Gestational trophoblastic disease (GTD) is an umbrella term for a group of benign and malignant trophoblastic tumors that develop during or after pregnancy. Despite the fact that trophoblastic tumors are quite rare, they represent an important problem in obstetrics. GTD can result in serious fetal and maternal complications, especially if it is associated with coexisting progressing pregnancy. This lecture covers general concepts related to trophoblastic disease, the role of ultrasound examination and MRI in the primary diagnosis of GTD during developing pregnancy and follow-up monitoring after treatment, as well as sonographic and magnetic resonance signs of this condition.

The treatment of patients with pancreatic cancer is one of the difficult problems in modern oncology. Surgical treatment of pancreatic cancer is still the most radical method, but at the time of diagnosis, the tumor is considered resectable in about 20% of patients. The biological features of ductal adenocarcinoma of the pancreas, primarily its radio and chemoresistance, a tendency to rapid dissemination, contributed to the development of combined / complex treatment programs. In particular, they led to the development of remote radiotherapy techniques both in combination with antitumor drug therapy and in independent treatment.

OBJECTIVE: Аnalysis of data from clinical studies of radiotherapy methods in the treatment of patients with pancreatic cancer, as well as assessment of the effectiveness and safety of modern radiation and chemoradiation therapy programs in this disease.

MATERIALS AND METHODS: Literature data in Russian and English for the period from 1981 to 2023 were searched and analyzed in Medline/PubMed, RSCI/Elibrary, CyberLeninka, Google Scholar databases related to the problem of pancreatic cancer radiotherapy.

RESULTS: The final analysis includes data from 36 literature sources on the use of radiation therapy for the treatment of pancreatic cancer, both alone and in combination with chemotherapeutic drugs. Conducting large clinical randomized trials of pancreatic cancer radiotherapy is historically associated with the difficulty of recruiting patients, the complexity of radiation methods, as well as the high specific gravity of generalized forms, which does not provide an unambiguous assessment of the role of radiation therapy as an independent method.

DISCUSSION: An analysis of the presented literature sources demonstrates that a combination of radiotherapy and current chemotherapeutic regimens can provide high local control over the disease (more than 75%) and achieve an overall survival of more than 20 months.

CONCLUSION: This work summarizes more than 40 years of experience in the use of radiation therapy in the treatment of pancreatic cancer, both independently and in combination with chemotherapy drugs, demonstrates the evolution of therapeutic approaches from 2D planning to stereotactic methods that allow achieving high local control rates with a low frequency of severe post-radiation reactions. The widespread introduction of modern accelerator technology in everyday clinical practice makes it possible to use remote radiotherapy both as a radical treatment and in palliative care programs, in cases where surgery is not possible.

INTRODUCTION: By 2050, approximately 22% of the world’s population is expected to be over 60 years of age. Increasing life expectancy leads to an increase in the prevalence of chronic non-communicable diseases, including osteoporosis. Osteoporosis is the most common cause of low-energy bone fractures, thereby reducing life expectancy and quality of life.

OBJECTIVE: To present up-to-date data on the methods of radiodiagnostic diagnosis for osteoporosis using X-ray absorptiometry, quantitative computed tomography, panoramic dental tomography and bone ultrasonometry.

MATERIAL AND METHODS: The research and analysis was conducted to search for scientific publications and clinical recommendations in information-analytical systems eLIBRARY.RU and PubMed for 2005–2024 by the following keywords: osteoporosis, quantitative computed tomography, osteodensitometry, absorptiometry, dual-energy x-ray absorptiometry, panoramic tomography, bone ultrasonometry, bone mineral density.

RESULTS: 454 articles was analyzed, 27 of which were used to compile the review. Data on diagnostic sensitivity, specificity, and calculated indices of each method are presented.

CONCLUSION: Each of the radiation methods described in this review has its place and development prospects in the diagnosis of osteoporosis. The analysis of scientific data on the described methods shows a continuous development and an increasing interest in each of the methods.

