INTRODUCTION: The development of iron overload syndrome may be due to both hereditary and acquired factors. The danger of this condition is manifested in the irreversible loss of parenchymatous pool as a result of cirrhotic transformation and marked fibrosis, caused by the consequent accumulation of iron complexes, of such important internal organs as the liver and heart. The amount of iron in the body is assessed by detecting serum ferritin concentration or by measuring liver and heart iron concentration by biopsy (LIC — liver iron concentration; HIC — heart iron concentration). Insufficient diagnostic significance of the serum ferritin concentration criterion, as well as the invasiveness and traumatization of biopsies, are limitations to the widespread use of these methods.

OBJECTIVE: The purpose of this review is to present the main etio-pathogenetic factors of iron overload, the impact of this metabolic disorder on the body, and to reflect the basic principles of diagnosis and the leading role of quantitative MRI in the assessment of iron overload of vital internal organs.

MATERIALS AND METHODS: Performed literature search in Russian and English languages for the period from 2001 to 2022 years in Medline/PubMed, RINC/Elibrary, CyberLeninka, Google Scholar databases by keywords: iron overload syndrome, liver, liver cirrhosis, ferritin, hemosiderin, MR diagnostics iron overload, MR relaxometry, R2*/T2*, thesaurismoses, magnetic resonance tomography, SIR (signal intensity ratio), LIC (liver iron concentration), biopsy, chronic diffuse liver diseases, DIOS.

RESULTS: The final analysis included 27 publications devoted to various etio-pathogenetic aspects of iron overload syndrome. The forms of iron complexes residence in liver parenchymatous tissue are presented. Characteristics of MR-signal behavior depending on the severity of inhomogeneity of the magnetic field created by iron complexes are characterized. The areas of application of magnetic resonance imaging scanning modes for detection and quantitative diagnostics of iron overload are reflected.

CONCLUSION: The ferritin-iron complex, also called ferrihydride, has high paramagnetic properties that provide high contrast MR images in the state of tissue iron overload. The leading methods for quantitative assessment of iron overload are the signal intensity ratio (SIR) method and T2*/R2*-relaxometry. Advantages and disadvantages of these methods, consisting in the limits of determining the degree of overload, make it possible to cover a wide range of overload values by complementing each other. Also the influence of parenchyma architectonics disturbances and concomitant accumulation diseases contribute to the formation of diagnostic inaccuracies. Therefore, the development of complex qualitative-quantitative MR diagnostics in order to isolate highly selective biomarkers will play an important role in MR diagnostics of iron overload syndrome.

INTRODUCTION: Early detection of breast cancer is essential in the diagnosis and treatment of this disease. The results of core biopsy, immunohistochemical methods or removed surgical specimens contributed to the identification of molecular markers. Currently, the attention of researchers is attracted by the anatomical and functional features of tumor tissue obtained using imaging methods. The correlation of specific phenotypes based on images (radiomics) with large-scale genomic analysis (genomics) is a new field of research called “radiogenomics” or, more precisely, “image genomics”. This new field examines the relationship between diagnostic methods and gene data, as well as with other clinically relevant information.

OBJECTIVE: To analyze current trends in the development of radiogenomics in the study of breast cancer based on the literature data.

MATERIALS AND METHODS: The medical literature was searched using information and analytical databases Cochrane, Medline, and Elibrary using the text search queries “radiogenomics of breast cancer”, “mammography and radiogenomics”, “magnetic resonance imaging and radiogenomics”, “ultrasonic radiogenomics”.

RESULTS: We found strong evidence that there is a moderate relationship between imaging characteristics and genomic characteristics of breast cancer. However, the results obtained have a number of limiting factors that distort the overall picture.

CONCLUSION: Precision medicine can be optimized based on the genotypic and phenotypic characteristics of the tumor. However, the development of this direction requires new research and the development of databases using a multicenter approach.

