INTRODUCTION: From the very beginning of the theoretical substantiation of the creation of artificial intelligence, there were ideas about creating an electronic assistant for a doctor. The most effective for solving such a problem in medical diagnostics are complex systems based on one of the most advanced methods of artificial intelligence — neural networks. Study design: a systematic review.

OBJECTIVE: Determining the capabilities of neural networks at the current stage of their development in the field of such tasks as segmentation and detection of spine images.

MATERIALS AND METHODS: Using the PRISMA protocol, a search was performed in the Pubmed database for the period from January 2017 to December 31, 2022 using keywords «deep learning» OR «neural network» OR «artificial Intelligence», AND («spine») AND («detection» OR «segmentation»).

RESULTS: For the systematic review, 30 articles were selected that described such functions of neural networks as segmentation and detection in the analysis of spinal images. DISCUSSION: Based on the analysis of literature sources, conclusions were made about the usefulness of using artificial intelligence at the current stage of development in vertebrology.

CONCLUSION: Neural networks cope quite well with the tasks of segmentation and detection in vertebrology. In segmentation tasks, there is a clear leader — U-Net and its various modifications. In detection, the leading architectures are: SCRL, 3D FCN, CNN of our own design and a combination of Mask R-CNN+ResNet101 networks. Software based on the work of artificial intelligence can help both a radiologist and a vertebrologist reduce the load and simplify the work by automating and semi-automating the diagnostic process.

INTRODUCTION: Over the past ten years, advances in prenatal diagnosis have led to a steady increase in newborn patients with isolated vascular rings (VR). Fetal echocardiography allows us to change the natural history of patients with VR due to timely diagnosis and the possibility of earlier surgical intervention, probably even before the clinical manifestation of the defect in certain anatomical groups. However, how best to diagnose and treat these children remains uncertain.

OBJECTIVE: To assess the impact of prenatal diagnosis on postnatal management of newborns with isolated VR according to the available literature.

MATERIALS AND METHODS: A literature search was performed in Russian and English for the period from 2010 to 2023 in Medline/PubMed, RSCI/Elibrary databases by keywords: vascular ring, double aortic arch, right aortic arch, aberrant subclavian artery, Kommerell’s diverticulum, newborn, surgical treatment, fetal echocardiography.

RESULTS: At the present stage, there is no mention of vascular rings in national recommendations, that is, there is no generally accepted clinical and diagnostic tactics for managing patients with VR. A review of the present data will help provide recommendations regarding the optimal management of neonates with prenatally diagnosed VR.

CONCLUSION: Advances in fetal imaging provide an opportunity to better understand the anatomical spectrum of nonobstructive aortic arch anomalies, clinical presentation, and need for surgical intervention in an emerging cohort of patients. The accumulation of knowledge and improvement of diagnostic and treatment capabilities dictates the need to analyze and rethink the currently available scientific information on the feasibility and methods of postnatal diagnosis verification, as well as determining indications for surgical treatment in the modern population of patients with VR in order to select the optimal approach and improve the expected treatment results.

INTRODUCTION: Radiomics is the analysis of medical images to assess the structure of a tumor by extracting a large number of quantitative features. The review describes the process of conducting texture analysis and creating radiomics models.

OBJECTIVE: Тo analyze literature data on the technology, prospects and problems of radiomics of CT images of the abdomen.

MATERIALS AND METHODS: A study of the international literature on texture analysis was performed, and the reported data was compared to the findings of radiomics studies performed by the specialists of our institute. A search was conducted for scientific publications in the information and analytical system PubMed for 2018–2024, which essentially focused on the abdominal CT radiomics by keywords: «radiomics», «CT», «texture analysis», «pancreas», «liver», «metastases» and «GIST».

RESULTS: The literature review describes the methods, directions and prospects of radiomics, the problems of using texture analysis in clinical practice and ways to solve the presented problems.