INTRODUCTION: Stab wounds to the spinal cord are a rare but clinically significant problem. These injuries can lead to serious consequences. Modern methods of radiation diagnostics (CT and MRI) play a key role in their detection and differential diagnosis. The results are sent to forensic medical institutions for examination. The main task of a forensic medical expert in the examination of a living person is to establish the severity of harm to health. The medical criteria approved by the Decree of the Government of the Russian Federation No. 522 are the main document on which the expert relies. To qualify spinal cord injury as serious harm, it is necessary to prove a penetrating wound into the spinal canal on the basis of the paragraph «A wound penetrating into the spinal canal of the cervical, thoracic, lumbar or sacral spine, including without damage to the spinal cord and the «horse tail». Radiation diagnostic data are the main noninvasive methods capable of providing arguments for expert conclusions.

OBJECTIVE: To evaluate the diagnostic capabilities of CT and MRI in spinal cord stab wounds based on the analysis of 9 clinical cases, as well as to determine the correlation between the lesion level, clinical picture and visual data.

MATERIALS AND METHODS: The study included 9 patients (7 men, 2 women) with stab wounds to the spine and spinal cord aged from 23 to 49 years. All patients underwent CT and MRI at the place of hospitalization. To determine the severity of the injury, a forensic medical examination was conducted with the involvement of a radiologist.

RESULTS: CT scans revealed damage to bone structures: 33.3% (fractures, subluxations). Traces of a piercing object: 66.7% (linear pressure channels). Pneumomyelia: 2 patients (violation of the tightness of the membranes of the spinal cord). According to the MRI data, a violation of the integrity of the dural sac was revealed: 100%. Myelopathy is 44.4% (hyperintensive signal, edema, hemorrhages). Hematomas: 33.3% (epidural and subdural). A correlation of clinical symptoms with the lesion level was noted. The cervical region has a pronounced neurological deficit (tetraparesis, hemiplegia). Thoracic region — bilateral sensorimotor deficit, pelvic organ dysfunction. Lumbar region — paresis of the feet, dysesthesia, without gross motor disorders.

DISCUSSION: Stab wounds of the spinal cord (CRSM) represent a complex diagnostic problem that requires an integrated approach in judicial practice. Computed tomography (CT) effectively detects bone damage and analyzes the trajectory of a wounding object, while magnetic resonance imaging (MRI) detects damage to soft tissue structures. The results of the study show that CT is the most informative for bone injuries, while MRI is the most informative for assessing the condition of the spinal cord and soft tissue structures, including myelopathy and hematomas. Clinical data confirm that the severity of neurological deficits depends on the level of spinal cord injury, and the use of CT and MRI in forensic medical examination makes it possible to objectify the severity of injury and the mechanism of injury.

CONCLUSION: The results obtained can be used to improve diagnostic algorithms and expert assessment of such injuries in forensic medical practice. In the future, it is necessary to expand the base of clinical observations and conduct comparative studies involving more patients in order to clarify diagnostic criteria and improve the accuracy of expert opinions.

INTRODUCTION: The increasing frequency of cesarean section has led to a rise in postoperative complications. One of these complications is the formation of a «niche» in the uterine scar. To determine the appropriate management strategy for patients at the preconception stage, it is essential to thoroughly assess the condition of the postoperative scar.

OBJECTIVE: Evaluate the effectiveness of magnetic resonance imaging (MRI) in assessing the condition of the uterine scar niche following cesarean section.

MATERIALS AND METHODS: A retrospective analysis was performed on 63 pelvic MRI scans (1.5/3.0 T) of women aged 18– 45 years with a uterine niche after cesarean section (residual myometrial thickness < 3 mm). Two radiologists independently assessed scar morphometric parameters in T2-weighted imaging. Measurements were performed using RadiAnt DICOM Viewer. Statistical analysis was conducted using StatTech v. 4.8.0 (StatTech LLC, Russia).

