INTRODUCTION: In people who have experienced a new coronavirus infection (COVID-19), long COVID disorders can manifest as persistent cognitive and neuropsychiatric disorders that endanger daily activities and psychosocial adaptation. The long-term persistence and polymorphism of symptoms after COVID-19 is a growing concern. It is characterized by undulation, when some of the symptoms may temporarily disappear and then return again. As of 2024, the prevalence of long COVID is 6–7% in adults and about 1% in children. Using neuroimaging techniques is an integral part of the timely diagnosis of acute disorders and consequences associated with COVID-19.

OBJECTIVE: To assess the nature of health complaints, features of neurological and cognitive disorders and compare them with radiological changes in the brain in people in the post-COVID period.

MATERIALS AND METHODS: For the period from 2023–2024, 170 patients aged 18 to 60 years participated in the study, with a history of established fact of COVID-19, confirmed by polymerase chain reaction (PCR) SARS-CoV-2. The main socio-demographic and clinical and laboratory indicators were evaluated for all participants, with further radiological examination. As part of the neuropsychological examination, the Montreal Cognitive Assessment Scale (MoCA), «10 words» by A.R. was evaluated. Luria, «Schulte Tables», neuropsychological tests to study the state of praxis and the state of various aspects of gnosis, as well as a subjective assessment of 38 symptoms, which included: memory impairment, concentration, fatigue, anxiety, the presence of panic attacks, pain of various localizations, etc. The neuroimaging examination included structural MRI and  1 H-MRI, performed on a SIGNA Architect 3 Tl tomograph (GE HealthCare, General Electric, USA).

RESULTS: The majority of the (n=170) was represented by women (80%). Over  ²⁄₃ of the respondents belonged to the working-age population; the average age was 38.2±11.3 years. The most common symptoms of the acute phase of NCI were: an increase in body temperature above 38˚C, shortness of breath during physical exertion, and impaired consciousness. Most often in the post-COVID period, patients presented the following non-specific complaints: hair loss (56.6%), decreased/increased appetite (52.6%), pain in different parts of the abdomen (45.7%), fluctuations in blood pressure, the frequency of which increased with increasing age (p<0.05). The frequency of complaints about fluctuations in blood pressure and hair loss was associated with a more severe COVID-19 (p<0.05). According to the results of the neurological examination, 53.8% of the respondents had some kind of disorder related to the functioning of the structures of the central and peripheral nervous systems. The most common in people in the post-COVID period were anxiety and depressive disorders (30%), insomnia (14.6%), tension headache (13.1%), and amnesia syndrome (6.2%). Dysthymia (2.3%), migraine (2.3%), asthenic syndrome (2.3%), persistent perceptual postural dizziness (3.1%), mild cognitive impairment (1.5%), etc. were also detected. With MoCA, a significant decrease in the general state of cognitive functions was found in 7.7% of respondents in the post-COVID period. The conducted experimental psychological examination revealed the following leading violations of the higher mental functions of individuals: a decrease in long-term memory (7.7±1.7 with a norm of 8), insufficiency of the memorization process (9.2±1.1 with a norm of 10), a decrease in attention stability (1.01±0.3 with a norm of <1), significant difficulties in performing samples of spatial praxis (errors were made in 43.6%), and optical-spatial gnosis (only 5.7% coped without errors). Attention is drawn to the severity of symptoms of asthenia, which 64.9% of participants complained about after suffering COVID-19. In the results of MRI studies, the most common signs were general cortical atrophy (45%), focal changes (35%), cystic changes in the pineal body (25%), and signs of hippocampal atrophy (15%). Changes in the ratios of metabolites were noted in the MRC results – a decrease in NAA/Cr (20%), and an increase in Cho/Cr (20%), an increase in mI were noted in 10% of cases.

