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Tyrimo tikslas. Įvertinti neinvazinius tyrimus kaip alternatyvą biopsijai, nustatant kepenų fibrozę ir vertinant atsaką į gydymą. Tyrimo metodai. Nuo 2020 m. gruodžio mėn. iki 2021 m. vasario mėn. atrinktos mokslinės publikacijos iš „PubMed“ duomenų bazės pagal reikšminius žodžius, remiantis įtraukimo ir neįtraukimo į tyrimą kriterijais. Rezultatai. Magnetinio rezonanso elastografija (MRE) yra jautresnė vertinant kepenų fibrozę ir cirozę nei magnetinio rezonanso tyrimas (MRT). MRE, neinvazinė vibracijos kontroliuojama trumpalaikė elastografija (angl. vibration-controlled transient elastography (VCTE)) ir 2D skersinės bangos elastografija (angl. 2D shear wave elastography (2D-SWE)) tikslūs diagnozuojant kepenų fibrozę pacientams, sergantiems nealkoholiniu kepenų suriebėjimu. Realaus laiko elastografija (angl. real time elastography (RTE)) leidžia nustatyti pažengusią fibrozę, o VCTE tiksliai nustato tiek ankstyvą, tiek pažengusią fibrozę. Kompiuterinės tomografijos (KT) tyrimas yra gana reikšmingas kepenų fibrozei diagnozuoti ir gydymo atsakui įvertinti. Išvados. Šie neinvaziniai tyrimai gali būti kaip alternatyva plačiai taikomai kepenų biopsijai.

Tyrimo tikslas. Įvertinti radiomikos panaudojimo galimybes diagnozuojant krūties vėžį ir atsaką į gydymą. Tyrimo metodai. Nuo 2021 m. sausio mėn. iki 2021 m. balandžio mėn. atrinktos mokslinės publikacijos iš „PubMed“ duomenų bazės pagal reikšminius žodžius, remiantis įtraukimo ir neįtraukimo į tyrimą kriterijais. Rezultatai. Devyni straipsniai atitiko įtraukimo į tyrimą kriterijus ir buvo naudojami tolesnei literatūros analizei. Nomograma, apimanti radiomikos balą ir BI-RADS kategoriją, turi potencialią krūties vėžio prognozavimo reikšmę pažeidimams, priskiriamiems BI-RADS UG ketvirtai arba penktai kategorijai. Klinikiniais parametrais kompleksinė radiomika su įprastiniais krūties UG ir SWE vaizdais leidžia neinvaziniu ir praktišku būdu prognozuoti pažasties limfmazgių pašalinimo mastą ir gydymo galimybes sergančiosioms ankstyvos stadijos krūties vėžiu. Derinant kiekybinius navikų radiominius duomenis su kontralateralinėmis parenchimos charakteristikomis gerėja krūties vėžio diagnozavimo tikslumas. Radiomika suteikia papildomos naudos įprastinei kontrastinei krūtinės KT, padeda planuoti pacientų gydymo strategiją. Modeliai, pagrįsti 18F-FDG PET/KT vaizdais, galėtų padėti tiksliai atskirti krūties karcinomą nuo krūties limfomos. Daugiaparametrinės MRT radiomikos gali prognozuoti patologinį atsaką į neoadjuvantinę chemoterapiją krūties vėžio atveju, taip pat nustatyti imunologiškai aktyvius navikus. Išvados. Radiomika gali būti naudinga diagnozuojant krūties vėžį, prognozuojant jo išplitimą, renkantis operacijos mastą bei siekiant nustatyti gydymo efektyvumą.

Background There is lack of guidance on specific CT protocols for imaging patients with coronavirus disease 2019 (COVID-19) pneumonia. Purpose To assess international variations in CT utilization, protocols, and radiation doses in patients with COVID-19 pneumonia. Materials and Methods In this retrospective data collection study, the International Atomic Energy Agency (IAEA) coordinated a survey between May and July 2020 regarding CT utilization, protocols, and radiation doses from 62 healthcare sites in 34 countries across five continents for CT exams performed in COVID-19 pneumonia. The questionnaire obtained information on local prevalence, method of diagnosis, most frequent imaging, indications for CT, and specific policies on use of CT in COVID-19 pneumonia. Collected data included general information (patient age, weight, clinical indication), CT equipment (CT make and model, year of installation, number of detector rows), scan protocols (body region, scan phases, tube current and potential), and radiation dose descriptors (CT dose index (CTDIvol) and dose length product (DLP)). Descriptive statistics and generalized estimating equations were performed. Results Data from 782 patients (median age (interquartile range) of 59(15) years) from 54 healthcare sites in 28 countries were evaluated. Less than one-half of the healthcare sites used CT for initial diagnosis of COVID-19 pneumonia and three-fourth used CT for assessing disease severity. CTDIvol varied based on CT vendors (7-11mGy, p

