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Cognitive impairment is a very common comorbidity in patients with heart failure (HF). Patients with HF show signs of memory decline, difficulty concentrating, and attention deficits. Cognitive dysfunction in HF is associated with a poor prognosis. However, the diagnosis of cognitive impairment in heart failure has received insufficient attention in routine clinical practice. Neuropsychological screening tests are available to screen for cognitive impairment, but they are used infrequently. Therefore, it is of practical interest to search for magnetic resonance equivalents of cognitive disorders. The use of magnetic resonance imaging as a tool for identifying and quantifying neural correlates of cognitive functions is discussed.

Balo concentric sclerosis is considered a fulminant demyelinating disease that is characterized by the formation of specific concentric foci in the white matter of the brain that resemble sawing trees. This article describes the clinical case of a patient who has come with complaints of weakness and stiffness in the lower limbs, more in the left leg, a feeling of stiffness and tension in the left hand, the inability to walk without aids. Taking into account the complaints, the clinical picture and the pre-test: laboratory examination of blood and liquor, magnetic resonance imaging (MRI) of the brain and thoracic spine with contrast, the patient was diagnosed with multiple sclerosis, secondary-spineprogressive current (Balo variant), reliable according to the 2017 McDonald Criteria. The following is a literature review describing the pathogenesis, clinical profile, diagnostic approaches and treatment options for the disease.

Rationale: One in five women worldwide delivers through cesarean section, which is associated to a high rate of placenta previa and abnormal placenta attachment to the uterine wall. The grade of placenta accreta spectrum (PAS) correlates with blood loss volume, which could be related to vascularization characteristics. Up to now, there have been no studies on the diagnostic value of magnetic resonance criteria for hypervascularization of the uterine wall and their correlation with an assumed grade of PAS according to the International Federation of Gynecology and Obstetrics (FIGO) classification. Also, abnormal vessels location and their wall structure have not been studied with state-of-the-art pathomorphological methods. Aim: To develop a classification for various types of the uterine wall hypervascularization depending on the depth of placental invasion assessed by magnetic resonance imaging (MRI). Methods: We retrospectively analyzed medical files of 66 patients aged 18 to 45 years, who were assumed to have PAS based on their sonography results. To clarify the extent and localization of the placental invasion, all patients had MRI performed at 24 to 32 weeks of gestation. In all patients, the PAS grade was verified pathologically; in 30 of them (45,5%), a detailed pathological examination was additionally performed. The PAS grades were classified according to Morbidly Adherent Placenta Imaging Reporting and Data System (MAPI-RADS). The MRI data were correlated with the PAS (FIGO) grade estimated from intraoperative data and with intraoperative blood loss. At the final study step, the MRI data was correlated with abnormal pathomorphology, with the assessment of the degree of vascularization and the visual picture of abnormal uteroplacental vasculature. Results: We have proposed a classification of MRI signs of hypervascularization in the lower uterine segment correlating with the depth of placenta accreta. Type 1. Single small vessels in the myometrium, medium caliber arteries in the projection of the uterine serosa (normal variation for the 3rd trimester of gestation). Type 2. Numerous small confluent vessels, mainly in the uteroplacental region, and retroplacental hematomas (typical for placenta accreta, or FIGO PAS 1). Type 3. Intrauterine hypervascularization with a deficient myometrium thickness, predominantly vessels of the middle layer (typical for placenta increta, or FIGO PAS 2). Type 4. Thinning of the lower uterine segment due to significant bulging of the placenta in the presence of curved anastomosing vessels of vast caliber over 4 mm (typical for placenta increta – FIGO PAS 2, as well as placenta percreta – FIGO PAS 3a). Type 5. Hypervascularization outside the uterus, over its surface and in the parametrial tissues: at the border with the bladder, uterine isthmus, including signs of fibrosis and growing into the posterior bladder wall (typical for various grades of placenta percreta – FIGO PAS 3b, 3c). Conclusion: The proposed classification of uterine wall hypervascularization in accordance with the grades of placenta accreta spectrum (FIGO PAS) could be useful for its practical implementation by radiologists.

The article presents the possibilities of radiation methods in the diagnosis of spinal echinococcosis based on publications and our own clinical observation. An electronic literature search was conducted using PubMed/ MEDLINE, Cochrane Library, ResearchGate databases; the review included case reports, retrospective studies, and literature reviews published from 1991 to 2023. A clinical case of a patient with spinal echinococcosis was described showing that for this disease, a comprehensive radiation examination using radiography, computed tomography and magnetic resonance imaging (MRI) provides the necessary information. MRI is the most informative method, since it gives excellent visualization of spinal canal structures and allows detecting a number of spinal echinococcosis characteristic manifestations.

Оn March 27, 2023, а multidisciplinary Advisory Board meeting was held in Moscow with the participation of Е.V. Artamonova, Е.А. Busko, V.V. Didenko, А.D. Zikiryakhodzhaev, М.S. Karpova, G.Е. Kvetenadze, P.V. Krivorot’ko, М.L. Mazo, А.V. Petrovsky, О.S. Puchkova, S.V. Serebryakova under the chairmanship of I.Е. Tyurin and N.I. Rozhkova. The participants discussed different issues of early diagnostics and treatment planning of breast cancer. We present the conclusion made by the Advisory Board.

BACKGROUND: Magnetic resonance imaging is more often used to confirm the presence of pectus excavatum and assess compression changes in the heart at this level. AIM: To evaluate pectus excavatum preoperatively according to magnetic resonance imaging findings. MATERIALS AND METHODS: A retrospective evaluation of chest magnetic resonance imaging data of 38 patients (male, n=30; female, n=8) was performed. The average age was 19.9 years (±9 years).Cardiac magnetic resonance imaging was performed on a 1.5-T General Electric Optima MR450w GEM scanner with 2D-FIESTA-C pulse sequences, as well as functional assessment of the left and right ventricles. Parameters for surgical treatment of pectus excavatum were as follows: the Haller index, correction index, and sternum rotation angle. Statistical analysis of the relationship between the Haller index, correction index, and sternum rotation angle and ejection fraction of the right ventricle was conducted. A p-value 0.05 was considered significant. RESULTS: Moderate and severe pectus excavatum were found in 92% of the cases. No significant Pearson correlation was obtained between the Haller index and right ventricular ejection fraction (inspiratory and expiratory ejection fraction, p=0.777 and 0.798, respectively). The mean right ventricular ejection fraction was 46%. A correlation was noted between the Haller index and the correction index (p 0.05). The rotation angle of the sternum, which required modification of surgical intervention, was detected in 44.7% of patients. CONCLUSION: Magnetic resonance imaging is an informative diagnostic method for pectus excavatum pectus excavatum without radiation exposure and enables detailed preoperative assessment. A correlation was noted between the Haller index and the correction index (p 0.05). Magnetic resonance imaging revealed a decrease in the ejection fraction of the right ventricle.

BACKGROUND: Liver function assessment is very important in clinical practice. The use of magnetic resonance imaging for the anatomical and functional evaluation of the liver is possible in actual clinical practice. AIM: To examine the possibility of using hepatobiliary contrast-enhanced magnetic resonance imaging for the evaluation of liver function. MATERIALS AND METHODS: Datasets of patients who underwent gadoxetic acid-enhanced magnetic resonance imaging were retrospectively reviewed. Patients were divided into two groups: group 1 included patients with impaired liver function, and group 2 included those with normal liver function. Based on magnetic resonance imaging in the hepatobiliary phase, the liver parenchyma signal intensity and its ratio to spleen signal intensity and portal vein signal intensity were estimated. Differences among these parameters were compared between groups. The correlation between liver parenchyma signal intensity and laboratory blood tests reflecting liver function (total bilirubin, albumen, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma glutamyl transpeptidase, and prothrombin time) were analyzed. RESULTS: Datasets of 53 patients (25 men and 28 women, aged 24–84 years) were analyzed. Group 1 included 19 patients, whereas group 2 included 34. The median liver parenchyma signal intensity was 919.05 [669.65; 1258.35] in group 1 and 1525.13 [1460.5; 1631.4] in group 2 (p=0.0000001). The median ratio of liver parenchyma signal intensity to spleen signal intensity was 1.2 [1.04;1.7] in group 1 and 1.7 [1.46; 1.96] in group 2 (p=0.00076). The median ratio of liver parenchyma signal intensity to portal vein signal intensity was 1.44 [1.29; 1.83] in group 1 and 1.6 [1.43; 1.83] in group 2 (p=0.1). The estimated correlation values between liver parenchyma signal intensity and blood tests parameters were as follows: total bilirubin (r=–0.61; p=0.000001), albumen (r=0.13; p=0.61), aspartate aminotransferase (r=–0.57; p=0.000009), alanine aminotransferase (r=–0.44; p=0.001), alkaline phosphatase (r=–0.45; p=0.0007), gamma glutamyl transpeptidase (r=–0.5; p=0.0003), prothrombin time (r=–0.34; p=0.04). CONCLUSION: The study reflects the ability to assess liver function using indices (liver parenchyma signal intensity and its ratio to spleen signal intensity) derived from gadoxetic acid-enhanced magnetic resonance imaging. However, this study did not confirm the assumed effectiveness of using the liver parenchyma signal intensity to portal vein signal intensity ratio as an index of liver function. A significant inverse correlation was identified between liver parenchyma signal intensity and blood test parameters in reflecting liver function, except for albumin. The results indicate the possibility of using magnetic resonance imaging to assess liver function.