DISCUSSION: The results obtained within the framework of neurological and neuropsychological examination indicate the presence of a predominantly modal-nonspecific factor lesion, that is, changes in the processes of activation/inactivation of brain structures, contributing, among other things, to the occurrence of the above-mentioned anxiety and depressive states. The described disorders indicate the leading role of damage to the structures of the first block of the brain according to A.R. Luria, indicating the presence of damage in persons in the postcovid period in the area of the mediobasal cortex of the frontal lobes, hippocampus, and stem structures. In addition, imaging ultrastructural data (MRS) has the potential to be a neuromarker of manifestations of post-COVID neurological syndrome.

CONCLUSION: Post-COVID syndrome is characterized by multi-systemic manifestations, while central nervous system lesions can be attributed to the most common complications of infection caused by SARS-CoV-2. The conducted study demonstrates the high frequency and versatility of manifestations of post-COVID disorders on the part of the nervous system, regardless of the severity of the disease, which in some cases were reflected in the framework of radiological studies. Future work involves the use of complex clinical, radiological, laboratory immunological, virological and genetic techniques to search for predisposing factors, understand the mechanism of pathogenesis, and possible ways to influence and prevent the development of postcovid syndrome.

INTRODUCTION: Soft tissue tumors are a diverse group of growths that can occur anywhere in the body. While sarcoma only account for about 1% of all malignant neoplasms, they come in many different types and often recur after treatment. This makes accurate diagnosis and monitoring of these tumors and postoperative scars essential.

OBJECTIVE: To analyze scientific works of the latest 5 years, which examined medical imaging techniques, specifically multiparametric ultrasound and MRI, and assess their effectiveness in diagnosing soft tissue tumors, including sarcomas and their recurrences.

MATERIALS AND METHODS: Search queries were performed in the Google Scholar, PubMed and Web of Science databases and were based on the keywords: «sarcoma of soft tissue», «soft tissue tumor», «soft tissue Ultrasound», «soft tissue MRI», «soft tissue CEUS».

RESULTS: The literature analysis determined that multiparametric contrast-enhanced ultrasound is more effective in diagnosing soft tissue tumors than studies without contrast and can be comparable in accuracy to magnetic resonance imaging. However, the accuracy rates reported in publications on this topic were significantly influenced by factors such as the criteria used to select patients, the design of the studies, and the size of the samples.

DISCUSSION: This review shows that developing an optimal diagnostic algorithm for soft tissue tumor requires a comprehensive approach considering both the strengths and weaknesses of individual methods and the potential of cost-effective new technologies to improve diagnostic quality.

CONCLUSION: Additional research needs to investigate all modes of multiparametric ultrasound and magnetic resonance imaging, as well as the role of echo contrast both in a diagnostic algorithm for detecting soft tissue tumors and in monitoring after surgical resection for sarcomas.

INTRODUCTION: Accumulation of excess iron in the body or systemic iron overload occurs for various reasons, mainly as a result of inherited disorders of iron regulatory pathways, long-term and/or regular blood transfusions, uncontrolled breakdown of hemoglobin in hemolytic anemias, hematological malignancies. Mild iron overload can be associated with chronic liver disease and metabolic syndrome (dysmetabolic iron overload).

Despite optimal control of chelation, iron is deposition in vital organs such as the liver, heart, endocrine glands and subsequently damaged. Liver Iron Concentration (LIC) is linearly related to total body iron stores and may contain about 70% of the iron in the body. The introduction of MRI into the examination algorithm for patients with storage diseases provides the opportunity for early diagnosis of iron overload and monitoring the effectiveness of therapy.

OBJECTIVE: To summarize the current state and prospects for the clinical use of MR methods for quantitative assessment of iron content in the liver.

MATERIALS AND METHODS: An analysis of the main publications of domestic and foreign literature on non-invasive assessment of the degree of liver iron overload over the past 10 years was carried out in the main medical databases: Medline/PubMed, RISC/Elibrary, CyberLeninka, Google Scholar.