Introduction: Diffusion-weighted magnetic resonance imaging (DWI- MRI) has the potential for identifying inflamed bowel segments for patients with Crohn's disease (CD). Objectives: We aimed to determine diffusion-weighted imaging (DWI) value to predict active CD and compare apparent diffusion coefficients (ADC) with endoscopic and conventional magnetic resonance imaging (MRI) CD activity indices. Patients and Methods: Overall, 229 patients with suspected and diagnosed CD prospectively underwent magnetic resonance enterocolonography (MR-EC) with DWI sequence and ileocolonoscopy. Magnetic resonance activity index (MaRIA), Clermont index, and CD endoscopic index of severity (CDEIS) were calculated. Results: Of the 229 investigated patients, the clinical diagnosis of CD was confirmed in 100 persons. DWI score ≥2 had 96.9% sensitivity and 82.3% specificity for diagnosing CD. A threshold ADC value of 1.30 × 10–3 mm2 /s can distinguish between normal and inflamed bowel segments with a sensitivity of 73.8% and a specificity of 98%. While using MaRIA, the threshold ADC value of 1.32 × 10–3 mm2 /s with a sensitivity of 97.9% and a specificity of 97.8% was established. There were significant differences in the DWI scores and ADC values comparing patients with inactive, mild, moderate-severe disease (P < 0.01). ADC correlated with MaRIA-G (global) (r = −0.69, P = 0.001), Clermont-G (r = −0.722, P = 0.001) and CDEIS (r = −0.69, P = 0.001). Conclusions: DWI is a valuable tool that is able to identify inflamed bowel segments as accurate as a conventional MaRIA score and to discriminate between mild and moderate and severe CD activity.

Kepenų steatoze vadinamas perteklinis riebalų susikaupimas hepatocitų citoplazmoje. Bendrojoje populiacijoje ši būklė nustatoma apie 20–30 proc. asmenų, tačiau yra užfiksuotas paplitimo augimas. Nors steatozė yra potencialiai grįžtamasis procesas, tačiau ilgainiui gali atsirasti negrįžtamųjų struktūrinių kepenų pokyčių. Šiuo metu diagnostikos „auksiniu standartu“ laikoma kepenų biopsija, vis dėlto tai yra invazinis metodas. Perteklinio trigliceridų susikaupimo kepenų ląstelėse sukelti kepenų parenchimos pokyčiai taip pat gali būti randami pasitelkiant ultragarsinį tyrimą, kompiuterinę tomografiją ir magnetinio rezonanso tomografiją. Šiame straipsnyje aptariami pagrindiniai šių radiologinių metodų privalumai ir trūkumai.

Hematogenous Candida meningoencephalitis (HCME) is a life-threatening complication of neonates and immunocompromised children. Amphotericin B (AmB) shows poor permeability and low cerebrospinal fluid (CSF) concentrations, but is effective in treatment of HCME. In order to better understand the mechanism of CNS penetration of AmB, we hypothesized that AmB may achieve focally higher concentrations in infected CNS lesions. An in vitro BBB model was serially infected with C. albicans. Liposomal AmB (LAMB) or deoxycholate AmB (DAMB) at 5 μg/ml were then provided, vascular and CNS compartments were sampled 4h later. For in vivo correlation, rabbits with experimental HCME received a single dose of DAMB 1 mg/kg or LAMB 5 mg/kg, and were euthanized after 1, 3, 6 and 24h. Evans blue solution (2%) 2 ml/kg administered IV one hour prior to euthanasia stained infected regions of tissue but not histologically normal areas. AmB concentrations in stained and unstained tissue regions were measured using UPLC. For selected rabbits, MRI scans performed on days 1-7 postinoculation were acquired before and after IV bolus Gd-DTPA at 15min intervals through 2h post-injection. The greatest degree of penetration of DAMB and LAMB through the in vitro BBB occurred after 24h of exposure (P=0.0022). In vivo the concentrations of LAMB and DAMB in brain abscesses were 4.35±0.59 and 3.14±0.89-times higher vs. normal tissue (P≤0.019). MRI scans demonstrated that Gd-DTPA accumulated in infected areas with disrupted BBB. Localized BBB disruption in HCME allows high concentrations of AmB within infected tissues, despite the presence of low CSF concentrations.

Background and Objectives: Both chronic pancreatitis (CP) and pancreatic ductal adenocarcinoma (PDAC) may lead to cachexia, sarcopenia, and osteoporosis due to different mechanisms. Neither patient gender, age, nor body weight are good predictors of these metabolic changes having a significant negative impact on the quality of life (QOL) and treatment outcomes. The aim of this study was to evaluate radiological changes in body composition and to compare them with manifestations of exocrine and endocrine pancreatic insufficiency, body mass, and QOL among patients with CP and PDAC. Materials and Methods: Prospectively collected data of 100 patients with diagnosed CP or PDAC were used for analysis. All patients underwent dual-energy X-ray absorptiometry (DXA), computed tomography (CT), and magnetic resonance imaging (MRI). The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) was used to assess QOL. Diabetes and changes in fecal elastase-1 were also assessed. Results: There was no significant difference in skeletal muscle mass (SMM) among patients with CP and PDAC (p = 0.85). Significantly more underweight patients had low SMM (p = 0.002). Patients with CP had more pronounced pancreatic fibrosis (PF) (p &lt, 0.001). Data showed a significant relationship between a high degree of PF and occurrence of diabetes (p = 0.006) and low fecal elastase-1 levels (p = 0.013). A statistically significant lower QOL was determined in patients with PF &ge, 50% and in the CP group. Conclusions: Sarcopenia and osteoporosis/osteopenia are highly prevalent among patients with chronic pancreatitis and pancreatic cancer, and CT- and MRI-based assessment of body composition and pancreatic fibrosis could be a potentially useful tool for routine detection of these significant metabolic changes.