BACKGROUND: In recent decades, the incidence of cervical adenocarcinomas has increased from 5% to 20%. Endocervical adenocarcinomas are characterized by a more aggressive course and early metastasis. Owing to the difficulties in the cytological diagnosis of cervical adenocarcinoma, early radiation diagnostics and staging subsequently play a key role. Very few studies have examined the use of magnetic resonance imaging in diagnosing cervical adenocarcinomas. AIM: To determine the diagnostic informativeness of magnetic resonance imaging in the staging of cervical adenocarcinomas according to the T-criterion and assessing the depth of tumor invasion into the stroma of the cervix and clarify the semiotic signs of adenocarcinoma and features of tumor growth in the uterus. MATERIALS AND METHODS: In total, 123 patients diagnosed with cervical cancer (C53), who underwent diagnosis and treatment between 2020 and 2023, were examined. The examination results of 22 (18%) patients with cervical adenocarcinoma were analyzed. The average patient age was 56 years. A multiparametric magnetic resonance examination of the pelvic organs was performed on 22 patients using tomographs with a magnetic field strength of 1.5 T. Moreover, 14 (64%) patients underwent surgery including extirpation of the uterus and appendages with pelvic lymphadenectomy. The information value of magnetic resonance imaging was evaluated in 11 patients, whose first stage was surgical treatment. RESULTS: In this study, cervical adenocarcinoma was detected in 18% among all cases of cervical cancer. The information value of magnetic resonance imaging in assessing the local prevalence of endocervical adenocarcinoma according to the T-criterion was as follows (main value with the corresponding 95% confidence interval): sensitivity, 77.78% (39.99%–97.19%); specificity, 50.00% (1.26%–98.74%); positive predictive value, 87.50% (62.64%–96.69%); negative predictive value, 33.33% (7.30%–76.04%); and accuracy, 72.73% (39.03%–93.98%). The information value of magnetic resonance imaging in assessing the depth of tumor invasion into the cervical stroma was as follows: odds ratio, 3.500 (0.145%–84.694%); sensitivity, 85.7% (0.757%–0.993%); specificity, 33.3% (0.018%–0.0648%); positive predictive value, 75% (0.673%–0.883%); negative predictive value, 50% (0.027%–0.972%). CONCLUSIONS: The results of this study showed that magnetic resonance imaging is a good tool with high diagnostic informativeness in detecting endocervical cervical adenocarcinoma. The four macrostructures of tumor growth in endocervical adenocarcinoma identified during magnetic resonance imaging data analysis indicate locally aggressive tumor growth and a high frequency of endometrial dropouts. This finding will allow radiologists to structure a descriptive picture, including the verified cervical adenocarcinoma, to enhance methods of developing a treatment plan for the patient.

BACKGROUND: Magnetic resonance imaging is one of the leading imaging modalities of the musculoskeletal system. However, when imaging the hand, major problems in magnetic resonance imaging include the lack of specialized coils and reliable fixation devices for the hand, uncomfortable patient posture, motion artifacts, and small anatomical structures in the wrist. These factors inevitably lead to incorrect interpretation. AIM: To improve the quality of magnetic resonance imaging of the hand by developing an approach to coil selection, scanning protocol, and hand positioning and fixation. MATERIALS AND METHODS: A positioning device was developed to prevent hand movements. Two types of coils were evaluated. Magnetic resonance images were evaluated comparatively, as well as by a musculoskeletal radiologist. RESULTS: А head coil is more appropriate when scanning the entire hand, for example, in rheumatic diseases. A knee coil is more appropriate when studying smaller anatomical structures (including the wrist) owing to a smaller field of view and higher resolution. Based on the obtained data, guidelines for the selection of scanning parameters, sequences, and coils for magnetic resonance imaging of the hand were formulated. To prevent motion artifacts, a special fixation device of the patient’s hand was introduced. CONCLUSION: Certain factors directly affect the qualitative magnetic resonance imaging study of the hand, such as safety protocols, scanning parameters, and hand fixation. The guidelines presented in this study and the use of the developed specialized fixation device may improve the quality of magnetic resonance imaging of the hand.

Multiple biliary hamartomas are a benign incidental finding in the liver. They are not easily detected if one has never seen them, and if appropriate imaging tests are unavailable, and also can be challenging to differentiate from other liver lesions based on imaging alone. Thus, this study aimed to expand the radiologist’s digital image library, enabling a quick and precise differential diagnosis. This paper also highlights the importance of thorough radiological assessment and need for a multidisciplinary approach, involving radiologists, hepatologists, and pathologists, to ensure a precise diagnosis. The patient presented at the hospital for a computed tomography scan and an abdominal magnetic resonance imaging recommended by his general practitioner to assess the biliary tree (magnetic resonance cholangiopancreatography), owing to persistent abdominal pain. The patient had never undergone an abdominal magnetic resonance imaging previously; hence, the discovery of hepatic lesions was incidental and unexpected. Magnetic resonance imaging revealed multiple benign lesions in both the hepatic lobes comparable to the Von Meyenburg complex. These lesions are multiple hamartomas and behave differently in all magnetic resonance imaging sequences. Images acquired with different magnetic resonance imaging sequences were carefully examined. Multiple lesions were found scattered throughout the liver; however, the lesions were benign and consistent with the diagnosis of multiple biliary hamartomas. Medical practitioners should examine the presence of multiple biliary hamartomas and consider them in the differential diagnosis when patients present with hepatic abnormalities. This can prevent unnecessary interventions and guide appropriate patient management.

BACKGROUND: Mitral valve calcinosis is a chronic degenerative process in the fibrous structures of the mitral valve. Advanced stages increase the risk of endocarditis and cardiac rhythm disturbances and contribute to cardiovascular mortality. The cause of mitral valve calcinosis is still controversial; however, the contribution of atherosclerosis to its development is currently undisputed. The prevalence of mitral valve calcinosis varies in different age groups and on average is higher in people with cardiovascular disease. AIM: To assess the prevalence of mitral valve calcinosis in patients undergoing computed tomography angiography and identify the relationship between aortic and mitral valve calcinosis and coronary calcium index and signs of remodeling. MATERIALS AND METHODS: A retrospective study of 336 patients who underwent computed tomography coronary angiography with intravenous contrast enhancement at the Lomonosov Moscow State University Clinic between November 13, 2020, and May 14, 2022, was conducted. RESULTS: The prevalence of aortic (16.4%) and mitral (11%) valve calcinosis was high in people undergoing cardiovascular examination, and a relationship was noted between valve calcinosis and coronary calcium index. CONCLUSION: The detection of mitral valve calcinosis in patients during routine examination is important in predicting further treatment and outcomes because valve calcinosis is an indirect indicator of coronary heart disease risk. Although valve calcinosis is usually an incidental examination finding, it may indicate a high cardiovascular risk and should prompt further evaluation, if clinically necessary.

BACKGROUND: Differential diagnosis of chronic disorders of consciousness remains one of the most difficult problems even for experienced clinicians. AIM: To evaluate the inter-expert consistency and capacity of the researcher-developed structural scale based on magnetic resonance imaging to differentiate chronic disorders of consciousness, named, DOC-MRIDS, on a larger sample of patients. MATERIALS AND METHODS: Sixty patients with a clinically stable status diagnosed with consciousness disorders (vegetative state, n=32; minimally conscious state, n=28) were enrolled. The revised coma recovery scale (CRS-R) was included in the clinical assessment. All patients underwent structural magnetic resonance imaging with 3.0-T Siemens scanners including T2 and T1 sequences. Structural changes were assessed using the DOC-MRIDS scale and included the following features: diffuse cortical atrophy, ventricular enlargement, gyri dilatation, leukoaraiosis, brainstem and/or thalamic degeneration, corpus callosum degeneration, and focal corpus callosum lesions. A total score was calculated. Magnetic resonance imaging data were analyzed by three neuroradiologists, and inter-observer agreement (Krippendorf’s alpha) was assessed. RESULTS: A high inter-examiner agreement of the DOC-MRIDS scale score was found, with α=0.806 (95% confidence interval 0.757–0.849). The vegetative state group had a higher DOC-MRIDS score than the minimally conscious state group (p 0.005). A negative correlation was obtained between CRS-R and DOC-MRIDS scale scores (ρ=–0.457, p 0.0001), individual clinical scale domains, and magnetic resonance imaging features. CONCLUSION: When assessing structural changes in patients with chronic consciousness disorders, the use of the DOC-MRIDS scale helps differentiate the type of such disorders with sufficient specificity, sensitivity, and inter-rater agreement. This scale can be used in clinical practice as an additional differential diagnostic tool.