CONCLUSION: Radiomics is a promising method that can be used in medicine for diagnostics. However, there are currently limitations to the application of radiomics in clinical practice. In the presented literature review, we described the process of radiomics, using mainly studies on radiomics of CT images of the abdomen.

INTRODUCTION: Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive diagnostic method for diseases of the biliary tract and pancreas. It provides high-quality images that help physicians diagnose pathologies without the use of ionizing radiation. Despite its widespread use, there are problems associated with image quality, breathing artifacts, lack of standards, and scanning duration.

OBJECTIVE: To analyze the problems arising in the clinical practice of MRCP and evaluate theoretical approaches to their solution.

MATERIALS AND METHODS: Articles from the PubMed, Web of Science, and Scopus databases were used for the review. Attention was paid to studies of the last five years devoted to new visualization methods and theoretical approaches to solving current problems of MRCP. A total of 36 publications were selected and analyzed.

RESULTS: The main problems of clinical application of MRCP include respiratory artifacts, lack of standardized monitoring protocols in primary sclerosing cholangitis (PSC), scanning time and the need to develop shortened protocols for emergency diagnostics. To correct respiratory artifacts, compressed probing (CS) and parallel imaging (PI) methods have been proposed, which improve image quality and reduce scanning time.

DISCUSSION: The review discusses the use of CS and PI methods to improve image quality and reduce scanning time. Accelerated MRCP protocols have been developed for emergency diagnostics, which is especially important for patients with acute conditions. Standardized monitoring protocols for patients with PSC are needed for early diagnosis of malignant neoplasms.

CONCLUSION: MRCP is an important tool in modern diagnostics, but its application faces a number of problems that can be solved through the use of modern technologies, such as CS and PI. The development of new protocols and standardization of monitoring approaches will improve the efficiency of diagnostics and clinical outcomes.

INTRODUCTION: One of the main difficulties in prognosis and treatment planning in children with brainstem glioma is rare histological verification of the diagnosis, which prompts increased attention to non-invasive diagnostics using neuroimaging.

OBJECTIVE: To study the metabolic characteristics of brainstem and thalamic tumors in children using PET/CT with ¹¹Cmethionine (Met) in association with MRI results.

MATERIALS AND METHODS: The study included the results of Met PET/CT in 63 children aged 3 to 18 with brainstem gliomas who underwent contrast-enhanced MRI (CE) and ¹¹C-methionine PET/CT before treatment. The analysis was performed on fused PET and MRI images and consisted of visual assessment and calculation of Met tumor-to-brain ratio (TBR) and the metabolic tumor volume.

RESULTS: Tumors were divided into two groups: diffuse intrinsic pontine gliomas (DIPG) and other gliomas (OG). Significant differences between DIPG and OG were found in lesion size and initial tumor bed. No differences were found in the frequency of tumor contrast enhancement (p=0.21). Met high uptake was observed in 72% of DIPG and in 58% of other gliomas without significant differences (p=0.25), but TBR depended on the reference structure: cerebellum or frontal cortex (p=0.00001). Positive or negative Met tumor uptake, as well as TBR, were not associated with either the tumor type or its localization. The relationship between tumor enhancement and Met uptake pattern was found in DIPG.

DISCUSSION: Variability in amino acid transport and metabolism in brainstem tumors did not allow a reliable discrimination between tumor types, which may be due to the similar phenotypic features in DIPG and OG affecting Met uptake. The data obtained are consistent with the results of studies by other groups of authors, which showed that the greatest prognostic value for brainstem tumors is not the histological structure, but the glioma genotype.

CONCLUSION: The absence of a specific pattern of methionine transport and metabolism disorders for diffuse midline glioma limits the significance of metabolic biomarkers in the diagnosis and differential diagnosis of brainstem tumors.

INTRODUCTION: Spinal cord injuries in children account for up to 10% of all injuries in children, but remain a significant problem, as they often lead to serious consequences, including disability. Traditional MRI does not allow detecting differences in undamaged parts of the spinal cord in either the acute or chronic period. Introduction of diffusion tensor imaging (DTI) into the protocol for examining damaged spinal cord allows detecting even minimal but significant microstructural abnormalities.