Objective: To investigate the relationship between the new International Society of Urological Pathology (ISUP) grading system, biochemical recurrence (BCR), clinical progression (CP) and cancer related death (CRD) after open radical prostatectomy (RP) and determine whether the 2014 ISUP grading system influences the concept of high-risk prostate cancer (HRPCa). Patients and Methods: A total of 1,754 men who underwent RP from 2005 to 2017 were identified from a database at a single tertiary institution. Histopathology reports were reassessed according to the 2014 ISUP grading system. All preoperative, pathological, and clinical follow-up data were obtained. Univariable and multivariable Cox regression, Kaplan-Meier and log-rank analyses were performed. Results: At a median (quartiles) follow-up of 83 (48-123) months, 446 men (25.4%) had BCR, 77 (4.4%) had CP and 39 (2.2%) died from cancer. Grade groups 1, 2, 3, 4, and 5 were detected in 404 (23%), 931 (53.1%), 200 (11.4%), 93 (5.3%), and 126 (7.2%), respectively. 10-year biochemical progression free survival difference between Grade group 3 and 4 was minor but significant (log-rank p = 0.045). There was no difference between Grade groups 3 and 4 comparing 10-year clinical progression free and 10-year cancer specific survival: p = 0.82 and p = 0.39, respectively. Group 5 had the worst survival rates in comparison with other groups (from p < 0.005 to p < 0.0001) in all survival analyses. Pathological stage (hazard ratio (HR) 2.6, p < 0.001), positive surgical margins (HR 2.2, p < 0.0001) and Grade group (HR 10.4, p < 0.0001) were independent predictors for BCR. Stage and Grade group were detected as independent predictors for CP-HR 6.0, p < 0.0001 and HR 35.6, p < 0.0001, respectively. Only Grade group 5 (HR 12.9, p = 0.001) and pT3b (HR 5.9, p = 0.001) independently predicted CRD. Conclusions: The new ISUP 2014 grading system is the most significant independent predictor for BCR, CP, and CRD. Grade group 3 and 4 had similar long-term disease progression survival rates and could potentially be stratified in the same risk group. High-risk cancer associated only with group 5. ispartof: FRONTIERS IN ONCOLOGY vol:9 ispartof: location:Switzerland status: published

This article discusses a study performed with an aim to determine the usefulness of diffusion-weighted MRI in pre-treatment assessment and evaluation of chemotherapy response of mediastinal lesions of malignant lymphoma by analysing signal intensity, accumulation of contrast agent and changes in values of ADC. Comparing the results of PET/CT and DW-MRI was another goal of this study. We reviewed data of 21 patients that underwent treatment during years 2013-2014 at the Hospital of Lithuanian University of Health Sciences Kaunas Clinics and had DW-MRI and PET/CT scans carried out. For all patients the diagnosis of malignant lymphoma in mediastinal lymph nodes was confirmed histological. Whether the lymphoma was in active state was determined by PET/CT or histological data. In MRI scans, signal intensity and ADC values were evaluated, while in PET/CT maximum and average standardized uptake values were assessed. Patients underwent chemotherapy and follow up scans were performed to evaluate response. In total, 25 PET/CT and 50 DW-MRI scans were analysed. We found statistically significant difference of values of ADC in active and inactive states of malignant lymphoma of mediastinal lymph nodes. In follow up tests, performed during 2 years after treatment, a tendency of decreasing ADC values over time was seen when chemotherapy was successful and no relapse was observed. Among the reviewed cases, DW-MRI had slightly worse specificity than PET/CT in differentiation of malignant and benign changes in lymph nodes.

Aim Crohn’s disease (CD) is characterized by continuing inflammation and progressive gut damage. Despite many scoring indices of CD, there is a lack of more global assessment tools for the evaluation of the total disease impact on the gut. Methods Fift y-three adult patients with proven CD underwent magnetic resonance enterocolonography (MR-EC), colonoscopy, and clinical activity assessment, including CRP. Quality of life was assessed using IBDQ. MR-EC was used to evaluate the Magnetic Resonance Index of Activity (MaRIA- global (G)) and the Lemann Index (LI). The CD Endoscopic Index of Severity (CDEIS) was used to score the endoscopic activity of the disease. Results A signifi cant correlation between the LI and IBDQ was found (r=-0.812, P Conclusion A signifi cant negative correlation between the LI and quality of life, measured by IBDQ, was found in our study, suggesting that the LI could resemble more global features of the disease, besides inflammatory activity of the gut.

Background and objectives: Non-invasive imaging of the heart has an important place in the diagnosis and management of pulmonary arterial hypertension (PAH). The aim of this study was to establish the thresholds of cardiac magnetic resonance imaging (CMRI)-derived biventricular deformation, function parameters, and levels of N-terminal pro brain natriuretic peptide (NT-proBNP) for the prediction of survival of pre-capillary pulmonary hypertension (PHprecap) patients. Materials and Methods: In total, 64 incident PHprecap cases, who underwent CMRI, were consecutively enrolled in a prospective cohort study. Patients underwent a systemic evaluation, including measurement of NT-proBNP, two-dimensional (2D) echocardiography, six-minute walk test (6MWT), CMRI with feature tracking (FT), and right-heart catheterization (RHC). Patients were divided into two groups according to one-year survival (survival and non-survival groups). Survival analysis was performed. Results: One-year survival was 79.6%. The distribution between age, sex, mean pulmonary artery pressure (mPAP), New York Heart Association (NYHA) functional class, and 6MWT did not differ between the groups. Survival was significantly lower in the PAH group associated with connective tissue disease (CTD-PAH), where 44% (n = 4) of patients died during the first year. Univariate analysis revealed that severely reduced right-ventricle (RV) ejection fraction (EF) &lt, 25.5%, left-ventricle global longitudinal strain (LV GLS) &gt, &minus, 14.18%, and right pulmonary artery (RPA) relative area change (RAC) &lt, 19%, and severely increased NT-proBNP level &gt, 1738 (ng/L) indicate an increased risk of death in PHprecap patients. Conclusions: Impaired RV systolic function and LV global longitudinal strain, decrease of pulmonary artery distensibility, and CTD-PAH etiology, together with high NT-proBNP level, impair prognosis in pre-capillary PH patients. These findings are important for the risk stratification and management of pre-capillary pulmonary hypertension patients.

