One of the most common threats to reducing the duration and quality of life among the population is malignant tumors, which have high biological aggressiveness. It is possible to increase the detection of aggressive tumors at an early, potentially curable, stage of the tumor only through specialized medical examination of high-risk groups among the population, taking into account gender, age, hereditary predisposition, the influence of carcinogenic and other factors. In this regard, there is a growing need for interdisciplinary communication, improvement of diagnostic and therapeutic technologies, an alliance of doctors, biologists, chemists, physicists, engineers and mathematicians for symbiosis in the development of biotechnologies, machine learning algorithms, replenishment of the evidence base and improvement of auxiliary resources of artificial intelligence. The article is devoted to the analysis of the challenges facing modern biomedicine and ways to solve them.

INTRODUCTION: Triple negative cancer is one of the most aggressive subtypes of breast cancer. Currently, no effective treatment methods have been proposed that would significantly affect the long-term results of treatment.

OBJECTIVE: To summarize the possibilities of theranostics and nanteranostics in the visualization and elimination of malignant cells and immunosuppressive cells of the microenvironment of thriple negative breast cancer.

MATERIALS AND METHODS: A search was conducted for scientific publications in the PubMed information and analytical system for 2015–2022 by keywords: «triple negative breast cancer» («triple negative breast cancer»), «signaling pathways» («signaling pathways»), «tumor microenvironment» («tumor microenvironment»), «cancer stem cells» («stem tumor cells»), «theranostics», «nanomaterials» («nanomaterials»), «nanotheranostics» («nanoteranostics»). After excluding articles devoted to the technical aspects of molecular biological research, 57 publications related to the theranostics of thrice-negative breast cancer were analyzed.

RESULTS: Targets for theranostics of triple negative breast cancer are associated with tumor cells and components of the microenvironment. The article presents data on the composition and interaction between various cellular subpopulations in the tumor microenvironment, as well as on the role of cancer stem cells in its formation. State of art classifications of triple negative breast cancer and data on molecular defects associated with various subtypes are presented. Targets for theranostics associated with stem, differentiated tumor cells and components of the tumor microenvironment are described. The authors present their own data on the nature of the distribution of various subpopulations of the microenvironment, which should be taken into account when choosing the nature of the effect on the tumor. The possibilities and applications of radiopharmaceuticals and nanoparticle-based preparations developed to date have been analyzed.

CONCLUSION: Triple negative breast cancer is characterized by the presence of a large number of biomarkers that can be targets for diagnostic and therapeutic drugs. It is advisable to use artificial intelligence technologies for their selection. The use of nanoparticles makes it possible to reduce toxicity and ensure the implementation of several treatment methods simultaneously.

INTRODUCTION: Medullary carcinoma is a rare malignant neuroendocrine tumor of the thyroid gland. Medullary thyroid carcinoma (MTC) has no specific clinical symptoms. Due to the absence of specific symptoms, the disease is usually diagnosed at the stage of metastatic lesions of regional lymph nodes, and sometimes, internal organs. The five- and ten-year survival after detection of distant metastases is 25% and 10%, respectively.

OBJECTIVE: To analyze the available foreign and domestic literature to determine the role of PET/CT with various radiopharmaceuticals in the complex radiological diagnosis of MTC.

MATERIALS AND METHODS: A search was made for scientific publications and clinical recommendations in the information and analytical systems PudMed, elibrary over the past ten years, dedicated to the diagnosis of MTC, including PET/CT with ¹⁸F-DOPA, ¹⁸F-FDG, ⁶⁸Ga-DOTA peptides, etc. by keywords «medullary thyroid cancer», «medullary thyroid carcinoma», «PET/CT», «¹⁸F-L-dihydroxyphenylalanine», «¹⁸F-DOPA», «¹⁸F-DOPA», «⁶⁸Ga-DOTA peptides», «⁶⁸Ga-DOTA-peptides», «theranostics», «theranostics».

RESULTS: The analysis of publications demonstrated the prospects for the use of PET/CT with various radiopharmaceuticals for the diagnosis of recurrent tumors and the prevalence of the process in biochemical recurrence of MTC, as well as the possibility of peptide-receptor radionuclide therapy for the treatment of advanced forms of the disease. The choice of radiopharmaceuticals is based on the results of laboratory diagnostics and conventional methods of anatomical imaging. PET/CT with ⁶⁸Ga-DOTA peptides is performed to predict the effectiveness of peptide-receptor radionuclide therapy.