OBJECTIVE: Тo evaluate, using DTI, microstructural changes in the ascending and descending fibers of the cervical spinal cord above the level of injury in patients with spinal cord trauma at different periods after injury.

MATERIALS AND METHODS: The study included 39 children aged 12 to 18 years (mean age 14.3±1.8 years) with spinal cord injury below the level of the Th3 vertebra, including: 21 patients with complete spinal cord injury — grade A according to the ASIA classification (group A), 18 patients with incomplete spinal cord injury — grade B-D according to the ASIA classification (group B). The study was performed on an MRI scanner 3.0 T Philips Achieva dStream. The following DTI parameters were taken into account: FA, AD, MD, RD.

RESULTS: In the area of lateral corticospinal tract, a decrease in FA value and an increase in RD value for patients of group A compared to the control group during the recovery period were revealed. In the area of the dorsal funiculi, a decrease in FA values for patients of group A is observed already in the subacute period after injury.

CONCLUSION: DTI is a convenient tool for analyzing the post-traumatic spinal cord, since it allows not only to detect changes that are not visible with other research methods, but also to obtain quantitative characteristics, which allows on their basis to form objective criteria for assessing state of spinal cord, which can then be used to monitor the treatment and rehabilitation of children with spinal cord injury.

INTRODUCTION: Postresuscitation disease (PRD) in acute poisoning with narcotic substances is an actual problem of intensive care and clinical toxicology. Radiation changes of the brain in this pathology are insufficiently covered in the Russian literature.

OBJECTIVE: Тo determine the main brain changes according to computed tomography (CT) data in patients with acute drug poisoning who have suffered clinical death.

MATERIALS AND METHODS: 22 patients who suffered clinical death from acute poisoning with various narcotic substances were examined. CT scans were performed to study brain changes.

RESULTS: A CT scan of the brain was performed in 22 patients (due to the critical condition, 5 patients could not perform a CT scan of the brain), of which 16 patients revealed pathological changes (3 types of brain changes), which are described in the article.

DISCUSSION: Patients after cardiac arrest are susceptible to hypoxic-ischemic damage to organs and systems, while the brain is most susceptible to hypoxia. The presence and extent of these injuries is important for treatment tactics, prognosis, and rehabilitation. It is possible to assess the degree of damage to the GM after clinical death in acute drug poisoning in the first hours after resuscitation and stabilization with CT.

CONCLUSION: CT scan of the brain in patients with acute drug poisoning who have suffered clinical death is necessary to diagnose pathological changes in the brain and provide individual, targeted therapeutic interventions aimed at reducing the severity of hypoxic-ischemic injuries.

INTRODUCTION: Accurate criteria of norm and pathology, as well as assessment of the degree of risk of adverse outcomes, are necessary to determine the managing of children with dilated calyx-pelvic system (CPS). The new classification of urinary tract dilation (UTD 2014) was created to standardize the primary ultrasound examination (US) and further management of such patients, but it needs validation in clinical practice.

OBJECTIVE: The aim was to compare two classifications of the dilation of the CPS (UTD and SFU) in predicting the need for surgical treatment of uropathies in children.

MATERIALS AND METHODS: The retrospective study included 152 children with dilated CPS due to various uropathies. The results of US of the urinary tract in accordance with the SFU and UTD classifications and the analysis of the frequency and time of surgical interventions for the correction of uropathies were evaluated.

Statistics: The data are presented as median, minimum and maximum, interquartile range. The Kraskal-Wallis method and the Mann–Whitney U-test were used to compare the groups. Surgery-free survival curves were constructed using the Kaplan-Meyer method. The diagnostic significance of the prognostic model was assessed by the ROC curve method. The differences were considered significant at p < 0,05.