OBJECTIVES: The aim of this study was to evaluate the utility of magnetic resonance imaging (MRI) for the noninvasive assessment of pancreatic fibrosis (PF).METHODS: Fifty-two patients who underwent surgical resection of the pancreas, histological examination of resection margins, preoperative abdominal MRI, and fecal elastase-1 test were enrolled in the study. Pancreatic tissue was identified on the MRI T1-, T2-, and diffusion-weighted imaging sequences. Apparent diffusion coefficient (ADC) was measured at the expected resection margin of the pancreas.RESULTS: There was a significant negative correlation between the ADC mean and histologically determined PF (r = -0.752, P = 0.001). For equal to or greater than 25% of PF, the ADC cutoff value was 1.331 or less, with a sensitivity of 77% and specificity of 88%. The unenhanced T1-weighted signal intensity ratio (T1SI) cutoff value was 172.1 or less. For equal to or greater than 50% of PF, the ADC cutoff value was 1.316 or less with a sensitivity of 85% and specificity of 88%. The highest sensitivity was obtained by combining ADC and T1SI values.CONCLUSIONS: Combining both the ADC and T1SI measurement allows the detection of early PF with good sensitivity and specificity. Magnetic resonance imaging has the advantage of being noninvasive and widely used in the clinical setting, thus making our results easily transferable to routine clinical practice.

Magnetinio rezonanso enterokolonografija santykinai naujas, perspektyvus žarnyno ligų diagnostikoje naudojamas tyrimas, pasižymintis gera minkštųjų audinių raiška be jonizuojančios spinduliuotės poveikio ir suteikiantis galimybę įvertinti žarnų spindžius, sieneles bei pakitimus, esančius už jų ribų. Šis tyrimas yra naudojamas uždegiminėms žarnyno ligoms nustatyti, aktyvumui ir gydymui vertinti, tačiau taip pat gali būti pritaikytas ieškant neaiškaus kraujavimo iš virškinamojo kanalo ar plonojo žarnyno obstrukcijos priežasties bei navikinio proceso. Gydytojai, naudodamiesi magnetinio rezonanso enterokolonografija, gali parinkti tinkamą gydymo taktiką ir vertinti jos efektyvumą esant Krono ligai ar opiniam kolitui. Tyrimo metu matomi radiologiniai požymiai padeda atskirti aktyvų žarnyno uždegimą, kuris gydomas medikamentais, nuo fibrozės, kuriai reikalinga chirurginė intervencija. Uždegiminių žarnyno ligų gydymo poveikis vertinamas remiantis klinikiniais indeksais, tačiau jie yra subjektyvūs ir dažnai neatspindi ligos sunkumo, todėl siūloma juos pakeisti tikslesniais, paremtais magnetinio rezonanso enterokolonografijos tyrimu. Šiems indeksams naudojami objektyvūs požymiai, todėl jie tinka ligos aktyvumui, gydymo efektyvumui, virškinamojo trakto pažeidimo lygiui nustatyti. Straipsnyje apžvelgiamos magnetinio rezonanso enterokolonografijos pritaikymo galimybės žarnyno ligų diagnostikoje, kiti naudojami tyrimo metodai bei aptariami indeksai ir jų perspektyvos klinikinėje praktikoje.

Darbo tikslas. Nustatyti MRT reikšmę diagnozuojant endometriozę. Tyrimo medžiaga ir metodai. Tyrime dalyvavo pacientės (n = 39), kurioms 2012 metais Lietuvos sveikatos mokslų universiteto ligoninėje Kauno klinikose buvo atlikti dubens organų MRT tyrimai dėl įtariamos giliosios endometriozės. Kontrolinės grupės (n = 28) pacientėms MRT tyrimai buvo atlikti pagal įprastinę metodiką. Tiriamosios grupės (n = 11) pacientėms MRT tyrimai buvo atlikti makštį ir tiesiąją žarną užpildžius ultragarso geliu. Rezultatai. Endometriozės židiniai MRT tyrimu aptikti 82 proc. pacienčių, iš jų 90,9 proc. tiriamojoje ir 78,6 proc. kontrolinėje grupėse. Vertinant giliosios endometriozės židinius, MRT tyrimo jautrumas – 100 proc. tiriamojoje ir 91,3 proc. kontrolinėje grupėse, specifiškumas – atitinkamai 50 proc. ir 80 proc., teigiama prognostinė vertė (TPV) – atitinkamai 90 proc. ir 95,4 proc., neigiama prognostinė vertė (NPV) – atitinkamai 100 proc. ir 66,7 proc., tikslumas – atitinkamai 90,9 proc. ir 89,2 proc. Išvados. Tiriant giliosios endometriozės židinius, konvencinė MRT pasižymėjo dideliu jautrumu, specifiškumu, TPV ir tikslumu bei vidutiniška NPV. Užpildžius makštį bei tiesiąją žarną vandens pagrindu pagamintu ultragarso geliu, MRT tyrimas pasižymėjo didesniu jautrumu, NPV ir tikslumu, tačiau mažesniu specifiškumu ir TPV negu konvencinė MRT. MRT tyrimu daugiausia endometriozės židinių buvo rasta užpakalinėje gimdos sienelėje ir kiaušidėse. Tiriamojoje ir kontrolinėje grupėse rezultatai iš esmės nesiskyrė.

