (AN) are presented.

OBJECTIVE: To study functional connectivity in the networks in resting state in patients with AN.

MATERIALS AND METHODS: 43 patients with anorexia nervosa aged 14 to 19 years were examined. The control group consisted of 31 healthy volunteers. The connectivity of the structures involved in the formation of the default mode brain network, frontoparietal and visual networks was analyzed. Statistics: Mathematical and statistical processing was applied in the programming environment of the Python programming language, using the Jupyter-notebook development environment and application modules for statistical analysis Pandas and Numpi. The main tools for statistical analysis of functional MRI were the specialized software package CONN-TOOLBOX.

RESULTS: In the default mode network, a decrease in connectivity between the medial prefrontal cortex and the cluster including the angular gyrus and the supramarginal gyrus, and an increase in connectivity between the right lateral parietal cortex and the cluster including the left precentral and postcentral gyrus, were revealed. In the frontoparietal network, significant indicators of a decrease in connectivity between the right lateral prefrontal cortex and three clusters were obtained, including the poles of the frontal lobes, the left superior and middle frontal gyri, and the left lateral occipital cortex. In the visual network, there was a decrease in connectivity between the left lateral visual network and the cluster which includes mainly the lateral parts of the cerebellar hemispheres and its vermis, the right lateral visual network and the cluster which includes mainly the right and left lingual gyrus, cerebellar hemispheres and vermis.

CONCLUSION: Our study showed a disruption of the functional connectivity in patients with AN, leading to visuospatial disorders and, as a result, a change in the complex process of setting goals, planning appropriate steps to these goals, and impaired cognitive control.

INTRODUCTION: In recent years we have observed various consequences of systemic hyperinflammation associated with COVID-19, including pericardium and pleura involvement. From 2020 to 2022 an increase in the incidence of effusion into the pleural and pericardial cavities was noted in the numerous of breast MRI studies, which could potentially be associated with the COVID-19 pandemic.

OBJECTIVE: To objectify this impression a comparative study was planned, which aimed to analyze the occurrence of pleural and pericardial effusion in groups of patients in 2022 compared with a matched group in 2019 and to describe the structures of the identified changes.

MATERIALS AND METHODS: Тhe database of breast MRI studies during 2019 and 2022 was processed, data from 220 women were selected, indicating as a complaint for breast pain at a mammologist’s appointment and COVID-19 transferred in the group 2022. The telephone questionnaire of the 2022nd year patients were conducted about the presence of common symptoms of inflammation. Statistic: Statistical analysis was carried out using the program Statistica 13.5.0.17 TIBCO Inc. Quantitative parameters are presented as median, 5th-95th percentiles. A 2-tailed t-test was used to compare quantitative parameters. Binary data correlations were carried out using a contingency table. RESULTS: Age included 46 [33–66] years old. MRI was performed 105 [21–198] days after COVID-19. In the 2022 group, at the time of survey, 36% had general inflammatory symptoms in addition to chest pain. In 2022 vs 2019 increase the chance of encountering a pleural effusion (OR 5 [3–8]), the volume of effusion (5 [2–11] mm vs 2 [2–5] mm), incidence of pericardial (OR 31 [11–89]) and combined effusion (OR 11 [4–28]). The detection and the size of effusion of any localization didn’t correlate with age. Patients with breast implants during the pandemic years turned to a mammologist after 29 [8–44] months, before the pandemic — after 40 [19–56] months after surgery and tended to more frequent detection of effusion of all localizations and an increase in the volume of seromas. In the majority of MRI protocols, the effusion was not described.

DISCUSSION: Our study will help to increase the doctors literacy about the frequency and manifestations of serositis associated with COVID-19 in a group of young, non-comorbid women who had a mild infection on an outpatient basis. The barriers to describing a small effusion on an MRI are its probability in physiological conditions, the absence of specific symptoms at the patient and none request from the attending physician. Considering the possibility that effusion into serous cavities may be a sign of pathology that led to chest pain will allow diagnosticians to describe it even with a small amount and will give the attending physician a support for a differential diagnosis. Findings in patients with breast implants confirm the connection of changes with an infectious trigger, and that there is some initial tension of the immune system, which, with additional external provocation, results in a brighter response.

CONCLUSIONS: Effusion into the pleural cavity or pericardium is a common finding in patients who have undergone COVID19, which may reflect systemic inflammatory syndrome and cause chest pain.

INTRODUCTION: Despite the wide availability of the use of ultrasonic elastography to assess fibrosis in patients with diffuse liver diseases, this method didn’t have a high specificity for diagnosing intermediate stages of fibrosis.

OBJECTIVE: To evaluate the diagnostic effectiveness of perfusion computed tomography (PCT) for detecting intermediate stages of fibrosis in patients with diffuse liver diseases.