RESULTS: The median age of patients at the time of the first US was 4 days, the median follow–up was 10 months. Surgical treatment was performed in 27 (18%) patients: 0/8/35/60% of patients with SFU categories I/II/III/IV; 0/2/31/60% of patients with UTD categories 0/I/II/III, respectively. Both classifications made it possible to stratify the risk of surgical intervention with high accuracy (AUC 0,836 and 0,873 for SFU and UTD, respectively). Surgery-free survival curves of patients differed depending on the SFU category, however, the differences between SFU I and II, as well as SFU III and IV were not significant; the curves of UTD 0 and I practically coincided, while the differences between the other UTD categories were statistically significant (p≤0,001).

DISCUSSION: The main differences between the UTD and the SFU classifications is that, besides to describing the CPS and renal parenchyma, US characteristics of the ureters and bladder were added, and a lower threshold value of the anterior-posterior pelvis size was proposed — its isolated expansion to 10 mm is considered a variant of the norm (according to SFU — 5–7 mm). The data of our study demonstrated that the new standards for the pelvis size do not lead to an underestimation of the risk of uropathies in children, and additional US signs make it possible to stratify the risks not only for patients with isolated hydronephrosis, such as SFU, but also for patients with other uropathies (vesicoureteral reflux, obstruction of the ureterovesical junction, ureterocele).

CONCLUSIONS: The UTD has high accuracy in predicting the need for surgical intervention in children with dilated CPS and is not inferior to the SFU in this. Isolated expansion of the pelvis to 10 mm and central calyces does not increase the likelihood of surgical treatment and can be regarded as a variant of the norm.

INTRODUCTION: Тhe development of new methods of radical treatment of prostate cancer (PCa) aimed at maintaining a high quality of life is the most important task of modern oncourology. Radiation therapy with a dose reduction to the area of critical vascular erectile structures is one of them.

OBJECTIVE: Сompare different approaches for «vessel-sparing» stereotactic radiation therapy (VS-SRT) PCa.

MATERIALS AND METHODS: Тhe study included 20 patients with histologically confirmed PCa of low and intermediate risk of recurrence (NCCN). SRT was planed at five fractions of 7.25 Gy. During planning we ad to the standard critical organs, vascular structures that are responsible for erectile function (ErOAR)): penile bulb (PB), crura of the cavernous bodies (CCB) and internal pudendal arteries (IPA)). For each patient, four dosimetric plans (DP) were calculated: «vessel-sparing» (DP-VS); standard (DP-S); «vessel-sparing» plan calculated in the formation of the generally accepted anisotropic indent of 5 mm for the planned volume of irradiation and a step towards the rectum — 3 mm (DP-5/3); «vessel-sparing» plan for irradiation using a 0.5-centimeter multi-life collimator (DP-0.5). All dosimetry plans, with the exception of DP-0.5, were generated for a linear accelerator with a 0.25 cm multi-leaf collimator.

RESULTS: Аll dosimetry plans, were cherecterized by exellent target coverage abd meet the prescribed limits for the critical organs. Most efficient sparing of ErOAR was achieved in DP-VS. The advantages of DP-VS in comparison with DP-S was significant reduction (30%) of D2% for CCB (IPA) (р0.05).

DISCUSSION: Тhe obtained results indicate that VS-SRT is feasible in the vast majority of patients suffering from PCa. A significant reduction in the dose delivered to the ErOAR can be achieved at most linear electron accelerators equipped with modern multi-leaf collimators.

CONCLUSION: The greatest contribution to the reduction of radiation dose to ErOAR in VS-SRT PC is made by the reduction of standard PTV, while the width of the collimator leaf does not have a significant effect on the dose priscribed to this region.