Cor triatriatum dexter is a rare congenital heart anomaly in which the right atrium is divided into 2 chambers by a membrane. Clinical manifestations vary depending on the degree of the right atrium separation and the presence of concomitant anomalies. We report a case of asymptomatic cor triatriatum dexter diagnosed during transthoracic echocardiography. The diagnosis was confirmed by transesophageal echocardiography, computed tomography, and magnetic resonance imaging. Transthoracic echocardiography is a sensitive primary diagnostic tool for such congenital heart disease as cor triatriatum dexter.

The study of blood flow is becoming a new trend in cardiology and cardiovascular surgery. Based on the literature and our own data, a review is presented on the use of 4D flow in diseases of the heart and blood vessels. The main state of the question about the features of the application of the technique in various pathologies of the cardiovascular system is described in detail, the priorities, limitations and promising directions of the technique application are considered taking into account the goals of practical medicine. The review consists of two parts. The first is devoted to general issues, limitations of the technique, and issues of 4D flow mapping in patients with lesions of the great vessels. In the second part, the emphasis is on the use of 4D flow MRI in the study of intraventricular blood flow and the application of the technique in congenital heart and vascular diseases.

This case report and literature review presents the imaging features of the rare pathological condition – intravenous leiomyomatosis. Correct interpretation of diagnostic imaging data and morphological verification of intravenous leiomyomatosis helps to perform timely and complete surgical treatment.

In the Russian Federation, the incidence of uterine body cancer remains the highest among malignant neoplasms of the female genital organs. Surgical treatment is the primary method for treating early stages of the disease; however, the issue of predicting metastatic lymph node involvement at the preoperative stage for performing lymphadenectomy remains debatable. The potential prognostic significance of tumor involvement in the lower uterine segment regarding lymph node metastases may justify the need to assess tumor localization before starting treatment. Magnetic resonance imaging (MRI) of the pelvic organs can help determine the involvement of the lower uterine segment in the tumor process, thereby creating a basis for expanding the scope of surgical intervention.

Background. Chronic liver disease is one of the most common diseases. In many countries, liver disease is among the top five causes of death. The liver is one of the main organs responsible for basic metabolic functions, protein and hormone synthesis, detoxification and waste elimination. In chronic liver disease, there is a continuous process of inflammation, destruction and regeneration, ultimately leading to severe dysfunction, causing the development of fibrosis and cirrhosis. The main task of the radiation diagnosis of chronic liver disease is the development and introduction into clinical practice of new noninvasive biomarkers for a comprehensive assessment of the structure of the liver parenchyma in order to choose further treatment tactics.Aim a comprehensive analysis of the modern possibilities of radiation imaging methods in the diagnosis of chronic liver disease.Materials and methods. The analysis of 107 modern publications of domestic and foreign literature devoted to the diagnosis of chronic liver disease of various etiologies was carried out.Conclusion. the review reflects the most common modern and promising methods of radiodiagnosis for chronic liver disease, which in most cases make it possible to avoid invasive interventions in the process of establishing a diagnosis and monitoring the response to treatment

Background. Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease, which is characterized by the inevitable disability of patients in the long term, which determines the relevance of this problem. Currently, active improvements are being made in the methods of diagnosing multiple sclerosis, which include the use of the central vein sign in magnetic resonance imaging (MRI) as a neuroimaging biomarker of MS with high sensitivity and specificity.Aim of study. Determination of the possibility of assessing the central vein sign (CVS) according to MRI data as a potential diagnostic biomarker of MS.Object and methods. An open single-center prospective study of brain MR data was conducted in 55 patients with a verified diagnosis of MS (EDSS 1.0-6.5) aged 19 to 72 years. MR-images were obtained on a tomograph with a magnetic field induction force of 3.0 T. Patients underwent MRI of the brain according to the standard protocol: T2-VI, FLAIR, T1-VI (before and after administration of contrast agent), SWI. A comprehensive statistical analysis and evaluation of the obtained MRI data was performed using the Statistica 12 program.Result. During the evaluation of MR-tomograms, all patients with a verified diagnosis in the foci of MS were found to have CVS. In 14.5 % of patients, CVS was detected in 10-30 % of foci, in 61.8 % of patients in 30-60 %, in 23.6 % of patients, from 60 to 95 % was detected. Accordingly, 52.7 % of patients overcame the threshold value of 45 % required for the differential diagnosis of MS from other conditions.Conclusion. The use of CVS in MRI helps to solve the problem of differential diagnosis of MS from other demyelinating diseases when using its threshold criterion – the percentage of foci containing central veins.

The objective of the study: to analyze characteristics of a standardized model of type B gunshot open global injury (open injury without intraocular foreign body).Methods: The experiment was carried out on 36 rabbits (71 eyes). Simulation of type B gunshot open global injury (GOEI) was accomplished using pump equipment. The complex of modern standard and high­technology diagnostic methods to study characteristics of type B GOEI in the control period was performed. Biomicroscopy, ophthalmoscopy, optical coherence tomography, electroretinography, ultrasound examination, MRI, enzyme multiplied immunoassay to determine vitreous fibronectin, and pathomorphological study of the eye globe were carried out. Non­parametric statistical methods of data analysis were used.Results: The above diagnostic methods being used, the GOEI experimental model characteristics were determined, including proliferative vitreoretinopathy (PVR) i.e.incidence rate and dynamics.Conclusion. High reproducibility (77–100 %) of microlevel signs of type B GOEI experimental model was demonstrated, that evidenced standardization of the developed model. The viability of the use of hyphema and hemophthalmia as the PVR and GOEI predictors was justified on the basis of correlation analysis in experiment. The analysis of proliferative signs being made when using different study methods (pathomorphological, indirect ophthalmoscopy, optical coherence tomography, ultrasound examination and MRI) proved their application as PVR markers possible. The interchangeability of the study methods used for PVR diagnosis was also justified.

Objective: comparative evaluation of output data of a set of trained convolutional neural network (CNN) models and interpretation of pathological changes in lumbar spine by radiologists during magnetic resonance imaging.Material and methods. More than 12,000 anonymized archives were collected to generate training and test neural network datasets from patients aged over 18 years. Each archive consisted of a set of programs in two planes containing T2-TSE, T1-TSE and T2 sequences with fat suppression program. Subsequently, the selected studies were tagged in two steps, directly consisting of manual tagging and its validation by experts. CNN training was performed separately for normal analysis, qualitative detection of individual pathological changes, and quantitative analysis. The accuracy of the models was verified by comparing the protocols of five radiologists and the output of CNN models in two steps. The first, intermediate stage evaluated the accuracy of the neural networks in detecting disc bulges, protrusions and extrusions, spinal canal stenosis, lateral stenosis, foraminal stenosis, spondylolisthesis and facet joint arthrosis. In the final stage, in addition to the pathologies considered in the intermediate one, the accuracy of detecting degenerative changes of the occlusive plates, synovitis of intervertebral joints, intervertebral discs degeneration, osteophytes, transitional vertebrae, hypertrophy of yellow ligaments and Schmorl’s hernia was tested. The reference value for all pathological changes considered in this paper was determined by majority vote and, in case of disagreement, by an external radiologist. The radiologists’ interpretations were then compared with those of the trained model.Results. The artificial intelligence (AI) showed comparable sensitivity and specificity values compared to the reference result in a group of experienced radiologists for binary classification (presence/absence) of individual lumbosacral spine degenerative changes. The sensitivity and specificity of AI results were 0.88 and 0.97 for extrusions, 0.81 and 0.94 for protrusions, 0.87 and 0.98 for central stenosis, 0.83 and 0.85 for lateral stenosis, 0.92 and 0.84 for foraminal stenosis, 0.85 and 0.5 for osteoarthritis, 0.73 and 0.96 for occlusive plates degeneration, 0.85 and 0.84 for intervertebral joint synovitis, 0.91 and 0.88 for osteophytes, 0.93 and 0.72 for intervertebral disc degeneration, 1.0 and 1.0 for transitional vertebrae, 0.8 and 1.0 for spondylolisthesis, 0.67 and 0.99 for yellow ligament hypertrophy, and 0.75 and 1.0 for Schmorl’s hernia, respectively. The accuracy of quantitative size characterization of lumbosacral spine protrusions and extrusions showed unsatisfactory results, but improvements in the quality of determination of these parameters are planned in future work.Conclusion. AI models showed comparable performance to expert radiologists in detecting lumbosacral spine degenerative changes. Consistent improvement of CNN models based on comparative evaluation with radiologists improves the sensitivity and specificity of pathologic change detection.