MATERIALS AND METHODS: PCT of the liver was performed in 73 patients (37 men, 36 women, mean age 47.2±4.4 years). All patients underwent a biochemical blood test, ultrasound elastography, PCT, based on the obtained biochemical blood test and instrumental data, the examined patients were divided into three groups depending on diffuse liver disease: hepatitis (n=25), cirrhosis (n=26), non-alcoholic inflammatory liver disease (n=22). Statistics: The results were processed using the Statistica 10.0 for Windows software package. Identification of the relationship between two quantitative variables that do not obey the normal distribution law was carried out using the Spearman rank correlation coefficient. To assess the diagnostic efficiency of perfusion parameters in patients with DLD, an ROC-analysis (Receiver Operating Characteristic Analysis) was performed. In all statistical analysis procedures, changes were considered statistically significant at a significance level of p<0.05. RESULTS: BV correlated in all three groups of diseases with the elastography in patients with viral hepatitis — (r=–0.5; p><0.04), in patients with alcoholic cirrhosis (r=0.66; p><0.02), in patients with non-alcoholic inflammatory liver disease (r=–0.55; p><0.02). In patients with alcoholic hepatitis — correlation between HAF and elastography index (r=0.98; p><0.001), with viral hepatitis — HAF and elastography index (r=0.66; p><0.01). MTT was statistically correlated with elastography index in patients in the alcoholic cirrhosis group (r=0.78; p><0.006). The BF had the highest diagnostic effectiveness for differentiating F1 and F2 fibrosis in patients with diffuse liver diseases (p><0.0001). DISCUSSION: PCT is able to differentiate between minimal and intermediate fibrosis, which accompany not only hepatitis, but also non-alcoholic fatty liver disease, whose diagnosis is very relevant, and the use of ultrasound elastography is limited. CONCLUSION: The BF promotes to the differentiation of intermediate stages of fibrosis, and in combination with ultrasonic elastography can provide a promising direction for the dynamic monitoring of the parenchyma in patients with diffuse liver diseases.> p<0.05.

RESULTS: BV correlated in all three groups of diseases with the elastography in patients with viral hepatitis — (r=–0.5; p<0.04), in patients with alcoholic cirrhosis (r=0.66; p><0.02), in patients with non-alcoholic inflammatory liver disease (r=–0.55; p<0.02). ><0.02). In patients with alcoholic hepatitis — correlation between HAF and elastography index (r=0.98; p<0.001), with viral hepatitis — HAF and elastography index (r=0.66; p><0.01). MTT was statistically correlated with elastography index in patients in the alcoholic cirrhosis group (r=0.78; p<0.006). The BF had the highest diagnostic effectiveness for differentiating F1 and F2 fibrosis in patients with diffuse liver diseases (p><0.0001). >p<0.006). The BF had the highest diagnostic effectiveness for differentiating F1 and F2 fibrosis in patients with diffuse liver diseases (p<0.0001). ><0.0001).

DISCUSSION: PCT is able to differentiate between minimal and intermediate fibrosis, which accompany not only hepatitis, but also non-alcoholic fatty liver disease, whose diagnosis is very relevant, and the use of ultrasound elastography is limited.

CONCLUSION: The BF promotes to the differentiation of intermediate stages of fibrosis, and in combination with ultrasonic elastography can provide a promising direction for the dynamic monitoring of the parenchyma in patients with diffuse liver diseases.

INTRODUCTION: The algorithm for diagnosing ectopic pregnancy (EP), including b-chorionic gonadotropin in the blood and ultrasound of the pelvic organs, does not allow detecting its localization in the next 7 days after treatment in 10% of women.

OBJECTIVE: Тo improve the algorithm of diagnostics of EP by correcting the ultrasound protocol, as well as adding MRI studies.

MATERIALS AND METHODS: 290 patients with suspected EP, of which 278 were operated on. Women were divided according to menstrual delay: up to 6 weeks (Group 1, n=119), 6–9 weeks (Group 2, n=135), more than 9 weeks (Group 3, n=36). Ultrasound studies were performed in dynamics up to 144 hours on the VOLUSON-730 expert (GE); MR studies — on a 1.5T tomograph «Magnetom Avanto» (Siemens). Statistics: Statistical analysis of the study results was performed using the Statistica for Windows 10.0 software package (StatSoft, Inc., USA).

