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The increase in the incidence of endometrial cancer is noted not only in postmenopausal women, but also in a socially active group of women of reproductive age, starting from 25 years. Ultrasound and magnetic resonance imaging (MRI) are the main methods of non-invasive diagnosis of endometrial cancer. Our study included 69 patients with endometrial cancer stages I–IV aged 30 to 79 years. The diagnostic informativeness of the MRI method in detecting tumor invasion into the myometrium for all groups was: sensitivity – 82.30%, specificity – 6.6%, PPV – 93.30%, NPV – 40%. The diagnostic informativeness of the ultrasound method in detecting tumor invasion into the myometrium for all groups was: sensitivity – 91.3%, specificity – 88.4%. The peculiarity of this study was to evaluate the possibilities of radiation methods (ultrasound, MRI) in the staging of endometrial cancer.

Early detection of cervical (CC) and endometrial (EC) cancer recurrence in previously irradiated areas remains a difficult task for clinicians and radiologists. 18F-FDG PET-CT scope and limits in this matter are not clear yet.Purpose. To determine 18F-FDG PET-CT significance and diagnostic value in differential diagnosis of locoregional recurrence and post-radiation tissue changes in CC and EC patients with suspected relapse in preirradiated zones.Materials and methods. Follow-up data, including multiparametric MRI (T1-WI, T2-WI, DWI, DCE) and 18FFDG PET-CT full descriptions, were studied in 51pts., in 25(49%) CC and 26 (51%) EC Ia–IIIc FIGO, with suspected loco-regional recurrence in pre-irradiated area, 4–96 months after the end of treatment.Adjuvant combined radiotherapy (conformal pelvic EBRT – 3D-CRT, IMRT, VMAT, endovaginal 192Ir HDR brachytherapy) was performed in 33 (64,7%) pts. after radical surgery, adjuvant chemoradiation with Cisplatin 40 mg/m2 or Carboplatin AUC2 weekly – in 8 (24.2%) of them. 18 (35,3%) pts. were treated with definitive chemoradiation, median EQD2 for HR-CTV D90 81.6 ± 4.4 Gy (CI 95% 72.4 Gy – 93.7 Gy) and 54.6 ± 3.3 Gy (CI 95% 48.8–64.2 Gy) for metastatic pelvic and paraaortic lymph nodes.Indications for 18F-FDG PET-CT (Biograph True64, Siemens, 3.8–4.7 MBq/kg, total 169–356 MBq) in all pts. were suspicious clinical, cytological, complex ultrasound, and multiparametric MRI findings in pre-irradiated zones. Any areas of 18F-FDG pathologically increased uptake were considered hypermetabolic lesions, positive for cancer recurrence.Results. No evidence of loco-regional recurrence in pre-irradiated zones was confirmed in 32 (62.7%) pts. Clinical, morphological and radiological signs of progression were obtained in 16 (31.3%) 18F-FDG PET-CTpositive patients, with SUVmax 2.86–8.8 in this subgroup. 18F-FDG PET-CT false-positive results were obtained in 6 (11.8%) patients, false-negative – in 1 (1.9%) heavy pre-treated CC patient. 18F-FDG PET-CT sensitivity was 94.1%, specificity – 84.2%, positive predictive value – 72.7%, negative predictive value – 96.9%.Conclusions. 18F-FDG-PET-CT has a high diagnostic value in the differential diagnosis of loco-regional relapses and post-radiation tissue changes in CC and EC patients with suspected progression in pre-irradiated zones. But 18F-FDG-PET-CT findings evaluation and interpretation requires a multidisciplinary discussion and consensus for this cohort of patients.

