Search

The paper presents two clinical cases of patients with giant renal angiomyolipomas (AML), in one of whom its course was complicated by intratumoral hemorrhage. It describes key diagnostic criteria for computed tomography (CT), as well as the distinctive features of other neoplasms that should undergo a differential diagnosis. The similar clinical presentations and morphological characteristics of different renal neoplasms can cause certain diagnostic difficulties; however, the carefully collected historical data and distinctive criteria allow AML to be identified. Due to its high sensitivity and specificity, abdominal contrast-enhanced CT is an effective imaging technique in the detection and differential diagnosis of giant renal AML.

Gastric neuroendocrine tumors commonly called carcinoids arise from enterochromaffin cells of the stomach and are rare. Recently, their incidence has increased, which may be due to the improvement of diagnostic and therapeutic capabilities. The article describes a rare clinical case of gastric carcinoid 23 years after surgical removal of gastric cardia cancer.

The paper considers an algorithm for the diagnostic study of patients with cancer of different localization, the possibility and feasibility of involving imaging techniques in radiation therapy and brachytherapy (BT) planning. The most widely used ultrasound in BT planning does not exclude a subjective assessment of the boundaries of the tumor and organs at risk, as well as the inaccuracies caused by endostatic devices. Magnetic resonance imaging (MRI) provides a high level of achievement of the criteria necessary for BT planning, but it has financial constraints and the need for individual selection of research conditions. Computed tomography (CT) is the most effective technique for visualizing the tumor, endostatic devices, and organs at risk for BT 3D planning. The involvement of MRI and positron emission tomography with CT in BT planning is a promising area that requires equipping with a mathematical tool for double and triple contouring of the tumor and organs at risk and for defining protection priorities. The prescribed and used focal dose should be controlled by direct dosimetry methods to ensure quality assurance.

The early and complete diagnosis of lung carcinoid tumors is of great interest in clinical oncology, since this is the basis for the possibility of using options for organ-sparing surgical treatment. According to the 2015 WHO classification, carcinoids belong to the group of neuroendocrine tumors and are divided into two types: a typical carcinoid and an atypical one. Based on the data available in the literature, there are from 0.2 to 2 cases per 100,000 population. The paper considers the possibilities of radiation studies in the early diagnosis of this tumor, as well as those of determining the tactics, type, and scope of surgical treatment.

Acute mesenteric ischemia is an acute disruption of blood supply to part of the intestine, which, if untreated, leads to bowel wall necrosis and a patient’s death. Computed tomography (CT) plays a leading role in detecting mesenteric ischemia and in making the initial diagnosis, especially in patients with chronic critical illness, when productive contact is impossible. The final diagnosis is established during surgery or postmortem examination. Timely diagnosis and surgical treatment are a basic tool to reduce high mortality rates from this disease. The article presents the possibilities of CT in imaging and making the primary diagnosis of mesenteric ischemia and mesenteric thrombosis.

Computed tomography for coronavirus infection (COVID-19) is effective not only in making a diagnosis, but also in timely and accurately detecting some complications of this disease in different organs and systems. The paper shows various complications of coronavirus infection that a radiologist may face in practice, which develop both in the natural course and due to therapy for COVID-19, including hemorrhagic and thrombotic events in coagulopathy, pneumothorax, and pneumomediastinum as a result of the direct cytotoxic effect of SARS-CoV-2 on pneumocytes, and barotrauma during mechanical ventilation, as well as pathological fractures due to osteoporosis, including steroid osteoporosis that has developed during therapy with glucocorticosteroids. It considers the main causes and pathogenesis of various complications of coronavirus infection.