RESULTS: It was revealed that the main methods of MRI noninvasive assessment of the iron content in the liver are SIR and R2* – relaxometry. The latter defines modern approaches to both qualitative and quantitative assessment of iron overload, providing a linear correlation with LIC. Information about diffuse changes in the parenchyma is important, since the presence of fat deposits in the liver can lead to an increase in R2*, therefore, a simultaneous quantitative determination of iron and fat deposits in the liver is completely rational.

CONCLUSION: Diagnosis of liver iron overload is necessary to control and adjust the optimal treatment to prevent side effects of chelation therapy. To this end, the use of MRI has an enormous role, since the simultaneous acquisition of quantitative data on R2* and PDFF allows a comprehensive assessment of fat content and the degree of iron overload, which is not available to other imaging methods. The introduction of multiparametric liver MRI protocols with adaptation to new software will allow us to reach a new level of diagnosis of liver diseases.

MRI is the main tool for visualization, quantification and identification of the risks of liver iron overload. Modern multiparametric MRI of the liver has promising clinical significance for the quantitative assessment of iron deficiency and the degree of steatosis in the complex diagnosis of diffuse liver diseases.

INTRODUCTION: The terminal form of prostate cancer known as metastatic castrate-resistant prostate cancer (mCRPC) is a progressive disease with limited therapeutic options and poor survival prognosis. Therefore, there is a high demand for more effective (targeted) strategies of systemic therapy. Radioligand therapy (RLT) offers the possibility to treat mCRPC in a specific and tumor-selective manner by targeting prostate-specific membrane antigen (PSMA), which is overexpressed by prostate tumor cells.

OBJECTIVE: To analyze the efficacy and safety of RLT of mCRPC using low molecular weight PSMA inhibitors labeled with alpha-emitting radionuclide ²²⁵Ac based on the literature data.

MATERIALS AND METHODS: Literature search was performed during a period of 01.04.2024 to 27.04.2024 in Russian and English language in databases Medline/PubMed, Google Scholar, RINC/Elibrary using the following keywords: actinium-225 (²²⁵Ac), PSMA, ²²⁵Ac-PSMA, radioligand therapy of prostate cancer.

RESULTS: This review presents the current worldwide experience of mCRPC RLT using low-molecular-weight PSMA inhibitors labeled with the alpha-emitting radionuclide 225Ac. Data on the efficacy of RLT with ²²⁵Aс-PSMA-617 and ²²⁵Aс-PSMA-I&T as well as the results of tandem therapy are presented. The toxicity of this treatment is discussed in detail, and ways of their avoidance or reduction their intensity are reviewed.

DISCUSSION: RLT with ²²⁵Ac-PSMA ligands is an effective and safe strategy for mCRPC therapy, including tumors, which are resistant to conventional therapies, and also in case of inefficacy of RLT with ¹⁷⁷Lu-PSMA. More than a half of treated patients had PSA levels declined greater than 50%. The most common complication of RLT is xerostomia.

CONCLUSION: RLT with ²²⁵Ac-labeled PSMA-specific ligands is a promising therapy for patients with mCRPC, who have exhausted all possible antitumor therapies.

INTRODUCTION: Idiopathic normal pressure hydrocephalus (NPH) is a condition characterized by enlargement of the cerebral ventricles and an isolated disturbance of cerebrospinal fluid dynamics, the etiology and pathogenesis of which are still not fully determined.

OBJECTIVE: To evaluate changes in hemo- and cerebrospinal fluid dynamics in idiopathic normal pressure hydrocephalus according to phase-contrast MRI data.

MATERIALS AND METHODS: Three groups of subjects were formed: patients with NPH (12 people), elderly volunteers with atrophic ventriculomegaly (15 people), a group of healthy volunteers (15 people). For each subject, the data from a routine MRI study, the volumes of gray, white matter and cerebrospinal fluid were assessed, and the volume-velocity characteristics of CSF and blood flows at several levels were calculated.

Statistics: For quantitative indicators of cerebrospinal fluid dynamics, the median (Me), 25% and 75% percentiles, and interquartile range were calculated. An intergroup assessment of the significance of differences was carried out using the Mann-Whitney U test and nonparametric multivariate analysis of variance MANOVA.