INTRODUCTION: Bronchopulmonary sequestration is a rare congenital pulmonary malformation. A sequestration is generally defined as non-functioning lung tissue that is not in normal continuity with the tracheobronchial tree and derives its blood supply from systemic vessels. 

OBJECTIVE: To define the main clinical and radiologic features of intra- and extralobar sequestration of the lung, to study vessel variability and to analyse case of not obvious CT images of intralobar sequestration that was diagnosed intraoperatively. MATERIALS AND METHODS: We analysed literature found in PubMed and ScienceDirect regarding lung sequestration since 1979. The case report of a patient with extralobar sequestration diagnosed intraoperatively.

RESULTS: The main clinical and radiologic features of lung sequestration, challenges of differential diagnosis were summarised, including specificity of case report.

DISCUSSION: Presence of aberrant vessel requires verification of pathology before operation due to high risk of haemorrhage. The leading role in the verification belongs to radiologic imaging, however in rare cases aberrant vessel may not be visualised due to small diameter or occlusion.

CONCLUSION: The anatomy of aberrant vessels in sequestrations is extremely variable. In case report sequestration was seen in an adult. The pathology was not diagnosed prior to the operation due to failure of the vessel visualisation. Knowledge of possible diagnostic challenges decreases the risk of intraoperative complications.

INTRODUCTION: Since 2016, molecular markers, in particular, mutations in isocitrate dehydrogenase (IDH) 1 and 2, have been introduced as a classifying feature of cerebral gliomas that provided superior prognostication. The search for non-invasive biomarkers of the molecular profile of gliomas is necessary to improve the quality of preoperative diagnostics, identify patients with good and poor prognosis and determine treatment tactics.

OBJECTIVE: Was to study the relationship between the IDH genotype of diffuse cerebral gliomas and metabolic biomarkers according to the results of PET/CT with [¹¹C]methionine.

MATERIALS AND METHOD: The results of PET/CT with ¹¹C-methionine were identified to a retrospective analysis of 260 patients aged 18 to 75 years (median 40 years) with untreated cerebral glioma. Based on histological and molecular genetic studies of the surgical material including the determination of a mutation in the isocitrate dehydrogenase 1 (IDH1132H) gene, diffuse gliomas were classified according to the 2016 WHO classification of CNS tumors. Metabolic biomarkers included the calculation of tumor-to-brain ratio of ¹¹С-methionine (TBRmax, TBRpeak and TBRmean) as well as the metabolic tumor volume (MTV). Statistics. Non-parametric tests were performed to compare the differences among patient groups. ROC curve analysis was performed to screen the optimal parameter and its best cutoff value for the discrimination of glioma genotype. All data analyses were performed using “Statistica 10,0” and “MedCalc” ststistical software. p-values less than 0.05 were considered statistically significant.

RESULTS: According to the 2016 WHO classification astrocytic and oligodendroglial tumors of the adult type were divided into three groups: astrocytic gliomas with a mutation in the IDH1 gene (IDH1 mut) (n=95), astrocytic gliomas without a mutation in the IDH1 gene (IDH1 wild type — IDH1 wt) (n=103), and IDH1-mutant oligodendrogliomas (n=62). Significant differences in all ratios between the three molecular groups of gliomas were established. TBRmax cutoff of 2.27 differentiated between IDH1 wt and IDH1 mut gliomas with a sensitivity of 61% and a specificity of 77% (area under curve — AUC 0.752). When considering subgroups of gliomas that are homogeneous in terms of the IDH1 status or Grade, the dependence of TBR on the glioma histotype and grading was additionally established. In IDH1 mut oligodendrogliomas, TBR was significantly higher than in mutant astrocytomas, and in IDH1 wt astrocytomas, significant differences in TBR were established between Grade 2 and Grade 3–4. TBRmax was not a predictor of glioma type according to the WHO 2016 classification due to significant overlap of individual of TBR values. But TBRmax allowed diagnosing a cluster of malignant gliomas, including glioblastoma and astrocytoma Grade 3 IDH wt, as well as oligodendroglioma Grade 3 IDH1 mut, with a sensitivity of 65% and a specificity of 89% (AUC 0.848) at a cutoff of TBR=2.7. A strong correlation between the three tumor-to-brain ratios allows any ratio to be used in diagnostics. There were no significant differences in MTV between molecular types of gliomas.