Įvadas. Dėl geros minkštųjų audinių raiškos, magnetinio rezonanso enterokolonografijos tyrimas vis dažniau naudojamas diagnozuojant Krono ligą. Difuzijos seka padeda pastebėti ir diferencijuoti segmentinius žarnos pažeidimus bei suteikia papildomos informacijos apie žarnų sienelės funkcinius pakitimus. Tyrimo tikslas: Įvertinti tariamojo difuzijos koeficiento vertę sveikuose ir Krono ligos pažeistuose žarnos segmentuose. Medžiaga ir metodai. Tyrimo imtį sudaro trisdešimt trys pacientai, sergantys Krono liga, kurie nuo 2013 m. rugsėjo iki 2014 m. kovo mėnesio gydėsi Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų Gastroenterologijos klinikoje. Visiems pacientams buvo atliktas magnetinio rezonanso enterokolonografijos tyrimas naudojant standartines magnetinio rezonanso bei difuzijos sekas. Rezultatai. Tyrimo metu nustatyti 55 pakitę plonosios ir storosios žarnos segmentai, iš jų 28 plonojoje žarnoje: 2 – tuščiojoje, 5 – pradinėje klubinės žarnos dalyje, 21 – galinėje klubinėje žarnoje ir 27 storojoje žarnoje: 4 – kylančiojoje storosios žarnos dalyje, 6 – skersinėje, 8 – nusileidžiančioje, 9 – tiesiosios-riestinės žarnų dalyse. Aktyvia Krono liga sirgo 18 pacientų, 15 pacientų nustatyta neaktyvi ligos forma – remisija. Aktyvaus ir neaktyvaus uždegimo segmentuose tariamo difuzijos koeficiento vertė skyrėsi statistiškai patikimai: 0,8862 ± 0,077 x 10-3 mm2/s ir 0,9925 ± 0,077 x 10-3 mm2/s; p < 0,05. Išvada. Atlikus tyrimą paaiškėjo, kad tariamojo difuzijos koeficiento vertės patikimai skiriasi dėl uždegimo pakitusiuose ir sveikuose žarnyno segmentuose.

Darbo tikslas. Įvertinti kompresinių stuburo slankstelių lūžių dažnį tarp moterų, kurioms nustatyta sumažėjusi kaulų masė pomenopauziniu periodu, bei apibūdinti klinikinius ir radiologinius šių lūžių pasireiškimo ypatumus, įvertinti sąsajas su lūžių rizikos veiksniais. Tiriamieji ir metodai. Atliktas pjūvinis tyrimas, kurio metu menopauzės laikotarpį išgyvenančioms moterims, besikreipiančioms dėl profilaktinio sveikatos patikrinimo ar sveikatos sutrikimų į savo šeimos gydytojus, išmatuotas kaulų mineralų tankis dvisrautės radioabsorbciometrijos (dual-photon energy X-ray absorbtiometry – DXA) metodu. Tiriamosioms, kurioms buvo nustatytas sumažėjęs kaulų mineralų tankis (T lygmuo mažesnis už -1), buvo atliekama stuburo šoninės juosmeninės ir krūtininės dalių rentgenogramos, kurios įvertintos dėl kompresinių stuburo slankstelių deformacijų. Stuburo slankstelių lūžiai vertinti remiantis pusiau kiekybiniu Genanto metodu. Moterims, kurioms nustatytos kompresinės stuburo slankstelių deformacijos, vertinti klinikinės lūžių išraiškos bei rizikos veiksniai. Statistinė analizė atlikta PASW 18.0 programa. Rezultatai. Iš 330 tiriamųjų sumažėjusi kaulų masė nustatyta 206 (62,4 proc.) moterims, iš jų stuburo šoninės juosmeninės ir krūtininės dalių rentgenogramos atliktos 181, vertinimui tinkamos buvo 177 (85,9 proc.). Kompresiniai stuburo slankstelių lūžiai iš vertinimui tinkamų rentgenogramų nustatyti 18,4 proc. (33) tiriamųjų. Visi lūžiai įvertinti kaip seniai įvykę. Vyravo vieno slankstelio (69,7 proc. (23)) ir I° lūžiai (63,6 proc. (21)). Lėtinį nugaros skausmą jautė 24 (72,7 proc.), ūminį patyrė 4 (12,1 proc.) tiriamosios. 12 (36,4 proc.) moterų buvo skausminga palpacija stuburo slankstelių projekcijoje, priestuburinių raumenų skausmingumas ir vietinis tonuso padidėjimas – 9 (27,3 proc.). Didesnė kūno masė ir didesnis kūno masės indeksas bei fizinis aktyvumas statistiškai reikšmingai susiję su didesne kaulų mase. Lėtinis nugaros skausmas, lėtinės širdies ir kraujagyslių ligos, ūgio sumažėjimas, palyginus su buvusiu 30 m., bei didesnis gimdymų skaičius buvo statistiškai reikšmingai susiję su didesniu lūžusių slankstelių skaičiumi. Išvados. Kompresiniai stuburo slankstelių lūžiai nustatyti 33 (18,4 proc.) tiriamosioms iš 177 asmenų vertinimui tinkamų rentgenogramų. Visos nustatytos kompresinės stuburo slankstelių deformacijos įvertintos kaip seniai įvykę lūžiai. Vyravo vieno slankstelio ir I° lūžiai. Didesnis stuburo slankstelių lūžių skaičius reikšmingai statistiškai susijęs su dažniau jaučiamu lėtiniu nugaros skausmu, ūgio sumažėjimu, lėtinėmis širdies ir kraujagyslių ligos, didesniu gimdymų skaičiumi.