Objective. Comparison of the magnitude of the change in the density of lung tissue and the volume of these changes after radiation therapy over time based on the data obtained using the new method of quantitative analysis developed by us and with the usual visual assessment of the CT data.Materials and methods. We used the data of dynamic observation of 90 patients who underwent RT for the tumors of thoracic localization during the period from 2014 to 2021 at the Federal Institution “Russian Scientific Center of Roentgenoradiology”. These patients had CT examinations performed before and after RT. Control CT studies were performed 1–237 days after RT (mean control interval 96 ± 64.3 days). A total of 238 CT studies of these patients were analyzed, with an average number of RCT studies per patient of 2.6. Among the selected patients, there were 36 (40%) men and 54 (60%) women aged 23 to 86 years (the average age was 51.9 ± 15.6 years).Results. Radiation damage in the lungs using the method of quantitative analysis of CT data is detected starting from the value of ΔHU = 20 and volume from 3.2% for the early period (15–35 days) after the end of treatment. Starting from 15–25 to 50 days after the end of RT, quantitative analysis reveals primary changes in the lung tissue, incl. and undetectable visually (from 20 to 80 HU), and to suggest further dynamics of these changes depending on the characteristics of the performed RT. From 50 to 80 days – reveals the real volume of radiation pulmonitis by taking into account the changes invisible during visual analysis in the lung tissue irradiated at a dose of 20 Gy to 30 Gy. From 80 to 120 days – allows you to assess the presence and dynamics of changes in the lung tissue with the threshold radiation dose in the lung tissue 30–35 Gy. From 120 onwards, quantitative analysis of CT data, as well as visual assessment, reveals damage in areas of the lungs with the dose of more than 30–35 Gy, which is caused by post-radiation pneumofibrosis. On the basis of the obtained quantitative data on radiation lung damage, the mathematical regularities of the development of this process were calculated, taking into account the time and dose factors.Conclusions. Quantitative assessment of changes in lung density according to CT data in dynamics, carried out using the technique developed by us, is a radiomic indicator of their radiation damage during therapeutic irradiation in cancer patients, which, in combination with the presented mathematical model, can be used for diagnostic purposes to quantify the severity and predicting the dynamics of radiation damage to the lungs in general, as well as identifying individual radiosensitivity.The results obtained can be presented not only in the form of graphs, but also in the form of color maps with preservation of anatomical landmarks, which is convenient for use in clinical practice to support medical decision-making on patient management.

Breast cancer occupies the 1st place in the structure of oncological morbidity and mortality in the female population in the Russian Federation and is the second most common metastasis of primary solid malignant tumor after lung cancer, and the incidence of these often fatal lesions is currently increasing after improving systemic treatment.At the same time, the prognosis of patients who develop metastatic brain damage is usually unfavorable, since few of them live longer than 1 year.The purpose of the study: to analyze recent studies related to the use of magnetic resonance imaging in the diagnosis of breast cancer metastases in the brain.Conclusion. If there are characteristic results of MRI studies indicating the presence of possible primary gliomas of the brain, and not metastases, surgical intervention (biopsy) is necessary for histopathological studies, in order to finally establish the diagnosis of the underlying disease.

Objective. To present a unique clinical case of metastatic lesions of the perirenal space, ureter and bladder in Merkel's carcinoma with the development of transverse myelitis against the background of immuno-oncological therapy.Matherial and methods. The modern states of issue in diagnose and treatment of metastatic Merkel's carcinoma within multidisciplinary approach based on the medical documentation and radiological examinations (CT, MRI) was analysed in this article.Results. The unique clinical case of metastatic Merkel's carcinoma complicated by transverse myelitis during immuno-oncological therapy according to MSCT and MRI examinations report was demonstrated.Conclusion. Radiological examinations such as MSCT, MRI, ultrasound and PET/CT needed for detection, assess the incidence of tumor (metastasis and staging) and treatment efficiency control because of the rare occurrence and insufficient knowledge of Merkel's carcinoma.

Aaneurysmal bone cyst is a benign tumor-like bone lesion with an uncertain etiology with many blood-filled cavities. As an independent nosological form, this disease was isolated in 1942. There are several theories of the etiology of the primary aneurysmal bone cyst, including a response to traumatic local hemorrhage, reactive damage due to changes in the intraosseous blood flow, and true neoplasm secondary to gene rearrangements. The primary form of aneurysmal bone cysts must be differentiated from the secondary form – the latter develops against the background of bone pathology. About one third of all cysts develop against the background of a giant cell tumor, osteoblastoma, or chondroblastoma. Aneurysmal bone cysts are mainly observed in children and adolescents, with 80% occurring in patients under the age of 20–30. Women suffer a little more often M: F = 1: 1.16. Aneurysmal bone cysts can lead to a pathological fracture, which can dramatically worsen symptoms. Inside the spine, lesions can cause neurological disorders caused by massive exposure to the spinal cord or exit from nerve roots. Since they usually manifest in the pediatric population, growth plates can be affected, resulting in deformation of the limb. In practice, diagnosing AKC can be difficult. The differential diagnosis includes a giant cell tumor, fibrous dysplasia, a simple bone cyst, ossifying hematoma, chondroma, chondromyxoid fibroma, enchondroma, hemophilic pseudotumor and metastases. ACC is not a neoplastic lesion and it is very important to differentiate this nosology from malignant bone lesions. This article presents a rare clinical case of aneurysmal bone cyst of the frontal sinus and cells of the ethmoid labyrinth in a child before and after treatment. Purpose. Demonstration a clinical case of aneurysmal bone cyst before and after surgical treatment.