RESULTS: The analysis of MRI data showed that the residual thickness of the myometrium was 2.5 (2.0; 3.0) mm, with the median depth of the «niche» 5.0 (4.0; 6.2) mm, width 8.0 (6.0; 12.0) mm, and length 9.5 (7.0; 12.0) mm (n=63). The thickness of the adjacent myometrium was 12.0 (10.75; 15.0) mm, and the distance to the external cervical os was 28.0 (24.0; 30.0) mm. The prevalence of minor defects in the scar was 85.7% (54/63), while significant defects were observed in 14.3% (9/63) of patients. An inverse correlation was found between the myometrial thickness and the length of the «niche» (rs=–0.160, p=0.21), and between the residual myometrial thickness and the depth of the «niche» (rs=–0.256, p=0.042).

DISCUSSION: The use of magnetic resonance imaging (MRI) in the diagnosis of uterine scars provides high visualization accuracy and minimizes subjective influences from experts. MRI can be a useful tool for predicting the effectiveness of surgical treatment. Correlation analysis demonstrated that deeper and longer scar defects are associated with a reduction in the thickness of the residual myometrium.

CONCLUSION: During the preconception period, it is crucial to obtain detailed data on the condition of the scar. To achieve this, an extended protocol for measuring the scar should be used. A thorough description of the scar’s structure will help clinicians make informed decisions regarding the further management of patients.

INTRODUCTION: Dual-energy computed tomography (DECT) is a computed tomography method based on scanning a patient at low and high energies, one of the features of which is the ability to create virtual unenhanced images based on datasets obtained after contrast injection.

OBJECTIVE: Evaluation of the possibilities of using virtual unenhanced images created from arterial or venous phases by dualenergy computed tomography instead of native images in the differential diagnosis of adrenal gland tumors.

MATERIALS AND METHODS: 91 patients with adrenal gland tumors who subsequently underwent surgery due to the clinically malignant potential of the tumor or its hormonal activity were included in the study. All patients underwent contrast-enhanced computed tomography and dual-energy scanning in the arterial and venous phases. As part of the postprocessing, virtual unenhanced images from the arterial and venous phases were constructed. Next, the densities of tumors in the native image and virtual unenhanced images were compared.

RESULTS: According to the Wilcoxon test, it was found that for native CT and virtual unenhanced images from arterial phase of DECT we have p=0.148, for native CT and virtual unenhanced images from venous phase of DECT, p=0.072. The coefficient of intraclass correlation=0.984 (95% CI: [0.981; 0.990]) for virtual unenhanced images from arterial phase DECT, and coefficient of intraclass correlation=0.983 (95% CI: [0.973; 0.992]) for virtual unenhanced images from venous phase of DECT.

DISCUSSION: According to the data of the presented study, the absence of a statistically significant difference between virtual unenhanced images and real native images is illustrated.

CONCLUSIONS: The absence of a statistically significant difference between the virtual unenhanced images obtained from the arterial and venous phases of contrast enhancement and the real native images allows using virtual unenhanced images instead of native images in the differential diagnosis of adrenal gland formations. This, in turn, will help to avoid reducing radiation exposure and reduce the scanning time.

INTRODUCTION: Magnetic resonance imaging provides accurate and reliable detection of prostate pathologies, as well as staging of prostate cancer. The capabilities of the method are used in conducting targeted biopsy, treatment, and also for assessing metastatic lesions. Currently, more attention is focused on the possibilities of radiomics and artificial intelligence to improve the diagnostic capabilities of magnetic resonance imaging, in particular to improve the accuracy and timing of detection of formations. Artificial intelligence (AI) technologies have a huge number of potential applications in classifying and improving the quality of multiparametric prostate images, segmenting the prostate gland and suspicious lesions, detecting and differentiating clinically insignificant and significant cancers at the 3D level, and classifying lesions according to the Prostate Imaging Reporting and Data System (PI-RADS).