Darbo tikslas. Apžvelgti endometriozės diagnostiką MRT metodu. Endometriozė yra opi problema ginekologinėje praktikoje dėl didelio paplitimo, skausmo ir sukeliamų pasekmių (nevaisingumo). Šiuo metu dažniausiai yra atliekama invazinė endometriozės diagnostika laparoskopijos metodu, tačiau taikant radiologinius tyrimus gali būti atliekama ir neinvazinė endometriozės diagnostika. MRT yra jautriausias ir specifiškiausias endometriozės radiologinės diagnostikos metodas. Išvados. Dubens srities MRT yra informatyvus neinvazinis tyrimo metodas. MRT turėtų būti naudojama nustatant endometriozės židinius, vertinant medikamentinio gydymo efektyvumą ar išplitimą į aplinkinius audinius prieš numatomą operacinį gydymą.

Over the last two decades, a number of studies have been conducted on the planning of human resources in various professional qualifications of the healthcare sector in various parts of the world. The studies evaluated the supply and demand (as well as factors affecting them) of human resources in healthcare, yet no studies have been conducted in Lithuania on the planning of the number of radiographers as human resources in the healthcare system. The aim of this study was to estimate the prospective number of students accepted for studies in radiography up to 2030 in order to satisfy the need for these specialists in the labor market. Methods. The prognostication of the number of students accep- ted for studies in radiography is part of a more extensive study “The Prognosis of the Supply and Demand for Radiographers in Lithuania for 2012 – 2030”, where the supply and demand for those specialists were prognosticated according to two scenarios – the mean and the prospective ones [20]. In this study, we evaluated and compared the most likely prognoses of the supply and demand for radiographers according to the prospective scenario, and prognosti- cated the required number of entrants until the year 2030 to satisfy the demand for these specialists in the labor market. Results. The evaluation of the prospective scenario of the supply and demand for radiographers until the year 2030 showed a gap between the supply and demand for these specialists, which is likely to increase from 2016-2017 on. In 2020, the shortage was predicted to be 0.13 position per 10,000 population, and in 2030 – 0.37 position per 10,000 population. To avoid the predicted shortage of these specialists and to meet the need for them in the prospective scenario, the number of students accepted for studies of radiography should be increased by nearly one-fourth, compared to the current numbers. Conclusions. To meet the prognosticated demand for radio- graphy specialists according to the prospective scenario (which is most likely), the yearly number of entrants should be increased by up to 30% during the period of 2013-2026

Magnetinio rezonanso tomografijos (MRT) enterokolonografija,tai - tyrimas, kurio metu galime istirtivisą plonąjį ir storąjį žarnyną. Didžiausias tyrimo privalumas, kad galima įvertinti ne tik žarnos spindį,sieneles, pakitimus už žarnos sienelės ribų, bet ir diagnozuoti aktyvią uždegimine žarnyno ligą, atskirtiKrono ligą nuo opinio kolito ir nustatyti Kronosligos aktyvumo laipsnį.Darbo tikslas- įvertinti MRT enetrokolonografijos galimybe nustatyti uždegiminės žarnyno ligos požymiusir sių parametrų panaudojimą uždegiminių žarnyno ligų diagnostikoje.Metodika. Trisdesimt pacientų kliniskai įtarus aktyviąuždegimine žarnyno ligą įtraukti į tyrimą. MRT enterokolonografijos tyrimas atliktas kaip sio klinikiniotyrimo dalis. Pagal gautus tyrimo rezultatus pacientai buvo suskirstyti į dvi grupes: kontroline ir serganciųjų aktyvia uždegimine žarnyno liga. Visas žarnynas buvo padalintas į devynis segmentus. Kiekvienassegmentas buvo vertinamas dėl požymių, būdingų uždegiminei žarnyno ligai.Rezultatai. Nustatyta ženkli teigiama koreliacija tarp klinikinių ligos aktyvumo indeksų ir sienelės kontrastinės medžiagos kaupimo savybių, haustrų nebuvimo (atitinkamai r= 0,512, r=0,585, p=0,01), T2 žarnos sienelės hiperintensinio signalo ir reliatyvauskontrastinės medžiagos kaupimo (r= 0,785, p=0,01). Vidutiniska koreliacija buvo nustatyta tarp klinikinių ligos aktyvumo indeksų ir sienelės storio, opų, reliatyvaus kontrasto kaupimo (atitinkamair=0,379, r=0,384, r=0,397, p=0,05). Reliatyvuskontrastinės medžiagos kaupimo vidurkis: sergancių Krono liga 183,94±76,16, opiniu kolitu 152,53±72,94, kontrolinėje grupėje-56,33±33,42.Isvados. MRT enterokolonografija su intraveniniu kontrastavimu yra vertingas tyrimo metodas, kuriuo diagnozuojama uždegiminė žarnyno liga ir nustatomiKrono ligos bei opinio kolito uždegiminių ligų aktyvumo laipsniai.