Meckel diverticulum is a non-permanent diverticulum of the distal part of the ileum, which is the remnant of the yolk duct. Meckel diverticulum is a true diverticulum formed by all layers of the ileum wall. Usually it is located on the antimesenteric edge of the ileum at 60 cm from the ileocecal angle. This pathology is often asymptomatic, and the patient begins to be examined only when complications appear. Clinical manifestations depend on the type of complications.

Acute vascular pathology of the intestine is a collective concept that includes a number of conditions that develop due to insufficient supply of oxygen and nutrients to tissues. One of these conditions is an аcute mesenteric ischemia (AMIO). Diagnosis of AMIO reserves a lot of unresolved issues, in which CT angiography is the main method. Treatment of patients depends on the form of the course and stage of the disease. We present the case of a violation of the mesenteric blood circulation in a man against the background of poisoning by alcohol substitutes.

The development of secondary tumors is a rare but well-known late effect of radiation therapy of lesions of the central nervous system. At the same time, malignant gliomas most often occur. This article presents a rare clinical case of secondary anaplastic astrocytoma in a child who received chemoradia-tion therapy for medulloblastoma after surgical treatment. Purpose. Demonstration of a rare occurrence of anaplastic astrocytoma after surgical and chemoradiation treatment of medulloblastoma.

Purpose . To determine the possibility of MSCT in the differential diagnosis of acute appendicitis. Materials and methods . MSCT was performed on a multidetector 64-slice computer tomograph Aquilion company Toshiba with multi-phase contrast enhancement. The results of MSCT 108 (100%) patients hospitalized for emergency indications with suspected acute appendicitis in the surgical Department of the “City clinical hospital them M.E. Zhadkevich Of the Department of health of the city of Moscow” were analyzed from July 2017 to July 2018. Results . The age range of the subjects ranged from 18 to 81 years, including 53 women (49%), 55 men (51%). CT-picture of acute appendicitis was observed in 23 (21%) patients. In 85 (79%) cases, according to MSCT, no direct signs of inflammatory changes in the Appendix were determined. In this case, acute appendicitis was confirmed during surgery in 22 (20%) cases. A false positive result was obtained in one patient. In a comprehensive examination were diagnosed: acute mesenteric thrombosis -1(1%) case, acute mesadenitis - 1 (1%) case, acute pyelonephritis - 2 (2%) case, concretion of the right ureter -2 (2%) case, hemorrhage in the cyst of the right ovary -1 (1%) case, diverticulitis - 6 (5%) cases, tumors of the blind and ascending intestines - 2 (2%) case. In 68 (63%) cases, patients were discharged without surgery after intestinal colic relief. 2 (2%) patients were operated on with negative MSCT results, as the acute abdominal clinic was preserved. Acute phlegmonous appendicitis was diagnosed intraoperatively. The sensitivity of MSCT in the detection of acute appendicitis in our observations was 91.7%, specificity -98.8%, the prognostic value of the positive result-95.7%, the prognostic value of the negative result - 95.4%. Conclusion . Multispiral computed tomography is highly informative in the differential diagnosis of acute appendicitis, its use avoids unreasonable surgical interventions.

Invagination is the process of introducing one part of the intestine into another, which is a type of acute intestinal obstruction. Most often occurs in infants. Diagnosis in adults causes difficulties, often the disease simulates the clinic of other diseases of the abdominal cavity (pancreatitis, appendicitis, etc.). Distinguish between different types of invagination of the intestine: the cecal intussusception, colonic intussusception, ileal-colonic intussusception, small bowel invagination. The diagnosis uses ultrasound, CT, X-ray examination. Treatment of intestinal invagination in adults is surgical in most cases. We present a case of iliac-colonic invagination in an adult male with acute abdomen.