OBJECTIVE: To evaluate the diagnostic accuracy of automated measurement of prostate size and volume using artificial intelligence.

MATERIALS AND METHODS: A retrospective diagnostic research was conducted in accordance with methodology «STARD 2015». An original methodology for testing and monitoring AI services at life cycle stages was used. The accuracy assessment was carried out by binary classification: correct measurement and incorrect measurement. The proportion of correct measurements was assessed, then the accuracy of the morphometric AI service was calculated using the original formula — the ratio of the number of studies with the doctor’s consent to the measurements of the AI service to the total number of studies successfully processed by the AI service, multiplied by 100.

RESULTS: During the second calibration test, the accuracy of determining the vertical size of the prostate gland was 94.68%, the anteroposterior (sagittal) size accuracy was 97.87%, and the frontal (transverse) size accuracy was 96.81%. Overall, the accuracy of the morphometric AI service in measuring prostate gland size from MRI results was 96.45%.

DISCUSSION: The use of artificial intelligence for the analysis of MRI of the pelvic organs particularly of the prostate gland, has been studied by a limited number of authors. In contrast, automated analysis of studies of the chest organs, mammary gland or brain is significantly more common. Objective reasons explaining this imbalance are difficult to find. In fact, we can only limit ourselves to the standard statement about the lack of data for training algorithms — in the required volume and quality. Most researchers focus on the problems of detection, risk assessment and differential diagnosis of focal lesions of the prostate gland. In particular, among 11 AI-based that have received medical device approval in the USA and/or Western Europe, 5 perform the segmentation function, the other 5 focus on the detection of foci (with 2 presenting the results as a heat map and 3 providing reports), and one solution both segments the gland and calculates «several biomarkers» (e.g., PSA density) while also offering a description project of the study results. It should be noted that, in the latter case, Dice coefficient values for the segmentation task have been published, but data on the accuracy of biomarker calculations are not available.

CONCLUSION: The Moscow Experiment, within the framework of which our research was conducted, represents an impartial and objective external validation, moreover, conducted according to a standardized methodology and with «transparent» results. The task of automating the morphometry of routine measurements of the prostate gland has been successfully implemented. The use of artificial intelligence technologies for the analysis of pelvic organs, in particular, the prostate gland, remains a relevant and little-studied area.

INTRODUCTION: Prostate cancer (PCa) is one of the most common cancer diseases. Approximately 30% of patients undergoing radical prostatectomy develop biochemical recurrence within the first 2 years after completion of treatment. One of the leading and available methods for diagnosing local recurrence of prostate cancer is multiparametric magnetic resonance imaging (mpMRI).

OBJECTIVE: To determine the effectiveness of mpMRI in detecting local recurrence of PCa in patients after radical prostatectomy (RP) with different levels of total prostate-specific antigen (tPSA).

MATERIALS AND METHODS: mpMRI of the pelvis was performed in 118 patients with biochemical relapse of PCa. The criteria for inclusion of patients in the retrospective study were the absence of previous radiation and hormonal therapy. Patients with positive surgical margins were excluded from the study. 46 patients were at low risk of PCa progression, 38 patients were at intermediate risk, and 34 patients were at high risk. Median obPSA 1.72 ng/ml (range 0.22 to 22.19 ng/ml). Median biochemical relapse 11 months. Patients were divided into groups depending on the level of obPSA (I group 0.2–0.5 ng/ml; II group 0.5–1.0 ng/ml; III group 1.0–3.0 ng/ml; IV group more than 3.0 ng/ml). Interpretation of the results was carried out according to the unified reporting system for assessing local recurrence of prostate cancer in patients after RP and RT — prostate imaging recurrence reporting (PI-RR). The probability of local recurrence of prostate cancer depending on the level of obPSA was analyzed using a statistical logistic regression model.