CONCLUSION: PET/CT with various radiopharmaceuticals makes a significant contribution to the diagnosis of recurrent tumors, assessment of the prevalence of the tumor process and selection of patients for peptide-receptor radionuclide therapy.

INTRODUCTION: Volvulus of the stomach is a rare disease that can lead to serious consequences, including death of the patients. Among all volvulus of various parts of the gastrointestinal tract, volvulus of the stomach corresponds to 0.5% of cases.

Chronic volvulus, while being detected timely, can be successfully treated conservatively or surgically without leading to life threatening conditions. So the diagnosis of chronic gastric volvulus is an important and topical problem.

OBJECTIVE: The aim of the study was the analysis of radiological data of patients with gastric volvulus.

MATERIALS AND METHODS: Results of chest, esophagus and stomach X-ray examination of 23 patients with gastric volvulus were analyzed.

RESULTS: The results of X-ray examination of 23 patients with gastric volvulus are described. In 9 cases organo-axial volvulus of the stomach was detected, in 12 — mesenteric-axial volvulus, 2 patients had a combined type of inversion. In 3 cases chronic volvulus was combined with total hiatal hernia, in 6 — with gastric tumors, in 9 cases — with perigastritis, in 5 patients volvulus was observed after abdominal surgery.

DISCUSSION: In our observations, most patients were diagnosed with chronic volvulus of the stomach along the transverse axis, and longitudinal was less common. We also observed a rare combined gastric volvulus. The development of volvulus in our observations was provoked by perigastritis, gastric tumors, surgical interventions and total hiatal herniaal signs.

Complaints of patients and the clinical signs were non-specific, in some cases the disease was asymptomatic. X-ray examination of the esophagus and stomach showed high efficiency in the diagnosis of various types of gastric volvulus.

CONCLUSION: X-ray allows to reliably diagnose various types of gastric volvulus. 

INTRODUCTION: Intracranial meningiomas are the most common considered benign tumors of the central nervous system with clinically aggressive behavior. Meningiomas account for up to 36% of all brain tumors. Metastases, are highly malignant brain lesions with an undetermined incidence of World Health Organization. It is believed that up to 30% of adult patients with cancer of one localization or another suffer from secondary tumors of the brain. The vast majority of meningiomas originate from the coverings of the brain, and more than 90% are solitary. Intracranial meningeal metastases occur in 8–9%, and in 10% the brain is the only secondary tumor site, and in 50% of cases metastases are solitary. Usually, the task of distinguishing between meningioma and a dural metastasis does not cause difficulties. In some cases differential diagnosis between these tumors is ambiguous, since meningiomas and dural solitary metastases (dMTS) may have similar characteristics: a cavityless solid appearance, restricted diffusion of water molecules, presence of extensive peritumoral edema, and an identical contrast enhancement pattern.

OBJECTIVE: To determine the significance of multiparametric mapping (MR-perfusion and apparent diffusion coefficient) for the differential diagnosis of meningioma and solitary dural metastasis.

MATERIALS AND METHODS: This study included 100 patients with newly diagnosed CNS tumors, who subsequently underwent examination at the Meditsinskii gorod (Tyumen, Russia) with histological verification in the period from 2017 to 2022. The mean age of the patients was 54 years, the median was 58 years. Depending on the histological data, 2 groups of patients were distinguished: 1–50 cases with meningiomas, 2–50 cases with solitary meningeal metastatic lesions. The examination was performed with a General Electric Signa Voyager 1.5Т MRI machine before and after contrast enhancement.

Statistics. Statistical analysis was performed using IBM SPSS (version 24.0). Gender, age, presence of dislocation of midline structures, bone invasion, and severity of perifocal edema were compared for both groups of patients using Pearson’s Chi-square test. ADC, CBV, rCBV, CBF, rCBF, MTT values were compared for both groups of patients using the Mann-Whitney U test. The optimal cut-off value for sensitivity and specificity was determined by analysis of ROC curves. For all tests, the alpha level was set to p^*≤0.05, p^**≤0.01, p^***≤0.001.