Cardiac valve injuries are an extremely rare complication of blunt chest trauma. The most common cause of aortic insufficiency in the early and long-term posttraumatic periods are ruptures of the aortic valve annulus, which is more vulnerable to traumatic alterations than other valves. In rare cases, dissection of the aortic root intima may result in the development of pseudoaneurysms of the Valsalva sinus. A 45-year-old patient was admitted to the Kirov Military Medical Academy due to uncontrolled arterial hypertension, chest pain during physical activity, and sporadic heart palpitations. In the patient’s anamnesis it was stated that six years ago, a blunt chest trauma occurred while executing professional duties. An additional structure was discovered by echocardiography between the leaflets of the left and right aortic valves. In this clinical case study we aim to demonstrate the advantages of multimodal diagnostics, including the latest generation of CT scanners, to diagnose a rare complication of blunt chest trauma such as pseudoaneurysm of the left coronary leaflet of the aortic valve, to exclude the underlying causes of its development and to follow up on patients with such trauma.

OBJECTIVE: This article demonstrates the resolution capabilities, distinctive features in visualization of gallbladder and bile ducts pathology using computed tomography (CT) and magnetic resonance imaging (MRI) as illustrated by a clinical case.

MATERIALS AND METHODS: Retrospective analysis of CT and MRI methods capabilities in diagnostics of biliary tract cancer was carried out on the basis of a private medical practice case, and modern diagnostic capabilities to be applied in case of pathology of this localization were analyzed with reference to literature sources.

RESULTS: This article presents a clinical case reflecting the difficulties in diagnostics of the gallbladder and bile ducts pathology by the CT and MRI and compares the diagnostic capabilities of these methods.

CONCLUSION: It is essential to know the criteria of differential diagnostics of malignant neoplasms of gallbladder and bile ducts, understand the advantages and limitations of different diagnostic methods to interpret the character and extent of detected changes, to choose the proper patient management tactics.

INTRODUCTION: Carbon dioxide (СО₂) is a safe contrast agent for patients requiring endovascular and angiography-assisted procedures due to lack of renal toxicity and allergic potential. It is highly important in patients with renal failure and allergies to iodinated contrast agents.

OBJECTIVE: To demonstrate a clinical case of percutaneous biopsy guided with the flat-detector computed tomography (FDCT) CO₂ arteriohepaticography in the patient with suspected metastatic lesion of the liver, history of cervical squamous cell carcinoma and chronic kidney disease (CKD).

MATERIALS AND METHODS: A patient with squamous cell carcinoma of the cervix, due to concomitant kidney pathology (chronic tubulointerstitial nephritis, gouty nephropathy, CKD C4 according to the KDIGO classification) has contraindications for iodinated contrast, hence contrast enhanced computed tomography (CT) and regular FDCT angiography. A native CT study revealed a hypodence 17 mm diameter lesion in SVII of the liver. US and MRI data were ambiguous. The presence of a clear hypervascular rim in the arterial and venous phases of dynamic contrast enhancement could not rule out the metastasis. In order to clarify the nature of the lesion in the liver, multidisciplinary team suggested biopsy under digital subtraction angiography and FDCT arteriohepaticography using CO₂ as a contrast agent because of the risk of the haemorrage. For this purpose, using the Seldinger technique, through right femoral artery, by means of an Artis Zee angiographic unit (Siemens, Germany) catheterization and gas subtraction angiography of the common hepatic artery were performed. FDCT-CO₂-arteriohepaticography of the common hepatic artery was performed afterwards using the same installation and injecting 30 ml of carbon dioxide at the rate of 3 ml/sec (special «Angiodroid» (Italy) CO₂ injector was used) and a scanning delay of 3 sec (in 6sDCT Body mode).

RESULTS: Вy means of subtraction CO₂-arteriohepaticography and FDCT arteriohepaticography using CO₂ in SVII of the liver the solitary hypervascular 15 mm lesion was detected. In order to verify the lesion single-shot US and FDCT-guided biopsy was performed. It was followed by a control FDCT arteriohepaticography using _CO2 to exclude bleeding. Histopathology refuted metastasis.

CONCLUSION: CO₂ is a safe contrast agent in patients with renal failure and allergies to iodinated contrast agents. FDCT CO₂ arteriohepaticography is an effective alternative method, that allows safe visualization and bleeding control after interventions in patient with renal failure.