The incidence of trigeminal neuralgia (TN) is 4–5 cases per 100,000 population per year, and the prevalence is about 20–50 cases per 100,000 population. According to the modern classification, the following types of TN are distinguished: classical, symptomatic and idiopathic. The cause of classical TN is a neurovascular conflict, of symptomatic TN – neoplasms in the petroclival area, vascular anomalies, multiple sclerosis, etc. In the absence of a reliable etiological factor, TN is considered idiopathic. TN pathogenesis remains one of the most challenging topics in neuroscience. Today, there are many theories and hypotheses regarding the peripheral and central mechanisms of trigeminal neuralgia. The most popular theory is the neurovascular conflict that occurs between the trigeminal nerve and the cerebral vessels, but this theory is not the only one. It is known that even after microvascular decompression, patients may continue to experience facial pain. Therefore, other pathogenetic mechanisms are discussed: short circuit theory, multineuronal mechanism, allergic and immune hypothesis, gate theory, bioresonance hypothesis, trigeminal convergence projection theory, “ignition” hypothesis and ion channel pathology. TN is a clinical diagnosis, and its establishing requires certain criteria proposed by the International Headache Society. Using instrumental research methods, namely magnetic resonance imaging of the brain, is necessary for the differential diagnosis of classical and symptomatic TN, and imaging results should always be interpreted in combination with clinical data to make correct decisions on further treatment tactics.

Background. Breast cancer (BC) is a heterogeneous disease, in which it is crucial not only to detect the tumor, but also to determine its biological characteristics to choose an optimal treatment strategy. Herein, we review existing literature on the subject and analyze own data.Aim. To analyze clinical and morphological characteristics of rare histological types of BC.Materials and methods. In this retrospective study, we analyzed the results of instrumental examination of 180 patients with mucinous BC treated in Sverdlovsk Regional Oncology Dispensary between 2020 and 2022. The mean age of the participants was 62.5 years. All patients underwent comprehensive examination, including digital mammography using the Fujifilm Amulet Innovality system, multiparametric ultrasound breast examination using the EPIQ 5 system (Phillips, Netherlands), and 1.5 T dynamic contrast-enhanced magnetic resonance imaging with a 16-channel – dedicated breast coil (GE Healthcare, USA).Results and conclusion. The incidence of mucinous BC was 1.8 %. Other rare types of BC, such as occult, medullary, papillary, tubular, and cribriform cancer were observed in less than 1 % of cases, which is consistent with the available literature data. Mucinous tumors were primarily represented by luminal B histology (73.3 %); the Ki-67 proliferation index was usually 35 %. The most common radiological manifestation was a hyperdense formation with clear contours (85 %). Ultrasound examination usually revealed a hypoechoic formation with clear and irregular contours (92 %); however, 8 % of patients presented with isoechoic formations that can hardly be distinguished from the background. Magnetic resonance imaging showed the following patterns: mass (87.5 %) with a persistent type of contrast accumulation (56.2 %) (type I curve) or curve exhibiting a plateau (43.8 %) (type II curve). Contrast agent accumulation started from the first minutes and was >100 % in all patients. Limitation of diffusion was observed in 25 % of patients. Patients with mucinous BC were usually characterized by late manifestation; 3 patients additionally had other cancers, including colorectal cancer, mucoepidermal tumor of the salivary gland, pancreatic cancer. None of these patients had family history of cancer. Isolated findings of X-ray mammography, ultrasound, and magnetic resonance imaging suggested benign breast tumors and no cancer-specific features.A multimodal approach enabled early detection of non-specific signs of rare forms of BC characterized by a specific clinical pattern with symptoms typical of this particular cancer from.

In recent years, the frequency of contrast-enhanced radiological studies has increased significantly, and the issues of their selection and rational use do not lose their relevance. These methodological recommendations represent a complete up-to-date guide for using contrast agents (CA) in radiology. Types of currently used CA in computed tomography, magnetic resonance imaging, and ultrasound examinations are described. Safety rules for injection of each CA type are systematized, the principles of dosing and possible side effects are explained. In addition, it is important to highlight the issues of interactions between CA and other drugs that patient might take, in particular, the possible deterioration of renal function when using CA in diabetes mellitus patients taking metformin. It should be noted that these recommendations have undergone significant changes in recent years. Also questionnaire templates for patients prior to the contrast-enhanced study are given in the supplements. The methodological guidelines are based on current publications of international experts on CA use in radiology as well as on the data of two major guidelines: American College of Radiologists (ACR) Guidelines (2023) and European Society of Urogenital Radiology (ESUR) Safety Recommendations (2018, version 10). Thus, the information presented is validated, which provides grounds for its application in real clinical practice. The guidelines will be actualized as new scientific evidence becomes available, but to date they appear to be the most relevant.

The study of blood flow is becoming a new trend in cardiology and cardiovascular surgery. Based on the literature and our own data, a review is presented on the use of 4D flow in diseases of the heart and blood vessels. The main state of the question about the features of the application of the technique in various pathologies of the cardiovascular system is described in detail, the priorities, limitations and promising directions of the technique application are considered taking into account the goals of practical medicine. The review consists of two parts. The first is devoted to general issues, limitations of the technique, and issues of 4D flow mapping in patients with lesions of the great vessels. In the second part, the emphasis is on the use of 4D flow magnetic resonance imaging in the study of intraventricular blood flow and the application of the technique in congenital heart and vascular diseases.

The article describes segmentation methods used in the analysis of medical images. The advantages and disadvantages of such methods as threshold values, classification, clustering, Markov networks, neural networks, deformable models used in the analysis of magnetic resonance imaging and computed tomography images are considered. The process of developing software technology for processing graphic data using computer vision in the healthcare sector is presented. The stages of design and modeling of the developed system are described. Data processing through image segmentation promotes diagnostic accuracy and close interaction between application users. A database and cross-platform application have also been created that allows you to store a volume of research in the application cloud. Full testing of the created mobile application was carried out. In the healthcare sector, medical image segmentation is becoming an increasingly necessary function for more accurate diagnosis and further verification of the patient's diagnosis, and therefore, thanks to the timely detection of various diseases, it will be widely used for more rational and targeted treatment, improving the quality of life of the population. When developing the application, data processing was carried out using libraries such as OpenCV, Tensorflow, PyTorch, which facilitate the analysis of graphical data. [ABSTRACT FROM AUTHOR]

Introduction. Syndesmophyte, which is the hallmark of ankylosing spondylitis (AS), is a vertically oriented ossification located outside the fibrous ring of the intervertebral disc. In recent decades, the most widespread theory is that after inflammation in the area of attachment of the fibrous ring to the vertebral body, fatty degeneration occurs with reparative processes, as a result of which the growth of new bone – syndesmophyte – begins. It is believed that the likelihood of developing syndesmophyte is two to three times higher in the angles of those vertebrae in which active inflammation or fatty changes were detected on magnetic resonance tomography (MRI) in the previous 2 years, the latter having a stronger association with subsequent pathological bone formation. However, this relationship is ambiguous according to different studies.The aim – comparison of the exact localization of magnetic resonance tomography and computed tomography (CT) signs of lesions on the vertebral endplates, characteristic of axial spondyloarthritis, in patients with ankylosing spondylitis.Material and methods. The cross-sectional study included 10 patients with AS who met the inclusion criteria.All patients underwent a standard examination for AS, as well as MRI and CT examination of the lumbar spine.A special technique for joint assessment of changes detected during MRI and CT examination has been developed.For the primary analysis, changes found on the upper endplates of 5 lumbar vertebrae were taken.Results. On the upper endplates of 5 lumbar vertebrae, a CT examination revealed 35 syndesmophytes (from 1 to 7 syndesmophytes in 1 patient), and MRI revealed 9 foci of acute inflammation and 24 of chronic inflammation (fatty degeneration). When jointly analyzing the MRI foci of detectable inflammation and syndesmophytes transferred to the vertebral diagram, it turned out that in the majority of cases (68%), the latter were not associated with sites of active and/or chronic inflammation. Correlation analysis showed a certain direct relationship only between the number of syndesmophytes and foci of chronic inflammation (r=0.68).Discussion. Preliminary data show that the proposed method for comparing MRI and CT lesions in AS allows us to jointly study the localization of MRI and CT spinal injuries in patients with AS using multidirectional sections. The first results of our one-time study showed that in most cases the localization of developing syndesmophytes does not coincide with the foci of inflammation detected by MRI (both acute and chronic).