Stomach bezoar is a foreign body in the digestive organ, formed as a result of ingestion and digestion of certain substances that have vegetable, animal or chemical origin. This pathology, rarely found in patients, has another name, that is, gastric concretions. The article presents a clinical case of complex diagnosis and treatment of intestinal obstruction caused by plant bezoar (persimmon). The results of traditional x-ray, ultrasound, MSCT and endoscopic methods are presented. Surgical treatment was carried out: laparotomy, enterotomy, removal of bezoar.

Adrenocortical cancer (ACC) – a neoplasm of the adrenal cortex, which is rare, in 0.02–0.06% of cases. It is characterized by various clinical manifestations in the form of hypercorticism of varying severity and unfavorable prognosis. Typically, a tumor in the form of a node, often with signs of infiltration growth. Some tumors are formed by light and dark cells, there is often significant cellular polymorphism. Malignant tumors of the adrenal cortex have a pronounced tendency to hematogenous metastasis, usually in the lungs, bones and other organs. The article presents a rare clinical case of metastatic lung injury, identified 22 years after the removal of the adrenal malignant tumor (AKP).

Сlinical case of a rare and poorly studied disease – intravenous leiomyomatosis (IVL) is presented. Presented the literature data and our own clinical case of this rare pathology with dissemination to the v. cava inferior, to the right ventricle of the heart. The radiology semiotics of metastatic intravenous leiomyomatosis is described, the advantages and limitations of the methods of radiation diagnosis are noted. The clinical case is of particular interest, because there is a combination of simultaneous intravenous injury, heart damage and benign metastatic lung injury. The final diagnosis is verified by the data of morphological and molecular-genetic research based on the results of surgical intervention.

Ependymoma is a brain tumor that develops from ependemic cells that lining the inside of all the ventricles of the brain. Ependymomas are twice as likely to appear in the region of the posterior cranial fossa. Pseudoprogression is a change that develops after surgical and/or chemoradiotherapy, caused by vascular changes leading to a transient increase in the permeability of the BBB. These changes coincide with early delayed reactions to radiotherapy and are considered as a subacute reaction of the brain. On MRI, there is a transient occurrence of foci that accumulate contrast for several weeks to 6 months or more after chemoradiotherapy. Dynamic control shows an improvement, which confirms the absence of true tumor growth. Changes take place without specific treatment. In the article, we give a rare clinical observation that shows the importance and effectiveness of dynamic MRI monitoring in differential diagnosis.

Purpose. To assess the possibilities of methods of radiation diagnosis in the recognition and staging of gastric cancer. Material and methods. The results of inspection of 307 patients with cancer of a stomach at which endoscopic, radiological and computer tomography researches on purpose, both primary diagnosis of gastric cancer, and establishment of a staging of process have been executed have been analyzed from 2014 to 2017. Results. At a radiological research proximal cancer of a stomach is revealed at 63 (20,5%) patients, a body – at 202 (65.8%) and distally – at 42 (13.7%) patients. In all cases we managed to diagnose precisely stomach cancer, its localization and distribution on stomach walls. MSCT allowed to determine the spread of the tumor beyond the organ. Results of comprehensive examination of patients with cancer of a stomach have allowed to stage the process. The first stage has been established at 40 (13.0%) patients, second – at the 117 (38.2%), third – at the 102 (33.2%), fourth – at 48 (15.6%). Of the 307 patients with gastric cancer, various types of interventions were subsequently performed in 254 (83%), chemotherapy, as an independent type of treatment was performed in 49 (16%), refused any treatment of 4 (1%) patients. Conclusion. Complex radiation diagnosis is highly informative for the detection and staging of stomach cancer.