Galvos smegenų trauma (GST) visame pasaulyje yra aktuali medicininė bei socialinė problema. Lietuvojetai yra viena dažniausių invalidizacijos priežascių.GST apibūdinama kaip būklė, kuriai būdingaskinetinės energijos poveikis kaukolei ir galvos smegenims, sukeliantis funkcinius ir morfologinius smegenų pokycius bei sutrikdantis jų veiklą. Siuo metu pradinis įvertinimas pacientams, patyrusiems galvos smegenų traumas, yra pagrįstas klinikiniais tyrimais pagal Glasgow komos skale (GKS) ir galvossmegenų kompiuterine tomografija (GSKT). Dažniausiai terapiniai sprendimai yra pagrindžiamisiais tyrimais. Taciau neretai patiriamos lengvos galvos smegenų traumos, kurių požymius galima matyti tik kompiuterinės tomografijos pagalba, o GKS neatspindi esamo pažeidimo.

OBJECTIVES: To evaluate thermal images (TIs) by using an algorithm for optimized region of interest (ROI) and image segmentation, in order to find zones of the facial skin surface with asymmetrical temperature, and to test consistency with CT findings, to detect maxillofacial pathologies (i.e. tumours). METHODS: The following steps for the TI evaluation were applied: data acquisition/pre-processing of frontal face and mouth projection, detection of face and mouth external contour, finding face and mouth symmetry axis, calculation of differences in average and maximal temperatures between left and right face and mouth sides, image segmentation of the selected ROI, and evaluation of diagnostic accuracy by comparing the TI results with CT findings. RESULTS: In healthy subjects, the average temperature difference between left/right sides of facial and mouth ROI was negligible (0.02 ± 0.21 °C and 0.05 ± 0.19 °C, respectively; n = 23). In the presence of tumour, the average temperature difference was higher in corresponding TIs (0.47 ± 0.1 °C and 0.66 ± 0.1 °C, for facial and mouth ROI, respectively; n = 19, p < 0.05). For large tumours, thermal asymmetry in the corresponding TI is easily detected, and image segmentation is optional for finding the affected zone. For small or deeply localized tumours, segmentation of the mouth cavity of the ROI was required for the detection of hot and cold spots. CONCLUSIONS: Asymmetrical temperature zones and their location as detected from thermal images coincide well with the presence and localization of maxillofacial pathologies (i.e. tumours) established by CT. However, accurate information could often be obtained only after application of image segmentation algorithm to the selected ROI.

Background and objective: Cardiovascular magnetic resonance (CMR) - based feature tracking (FT) can detect left ventricular (LV) strain abnormalities in pulmonary hypertension (PH) patients, but little is known about the prognostic value of LV function and mechanics in PH patients. The aim of this study was to evaluate LV systolic function by conventional CMR and LV global strains by CMR-based FT analysis in precapillary PH patients, thereby defining the prognostic value of LV function and mechanics. Methods: We prospectively enrolled 43 patients with precapillary PH (mean pulmonary artery pressure (mPAP) 55.91 &plusmn, 15.87 mmHg, pulmonary arterial wedge pressure (PAWP) &le, 15 mmHg) referred to CMR for PH evaluation. Using FT software, the LV global longitudinal strain (GLS) and global circumferential strain (GCS), also right ventricular (RV) GLS were analyzed. Results: Patients were classified into two groups according to survival (survival/non-survival). LV GLS was significantly reduced in the non-survival group (&minus, 12.4% [&minus, 19.0&ndash, (&minus, 7.8)] vs. &minus, 18.4% [&minus, 22.5&ndash, 15.5)], p = 0.009). By ROC curve analysis, LV GLS &gt, &minus, 14.2% (CI: 3.229 to 37.301, p &lt, 0.001) was found to be robust predictor of mortality in PH patients. Univariable analysis using the Cox model showed that severely reduced LV GLS &gt, 14.2%, with good sensitivity (77.8%) and high specificity (93.5%) indicated an increase of the risk of death by 11-fold. LV GLS significantly correlated in PH patients with RV ESVI (r = 0.322, p = 0.035), RV EF (r = 0.444, p &lt, 0.003). Conclusions: LV systolic function and LV global longitudinal strain measurements using CMR-FT correlates with RV dysfunction and is associated with poor clinical outcomes in precapillary PH patients.

INTRODUCTION The main treatment of burns is early excision of injured tissues. AIM TO COMPARE TWO DIFFERENT METHODS OF EXAMINATION OF BURNED PATIENTS: clinical burn depth examination (CDE) and laser Doppler imaging (LDI). MATERIAL AND METHODS A prospective randomized study of 57 burn patients treated in 2009-2011 was carried out. The burned patients were randomized into a CDE group and an LDI group. The CDE and LDI scan were performed 72 h after injury, with the second and third CDE and LDI scan on the 7(th) and 14(th) day after the burn. Age, sex, length of inpatient stay, cost of burn treatment, burn depth, cause and localization of the burns were analyzed between the two groups. RESULTS Fifty-seven patients were treated during 2 years. Thirty-two patients were in the CDE group and 25 patients were in the LDI group. Most of the patients were male (45 male vs. 12 female, p < 0.001). The age was similar between the males and the females (female: 46.4 ±16.9 years vs. male: 46.3 ±12.5 years; p = 0.11). The mean length of stay in hospital was significantly higher in the CDE group (47 ±34.4 day vs. 25 ±10.8 day; p = 0.005). The mean cost of treatment of burned patients was significantly higher in the CDE group. CONCLUSIONS The length of stay and cost of treatment of burn patients depends upon early diagnosis of the deep burns and well-timed surgical treatment of burn wounds.