DISCUSSION: Early diagnosis of PCa recurrence includes the need to identify local or distant recurrence, determine its volume and precise localization. mpMRI is highly effective in patients with BCR after RP with a total PSA level of more than 1 ng/ml. With a lower PSA level, the percentage of local recurrence detection is lower, which may be due to the small size of the recurrent lesion. In patients with biochemical recurrence of PCa, when mpMRI data indicate a low or uncertain probability of recurrence (PI-RR 1, 2 and 3), PET/CT with 68Ga-PSMA is recommended to exclude distant and regional metastases, as well as as an additional diagnostic method for detecting local recurrence of PCa.

CONCLUSION: mpMRI is a highly effective diagnostic method for biochemical recurrence of prostate cancer, which allows for a personalized approach to further treatment. A significant relationship was found between the level of total PSA and the probability of detecting local recurrence according to mpMRI data. Local recurrence of prostate cancer is most often detected at a PSA level above 1 ng/ml, with a sensitivity of 91.8% and a specificity of 88.9%. With a lower value of total PSA, sensitivity and specificity decrease. With a recurrence focus value of ≥7.8 mm, local recurrence is confirmed in 90.4% of patients with subsequent histological examination.

INTRODUCTION: According to international and domestic clinical guidelines for assessing the response to treatment in patients with lymphomas according to PET/CT with FDG uses a 5-point PET scale based on changes in the level of uptake of RFLP in tumor masses. Of particular interest when using this scale are 3 points due to the difficulties in interpreting the data obtained in patients when assessing the prognosis of the disease.

OBJECTIVE: Тo calculate and compare such metabolic quantities as the level of FDH absorption and tumor volume in patients with different periods of ED who had 3 points on the PET scale after treatment. Statistics: The MTV was determined using specialized software installed on the AW 4.7 (GE) workstation. The algorithm is an iterative mechanism for classifying the tumor/background within a selected area, applying a tissue weighting coefficient (w) to the SUV MAX values, set by default at 0.5 damage. Logistic regression was used to perform multifactorial analysis and build diagnostic models. The significance of regression coefficients was analyzed, and the odds ratio (OR) and the 95% confidence interval for it were estimated for significant regressors. A ROC analysis was performed to compare the quality of the forecast and select the best models.

MATERIALS AND METHODS: The study included 97 patients with a score of 3 on the PET scale after treatment. In all patients, the tumor volume and the level of RF absorption were calculated in order to compare them. The Kruskal–Wallis test was used for comparative evaluation. The differences were considered statistically significant at the level of p < 0.05.

RESULTS: As a result, the calculation and comparison of the averages of these values were carried out. In patients who underwent PFS for more than two years (n=69), the minimum average value of RF absorption was recorded when comparing the indicators before and during treatment, the difference was 6.5; the maximum average value of RF absorption was observed when comparing the indicators after and during treatment, the difference was 10.8, which is equivalent to 77.1% and 42.3% accordingly. The indicators of RF absorption and tumor volume differ statistically significantly depending on the following pairs of variables: %SUVperv/prom and %SUVperv/otv (p=0.016); %SUVperv/prom and %SUVprom/otv (p=0.045); %MTVperv/prom and % ΔMTVperv/rel (p=0.05).

DISCUSSION: The main differences and at the same time advantages of our study from those presented above are a wider range of included types of lymphomas, in the study of S. Semary et al. (2024) this is only Hodgkin’s lymphoma, in the study of X. Li et al. (2020), David Z. Ng et al. (2022) this is only diffuse B-cell lymphoma, and in the study of H. Y. Yhim et al. (2018) this is peripheral T-cell lymphoma, at the same time, our study includes not only these types, but also follicular lymphoma and mantle zone lymphoma, which blurs the boundaries for expanding the scope of the results. In addition, these studies are based either on an assessment of the prognostic value of the scale itself, that is, on an assessment of only the result — 3 points, or on the use of the result — 3 points and the level of accumulation of RFLP, which distinguishes our study by using and evaluating not only the level of accumulation of RFLP, but also the tumor volume, which, according to X. Li et al. (2020), along with other quantitative values, will not only be more easily reproducible and comparable compared to the 5-point PET scale, but also more effective. In addition, in his opinion, they may turn out to be more accurate. I would also like to note that in our study we did not evaluate the three–year PFS or OS in patients with 3 and 4 points, but drew attention to a shorter period — two-year PFS and only in patients with 3 points on the PET scale, which, in our opinion, is also no less relevant.