BACKGROUND: One of the primary pathophysiological mechanisms of functional dyspepsia is a disruption in the postprandial reflex relaxation of the proximal part of the stomach, which results in an impairment of its motor-evacuation function. This impairment can be verified by magnetic resonance imaging with a stress drinking test. Correction of gastric relaxation accommodation disorders in functional dyspepsia is possible with the help of drinking mineral waters. However, further studies are required to assess the effect of these waters on the motor-evacuation function of the stomach. AIM: The study was aimed at comparative evaluation of the effect of intake of therapeutic medium mineralized sulfate-sodium-calcium mineral water and ordinary drinking water on gastric evacuation function using magnetic resonance tomography. MATERIALS AND METHODS: A two-fold magnetic resonance imaging procedure was conducted on an empty stomach using a closed-type Philips Intera 1.5T device (Philips, Netherlands) in 10 patients aged 22.8±1.2 years with a diagnosis of functional dyspepsia. On day 1, 200 ml of drinking water was used, and on day 2, 200 ml of mineral water was used. The examination was conducted in abdominal mode, with the subjects lying on their back. A slice thickness of 3 mm was used in coronal, axial, and sagittal projections, with images acquired every 5 minutes for 20 minutes. The following imaging modes were employed: T1, T2-weighted images, T2 Spair, and b-FFE. The volume of gastric contents and the rate of fluid evacuation were calculated using the RadiAnt DICOM Viewer program (Medixant, Poland). RESULTS: In patients with functional dyspepsia, the volume of liquid in the stomach after ingestion of 200 ml of drinking water was 163.71 ± 28.9 mL, while after ingestion of mineral water, the volume was 101.57 ± 26.88 mL. Furthermore, the volume of evacuated liquid after ingestion of mineral water was 1.040–2.5 times greater. By minute 15, the volume of liquid in the stomach was 8.0 ± 6.16 mL after mineral water intake and 58.85 ± 40.06 mL after drinking water. The mean gastric evacuation rate following ingestion of ordinary drinking water was 12.9 ± 5.29 mL/min, while that following ingestion of mineral water was 24.1 ± 4.53 mL/min (1.07–3.76 times greater). The increase in gastric evacuation rate observed in the examined subjects when using mineral water ranged from 7.58% to 276.21%. CONCLUSIONS: Magnetic resonance imaging of the stomach allows for the verification of the effect of mineral water on its motor-evacuation function, thus enabling the estimation of the rate of gastric emptying. A single intake of the studied mineral water has a prokinetic effect, which can be used to correct motor disorders in patients with functional dyspepsia.

BACKGROUND: The pituitary gland is an endocrine gland that plays a crucial role in the regulation of metabolism, physical and sexual development. Modern medical imaging techniques allow the study of changes in the hypothalamic-pituitary region in children with low physical development [1–3]. AIM: The aim of the study was to investigate the state of the hypothalamic-pituitary region in children with different forms of nanism using magnetic resonance imaging. MATERIALS AND METHODS: The study included 102 boys and 96 girls with complaints of growth retardation. Magnetic resonance imaging of the brain with targeted studies of the pituitary region of children and adolescents aged 8–15 years was studied. Using a high-field magnetic resonance imager, the brain was scanned in the axial, coronal, and sagittal planes using standard modes and targeted examination of the pituitary region using T1- and T2-weighted pulse sequences with a slice thickness of 2.0 mm. Inclusions in the pituitary gland requiring differential diagnosis betwe en adenoma and Rathke’s cleft cyst were imaged with intravenous contrast. The physical development of the children was evaluated using the AntroPlus computer program. The significance of differences between groups was determined by the confidence interval; differences were considered significant at p 0.05. RESULTS: Analysis of the obtained data shows that 92.0% of children and adolescents with idiopathic stunting have a standard deviation of growth from –2.0 to –3.0. In these children, hypoplasia of the pituitary gland was found in 36.4% of cases, residual structures of Rathke's cleft cyst in 16.5%, and inactive pituitary adenoma in 4.2%. Normal structure of the pituitary gland was found in the remaining children. In the group of patients with growth hormone deficiency, children with standard deviation of growth coefficient from –3.0 to –4.0 are more frequent (52.6% of patients), and 31.4% of boys and girls have growth retardation more than –4 σ. In these children, in addition to hypothalamic-pituitary masses and hypoplasia of the adenohypophysis, magnetic resonance imaging revealed in 26.7% of cases (including 83.4% of boys and 16.6% of girls) an abnormality of pituitary development in the form of a triad: hypoplasia of the adenohypophysis, shortened pituitary pedicle, and ectopia of the neurohypophysis. In the group of patients with growth retardation due to the presence of hereditary syndromes, 32.7% of those studied had a coefficient of standard deviation of growth between –2.0 and –3.0, and 33.4% had a coefficient of standard deviation of growth between –3.0 and –4.0. In children with more severe growth retardation, magnetic resonance signs of empty sella (22.6%) and hypoplasia of the pituitary gland (34.8%) were more frequently visualized. CONCLUSIONS: Magnetic resonance imaging is the primary method for evaluating the pituitary gland [4]. Children with idiopathic stunting exhibit a coefficient of standard deviation of growth that is 5.4 times less frequent than that observed in boys and girls from other groups. In the group of children with growth hormone deficiency, the coefficient of standard deviation from –3.0 to –4.0 is 1.6 times more frequent than in those with hereditary syndromes. One-third of children with pituitary stunting who exhibited a growth deficit greater than –4 σ exhibited a pituitary developmental anomaly in the form of a triad (hypoplasia of the adenohypophysis, shortening of the pituitary gyrus, and ectopia of the neurohypophysis). In contrast, no such anomaly was found in the other groups. The coefficient of standard deviation of growth greater than –4 was found in single cases.

BACKGROUND: One of the principal indications of placenta accreta is pathological vascular remodeling in the region of the placental site. This phenomenon, which may result from various mechanisms, can give rise to significant blood loss in women undergoing cesarean section [2]. AIM: The study aims to evaluate the correlation between different types of abnormal hypervascularization observed on pelvic magnetic resonance imaging in pregnant women with placenta accreta and blood loss during surgical delivery by cesarean section. MATERIALS AND METHODS: A total of 224 patients in the second and third trimesters of pregnancy with placenta previa and placenta accreta were examined. This was confirmed by ultrasound and magnetic resonance imaging, and subsequently by histopathologic examination. The mean age of the patients was 34.8±0.41 years (M±SE, p 0.05). Magnetic resonance imaging was conducted in accordance with a three-stage protocol on tomographs with magnetic field strengths of 1.5 and 3 Tesla. The diagnosis of placenta accreta was based on 11 signs, as outlined in the joint consensus statement of the Society of Abdominal Radiology and the European Society of Urogenital Radiology [1]. In addition, signs of hypervascularization were evaluated, including intrauterine (retroplacental, intramural, and subserosal) and extrauterine (parametrial, paracervical, and uterine-ovarian anastomosis zone) regions. The diagnostic criteria for hypervascularization were defined as an increase in the diameter of vessels, as indicated by areas of magnetic resonance signal dropout, their pronounced tortuosity, and their location in the corresponding anatomical regions relative to the uterus. Blood loss during labor was assessed in five categories: 1000 mL, 1000–1500 mL, 1500–2000 mL, 2000–3000 mL, and 3000 mL [3]. The correlation between variables was assessed using linear regression and Pearson’s correlation coefficient (r) and one-way analysis of variance. Differences were considered statistically significant at p 0.05. RESULTS: According to the data of correlation analysis, the formation of anterior (r=0.3591, p 0.0001) and lateral (r=0.2799, p 0.0001) parametrial vascular collateralization, as well as utero-ovarian anastomosis (r=0.1369, p=0.0407) had the most significant effect on the severity of postpartum hemorrhage. There was no statistically significant effect of retroplacental hypervascularization on the increase in blood loss volume (r=–0.01611, p=0.6051). CONCLUSIONS: The study demonstrated that patterns of abnormal vascular remodeling in the placental site can be clearly identified by magnetic resonance imaging and used as a predictor of severe hemorrhage. Pregnant women with such MRI findings should be referred to a level 3 perinatal center to ensure adequate control of increased risks of obstetric hemorrhage during operative delivery.

Background. Recently, multiparametric magnetic resonance imaging (MRI) techniques have been developed to stratify clinically significant changes in chronic liver diseases (CLD). The advantage of multiparametric MRI is the visualization of the entire organ to eliminate the variability of the results during biopsy and the assessment of the quantitative characteristics of individual parameters of the liver parenchyma. A relatively new direction is the use of multiparametric MRI for the diagnosis of CLD with quantitative determination of fat, iron and fibrous changes in the liver parenchyma.Aim. To develop a multiparametric MRI technique for the quantitative assessment of biomarkers in CLD.Object and methods. A multiparametric MR study was performed in 57 patients with CLD using various pulse sequences.Conclusion. The article reflects the developed multiparametric MRI technique for quantifying biomarkers in CLD, based on data of which it is possible to abandon invasive interventions in the process of diagnosis and monitoring the response to treatment.

Introduction. Radiomics is a rapidly developing field in oncology visualization aimed at searching for prognostically effective imaging features associated with specific genetic events that determine various characteristics of the disease course. According to numerous studies, the presence of IDH mutations in glial tumors determines a longer overall survival. Despite the fact that biopsy is considered to be the «gold standard» for brain tumors differential diagnosis, it is though quite difficult to perform due to the complexity of surgical access, common cases of the repeat procedure impossibility, serious complications and mortality.Aim: a search for imaging features providing prognostic data on the presence of certain mutations and gene expression in gliomas, obtained using traditional pulse sequences and characterized by the absence of restrictions on applicability depending on the tumors visible morphological features.Material and methods: retrospective analysis of 49 eligible patients' primary brain MRI data between 2021 and 2023 from Almazov National Medical Research Centre (n = 31) and Napalkov Oncological Centre (n = 18) with glial tumors and subsequently identified status of the target variable; preprocessing of MR images using the histogram matching; regions of interest determination and semi-automated slice-by-slice segmentation with subsequent extraction of radiomics features; search for predictive radiomics features regarding the status of target variable using statistical analysis tools.Results. Dependence Entropy was found to be highly effective as a predictor of IDH mutations (area under the ROC-curve – 0.766 [0.627–0.880]).Conclusions. We determined a target variable for the development of a predictive model (IDH status), a pulse sequence (T2-Tirm), a tool for initial imaging data preprocessing (histogram matching), regions of interest (tumor-associated T2-Tirm-hyperintensity including cystic and/or necrotic lesions). As a result, a statistically significant relationship between the Dependence Entropy feature and IDH status of glial tumors was found. In the course of further work it is planned to increase the size of a database, improve the accuracy of the existing statistical model, search for relevant radiomic features extracted using other traditional pulse sequences, create a comprehensive predictive radiogenomics model and develop a software.