DISCUSSION: Distinguishing glioma types based on the 2016 WHO classification of the CNS tumors on the basis of ¹¹Cmethionine uptake seems to be not reliable due to many factors that affect its uptake. In astrocytomas high TBR is associated with malignant grade and wild type IDH1 gene. However, the lack of differences in TBR between these astrocytomas and Grade 3 IDH1-mutant oligodendrogliomas does not allow one to predict the IDH1 status of the tumor in the absence of other radiological signs of the glioma histotype. The absence of differences in TBR between Grade 2 and Grade 3 astrocytomas IDH1 mut supports the view that they are considered as a single subgroup of lower grade gliomas. 

CONCLUSION: PET/CT with ¹¹C-methionine has limited potential to assess the IDH status of diffuse gliomas. High TBR is associated with malignant glioma with wild-type IDH1 gene or oligodendroglial structure. 

INTRODUCTION: Acute ischemic stroke (AIS) is not uncommon in patients with novel coronavirus infection. During the COVID-19 pandemic, an increase of the frequency of adverse clinical and functional outcomes of AIS was noted.

OBJECTIVE: The recent study was to evaluate the impact of the COVID-19 pandemic on the clinical and diagnostic characteristics of patients with AIS, as well as on the results of various types of treatment.

MATERIALS AND METHODS: The prospective study included 460 patients with AIS after systemic or selective thrombolysis, thromboextraction and combination of thromboextraction with thrombolysis and stenting, hospitalized in 2019–2022: 55 patients in 2019, and in 2020–2022 — 405 patients. All patients were clinically evaluated using NIHSS and Rankin scales. Instrumental data included: assessment of computed tomography (CT) lesion size, extracranial and transcranial Duplex ultrasound (DUS) and computed angiography. Patients who received invasive treatment (thromboextraction, including in combination with thrombolysis or stenting) underwent cerebral angiography (CA). The characteristics of cerebral hemodynamics before and after the use of various types of treatment, clinical and functional outcomes were subject for comparison.

Statistics: The statistical software Statistica 12.0, SPSS Statistics 17.0 were used. Normality of distribution was assessed using the Shapiro–Wilks test. Comparison of groups based on quantitative parameters was carried out using the Mann–Whitney U test. When testing statistical hypotheses, the acceptable level of error of the first type was considered to be a value not exceeding 0.05. To assess the correlation between parameters, the Spearman method was used.

RESULTS: During the pandemic of COVID-19, patients with AIS were younger, had lower percentage of comorbidities and a higher NIHSS score. A significantly lower rate of favorable clinical and functional outcomes was obtained during the pandemic compared to the period before the pandemic, including after the use of invasive treatment methods: only 47% of patients had clinical improvement during the pandemic, while in 2019 the proportion of favorable outcomes was 64% (p=0.003). There was an increase in the share of pulmonary embolism and pneumonia in the structure of mortality from AIS during the pandemic (25% in the period before the pandemic vs 38% during the pandemic). Duplex ultrasound of cerebral arteries demonstrated high comparability with angiography data (correlation coefficient with invasive methods 0.84).

DISCUSSION: According to the literature data, strokes are not uncommon in patients with COVID-19, especially in those with severe disease and risk factors. The authors consider thrombosis and/or thromboembolism of cerebral arteries to be possible ways of cerebral ischemia. According to Russian scientists, from the beginning of the pandemic, a significant increase in the incidence of ischemic stroke of varying severity was noted. The statistical pattern we identified confirms the data from literature sources that when infected with the SARS-CoV-2 virus, the brain and cerebral arteries are target organs. It is significant for clinical practice that we have evaluated the clinical and instrumental characteristics of these lesions in relatively homogeneous gender, age and clinical groups.