RESULTS: Individual neuroimaging markers of IGT were determined, as well as an increase in the volume-velocity characteristics of CSF flow at the level of the cerebral aqueduct (p<0.01, with a predominance of the retrograde component) in comparison with the control group and patients with atrophic ventriculomegaly. Multidirectional changes in the volume of intracranial venous outflow were revealed in the study groups: in patients with IGT – a decrease in outflow along the straight sinus by 1.4 times (p<0.01), in patients with atrophic ventriculomegaly – a decrease in outflow along the superior sagittal sinus by 1.3 times (p<0.05).

DISCUSSION: The data obtained show a significant impairment of cerebrospinal fluid dynamics in patients with NPH, in contrast to elderly volunteers with age-related atrophy and replacement expansion of the cerebrospinal fluid spaces at the level of the brain aqueduct, and also indicates the importance of the venous link in maintaining intracranial volumetric interactions.

CONCLUSION: The combined use of a routine protocol and phase-contrast MRI techniques made it possible to identify a number of neuroimaging, hemo- and CSF dynamic changes in patients with NPH in comparison with healthy volunteers, and also, most importantly, with patients of comparable age with the presence of replacement ventriculomegaly against the background of atrophy.

INTRODUCTION: The presence of steadily progressive neurological deficit in patients with multiple sclerosis (MS) is the main indication for complex rehabilitation with the involvement of a multidisciplinary team of specialists. A detailed analysis of changes in brain connectivity may provide a better understanding of which compensatory brain mechanisms contribute to productive rehabilitation. MRI markers of neurorehabilitation, on the other hand, can facilitate the standardization of rehabilitation measures, help ensure an individual approach and objectify the results of the treatment process. It should be noted that the possibility of using functional resting state MRI (rs-fMRI) as a technique for assessing the results of neurorehabilitation has still not been sufficiently studied.

OBJECTIVE: To evaluate early and delayed changes in the brain connectome in patients with multiple sclerosis before and after complex neurorehabilitation by using resting state functional MRI.

MATERIALS AND METHODS: The study involved 15 patients with multiple sclerosis (EDSS 1.5–6). A comprehensive neurological examination was performed before and after comprehensive inpatient neurorehabilitation. Resting state functional MRI was performed at three control points: before admission, within 3–5 days after completion of neurorehabilitation, and within 25–30 days after discharge.

Statistics: Statistical processing and evaluation of fMRI data results was carried out using the CONN v.22 software package (p-FDR<0,05).

RESULTS: A decrease in connectivity between the regions of the default mode network of the brain (DMN), the subcallosal and occipital cortex (T= –8,34, Т= –9,12), and an increase in connectivity between the regions of the DMN and the left superior parietal lobule were revealed (T=11,72). There was also increased connectivity between the left superior parietal lobule and elements of the salience network (Т=8,38). Connectivity between visual network components and the right frontal lobe increased (Т=7,04), while connectivity with the left frontal and temporal lobes decreased (Т= –8,69, T= –17,68).

DISCUSSION: A decrease in connectivity in the elements of the DMN in patients indicates the stabilization of its functioning and the restoration of the connection between it and the subcallosal cortex, which belongs to the limbic system. A decrease in connectivity between the lingual gyrus and the DMN regions and a simultaneous increase in connectivity with elements of the right frontal lobe may indicate an increase in the functioning of the directed action system. The identified increase in connectivity between elements of the salience network and the left superior parietal lobule may indicate an improvement in the functioning of the sensorimotor system, incl. its conscious components. Increased connectivity between elements of the medial visual network and the right frontal lobe may also indicate an increase in the quality of directed sensorimotor actions, incl. in the «vision-hand» system. Reduced connectivity between elements of the right occipital lobe and the right sections of the somatosensory network, responsible for the perception of space, the location of the limbs, as well as with the left frontal visual field, precuneus and left inferior temporal gyrus, more probably associated with a reorganization of the structures of directional eye movement and attention.