Diagnosis of breast cancer remains a largely unsolved problem, despite the introduction of screening programs. Recently, magnetic resonance imaging has become more often used not only as a clarifying method, but also as a primary method for diagnosing breast cancer. Unified assessment systems have been developed as tools to assist in decision-making based on the results of radiation examination of the mammary glands: BI-RADS and Kaiser. The BI-RADS score provides a systematic approach to the description of breast images of various modalities. The Kaiser system, on the contrary, is highly specialized and is suitable for interpreting magnetic resonance imaging data only.Purpose. To determine the agreement of experts in assessing breast condition using the BI-RADS and Kaiser scales.Object and methods. We examined 40 patients (average age 45 years), we analyzed 87 neoplasms and areas of changes. The studies were performed on a magnetic resonance imaging scanner with a magnetic field of 1.5 T with appropriate scanning protocols, the results were assessed by independent experts with and without experience. Spearman's correlation analysis and Kendall's coefficient of concordance were used to analyze the results.Results. Spearman's correlation showed a relationship between BI-RADS scores and Kaiser in the inexperienced rater. The agreement between experts was higher when using the Kaiser system - 0.66, using the BI-RADS scale – 0.53.Conclusion. The lack of correlation between BI-RADS and Kaiser scores in an experienced examiner suggests a significant contribution of specific magnetic resonance features. The agreement between experts using the Kaiser system is higher than when using the BI-RADS scale.

BACKGROUND: A wide range of indicators and examination methods in acute myocardial infarction complicates their interpretation, affecting the objectivity and reliability of the final conclusions. In this situation, the results of a multivariate mathematical analysis can serve as a guide, allowing one to determine statistically significant indicators and establish a range of critical values for a particular case. AIM: to establish prognostically significant ranges of global and segmental deformation of the left ventricle using speckle tracking echocardiography in patients with acute inferior wall myocardial infarction of the left ventricle, who have undergone primary percutaneous coronary intervention, at the time of discharge from the hospital and in the long-term period. METHODS: Using speckle-tracking technology, the echocardiographic data were analyzed at the time of discharge and on the second year for 144 patients with acute inferior myocardial infarction of the left ventricle who underwent percutaneous coronary intervention. In the post-infarction period, 10 patients underwent magnetic resonance imaging and 15 patients underwent stress echocardiography. RESULTS: Using the tree construction method, the critical values of 7 ultrasound parameters were identified (for the left ventricle — ejection fraction, end-systolic volume index, global longitudinal and circular strains, for the right ventricle — tricuspid S’, global longitudinal strain, free wall strain), which predict a repeat revascularization with a probability of 89.4%. The identification of the possible areas of myocardial fibrosis in the remote period by speckle-tracking echocardiography has a sensitivity of 46–57%, specificity of 68–76%, and a negative predictive value of 74–87% relative to the gold standard detection of post infarction scarring by magnetic resonance imaging. According to the results of stress-echocardiography, new zones of local contractility impairment registered after exercises were not accompanied by changes in the segmental longitudinal deformation. CONCLUSION: The results of echocardiographic screening using speckle-tracking technology in patients with acute inferior myocardial infarction of the left ventricle have high prognostic significance in assessing the likelihood of repeated revascularization at the time of discharge and diagnostic information value for verifying post-infarction fibrous changes in the long-term period.

Over the past decade magnetic resonance imaging is being increasingly used in revealing pathological changes in peripheral nervous system due to a number of technical innovations and growth of diagnostical strength, and, therefore, due to initiation of research of several magnetic resonance imaging methods which allow to perform quantitative assessment of peripheral nerves. Among them, diffusion tensor magnetic resonance imaging which gives an opportunity to investigate microstructural changes in nerves tissue by water diffusion evaluation should be mentioned first. T2‑relaxometry and magnetization transfer ratio studies allow assessing macromolecular integrity of peripheral nerves elements. Chemical shift‑based fat fraction evaluation in peripheral nerves and corresponding muscles is also of great scientific interest both for diagnostic and therapy effect monitoring purposes. Manuscript presents brief description of above‑ mentioned methods, as well as recent results and perspectives of their application for peripheral nerves evaluation, supplemented with own illustrations of experimental observations.

Methods: On average, almost every second case of tuberculosis (TB) among patients with HIV infection remains undetected. A clinical observation of two twin girls aged nine years is presented here when extrapulmonary foci of TB dissemination were identified using high-field magnetic resonance imaging (MRI) of the whole body. This paper presents a clinical case illustrating the high effectiveness of MRI compared with computed tomography (CT) with less radiation exposure of the body of an HIV-infected child.

Modern methods of neuroimaging make it possible to develop approaches for assessing intracranial pressure as a replacement for the “gold standard” of invasive monitoring. Aim of the study was to investigate the possibility of using magnetic resonance (MR) characteristics to assess the increase in intracranial pressure in patients with secondary intracranial hypertension. Material and methods. Group 1 – 40 patients with brain tumors, group 2 – 15 patients with communicating hydrocephalus, control group – 36 individuals. The patients underwent MRI with measurement and evaluation of the optic nerve sheath diameter (ONSD), the optochiasmal cistern and the pituitary gland vertical sizes, and tortuosity of the ON. Patients of the 2nd group underwent a phase-contrast MRI with an assessment of the velocity and volumetric characteristics of blood and cerebrospinal fluid flows with the calculation of the intracranial compliance index (ICC). Using the FreeSurfer program, the brain volumes were estimated. Results and discussion. A statistically significant increase in ONSD was found in the groups of patients compared with the control group (by 24 %, p < 0.05), decrease in the vertical size of the pituitary gland and an increase in the vertical size of the optochiasmal cistern (p < 0.05), as well as ICC lowering in group 2 (by 1.7 times, p < 0.05). Tortuosity of ON in group 1 was observed more often than in other groups. A statistically significant positive correlation between ONSD and brain volumes in group 1 (r = 0.55, p < 0.05) and a negative correlation between brain volumes and ICC in group 2 (r = –0.86, p < 0.05) has been found. Conclusions. Based on the presented results, we believe that the combined use of qualitative and quantitative MRI criteria can expand the diagnostic capabilities of non-invasive assessment of increased intracranial pressure.

Introduction: The leading cause of hemorrhagic stroke is a ruptured cerebral aneurysm (CA), accounting for 70%-85% of nontraumatic subarachnoid hemorrhages. The primary goals of CA treatment are to prevent a rupture, thrombosis, or symptoms of mass effect. The main treatment options for intracranial aneurysms are open clipping, flow-diverter device implantation, resection and stenting of aneurysms. Treated aneurysms should be monitored to assess the stability of the occlusion because more than 20% of surgically treated aneurysms are known to recur. Magnetic resonance angiography (MRA) has recently become increasingly attractive for the follow-up of surgically treated CAs because it is noninvasive, does not require hospitalization, and reduces complications associated with the frequent use of cerebral angiography.Objective: To evaluate capabilities of dynamic MRA in postoperative monitoring of patients with CAs.Materials and methods: The study was conducted at the premises of the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation). In a hospital setting, 38 patients with CAs were examined in the late postoperative period. All the patients underwent magnetic resonance imaging, 3-dimensional time-of-flight (3D-TOF) MRA, and dynamic MRA followed by cerebral angiography. Imaging findings (MRA, dynamic MRA, and cerebral angiography) were evaluated by radiologists, x-ray surgeons, and neurosurgeons. They assessed treated aneurysms according to the Raymond-Roy occlusion classification: complete obliteration (class 1), residual neck (class 2), and residual aneurysm (class 3). Untreated aneurysms in patients with multiple CAs and de novo aneurysms were also assessed, and we looked for other vascular malformations.Results: The study was conducted in the late postoperative period from 6 to 18 months. A total of 38 patients participated in the study; of them 27 were women (age, 32-77 years) and 11 were men (age, 32-65 years). Dynamic MRA detected neck remnants of 4 clipped aneurysms and 2 embolized ones, which was confirmed by cerebral angiography. According to the dynamic MRA results, in case of clipped aneurysms neck remnants were found in the anterior communicating artery (n = 2), internal carotid artery (n = 1), and anterior choroidal artery (n = 1). In case of embolized aneurysms, neck remnants were revealed in the internal carotid artery (n = 1) and basilar artery (n = 1). Dynamic MRA also detected 5 additional aneurysms: 2 internal carotid artery aneurysms, 1 basilar artery aneurysm, 1 anterior cerebral artery aneurysm, and 1 anterior communicating artery aneurysm. These findings coincided with those of cerebral angiography. Based on the results of our study, the sensitivity and specificity of dynamic MRA in detecting CA neck remnants and untreated aneurysms were 100%.Discussion: Dynamic MRA findings are fully consistent with those of cerebral angiography in terms of determining an aneurysm occlusion status during postoperative follow-up. As for evaluation of de novo intracranial aneurysms, dynamic MRA is also superior to noncontrast 3D-TOF MRA in assessment of aneurysm shape and neck detection. Therefore, dynamic MRA can clearly visualize the structure of cerebral vessels mainly due to the effect of blood flow and static tissue contrast, and the principle is mainly the effect of multiphase scanning and accumulation of contrast agent.Conclusions: Dynamic MRA has a number of advantages over cerebral angiography, such as noninvasiveness, high-resolution images of the cerebral arteries, absence of radiation exposure, use of iodinated contrast agent, and absence of artifacts from metal clips or embolic material.