RESULTS: In the meningioma group, the mean ADC was 912.14×10⁻⁶ mm²/s (SD: ±102.7×10⁻⁶ mm²/s). Median CBV was 19.25 ml/100g (CI: 18.08–28.96 ml/100g), median increase in rCBV was 4.1-fold (SD: 4.09–5.46). Median CBF was 155 ml/100g/min (SD: 157.48–206.65 ml/100g/min), median increase in rCBF was 3.85-fold (SD: 3.98–5.28). Median MTT was 11 seconds (SD: 10.18–11.29 seconds). In the metastasis group, the mean ADC was 867.67×10⁻⁶ mm²/s (SD: ±138.6×10⁻⁶ mm²/s). Median CBV was 39.85 ml/100g SDI: 36.50–46.83 ml/100g), median increase in rCBV was 7.15-fold (SD: 6.64–7.80). Median CBF was 293 ml/100g/min SDI: 261.65–306.12 ml/100g/min), median increase in rCBF was 6.7-fold (SD: 5.97–6.93). Median MTT is 10.85 seconds (SD: 10.15–10.86 seconds).

The cut-off value for CBV was 28.25 ml/100g. The sensitivity and specificity of the method are 76.5% and 78%, respectively. The cut-off value for rCBV was 5.4. The sensitivity and specificity of the method are 74.5% and 82%, respectively.

The threshold value of the CBF was 217.9 ml/100g/min. The sensitivity and specificity of the method are 80.4% and 86%, respectively.

The cut-off value for rCBF was 5.6. The sensitivity and specificity of the method are 82.4% and 76%, respectively.

DISCUSSION: Based on the results of the study, it was found that the use of mpMRI in the differential diagnosis of meningiomas and dural SMTS is limited by the similarity of the apparent diffusion coefficient values. The assumption, previously put forward in the literature, about the presence of a statistically significant difference in ADC values that allow to differentiate these tumors, was not confirmed. When analyzing perfusion data, dural SMTS showed higher CBF values compared to meningiomas (p<0.001). A threshold value of the CBF was determined, which amounted to 217.9 ml/100 g/min, above which it is possible to predict dural SMTS with a sensitivity and specificity of 80 and 86%.

CONCLUSION: Diffusion-weighted images are not reliable criteria for differentiating meningiomas from dural SMTS and should not influence the diagnosis suggested by imaging. The meningeal lesion perfusion technique predicts metastasis with a sensitivity and specificity close to 80–90% and deserves attention in making a diagnosis. Since dural MTS differ from meningiomas in the severity of neoangiogenesis and, accordingly, in greater vascular permeability, the technique for assessing vascular permeability (the wash-in parameter with dynamic contrast enhancement) can potentially be a clarifying criterion for distinguishing between dural lesions. 

INTRODUCTION: The differential diagnosis of mild cognitive impairment (MCI), due to the high prevalence in the population and the rapid increase in incidence, is an urgent task. The most common causes leading to the development of cognitive impairment are Alzheimer’s disease (AD), cerebrovascular pathology, and their combination. AD usually manifests as an amnestic type of mild cognitive impairment (aMCI) at the pre-dementia stage. Subcortical vascular mild cognitive impairment (svMCI) is considered as the prodromal stage of subcortical vascular dementia. According to the results of pathomorphological studies, it was found that subfields of the hippocampal formation are selective vulnerability to AD, ischemia/hypoxia, and aging.

Currently, using the FreeSurfer 6.0 software, it is possible to obtain quantitative indicators of the hippocampal formation subfields in vivo.

The current trend in medicine is the development and implementation of new diagnostic solutions based on artificial intelligence and machine learning. One of the machine learning algorithms is binary logistic regression, which we used in the course of the study for the differential diagnosis of MCI of various origins.

OBJECTIVE: To develop a method for the differential diagnosis of mil cognitive impairment of various origins.