CONCLUSION: The incidence of favorable clinical and functional outcomes during the pandemic was significantly lower compared to the pre-pandemic period. Complete and partial restoration of blood flow, as well as a decrease in the ischemic focus, were significantly more common before the pandemic. The effectiveness of invasive methods of cerebral revascularization during the pandemic were also lower. Duplex ultrasound serves as a reliable method not only for primary diagnosis, but also for dynamic monitoring. Initial changes in hemodynamics in patients with AIS before and during the pandemic did not differ significantly and were represented by hypoperfusion with a decrease in peripheral resistance. In 2020–2022 after treatment, hypoperfusion was observed significantly more often, which can be considered as one of the reasons for the less favorable clinical and functional outcomes obtained during the pandemic.  

INTRODUCTION: Despite the development and introduction of new neuroimaging methods into clinical practice, the proton magnetic resonance spectroscopy method has still not found wide application. This is hampered by various technical, methodological and organizational problems. On the other hand, there is no information about the clinical possibilities of proton magnetic resonance spectroscopy in the diagnosis of children with mental and speech retardation, assessment of their dynamics, and features of metabolic changes in the central nervous system. Due to the advent of new proton magnetic resonance spectroscopic techniques that allow the use of multivoxel volumes of the studied tissues, it has become possible to assess the role and place of proton magnetic resonance spectroscopy in children with similar manifestations.

OBJECTIVE: The study was to study the relationship between the complex of acetylaspartate and choline metabolism in the brain in children with neurological and mental disorders accompanied by a delay in mental and speech development.

MATERIALS AND METHODS: 102 patients were examined, of which: 30 children (29.4%) were with atypical autism and mental retardation; 22 patients (21.5%) with focal temporal epilepsy and delayed speech development; 18 children (17.8%) with focal temporal epilepsy and without delayed speech development; 13 patients (12.7%) with cognitive epileptiform disintegration; 19 children (18.6%) without CNS pathology were included in the comparison group. The age of the examined varied from 2 to 10 years, the average age was 4.9±2.0 years.

Statistics: The analysis included determining the numerical characteristics of the variables and checking the normality of the distribution of values. Methods of parametric and nonparametric statistics were used. For parametric statistics, a standard analysis using the Student’s t-test was used. From the methods of nonparametric statistics, methods of correlation analysis with calculation of the Mann-Whitney U-test coefficient were used. The results were considered reliable at p<0.05.

RESULTS: In the brain of children with atypical autism and mental retardation, the following changes were revealed: in the prefrontal cortex, on both sides, a decrease in the ratio of NAA/Cr concentrations, an increase in Cho/Cr and Cho/NAA (p<0.05); in the postcentral gyrus area, on both sides, a decrease in the ratio of NAA/Cr concentrations (p<0.05); in the area of the inner capsule, a decrease in the ratio of NAA/Cr concentrations and an increase in Cho/Cr (p<0.05); in the area of the temporal lobes, on both sides, a decrease in the ratio of NAA/Cr concentrations and an increase in Cho/Cr (p<0.05); in the area of the hippocampus, on both sides, a decrease in the ratio of NAA/Cr concentrations and an increase in Cho/Cr (p<0.05). In patients with temporal epilepsy and delayed speech development, the following changes were revealed: in the prefrontal cortex on both sides, an increase in the ratio of Cho/Cr concentrations (p<0.05); in the area of the postcentral gyrus, a decrease in the ratio of NAA/Cr concentrations on the right and an increase in Cho/Cr on both sides (p<0.05); in the area of the inner capsule on both sides, a decrease in the ratio of NAA/Cr concentrations and an increase in Cho/Cr (p<0.05); in the area of the temporal lobes, a decrease in the ratio of NAA/Cr concentrations is observed on the right and an increase in Cho/Cr (p<0.05); in the hippocampal region on both sides there is a decrease in the ratio of NAA/Cr concentrations, an increase in Cho/Cr and Cho/NAA (p<0.05). In children with focal temporal epilepsy without delayed speech development, the following changes were revealed: in the temporal lobe area on the right, a decrease in the ratio of NAA/Cr concentrations (p<0.05); in the hippocampus area on the right, a decrease in the ratio of NAA/Cr concentrations and an increase in Cho/Cr (p<0.05). In children with cognitive epileptiform disintegration, the following changes were revealed: in the prefrontal cortex, on both sides, an increase in the Cho/Cr concentration ratio (p<0.05); in the postcentral gyrus area, on both sides, an increase in the Cho/Cr concentration ratio (p<0.05); in the area of the inner capsule, on both sides, an increase in the ratio of Cho/Cr concentrations (p<0.05); in the area of the temporal lobes, on both sides, a decrease in the ratio of NAA/Cr concentrations, an increase in Cho/Cr and Cho/NAA (p<0.05); in the hippocampal region, on both sides, a decrease in the ratio of NAA/Cr concentrations (p<0.05).