CONCLUSION: The identified early and late changes in the functional networks of the brain indicate a decrease in the pathological activity of the network of the default mode of the brain, an increase in the activity of structures involved in sensory processing of space (including visual and auditory), as well as an increase in the activity of the salience network and elements of information processing from analyzers of proprioceptive sensitivity.

INTRODUCTION: Acute chemical poisoning with alcohol-containing products represents a pressing and socially significant health issue.

OBJECTIVE: To analyze changes in the brain associated methanol poisoning and lung complications using to CT and traditional X-ray examination, observe how these changed evolve over time, and compare them with the pathomorphological findings.

MATERIALS AND METHODS: Between 2017 and 2024, 80 patients aged 23 to 77 years (mean age: 44.2 years; men – 68; women – 12), were admitted to the Center for Acute Poisoning at the State Budgetary Institution «Research Institute of Emergency Medicine named after. I. I. Dzhanelidze» with signs of acute methanol poisoning. Of these, 45 patients died, and 35 were discharged. CT imaging of the brain was not performed in 13 deceased patients due to their extremely severe condition, as death occurrent within 2–3 hours to 24 hours of admission. CT was not conducted due to their stable condition, where no indications were present.

RESULTS: CT was performed in 50 patients (in 62.5% of cases). Of these, 22 patients (44%) exhibited normal brain structures and parameters with no pathological changes; while 28 patients (56%) demonstrated pathological changes. These included diffuse edema in 17 (60.7%) and hemorrhagic complications in 9 (32.14%).

CONCLUSION: In this study, diffuse brain edema, various types of hemorrhagic changes, and combination of hemorrhagic complications with diffuse edema. These radiological changes corresponded with the pathological findings observed during the forensic medical examination (FME). The data obtained can contribute to the refinement of diagnostic algorithms and the enhancement of medical care for methanol poisoning.

INTRODUCTION: In modern clinical practice, the diagnosis establishment and monitoring of pulmonary arteries are important components of care for patients with cardiovascular and respiratory diseases. However, in Russia, there remains a limited amount of epidemiological data on the prevalence of pulmonary artery dilation, especially at the population level.

This study aims to fill this gap by providing population-based data on the prevalence of pulmonary artery dilation in the city of Moscow. With the help of advanced artificial intelligence technologies, this work seeks to offer a comprehensive assessment of the pathology, covering both its main characteristics and the effects of various factors such as age and gender.

OBJECTIVE: To investigate the prevalence of pulmonary artery dilation in Moscow using the data from computed tomography (CT) scans of the chest analysed by means of an automatic artificial intelligence technology.

MATERIALS AND METHODS: The study involved the analysis of a large volume of chest CT scans acquired from September 2022 to February 2023. The total study sample comprised 134,218 patients. Artificial intelligence technologies were applied for the automatic detection of signs of pulmonary artery dilation.

RESULTS: An analysis of 125,878 CT scans, including 57,913 men and 67,965 women, revealed that 34.4% of patients (43,242 individuals) showed signs of pulmonary artery dilation. Among them, the proportion of men with this pathology was 35.6% (20,630 individuals), while for women it was 33.3% (22,612 individuals). The prevalence of the pathology increased with age, starting at 14.8% among younger patients and reaching 62.7% among the elderly. The prevalence of pulmonary artery dilation among the population of Moscow was 794.7 cases per 100,000 people.

DISCUSSION: The results of this research allowed us to draw conclusions regarding the meaning of pulmonary artery dilation as a predictor of pulmonary hypertension. The results demonstrated a correlation between the frequency of pathology occurrence and gender and age groups, with a more pronounced association observed in women. Detailed analysis also revealed corellations of pulmonary artery diameter with age and gender.

CONCLUSION: The study provided the first population-based data on the prevalence of pulmonary artery dilation in Moscow. The importance of early diagnosis to prevent severe complications, especially in patients with chronic lung diseases, is emphasized. The study results can provide a basis for screening strategies and treatment approaches for this pathology.