Neurofibromatosis type 2 is a rare genetic disease that occurs with a frequency of approximately 1 in 50,000 newborns and is characterized by benign tumors, mainly bilateral schwannomas of the VIII cranial nerve. It is inherited by an autosomal dominant type without sex. Clinical symptoms are associated with damage to the VIII pair of cranial nerves, skin manifestations are less common than with neurofibromatosis type 1. The tumor can be one-sided and can be combined with neurofibromas, meningiomas (intracranial and spinal), schwannomas of other cranial nerves, astrocytomas and ependymomas of the spinal cord. In detecting tumors and making a primary diagnosis, the leading role is played by instrumental diagnostic methods: magnetic resonance imaging (MRI) and computed tomography (CT). The final diagnosis is made after genetic analysis. The article presents the possibilities of CT and MRI in imaging and diagnosis of type neurofibromatosis type 2.

Carcinoid tumors are rare malignant neoplasms of the respiratory system. They belong to neuroendocrine tumors with a low degree of (G1, G2) malignancy. Even less common is the primary multiplicity of these tumors in the trachea and bronchi, which can complicate the only radical, surgical treatment. We present an observation of a 75-year-old patient who was able to diagnose a carcinoid of the cervical trachea and left main bronchus in a timely manner, determine the exact localization and prevalence of the tumor, and successfully conduct surgical treatment in 2 stages.

Objective: to evaluate the role and place of MRI lung screening in the detection of pneumonia and patient routing.Material and methods. 500 MRI tests were performed in the period from November 1, 2020 to December 15, 2020 on the basis of more than 20 diagnostic centers of the federal MRI-Expert network. Two groups were identified. In Group 1 (control, n = 50) MRI studies were compared with CT studies in a single time interval of 0–2 days; 25 patients had a positive PCR test for SARS-CoV-2 and 25 patients were conditionally healthy. In Group 2 (effective, n = 450) mediastinal MRI was performed with lung screening on Philips 1.5 T and Siemens 1.5 T devices. The statistical analysis of the medical data base was performed.Results. During the study, mandatory and additional MRI scanning programs were identified: for Philips 1.5 T tomograph, the mandatory programs are sSSh_fb: tra and cor; THRIVE: tra (inhale/exhale); for Siemens 1.5 T – T2_BLADE: cor, tra, sag. When comparing the visual data of the control group (n = 25) with a positive PCR test in a single time interval of 0–2 days, the fact of detecting MR changes coincided with CT changes in 76% of cases (n = 19). The group of patients were examined by only one method – MRI-screening of the lungs (n = 475), pathological changes in the lungs were detected in 44% (n = 209). Localizations of the pathological changes were as follows: bilateral changes – 70.3% (n = 147), right-side changes – 19.6% (n = 41), left-side changes – 10% (n = 21); lower parts 26.8% (n = 26), average departments – 10% (n = 21), the upper divisions – 14.8% (n = 31), mid-lower 29.6% (n = 62), total – 18.6% (n = 39). The ranges of the area of lesion of the pulmonary parenchyma on MRI were graded according to MRI criteria into 4 groups (< 25%, 25 – 50%, 50 – 75%, > 75%). The collective radiation dose decrease was calculated for a group of patients (n = 450), which averaged 2.025 man-Sv for 1.5 months, of which 0.077 man-Sv were control studies.Conclusion. Based on the results obtained, the analyses of the possibilities of the MRI method in displaying pulmonary changes was performed. The method of MRI screening of the lungs is recognized as a possible alternative to computed tomography for dynamic monitoring in conditions of a shortage of CT records or the inability to perform it, and as a tool to reduce the collective effective dose of radiation to the population.

The biceps muscle located between the shoulder and ulnar articulations is attached to the bone structures with a tendon, so in case of traumatic impact, the damage may be both in the proximal and distal parts. Most tendon ruptures occur in the proximal biceps, less often distally, in the area of radial tuberosity. The anamnesis and examination data play an important role in the diagnosis of ruptures. But the instrumental diagnostics is used for complete verification of the diagnosis and exclusion of complications or other diseases. The most reliable and comprehensive information is provided by the method of magnetic resonance imaging (MRI). The article presents analysis of MRI results in a patient with a complete distal biceps tendon rupture with the tendon pulled upward and the muscle retracted. The MRI study could make a correct clear diagnosis, which allowed the patient to immediately contact a specialized professional and to receive qualified assistance in time. Thus, it is shown that high-field MRI makes it possible to solve the problems of identifying the pathological processes and determining their severity with high accuracy.