DUSCUSSION: In the examined children with some neurological and mental disorders accompanied by a delay in mental and speech development, we revealed a significant change in the ratio of NAA/Cr concentrations in areas of the brain associated with the limbic system and subcortical nuclei. It is believed that when the functional integrity of neurons is impaired, the concentration of N-acetylaspartate may change, which is reflected in a change in the ratio of NAA/Cr concentrations. These changes may be responsible for verbal and non-verbal disruptions in social communication and interactions. Also, in these areas of the brain, a significant change in the ratio of Cho/Cr concentrations was recorded, due to an increase in the concentration of choline. This may be due to disorders of higher mental functions, in particular in the construction of complex cognitive circuits responsible for regulating social behavior and interaction with the outside world.

CONCLUSIONS: the proton magnetic resonance spectroscopy is a promising additional diagnostic method that allows obtaining (in vivo) information about the state of neurometabolism in brain tissues in children with certain neurological and mental disorders accompanied by a delay in mental and speech development, which can be useful in neurological practice.

INTRODUCTION: Insomnia is one of the most common sleep disorders, the interest of scientists in the occurrence and pathophysiology of insomnia is growing every year. In particular, the brain connectome and its changes in sleep disorders are being actively studied based on the data of resting state functional magnetic resonance imaging.

OBJECTIVE: The study is to assess changes in brain connectomes in patients with chronic insomnia using functional magnetic resonance imaging.

MATERIALS AND METHODS: 53 people took part in the study, of which 34 patients who applied for a somnologist’s appointment at the Almazov National Research Medical Center of the Ministry of Health of the Russian Federation were diagnosed with chronic insomnia, confirmed by polysomnography. All participants of the study had an MRI of the brain on tomographs with a magnetic field induction force of 3.0 Tl at two time points.

Statistics: Statistical analysis of MRI data was performed using MathLab 2018a, CONN v1.7. Descriptive statistics, the Kolmogorov-Smirnov criterion were used to process the materials, depending on the characteristics of the data, the MannWhitney U-criterion and Pearson Chi-squared were used to analyze demographic data.

RESULTS: The study, neuroimaging markers of insomnia were identified and changes in the functional networks of the brain were described in patients with insomnia and a group of healthy volunteers at different time points.

DISCUSSION: The obtained functional data demonstrate ambiguous results. Both an increase and a decrease in the functional connectivity of the medial prefrontal cortex with the structures of the visual analyzer, an increase in functional connections with the temporal pole, in particular with the hippocampus, is determined, which indicates changes in the consolidation of visually encoded information. The relative limitation in this study can be considered the heterogeneity of the age composition of the group.