INTRODUCTION: Associated with the development of radiopharmaceutical therapy with ¹⁷⁷Lu (¹⁷⁷Lu-DOTA-TATE, ¹⁷⁷Lu-PSMA-617), the issue of radiation protection of the public becomes important. Nowadays, national regulatory and methodological documents on radiation safety do not contain release criteria of patients after radiopharmaceutical therapy with ¹⁷⁷Lu. Existing approaches to determining the release criteria after radiopharmaceutical therapy do not consider radiation exposure from the patient during long-term contact with the patient (up to several days in a confined space) and possible of generation of biological waste containing ¹⁷⁷Lu in public transport during the first hours and days after release. In order to choose an optimal approach to determine release criteria, it is necessary to assess the radiation exposure from the patient on different categories of people from the public.

OBJECTIVE: Estimation of radiation exposure of people from public from patient after radiopharmaceutical therapy with ¹⁷⁷Lu considering the radioactive biological waste containing ¹⁷⁷Lu.

MATERIALS AND METHODS: The time of patient release from the hospital was determined upon reaching the previously proposed release criteria based on the patient dose rate. The ambient dose equivalent rate for the patient after therapy with ¹⁷⁷Lu labeled radiopharmaceuticals were determined based on the experimental data available in the literature. Various scenarios of exposure of individuals in contact with the patient after release from the hospital were developed; effective doses after contact with the patient were estimated based on the developed scenarios. The activity of ¹⁷⁷Lu generated in patient biological waste after therapy was determined as well. Based on the assessments, activity concentration of ¹⁷⁷Lu was determined in wastewater of residential sewage systems and in transport during patient traveling to the place of residence. Using specialized MCNP software, the doses of public exposure in transport from ¹⁷⁷Lu generated in wastewater in tanks of transport biotoilets were modeled and estimated.

RESULTS: Doses to some categories of people from the public after the contact with a patient released immediately after administration of a radiopharmaceutical with ¹⁷⁷Lu may exceed the dose limit of 1 mSv, but release in 4–6 hours after therapy when the release criterion is reached, established in accordance with the approach of NRB-99/2009, will not lead to dose limit exceedance. The activity concentration of ¹⁷⁷Lu, generated in transport biotoilet tanks after the patient with ¹⁷⁷Lu travelling, exceeds the limit value for classifying liquid waste as radioactive (0.025 kBq/g). Doses to passengers and crew members may be higher than 100 μSv. Doses from a patient may be higher than 1 mSv after release of patient in 4–6 hours in the case of a long-distance travel (several days on a train).

DISCUSSION: Exceeding the dose limit to the public is unacceptable and therefore the patient cannot be released immediately after ¹⁷⁷Lu administration. Due to the likelihood of exceeding passenger and crew dose limits in transport during long-distance travel of a patient with administered ¹⁷⁷Lu, it is necessary to limit the travel of patients by long-distance trains.

CONCLUSION: To ensure radiation safety of the public, the optimal approach is the previously used approach when establishing release criteria in NRB-99/2009 for other radionuclides. According to this approach, the value of the release criterion for the dose rate at 1 meter from the patient after therapy with ¹⁷⁷Lu is 29 μSv/h. The greatest questions in terms of radiation safety arise when releasing non-residence patients who will have to get to their place of residence in distant regions. Thus, it is reasonable to limit the patient traveling after radiopharmaceutical therapy with ¹⁷⁷Lu using long-distance trains (instead of it is recommended to use air transport).

Central nervous system neuroblastoma is a rare, usually metastatic (secondary) high-grade embryonal tumor, occurring in the early stage in less than 10% of cases. Generally, when malignant cerebral tumors are detected in adults, inclusion of primary neuroblastoma in the differential diagnosis naturally does not arise. The differential diagnosis consists mainly of high-grade glial tumors, metastatic lesions and cerebral lymphoma. Thus radiology, realized by multiparametric MRI mapping, is a decision making procedure. In thus publication we present a rare case of primary central nervous system neuroblastoma in a 32-year-old patient.