Multiple primary colon cancer is an urgent medical problem of our time, which is associated with a steady increment in the incidence of the above disease and with the high complexity of its diagnosis. According to the literary sources, the incidence of this form of cancer of the colon has recently amounted to as much as 17% among all multiple primary neoplasms and this organ is a very common site. The paper describes a clinical case confirming the need for a thorough diagnosis of multiple primary colon cancer, by applying radiation techniques to further define treatment policies.

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.

Objective: to reveal a relationship of lung changes to time after radiotherapy (RT), its dose, and irradiated volume, by using a new procedure to quantitatively evaluate lung tissue density changes according to the data of dynamic X-ray computed tomography (X-ray CT) imaging.Subjects and methods. Data on 29 cancer patients who had received RT to the chest area using 3D planning, 2-5-Gy fractions, and a total focal RT dose of 16 to 84 Gy in the lung tissue were retrospectively selected. Each patient underwent at least two X-ray CT studies (before and after RT); a total of 83 studies were analyzed. The new diagnostic procedure developed by the authors was used to quantitatively analyze lung tissue density changes in the areas with a selected dose range.Results. On days 1 to 15-30 after completion of RT, the quantitative analysis revealed no significant density changes. On days 70-80, there was an increase in changes that were different from those in the nonirradiated areas. On 80 to 100-120 days, there was a decline of radiation reactions with preserved changes in the areas irradiated at a dose of 19-20 Gy. From 120 days onwards, the changes were preserved in the areas irradiated at a dose of over 32-37 Gy through the formation of post-radiation pulmonary fibrosis. In addition, eight (27.6%) patients treated with less than 20 Gy were detected to have changes associated with the initial density values, which can be regarded as an increased individual radiosensitivity.Conclusion. The time course of a quantitative change in the median lung tissue density in the areas irradiated at different doses allows radiation-induced lung injury to be detected at X-ray CT until the visual signs of pneumonitis appear. A continuous, quantitative scale of changes will assist in more reliably and accurately studying post-radiation changes at a later time, and the time course of spaciotemporal changes will be able to compare and quantify lung injury when exploring new treatment methods and policies.

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.

Objective: to analyze the possibilities of standard and additional methods for X-ray mammography (MG) in the comprehensive diagnosis of nonpalpable breast masses and preclinical cancers; to identify the important radiological signs of malignancy as predictors for the application of multislice spiral computed tomography/ magnetic resonance imaging (MSCT/MRI-MG), as well as invasive studies in premenopausal women. Material and methods. The investigation enrolled 423 pre-menopausal patients with nonpalpable breast masses; 129 women were found to have breast cancer. The diagnosis was verified by comprehensive clinical and instrumental examination using standard and additional methods for X-ray mammography, ultra-sonography, MRI, MSCT of the breast and biopsy. Significant radiological signs of malignancy of the lesions were detected and their diagnostic value was identified. Results. The use of additional diagnostic techniques for mammography contributes to the confident visualization of important radiological criteria for malignancy, enhances the informative value of by 5%, and promotes a decline in the number of unjustified biopsies by 11%. Conclusion. Problems in visualizing and categorizing nonpalpable breast masses necessitate additional diagnostic techniques for X-ray mammography. The identification and confident interpretation of important radiological criteria for benign or malignant lesions increase the diagnostic value of X-ray mammography: the sensitivity from 91% to 98%, specificity from 61% to 75%. MSCT-MG and MRI-MG demonstrate even higher efficiency: contrast-enhanced (CE) MSCT–MG (100% sensitivity, 99% specificity) and CE MRI–MG (100% sensitivity, 98% specificity). Sequential radiological and morphological studies improve the quality and efficiency of diagnosis of nonpalpable breast cancer.