CONCLUSSION: Resting state functional MRI of the brain is a key neuroimaging method in determining the functional connections of the brain in patients with sleep disorders, which allows us to establish a impairment of functional interaction between brain structures involved in the processes of falling asleep and maintaining sleep.

INTRODUCTION: Transposition of the great arteries (TGA) is the classic, most common and severe form of cyanotic congenital heart defects in children, which is characterized by a variety of anatomical and hemodynamic variants, combined with other cardiac anomalies and high infant mortality rates. The surgical treatment and the possibility of performing simultaneous correction of TGA depend on the anatomical and hemodynamic features of the TGA and the presence of combined intra- and extracardiac anomalies, which must be determined using cardiac imaging techniques on the preoperative stage.

OBJECTIVE: To evaluate the capabilities of TTE and cardiac CT in the diagnosis and surgical planning of TGA in children.

MATERIALS AND METHODS: The study included 29 children with an incoming diagnosis of transposition of the great arteries. The average age of the patients was 31 (14.5; 67) days. All children underwent TTE, 21 — cardiac CT with intravenous contrast enhancement, 6 — catheterization of the cardiac cavities with conventional angiography. Cardiac MRI was not performed due to the severe and unstable general condition of all patients and the significant risks from a longer stay in anesthesia. Capabilities of TTE and cardiac CT in determining combined intra- and extracardiac anomalies were assessed and compared. All data from TTE and cardiac CT were compared with the results of conventional angiography and intraoperative data. The interval between TTE, cardiac CT and angiography or surgery was less than 10 days.

RESULTS: The accuracy of TTE and cardiac CT in TGA diagnosis and determining its type was 100% for both methods, however, with regard to determining combined intra- and extracardiac anomalies, the methods play a different role: the accuracy of cardiac CT in determining combined intracardiac anomalies in patients with TGA was 87.7% (AUC 89.3%), for TTE — 97.1% (AUC 97.3%). Comparing the capabilities of the techniques in determining intracardial anomalies, no statistically significant difference was obtained (p=0.092). The diagnostic accuracy of cardiac CT in determining concomitant anomalies of the great vessels and extracardiac pathology was 98% (AUC=98.9%). The sensitivity and specificity of TTE in the comprehensive assessment of concomitant extracardiac anomalies were 58% and 98%, respectively (accuracy 89.1%), AUC 81.1%. Comparing the capabilities of techniques in determining intracardial anomalies, cardiac CT showed to be a more accurate tool in comparison with TTE (p=0.041).

DISCUSSION: Results of our study demonstrate the high efficiency of TTE in determining indications for emergency palliative correction of transposition of the great arteries, however, the method has limited diagnostic capabilities in assessing surgical risks when planning radical correction of the defect. Cardiac CT has proven to be a highly accurate tool both in making a diagnosis and in identifying combined intra- and extracardiac anomalies, which play a decisive role in planning open surgical correction of transposition of the great arteries in children.

CONCLUSION: For patients with TMA and critical hypoxia, transthoracic echocardiography is the definitive diagnostic tool for planning endovascular repair. When planning open surgery, transthoracic echocardiography should be complemented by cardiac CT with ECG gating to assess the anatomy of the coronary arteries and possible associated extracardiac anomalies.

INTRODUCTION: Medullary thyroid carcinoma (MTС) is a rare neuroendocrine malignant neoplasm of the thyroid gland. In most cases, sporadic MTС is diagnosed at late stages due to the absence of specific symptoms. The main method of treatment of MTС is surgical — thyroidectomy and in most cases cervical lymphodissection. Current international guidelines suggest the use of basal calcitonin levels and cancer embryonic antigen (CEA) as markers of biochemical recurrence. In biochemical recurrence of the disease, it is advisable to search for tumor foci regardless of the level of cancer markers. Positron emission tomography combined with computed tomography (PET/CT) has the highest sensitivity and specificity for searching for local recurrence and distant metastases. Anatomical imaging methods (computed tomography (CT), magnetic resonance imaging (MRI)) have suboptimal sensitivity and specificity in detection of a recurrent tumor.