RESULTS: Ultrasound symptoms of EP: group 1 (n=94) — ectopic fetal egg (EPO) and tubal ring (TC) 5 times more often than hematosalpinx (HS) and heterogeneous adnexal formation (NPO) (χ₁²=14.28; p=0.0002 and χ₂²=13.75, р=0.0003); 2 (n=116) — EPO and TC 3 times more often than GS (χ₁²1=4.8; р₁²=0.028 and χ₂²2=8.1; р₂²=0.004) and NPO (χ₁²=6.65; р₁=0.009 and χ₂²=10.4; р₂=0.001); 3 (n=31) — TC and NPO more often than EPO (χ₁²=8.00; p₁=0.004; χ₂²=14.28; p₂=0.0002). Ultrasound is not informative: group 1 — more than half of the cases; 2 — 24.5%; 3 — 65% of cases. In pregnancies of unknown location (PUL, n=30), MR patterns of EP were studied : in 1⁄3 of cases, progressive early EP was found, in 1⁄3 — undilated fallopian tubes, and in 1⁄3 of cases of HS. Sensitivity of ultrasound in relation to EP: group 1 — 42%; 2 — 76.5%; 3 — 35%; it depends on the period of menstrual delay (r=0.507, p=0.01).

DISCUSSION: In PUL, MRI is indicated for all patients who have a menstrual delay of more than 6 weeks, regardless of the level of b-HCG in their blood, and with a menstrual delay of up to 6 weeks, only if the increase in b-HCG in the blood is less than 50% of physiological values.

CONCLUSION: The inclusion of MRI in the algorithm for diagnosing EP increases its sensitivity and specificity to almost 100%, regardless of the period of menstrual delay.

INTRODUCTION: Positron emission tomography combined with computed tomography (PET/CT) with prostate-specific membrane antigen-targeted (PSMA) radiopharmaceuticals is a valuable method for prostate cancer (PCa) imaging. Both 68Ga- and 18F-labelled PSMA ligands are used in clinical practice now, for example, 18F-PSMA-1007. Currently there is no consensus on time interval between 18F-PSMA-1007 administration and scanning start that served as the basis for this study. OBJECTIVE: The aim of this study was to determinate the optimal time interval between 18F-PSMA-1007 administration and scanning start at PET/CT in PCa patients.  

MATERIALS AND METHODS: This prospective analysis included the results of 18F-PSMA-1007 PET/CT of 26 patients with PCa (mean age — 69.1±7.1 years, mean PSA value — 3.9 (0.5; 10) ng/ml), 4 patients — at primary staging, 10 patients — with therapy assessment and 12 patients — with biochemical recurrence. The PET/CT scanning was performed at 60 and 120 minutes after 18F-PSMA-1007 administration with subsequent measurement and comparison of the pathological and physiological uptake. TBR value (Tumor-to-Background Ratio) was calculated for the pathological uptake in the prostate or prostate bed and lymph nodes lesions relative to the physiological uptake in urinary bladder and abdominal aortic blood pool respectively. Statistics: Statistical analysis was carried out using the software SPSS Statistics 28 to analyse the significance of the differences in median SUVmax (for pathological 18F-PSMA-1007 uptake), SUVmean (for physiological 18F-PSMA-1007 uptake) and TBR between two stages of scanning.  

RESULTS: There was a significant decrease of physiological 18F-PSMA-1007 uptake from median SUVmean 1.5 (1.0; 1.73) to 0.9 (0.5; 0.9), p<0.001 in the abdominal aortic blood pool, 2.6 (1.3; 3.6) to 1.7 (1.1; 2.8), p<0.05 in the urinary bladder, 0.4 (0.35; 0.44) to 0.33 (0.3; 0.37), p<0.05 in the right gluteus medius muscle in the second scan. Moreover, there was a significant increase of physiological 18F-PSMA-1007 uptake from median SUVmean 8.9±2.8 to 10.3±3.4, p<0.001 in the liver, 7.5±3.5 to 8.3±3.8, p<0,001 in the spleen, 9.8±3.7 to 11.6±4.3, p<0.001 in the right parotid salivary gland. Uptake in the bone marrow remained stable with median SUVmean 1 (0.8; 1.3), p=0.917. There was a significant increase of pathological uptake from median SUVmax 4.6 (2.7; 7.7) to 5.25 (3.2; 9.0), p<0.001 in 76 lesions without appearance of new lesions in the second scan at 120 minutes. Mean TBR value also significantly increased for the ratios «prostate or prostate bed/urinary bladder» from 1.7 (1.1; 4.7) to 3.6 (2.1; 9.5), p<0.05 and «lymph node/aortic blood pool»: per-lesion analysis from 2.8 (2.5; 5.2) to 6.2 (5; 10.1), p<0.001 and per-patient analysis from 4,6 (2.7; 5.5) to 9.8 (4.9; 12.1), p<0.05.  