CONCLUSION: As a result, it was found that patients with a period of PFS of more than 24 months have statistically significant differences in both parameters, which can be used as an additional factor in predicting the disease.

INTRODUCTION: Prostate cancer is called metastatic castration-resistant (mCRP) when it spreads to organs outside the prostate (for example, lymph nodes, bones, liver or lungs) and no longer responds to hormone therapy. Radium-223 is a radioactive molecule that emits strong radiation in a very small range around itself. It mainly gets into the bone, where the cancer has spread, and has a detrimental effect on cancer cells in this area.

OBJECTIVE: The purpose of the study was to prove the effectiveness, safety and identity of a domestic radiopharmaceutical drug based on Radium-223 chloride in comparison with the original drug. The main criterion for patient selection was diagnosis — metastatic castration-resistant prostate cancer with bone metastases in the absence of visceral metastases.

MATERIALS AND METHODS: The study involved 41 patients with an established oncological diagnosis who underwent planar bone scintigraphy in the «whole body” mode and PET/CT with ¹⁸F-PSMA. In all patients included in the study, the fact of metastatic lesions of the skeleton and the absence of visceral metastases were confirmed according to diagnostic studies before inclusion in the study. The effectiveness was assessed by comparing planar osteoscintigraphy and PET/CT data before treatment, after 4, 6 cycles and 3 months after the end of treatment, and pain syndrome was assessed. The safety of the drug was monitored by the results of the patient’s hematological profile over time before and after each cycle.

RESULTS: In the study group, out of the total number of patients at the start of the study, 8 patients (30.8%), according to instrumental studies, had disease progression in visceral metastases; 4 patients died (15.4%) (3 people from COVID-19 (11.5%), 1 due to progression of the main process (3.9%); in 15 patients (57.7%) stabilization of the process was noted skeletal system. In the control group, out of the total number of patients at the start of the study, 4 patients (26.7%), according to instrumental studies, showed progression of the disease through visceral metastases; 4 patients died (26.7%) (1 — due to progression of the main process (6.7%), 1 person from COVID-19, 1 patient due to heart failure, 1 — with a postmortem diagnosis of pulmonary embolism (20.0); in 8 patients (53.3%), stabilization of the process in the skeletal system was noted.

DISCUSSION: The results of the conducted studies have confirmed the high clinical efficacy and equivalent safety profile of the domestic radiopharmaceutical based on radium-223 chloride compared with the original one.

CONCLUSION: There were no statistically significant differences between the groups of patients, which allows us to conclude that the original and domestic radiopharmaceuticals based on Radium-223 chloride are completely consistent.

Biopsy has limited value and is relatively effective only against cystic tumors for preoperative diagnosis of mediastinal cysts. Noninvasive clinical imaging is relevant here, taking into account the localization of the neoplasm and its relationship to neighboring structures. Non-tumor cysts of the thymus gland (CTG) are divided into monolocular (congenital, primary) and multilocular (acquired, secondary). A clinical case of a 45-year-old woman with a multilocular CTG diagnosed by computed tomography and videothoracoscopically removed is presented. The issues of diagnosis and differential diagnosis of multilocular CTG and their possible connection with COVID 19 are discussed.

Mediastinal hemangioma is a rare benign tumor which can sometimes mimic the clinical presentation and radiological findings of malignant tumors. Here we present a rare case of cavernous hemangioma in the mediastinum in a patient with colorectal cancer, which required histologic verification before onset of treatment. Type of contrast enhancement, presence of drainage veins and calcification are typical characteristics of hemangioma.