Objective: to develop a methodology for quantitative assessment of changes in density parameters of pulmonary tissue on the basis of dynamic CT data, which makes it possible to assess the presence of the dependence of changes in lung tissue on the time elapsed after radiation therapy (RT), the dose and volume of irradiated pulmonary tissue.Materials and methods. Using the data collected by 11 patients with malignant lymphomas, we developed a new diagnostic technique for quantitative analysis, which is based on the analysis of the density of pulmonary tissue before and after RT in areas with a selected range of doses throughout the lung volume. All selected patients received LT in the chest region, using 3D-planning, fractions of 2Gy and total focal doses of 13–56 Gy. Also, each patient had at least two CT examinations (a total of 25 studies in the Dicom- format). The first CT scan was performed before LT, repeated – within 2–7 months after the end of RT.Results. In 6 patients, control CT examinations were performed 2.1–2.8 months after RT. As a result, a quantitative increase in the density indices in the range from +12 to +62 HU in regions of the lungs irradiated at a dose of more than 19 Gy was noted, different from the control areas. The volume of these areas of the lungs was from 16% to 30% of the total lung volume, and the volume of regions with the maximum values of density growth – from 7% to 14%. These changes in density are below the “visual” threshold. In control areas, the density change varied from −15 HU (increased airiness) to + 8 HU. According to the data of other CT studies performed later than 3 months after RT, the reverse development of changes characterizing the early radiation reaction was observed.Conclusions. A series of CT studies performed before and at various intervals after RT allows quantitative assessment of the dynamics of the indices of the density of irradiated pulmonary tissue, which is necessary for an objective assessment of the severity of early radiation-induced injuries of pulmonary tissue sites, depending on the dose. A study of the dynamics of these changes in pulmonary tissue density over time with RT and the connection of this indicator with the baseline data may allow one to predict radiation-induced damage to the lungs on the one hand, and on the other, to evaluate individual radiosensitivity.

Coloncancer is one of the first places in the structure of oncological diseases. According to statistics, edited by A.D. Kaprin, V.V. Starinskii, G.V. Petrova ofRussiafor 2015 was initially 36494 case of colorectal cancer, while 2% of cases are not diagnosed. Recurrence of colon cancer can occur at any stage regardless of the time elapsed after the radical treatment. Locoregionally originally is the presence of a tumor in the area of primary operation, which is represented by the primary tumor bed, the anastomosis, mesentery of the colon with lymphatic system, peritoneum and adjacent organs. Often after a diagnosis of “recurrence of the tumor in the colon” to the patient it is possible to provide only palliative care (colostomy, chemotherapy). The article cited clinical observation, confirming the important role of radiation techniques in determination of tactics of treatment of locoregional recurrence of the cecum cancer.

Objective. To clarify MRI semiotics of non-neoplastic changes in the vagina in women undergoing treatment for cancer of the female genital organs.Materials and methods. 141 patients with suspected tumor vaginal involvement were included in the study. In all the patients, the diagnosis was confirmed morphologically. According to the study, a tumor lesion of the vagina was established in 96 (68.1%) patients, with primary vaginal cancer detected in only 11 (11%) of the examined, the largest number of cases was a secondary organ damage – 85 (89%). The basis for differential diagnosis was the results of a comprehensive MR-study of 45 (31.9%) patients who did not receive data for the new formation, but determined the posttherapeutic changes in the small pelvis. MR-studies were performed on a Toshiba Vantage Atlas, 1.5T. A multiparametric MRI protocol was used for the study of pelvic organs, including T2WI with and without suppression of fat tissue signal, T1WI, diffusion-weighted images, T1WI with dynamic contrast enhancement. For the purpose of moderate expansion of the physiological folding of the vagina, we used an MP-compatible plastic applicator.Results. In the course of monitoring changes in the form of fibrosis of the dome of the vaginal stump were determined in 51.9% of observations, fibrous thickening of the vaginal walls with a narrowing of its lumen – in 18.5% of observations, prolonged edema of the vaginal tissues with a moderate change in anatomo-topographic relationships – in 73.3% of observations. In 12 (26.6%) patients with clinically pronounced fibrosis of the vaginal walls, strictures of different localization, accompanied by dyspareunia, dryness and increased bleeding of the vaginal tissues, even the possibility of examination was significantly limited, and MRI was practically the only complete differential diagnostic method.Conclusion. Knowledge of the anatomy of the operated vagina made it possible to correctly interpret the revealed changes in the vagina, to perform a detailed differentiation between the unchanged tissues of the dome of the vaginal stump and its tumor lesion.