MATERIALS AND METHODS: The study included patients with the syndrome of mild cognitive impairment who were examined in the department of geriatric psychiatry of the V.M.Bekhterev National Medical Research Center for Psychiatry and Neurology, from which two groups were formed: group 1 — patients with aMCI, group 2 — patients with svMCI. Conditionally healthy volunteers, comparable in age, sex and level of education, made up the 3^rd group (control). MRI examination was performed using a Excelart Vantage Atlas XGV magnetic resonance imaging system (Toshiba, Japan) with a magnetic field strength of 1.5 T, followed by MR morphometry of the subfields of the hippocampal formation.

Statistics: Statistical analysis was carried out using data that was converted from a database in Microsoft Excel to the statistical package IBM SPSS 21. To develop a differential diagnosis method, based on the data obtained, the binary regression method and ROC analysis were used.

RESULTS: Based on the obtained MR-morphometry data, a method was developed using the binary logistic regression equation. The value of p≥0.5 makes it possible to classify the patient to the aMCI group, and the value of p<0.5 — to the svMCI. The sensitivity of the method is 90%, the specificity is 80%, and the accuracy is 85%.

DISCUSSION: Using binary logistic regression, the selection of variants of sets of variables (quantitative indicators) was carried out, for which ROC curves were constructed. The selection criterion was the area under the ROC curve — the AUC criterion (Area Under the Curve). The largest area under the curve (AUC=0.824) in the differential diagnosis of aMCI from svMCI was determined for the combination of the volume of the left subiculum and the thickness of the right entorhinal cortex.

Since patients in the aMCI group have a significantly lower number of vascular foci than in the svMCI group (p<0.05), at the next stage, one more variable, the volume fraction, was added to the selected combination of two variables (volume of the left subiculum and thickness of the right entorhinal cortex) hypointense foci. When conducting an ROC analysis with a combination of three variables, an increase in AUC to 0.892 was noted. Further, using a combination of three variables and a binary logistic regression equation, a method for differential diagnosis of aMCI from svMCI was developed.

CONCLUSION: The method of differential diagnosis based on binary logistic regression using MR morphometry data allows to distinguish patients with aMCI from patients with svMCI with high sensitivity and specificity.

INTRODUCTION: The basis of renal rehabilitation after trauma is restoration of blood supply and microcirculation processes.

OBJECTIVE: To establish the kidneys’ functional activity indicators in the posttraumatic period using radionuclide diagnostics.

MATERIAL AND METHODS: Verification of severity degree (1–3) and segmental localization of kidney trauma was carried out using radiology methods in 196 patients. Static scintigraphy was used to determine general renal function and its deficit, dynamic scintigraphy was used for renal vascularization (%), glomerular filtration rate, radiopharmaceutical transit in the parenchyma.

The study was conducted in the immediate (up to 30 days) and distant (up to 6 months) periods after the injury.

Statistics: Statistical analysis was performed using Statistica 6/0 software packages; Excel Microsoft Office. Under normal distribution of variables, paired Student’s t-test was used to determine differences between two independent groups. The reliability of accepted statistical estimates was at least 95%.

RESULTS: The findings demonstrate that the volume of parenchyma involved in the injury and the severity of injury determine the functional activity of the kidney. Loss of total kidney function was found when the damage area involved up to 3 segments — 23.7±0.4% in the immediate period after injury, and 16.0±0.4% in the remote period. In cases of parenchymal tears, the loss of total function was 7.1±0.3%, but only in the immediate period after injury. Total blood flow in the compromised organ was significantly affected with injury of 3 segments at the studied follow-up periods, respectively: 34.9±1.0 and 41.8±0.4%. Decrease in GFR was seen in the remote post-traumatic period with maximal contusion zone (38.3±1.6 ml/min) and kidney part destruction (44.4±1.6 ml/min).

DISCUSSION: In case of trauma affecting circulation with development of a local area of ischemia, arterio-venous anastomoses are involved in the preservation of blood flow to intensify the tissue blood flow. Adaptive arterial hyperemia, designed to preserve kidney function, develops. In the case of segment 1 contusion an increase in vascularization and urinary excretion of the injured organ was established. Involvement of a greater volume of parenchyma reduces the probability of blood flow shunting through arterio-venous anastomoses and leads to deepening organ ischemia. Relative decrease in main perfusion pressure is followed by the decrease of its organ component in peritubular capillaries and increase of tubular pressure as evidenced by radionuclide transit data. Correspondingly, there is a decrease of glomerular filtration rate value that is functionally dependent on blood circulation. Restoration of parameters to the normal functional range in the distant period was found only in cases restricted up to 2 damaged parts of the organ parenchyma, and steady degradation of the parameters was leading in the groups with contusion of 3 kidney segments.