OBJECTIVE: To explore the diagnostic capabilities of PET/CT with ¹⁸F-DOPA in patients with biochemical recurrence of medullary thyroid carcinoma, depending on the concentration of calcitonin in blood plasma.

MATERIALS AND METHODS: To evaluate the diagnostic capabilities of PET/CT with ¹⁸F-DOPA in patients with biochemical recurrence of medullary thyroid carcinoma, 81 PET/CT studies were analyzed in patients after thyroidectomy. In most cases (76/81), at the time of the study, patients had elevated basal calcitonin levels (>10 pg/ml, including in 52/81 cases >150 pg/ml), which corresponded to a biochemical recurrence of the disease. In 6 cases, the calcitonin level was <10 pg/ml. PET/CT results were processed by visual image analysis, measurement of a semi-quantitative indicator of the maximal standardized level of radiopharmaceutical accumulation normalized to lean body mass (SUVlbm max) and the total volume of PET-positive tumor tissue (metabolic tumor volume).

RESULTS: In 41 studies, foci of pathological accumulation of ¹⁸F-DOPA were identified, corresponding to recurrent tumor foci. DOPA-negative results in patients with elevated calcitonin levels were regarded as false negative. The highest sensitivity of the method was achieved at calcitonin levels >150 pg/ml. A noticeable positive correlation was found between the concentration of basal serum calcitonin, the number of pathological foci of ¹⁸F-DOPA hyperaccumulation and the total metabolic volume of tumor tissue. In most cases of biochemical recurrence, the PET method was superior to the CT method in detecting recurrent tumor foci.

CONCLUSION: PET/CT with ¹⁸F-DOPA is the most informative method for molecular and structural imaging in patients with biochemical recurrence of medullary thyroid carcinoma. The results of the study directly correlate with the level of basal calcitonin in the blood.

INTRODUCTION: The rapid rejuvenation of breast cancer in recent years has made it necessary to look for non-X-ray methods of imaging microcalcifications in women not yet covered by mammography screening. Developing technologies to see these microcalcifications on ultrasound is a promising goal, potentially reducing the number of unnecessary biopsies.

OBJECTIVE: Evaluation of factors influencing the ability of the B-flow technique to detect the presence of a flickering artifact in patients with microcalcifications detected by mammography.

MATERIALS AND METHODS: A prospective study of 57 patients with microcalcifications detected on mammograms was conducted. The Nondoppler technology of B-flow ultrasound examination was used for targeted ultrasound with the search for these areas during ultrasound. The possibilities of visualization of the twinkle artifact were evaluated for various microcalcifications in size, distribution, their number, and for pathological processes of different nature. Images in B-flow mode were found to be positive when a bright local flash occurred against a dark background in B-mode. Verification of diagnostic findings was performed by ultrasound-guided core- biopsy from areas with a twinkle artifact (in the presence of an imaging area during ultrasound) or with stereotactic biopsy (in the absence of visualization of the suspicious area with ultrasound with B-flow).

Statistics: The ANOVA test was used for triple pairwise comparisons between positive groups. The p<0.05 value was considered statistically significant.