DISCUSSION: It’s not justified to use time interval in 120 minutes routinely because of the lack of new lesions in the second scan, irrational spending of the department resources and time of medical staff. However, there was an increase in the TBR values indicating the higher quality of images in the second scan at 120 minutes.  

CONCLUSION: Due to the lack of clinical benefits of the 120 minutes interval and the associated time cost, a 60 minutes interval between 18F-PSMA-1007 administration and the start of a PET/CT scan in PCa patients is more optimal, however, delayed scan is justified in cases of obtaining unclear results. 

INTRODUCTION: Percutaneous cryoablation is a method of minimally invasive treatment of patients with metastatic bone lesions, which is also used for lesions of the vertebrae. The spine is one of the most difficult anatomical areas for ablation due to the risk of mechanical and thermal damage to the spinal cord and adjacent structures.  

OBJECTIVE: Consideration of methodological aspects of performing minimally invasive percutaneous cryoablation in metastatic lesions of the vertebrae, clarification and systematization of puncture stereotaxic approaches.  

MATERIALS AND METHODS: The cryoablation procedure was performed in 10 patients. The sizes of metastatic lesions varied from 8 to 45 mm (34.6±9.7 mm). Positioning of cryoprobes was performed in sequential mode using the «free hand» method or using a robotic navigation attachment to a CT scanner. The process of installing cryoprobes and ablation was monitored using a multislice computed tomograph. Number and diameter of cryoprobes determined taking into account the characteristics of the lesion; in one procedure used from 1 to 3 cryoprobes. The PCA procedure included two cooling cycles to a temperature of –190 four °C with an exposure of 10 and 7 minutes, with automatic temperature maintenance at the set parameters and continuous temperature monitoring between cycles. After the end of ablation, active and passive thawing modes were used. Dimensions ice ball was assessed at periodic CT scans with an interval of 2–3 minutes.  

RESULTS: Two patients without previous pain syndrome using costovertebral and transforaminal approaches after the procedure developed a pain syndrome of 4–5 points on a digital analogue scale, which required medical analgesic correction using, among other things, narcotic analgesics. In a patient in the case of transforaminal access, the pain syndrome completely resolved within 7 days; in the second case, the pain decreased to 2 points, but persisted for 3 weeks. In 4 patients with previous pain syndrome after PCA, its decrease to 0–2 points was noted. These changes in 2 patients persisted throughout the entire observation period (more than 6 months), in 2 patients the effect was observed for 1 and 3 months; the resumption of pain was due to the local progression of the tumor process. In general, local tumor control was achieved in 7 patients (follow-up period 6–14 months). In 3 patients, according to the control CT scan, continued growth of metastases was established, while in all these clinical cases, the size of the foci before PCA exceeded 4 cm.  

DISCUSSION: In PCA of the vertebrae, a wide range of puncture approaches can be used: transpedicular, costovertebral, transforaminal, posterolateral, and posterior. The choice of the optimal variant depends on the spine and the features of localization, shape, size and structure of the lesion.  

CONCLUSION: When performing PCA of metastatic foci in the thoracic and lumbar spine, most of the known puncture approaches can be used. In case of marginal destruction of the vertebral body, posterolateral (in the thoracic region) and posterior (in the lumbar region) puncture approaches can be used, in which the cryoprobe is installed paravertebral, without direct perforation of the bone. 

INTRODUCTION: Peutz-Jeghers syndrome (PJS) is a rare (orphan) hereditary disease with a family history, primarily characterized by massive polyposis of the gastrointestinal tract and its complications. Every year, the syndrome is registered in 1 patient per 25,000–300,000 population.  

OBJECTIVE: To demonstrate the effectiveness of the combined use of diagnostic radiology and endoscopic imaging techniques in the diagnosis of this syndrome and its complications. A case report of a patient aged 47 years is given. A patient complained of persistent gastrointestinal bleeding, thrombosis of the arteries of the upper extremity, ventral hernia after the elimination of intestinal intussusception. A patient was admitted to the A. V. Vishnevsky NMRC of Surgery of the Ministry of Health of Russia (Moscow) to determine the tactics of treatment. Computed tomography of the abdominal organs and CT angiography of the upper extremities, esophagogastroduodenoscopy and colonoscopy were performed.  

CONCLUSION: The difficulties of the diagnosis and treatment of PJS and its associated complications were illustrated. A brief review of the literature (21 publications) by Russian and foreign authors on the problems of diagnosis, clinical manifestations and treatment of PJS were performed. According to the performed studies, total gastrointestinal polyposis, thrombosis of the arteries of the upper left limb, ventral postoperative hernia were revealed. Taking into account the ongoing complications of PJS, the patient was prescribed a gastrectomy. 

The article presents an analytical review of the state of radiation and instrumental diagnostics in St. Petersburg in 2021.