CONCLUSION: In case of blunt trauma of the kidney, grade 1 contusion injuries exceeding ¹⁄2 the volume of the involved parenchyma entail more severe impairment of renal function than a single non-penetrating tissue ruptures of the 2^nd and 3^rd grade.

INTRODUCTION: Radiomics is a promising area of diagnostics. In clinical practice, ultrasound and magnetic resonance imaging are widely used for Cervical Cancer (CC). The lack of standards when carrying out examinations entails the problem of distinguishing different signs, i.e. there is no possibility to compare results of different institutions.

OBJECTIVE: To review radiological diagnostic procedures and optimize a model to enable expanded large-scale multicentre mathematical analysis of radiological findings in comorbid women with CC.

MATERIALS AND METHODS: The data from 362 magnetic resonance imaging (MRI) procedures (Philips Achieva, The Netherlands, 1.5T), 500 pelvic ultrasound procedures (US), and 500 retroperitoneal US in 77 comorbid women with cervical squamous cell cancer and cardiovascular disease, carried out between 2012 and 2022, were retrospectively examined. FIGO pretreatment stage 1А–4А. Age: 48.3±13.1. Follow-up period: 3.7±1.3 years.

Statistics: Data analysis was carried out using the Stata 13 program (StataCorpLP, CollegeStation, TX, USA). The normality of the distribution of features was assessed using the Shapiro-Wilk criterion. The condition of equality of variances of the distribution of features was calculated according to the Leven criterion. For descriptive statistics of normally distributed features with equality of variances, the calculation of averages and standard deviations was used. Qualitative variables are represented as numbers (%). Logistic regression is performed. The significance level for all the methods used is set as p<0.05.

RESULTS: The possibility of segmentation was 2.6% according to US and 100% according to MRI. We analyzed 1443 T2 TSE, 531 T1 TSE, 563 diffusion-weighted images (DWI), 389 STIR, 1987 post-contrast series (in 272 cases (75%) the study was accompanied by contrast agent administration). An MRI model for subsequent feature extraction in patients with CC should consist of T2TSE in the sagittal plane, DWI in the axial plane with automatic construction of apparent diffusion coefficient (ADC) maps.

The most reproducible and valuable components of the model are found to be the DWI with automatic ADC map. The ADC value from the parametral fat significantly increased the probability of recurrence, and the cut-off point for ROC analysis was 1.1×10^–3 mm²/sec.

DISCUSSION: An analysis of medical ultrasound and MRI images in terms of their value for radiomics was carried out. According to the results, MRI is the preferred method. An important next step is to standardize series to extract additional value from diagnostic studies and to carry out multicentre retrospective studies using a multicomponent model.

CONCLUSIONS: MRI is a reproducible and frequently used method with the ability to extract additional value from images. T2 TSE in the sagittal plane and DWI in the axial plane with automatic ADC map, followed by segmentation of the parametral area adjacent to the tumor, are considered the most frequently used techniques. Postcontrast imaging are not a reproducible technique and have no added value. A model MRI procedure to determine additional textural characteristics in patients with СС consists of T2-TSE in the sagittal plane, DWI in the axial plane with automatic ADC map.

The study of the genetic aspects of endocrine diseases is based on the aspiration to develop the methods of early diagnosis, treatment and observation of patients. Von Hippel-Lindau syndrome is genetically determined disease characterized by damage of various organs and systems. The article presents a clinical case of treatment of a patient with retinal detachment who was first admitted to the surgical department of the Federal State Budgetary Institution «NMIC of Endocrinology» of the Ministry of Health of Russia with complaints of dry mouth, general weakness. Further examination, revealed pathological changes in the adrenal glands, kidneys, brain, pancreas, spleen, spinal cord. The presented clinical case demonstrates the need for a multidisciplinary approach to the management of patients with von Hippel-Lindau syndrome.

The article presents an analytical review of the state of radiation and instrumental diagnostics in St. Petersburg in 2022.