RESULTS: According to the results of the study, out of 57 cases with microcalcifications, 34 (60%) recorded a twinkle artifact. The amount of microcalcifications with a visualized twinkle effect in B-flow was significantly higher in benign processes 34 (82.9%) out of 41, and less often in malignant 8 (50%) out of 16 (p=0.035). The effect of calcification morphology on the mammogram on their detection by ultrasound in the B-flow mode (p=0.035) was statistically significant. The most frequently manifested twinkle artifact were rounded, regular-shaped calcifications in 19 (95%) out of 20, which were found in granulomatous mastitis, fibrocystic changes, fibroadenomas, sclerosing adenosis, as well as polymorphic calcifications in 7 (63.6%) of 11. In the B-flow mode, it was not possible to obtain a twinkle artifact mainly with point small calcifications of 9 (69.2%) out of 13, and in all cases with linear or linear branching calcifications. In amorphous microcalcifications, the characteristics of background echogenicity and the presence or absence of a nodal component in the gray scale mode had a much greater influence on the appearance of the twinkle effect in the normal B-mode, whereas in the B-flow mode, these characteristics did not have a decisive effect on the appearance of a flickering artifact (p=0.8). The density of distribution of microcalcifications, the size of calcifications, the final pathomorphology, mammography characteristics, the background environment during ultrasound by the presence or absence of nodular formation and anechoic zones, did not affect the appearance of a bright flash in the B-flow mode.

DISCUSSION: The density of calcification distribution was not decisive for the appearance of a shimmering artifact in the B-flow mode. The flicker artifact is recorded both in grouped microcalcifications and in single ones. B-flow can help to detect calcifications that are not visible in the usual B-flow mode due to the lack of pronounced tissue contrast. But this artifact cannot be used to differentiate between benign and malignant processes.

CONCLUSION: The B-flow technique is promising for clarifying the twinkle artifact in the detected microcalcifications on the mammogram, which could potentially increase the incidence of ultrasound-guided trephine biopsies by detecting more areas with microcalcification accumulations. 

Fibrous dysplasia is a benign pathological process with various manifestations. Sometimes the volume of lesions leads to «malignant» course of disease. This article presents a clinical case of a patient with a rare disabling isolated polyostotic form of fibrous dysplasia. This patient was admitted to a medical center due to the appearance of acute pain in the right lower limb and a change in the axis of the limbs. We present the case of a patient with rare disabling isolated polyostotic form of fibrous dysplasia.

Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by the accumulation of protein-lipid complexes in the alveoli due to impaired utilization of surfactant by alveolar macrophages; it is most often idiopathic and occurs in healthy men and women aged 30–50 years. The congenital form of PAP is extremely rare, its diagnosis is complicated by the fact that it is impossible to conduct functional lung tests in newborns, and lung biopsy is used extremely rarely. Against this background, data obtained by computed tomography (CT) of the lungs of newborns are of particular importance. The article presents a clinical case of treatment of a newborn with respiratory failure (RF) and signs of pulmonary hypertension, who was admitted to the neonatal intensive care unit of the Children’s City Multidisciplinary Clinical Specialized Center for High Medical Technologies at the age of the first day of life. The article reflects the role of computed tomography in diagnosing the causes of respiratory failure in newborns, as well as the importance of anamnesis and a thorough clinical examination of patients. The presented clinical case demonstrates the need for a multidisciplinary approach to the diagnosis of newborns with pulmonary alveolar proteinosis.

The article presents a rare case of the isolation of a large calcified lesion in a 1-year-old child A., who was treated for tuberculosis of the intrathoracic lymph nodes, after family contact with his grandfather, a patient with fibrocavernous tuberculosis with bacterial isolation. Bronchi and lymphatic vessels are the main routes of spread of the tuberculosis process in the lungs, and in some cases reactivation of tuberculosis foci is possible. This may be due to damage and destruction of the bronchial wall. Residual tuberculous changes, caseous masses can carry a certain danger in the form of their breakthrough into the lumen of the trachea and bronchus. Aspiration of the contents contributes to the spread of tuberculosis infection; atelectasis, atelectatic pneumonia, etc. may occur. In early childhood, asphyxia with sudden death (suffocation by caseous masses) can occur. During the treatment of tuberculosis, you may encounter rare manifestations of the X-ray picture, the details of which must be assessed in time to choose the right tactics for patient management. In the presented case, the patient did not have activation of residual tuberculous changes; a large calcified lesion was coughed up due to the disintegration of dystrophic changes in the trachea in the affected area. A favorable outcome was recorded.