Background: Cerebral contusions occur in approximately 43% of blunt head trauma cases. The gyri are predominantly affected, although severe traumatic brain injury (TBI) may damage the subcortical white matter and deep structures within the brain. Computed tomography (CT) of the brain is used to evaluate all forms of intracranial injuries, fractures, cerebral edema, and other associated injuries.Objective: To analyze the CT potential in the diagnosis of cerebral contusions during the acute phase of TBI in children younger than 3 years.Materials and methods: In 2021-2022 we performed CT using a Philips Ingenuity Elite 128 slice CT scanner in 1334 children with TBI (730 boys and 604 girls younger than 3 years). The area of interest in the examined children was the skull and cervical spine. We did not use enhancement. The effective dose range varied from 1.27 to 1.91 mSv.Results: Of 510 children, 448 (87.84%) patients had skull fractures that combined with intracranial injuries in 366 (81.7%) children, with 262 (71.58%) of them having severe injuries (Glasgow Coma Scale ≤ 8) and 36 (9.83%) of them undergoing surgery. Cerebral contusions were diagnosed in 58.5% (214 of 366) of children. Contusions (98% of which were hemorrhagic) had different volumes and degrees of hemorrhage and edema. The foci of contusions were in the frontal (37.1%), temporal (34.3%), parietal (20.6%), and, less often, occipital (8%) lobes.Conclusions: CT is the preferred imaging modality in acute TBI, which enables to accurately detect and adequately treat cerebral contusions, preventing secondary injuries. CT is the main diagnostic tool and should be performed in all children with TBI within the first hours after injury.

Transient ischemic attack (TIA) in the vertebrobasilar vascular territory (VB) causes difficulties in diagnosis when it manifests only with vestibular symptoms. Issues relating to the differential diagnosis of TIA are discussed, awareness of which is necessary for the selection of informative methods of examination and the prescription of effective stroke prevention in patients with an episode of isolated dizziness. The likelihood of TIA as the cause of dizziness is increased by the patients' high cardiovascular risk, the presence of atrial fibrillation, severe instability during an attack, and head and/or neck pain. If a TIA in VB is suspected, it is advisable to perform a minimal instrumental examination, including computed tomography (CT) of the brain and CT angiography or diffusion-weighted magnetic resonance imaging (MRI) and MRI angiography. In case of doubt, additional information can be obtained by a perfusion CT or MRI as well as a post-contrast MRI. When interpreting the results of these methods of examination, their limitations in terms of application time and resolution should be taken into account.

Involvement of axial skeletal in psoriatic arthritis (PsA) is often associated with inflammatory changes in peripheral joints and is asymptomatic or minimally symptomatic, and changes in the spine and sacroiliac joints are often found only on X-ray. The article, which is based on numerous studies, compares the characteristics of axial skeletal lesions in patients with the axial form of psoriatic arthritis (axPsA) and in patients with ankylosing spondylitis and discusses the possibilities of their diagnosis using radiography and magnetic resonance imaging (MRI), including modern methods such as diffusion-weighted imaging, contrast-enhanced dynamic scanning and whole-body MRI.The main difficulty in diagnosing axPsA is that there is no universally accepted terminology or standardized diagnostic criteria, making it difficult to clearly distinguish axPsA from other forms of axial spondyloarthritis. Determining the first symptoms of axPsA not only helps to make a timely diagnosis and prescribe appropriate treatment, but also to monitor the activity of the disease and the dynamics of structural changes, which allows appropriate adjustment of the therapy needed to improve the quality of life of patients.

The diagnosis of diseases from the group of autoimmune encephalitis (AE) requires a detailed analysis of clinical data and correlation of results from a wide range of laboratory and instrumental research methods. This article presents three clinical cases of patients with AE. In one patient, AE was associated with a malignant neoplasm, in the second one – with the novel coronavirus infection, and in the third patient, no comorbid pathology was detected. The specific type of encephalitis was determined for each of the three patients. The diagnosis of “autoimmune limbic encephalitis” was established in two patients based on visualization of changes in the medial temporal structures in the magnetic resonance imaging of the brain, detection of pathological bioelectrical activity in the temporal lobe cortex in electroencephalography, and pleocytosis in cerebrospinal fluid. The diagnosis of “anti-NMDA receptor encephalitis” was made based on the detection of specific antibodies to the subunit of the corresponding receptor. Neurological deficit regression was observed in two patients after the application of combined immune therapy methods and in one patient without the use of immune therapy.

Hurst’s disease (acute hemorrhagic leukoencephalitis) is a rare fulminant demyelinating disease of the central nervous system. It was singled out as a separate nosological form in the middle of the 20th century. The etiology is not fully understood. According to statistics, the disease most often occurs after a viral or bacterial infection. Patients have an increase in body temperature up to febrile values, headaches, gastrointestinal disorders, cognitive impairments. When making a diagnosis, they are guided by the results of neuroimaging (computed tomography/magnetic resonance imaging), analysis of cerebrospinal fluid, and brain biopsy. Corticosteroids, acyclovir, antibiotics, immunoglobulins, plasmapheresis are used for treatment. The prognosis in patients with acute hemorrhagic leukoencephalitis is poor.

Idiopathic inflammatory myopathies (IIM) are a group of chronic autoimmune conditions characterized by proximal muscle weakness and potentially accompanied by a range of extramuscular clinical manifestations. There are subtypes of IIM including dermatomyositis (DM), polymyositis (PM), immune-mediated necrotizing myopathy (IMNM), sporadic inclusion body myositis (sIBM), overlap myositis (OM) with subgroup of anti-synthetase syndrome (ASS) and cancer-associated myositis. Taking into account rarity of the disease, heterogeneity of clinical presentation, difficulties in detection methods and interpretation of myositis associated autoantibodies (MAAs) and myositis specific autoantibodies (MSAs), search for objective imaging methods of muscle damage continues. This is important to definitive diagnosis, predicting subtypes of IIM and case follow-up. One of the most promising methods is magnetic resonance imaging (MRI). The aim of the review was to examine the role of MRI in assessment muscle damage, in particular, most typical MRI-findings and there features in different types of IIM with further clinical cases.

A meeting of the Expert Council on September 9, 2023 considered the last challenges in the treatment of osteoarthritis (OA) including OA in comorbid patients. Leading experts in rheumatology, traumatology and other relevant disciplines participated in the meeting. The key goal of Expert Council was the discussion of potential application of a combination of undenatured (native) type II collagen, methylsulfonylmethane, boswellic acids, vitamins C and D (Artneo complex) as a part of complex OA therapy. The experts concluded that Artneo for stage I–III knee OA patients is not just non-inferior in comparison with a combination of chondroitin sulfate and glucosamine hydrochloride but excels it in the decrease of magnetic resonance imaging synovitis markers and dynamics of Lequesne index for knee osteoarthritis severity. The proven efficacy and the favorable safety profile of 6-months Artneo course deserve the attention of medical community and the active implementation of Artneo complex into ambulatory practice, first of all, for the treatment of patients with mild or moderate synovitis and/or burdened with comorbidities.

Background: Interdigital neuroma is one of the most common diseases in foot surgery. It is a common cause of metatarsalgia leading to debilitating pain. At the same time, the diagnosis of neuroma can be a difficult task for an orthopedic surgeon due to the complex anatomy of the forefoot and a large number of soft-tissue and bone structures. Besides, the existing manual testing methods are not pathognomonic specifically for neuroma. The clinical symptoms and history, as well as a physical exam and instrumental evidence are important in assessing and grading the disease. However, there are no recommendations in the modern Russian literature regarding the need for routine visualization of neuroma. The reproducibility of the study, the absence of ionizing radiation and the possibility of obtaining a second opinion, as well as high sensitivity makes magnetic resonance imaging an important diagnostic tool in the diagnosis of neuroma. Aim: To evaluate the importance of the anamnesis and complaints and the sensitivity of clinical tests and magnetic resonance imaging of the foot in the diagnosis of interdigital neuromas. Methods: The study presents a retrospective analysis of the medical histories and outpatient records of 28 patients (8 men and 20 women) treated at the EMC ECSTO in the period from 2017 to 2022. The examination was performed according to a standardized protocol: collection of complaints and anamnesis, palpation, manual testing, including Mulder's click test. As a part of examination, magnetic resonance imaging of the foot was performed for all the patients. The average patient’s age at the time of the surgical treatment was 45 years. The resection of a part of the affected nerve with the subsequent histological examination was considered a gold standard for the treatment and verification of interdigital neuromas. In all the cases, the histopathological study confirmed the diagnosis. Results: The sensitivity of magnetic resonance imaging in the diagnosis of interdigital neuromas was 86%, the sensitivity of the Mulder test was 61%. Pain during the palpation of the affected interdigital space was determined in 100% of cases. Conclusion: The combination of a manual examination and magnetic resonance imaging, along with the analysis of complaints and anamnesis makes it possible to diagnose Morton's neuroma in most cases.

Background: Metastatic brain lesions lead to the most unfavorable prognosis for the course of an oncological disease. Most often, brain metastases arise from primary tumors such as lung cancer, breast cancer, and melanoma. Of particular interest are groups of secondary intracranial tumors without an identified primary focus. Methods of non-invasive differential diagnosis based on a possible histological affiliation, including diffusion-kurtosis magnetic resonance imaging, can improve the diagnostic search for the primary tumor. Aim: The aim of this study is to improve the quality of differential diagnosis for brain metastases of tumors of different primary localization by introducing the diffusion-kurtosis magnetic resonance imaging technique into the magnetic resonance scanning protocol. Methods: Our work included studies of 60 patients who underwent examination and treatment at the N.N. Blokhin National Research Medical Center of Oncology of the Ministry of Health of Russia from October 2019 to March 2022. According to magnetic resonance imaging, metastatic formations were detected in the brain of the patients, with different localizations of the primary tumor. 20 patients were diagnosed with lung cancer (33.3%), 20 patients with breast cancer (33.3%) and 20 patients with melanomas (33.3%). We evaluated the tumor size, diffusion and kurtosis parameters, such as the mean kurtosis, axial kurtosis, radial kurtosis, kurtosis anisotropy, radial diffusion, and fractional anisotropy, and relative anisotropy, axial diffusion of the extra-axonal fluid, radial diffusion of the extra-axonal fluid, axonal fluid fraction, and tortuosity of the diffusion trajectory. Results: Statistically significantly (p 0.05) differing parameters of diffusion and kurtosis in the comparative evaluation of the above indicators were identified in the structure associated with melanoma and lung cancer axial diffusion, fractional anisotropy, relative anisotropy, radial kurtosis and tortuosity of the diffusion trajectory, as well as in the structure of melanoma and breast cancer — axial diffusion, axonal fluid fraction, fractional anisotropy, axial diffusion of extra-axonal fluid, mean kurtosis, relative anisotropy, radial kurtosis and tortuosity of the diffusion trajectory. Conclusion: Diffusion-kurtosis magnetic resonance imaging is a promising technique that allows obtaining additional differential information in the case of metastatic lesions of the brain matter, especially those from an undetected primary focus.

Background. Pancreatic head cancer ranks 6–7th among oncologic diseases and 4–5th among causes of mortality, with only 5% of patients achieving 5-year survival rate to date. Despite the successes of modern diagnostics and surgical treatment, the problem of early detection, staging of oncologic process and, as a consequence, combined treatment of pancreatic head cancer remains actual.Objective: increasing the accuracy of diagnostics and estimation of resectability of the pancreatic head cancer on the basis of the complex use of the radiation methods of investigation with pancreaticoduodenal zone 3D-reconstructions.Material and methods. The study included 93 patients (44 (47.31%) males and 49 (52.69%) females) with complicated pancreatoduodenal masses treated from 2019 to 2022 at the Surgical Department of the City Mariinsky Hospital. The patients’ age varied from 44 to 90 years, the mean age was 67±0.74 years. All patients underwent magnetic resonance imaging (MRI) on an Ingenia MR tomograph (Philips Medical Systems, Netherlands) with a magnetic field induction of 3 Tesla. The native examination of the abdomen and retroperitoneum, supplemented with MR-cholangiopancreatography protocol, and dynamic contrast enhancement with data collection in arterial, portal, and delayed phases were carried out. T2-weighted images were then performed using turbospin-echo technology, including fat-suppressed images, to evaluate structural changes and the presence of fluid in fascial spaces. Patients also underwent endoscopic ultrasound of the pancreaticoduodenal zone using the push and pull method, and abdominal multislice computed tomography (MSCT). To build 3D models, we used free 3D-slicer and Mimics programs, which allowed to build semi-automatic model for further evaluation of anatomo-topographic relations.Results. MSCT 3D modeling revealed tumor invasion into the superior mesenteric vein in 6 (23.06%) patients, whereas MRI models showed tumor invasion in 4 (15.38%) patients, intraoperatively the results were confirmed in 5 patients (19.23%). According to both MSCT and MRI modeling data, the invasion of the ventral trunk occurred in 1 (5.2%) case, which was confirmed intraoperatively. Inferior vena cava invasion on MSCT and MRI models was detected in 3 (11.54%) patients, whereas intraoperatively – in 4 (15.38%) patients. The MSCT and MRI 3D models coincided with the data on invasion of the ventral trunk in 1 (3.85%) patient and the superior mesenteric artery in 2 (7.69%) patients, which was fully confirmed intraoperatively.Conclusion. 3D modeling on the basis of MRI and MSCT studies is an informative method in preoperative staging of pancreatic head cancer and its resectability. This method allows to objectively determine the localization and prevalence of the tumor process on adjacent anatomical structures, as well as visually demonstrate the metastatic lesion of regional lymph nodes. By the parameters of diagnostic efficiency, 3D models are maximally close to the intraoperative picture, which allows planning both the volume and the course of surgical intervention.

The thyroid nodules (TNs) are widespread throughout the world: according to the pathological studies, they can be found in 50–60% of adults. Currently, ultrasound, computed tomography, magnetic resonance imaging and radionuclide diagnostics, such as positron emission tomography with computed tomography, are usually used to diagnose TNs in clinic. These techniques are mainly used to diagnose the nodile benignity and malignancy, the degree of invasion into adjacent tissues and metastases to lymph nodes. Thanks to the development of artificial intelligence, machine learning and the improvement of medical imaging equipment, radiomics has become a popular area of research in recent years. It allowes to obtain various quantitative characteristics from medical images, highlighting invisible features and significantly expanding the possibilities of identifying and predicting. Radiomics has a high potential in detecting and predicting TNs. We present the information on the development and workflow of radiomics. The article summarizes the application of various imaging techniques to identify benign and malignant TNs, determine invasiveness and metastases to lymph nodes, as well as some new advances in the field of molecular level and deep learning. The disadvantages of radiomics method are also given as well as prospects for its further development.

The use of magnetic resonance imaging in morphometry, as quantitative assessment of brain parameters (thickness, surface area, volume), allows to detect changes in many neuropsichiatric conditions that were previously considered intact. This article provides data on neuroimaging brain morphometry and effective use of this method in neurosciences.

Histologically, chronic demyelinating lesions in multiple sclerosis (MS) have been shown to include inactive lesions that do not change over time and active or “smouldering" lesions that tend to enlarge over time and are surrounded by pro-inflammatory activated microglial cells that are loaded with iron. To identify “smouldering" foci of demyelination and assess the “latent” inflammatory process in the brain, MRI sequences sensitive to the detection of substances with paramagnetic properties, including iron, must be used. They include an innovative technique such as quantitative susceptibility mapping (QSM).Objective: to identify, using MRI different types of chronic demyelination foci in MS, based on iron distribution and the degree of damage (myelination) in their structure.Material and methods. The patterns of iron distribution in demyelinating lesions in 90 MS patients were investigated using QSM. In addition, two lesions with different iron distribution patterns were randomly selected on the QSM map for each patient, in which the magnetic transfer ratio (MTR), indirectly reflecting the degree of myelination, was calculated. The identified changes were also compared with visualization of lesions in standard MRI modes (T1 MPRAGE, T2 FLAIR).Results. Despite the predominantly identical visualization in T2 FLAIR mode, chronic foci of demyelination show different patterns on the QSM maps, which is due to the peculiarities of iron distribution: some foci are not detected on QSM, while others are visualized either in the form of a homogeneous or a ring-shaped pattern. When comparing QSM data with MTR, it was found that MTR indicators were highest in non-visualized lesions (demyelination is minimal), while damage was most pronounced in lesions with ring-shaped iron distribution.Conclusion. Different patterns of iron distribution in demyelination foci compared to the degree of myelination in these foci according to MTR were identified using QSM, which is of great importance for the evaluation of latent inflammation and the development of the neurodegenerative process in MS.