The main treatment of deep burns is early excision of injuried tissues which reduce inpatient stay and decrease the cost of treatment. The clinical burn depth examination is still widely used in clinical practice which isn‘t accuracy and belongs of physician experience. The laser doppler imaging is mostly use method of burn depth examination. The aim of study – to estimate the accuracy of different methods of 2A and 2B degree of burn depth examination and to assess the importance of these methods of burn wound spontaneous epithelization. Methods. Prospective clinical study of 44 burned patients. The burned patients were examined 72 hours, 7 and 14 days after injury. The clinical burn depth examination, laser doppler imaging and tissue biopsy were made for all burned patients. The accuracy, sensitivity and specificity of different methods were analyzed. The burned tissue perfusion velocity and spontaneous burn wound epithelization were analyzed using laser doppler imaging examination. Results. The flame was the main reason of burn. Most of burn patients were male. The perfusion velocity was higher of conservatively treated patients compared with surgery patients. The critical perfusion velocity was since 55 to 149 PU. The perfusion velocity higher than 149 PU concluded higher rate of spontaneous burn wound epithelization. Conclusions. The laser doppler imaging enables to prognosticate spontaneous epithelization of burn wound and welltime select for surgical treatment of burned injuries.http://dx.doi.org/10.5200/sm-hs.2013.053 Article in Lithuanian

Naujosios, pažangios, daug naudos organizacijoms teikiančios verslo valdymo sistemos sparčiai vystytis pradėjo dar palyginti visai neseniai, jos nuolatos tobulinamos, plečiamas jų funkcijų ratas, Aarabi, Zameri Mat Saman, Wong, Beheshti ir Zakuan (2011) teigimu yra didinamas tokių sistemų prieinamumas smulkiajam ir vidutiniam verslui, tačiau nepatyręs klientas iš sistemų integravimo gali sulaukti ne planuotos naudos, o patirti nuostolių. Per mažas domėjimasis, nepakankamas žinių, apie sistemų naudą ar diegimo metu ir po jo iškylančias grėsmes, kiekis sąlygoja sistemų teikiamos naudos arba galimos žalos nepakankamą įvertinimą, o tai yra pagrindinė problema, susijusi su verslo valdymo sistemų integravimu., Nowadays, business has to face many challenges, including meeting the increasing needs of customers and a huge rivalry. Changes in the business environment force to look for ways to overcome arisen difficulties. One of the options is the implementation of the enterprise recourse planning in company’s activities. Although due to continuous improvements and different scientific evaluations, it is impossible to precisely define the enterprise recourse planning, yet it is best understood as a unified organization's information management system covering all the company's activities and contributing to the effectiveness and efficiency of the business process. Thus, the planning of competitive and evolving business cannot be imagined without the help of ERP, however, there is the lack of information about ERP implementation, and it results in an underestimate in systems benefits or potential harm.

Background. Diffusion-weighted magnetic resonance imaging (DW–MRI) has been employed in the diagnostics of malignant tumors of abdomen and pelvis relatively recently. Nowadays, there exists a particular interest in adaptation DW–MRI for assessing the response of tumors to chemoradiaton therapy. The aim of our study was to compare the mean value of the apparent diffusion coefficient (ADC) in a healthy cervix, cancer-affected cervix and a cervix after chemoradiation therapy, as well as to identify the ADC range typical of cervical cancer. Materials and methods. The study enrolled 108 female patients who underwent pelvic MRI in the Lithuanian University of Health Sciences Kaunas Clinics Hospital in 2008–2010. The study group consisted of 65 patients in whom cervical cancer had been clinically suspected and confirmed by biopsy before MRI examination. All these patients underwent pelvic MRI twice: before the chemoradiation therapy and 6 months after the therapy. The control group consisted of 43 patients in whom cervical cancer had been not suspected and MRI was performed because of other pelvic diseases. Results. The mean ADC value of the study group (0.658 ± 0.118 × 10–3 mm2/s) was lower than of the control group (1.171 ± 0.143 × 10–3 mm2/s) (t = 20.315, p = 0.03). The ADC threshold value of 0.945 × 10–3 mm2/s was defined, differentiating the cancer-affected cervical tissue from the normal. The mean ADC value of the patients who responded to chemoradiation therapy (1.111 ± 0.138 × 10–3 mm2/s) increased and in those who did not respond it remained lower (0.733 ± 0.073 × 10–3 mm2/s) (t = 9.518, p = 0.04). The ADC threshold value of 0.830 × 10–3 mm2/s was defined, differentiating the residual tumor tissue from the healthy cervical tissue after chemoradiation therapy. Conclusions. The ADC value in the case of cervical cancer was significantly lower than in the non-affected cervical tissue. The ADC value increases after effective chemoradiation therapy and becomes closer to the coefficient value of non-affected cervical tissue, but still remains lower. The 0.945 × 10–3 mm2/s ADC threshold was detected while differentiating between cancer-affected and normal cervical tissues, while the ADC threshold was 0.830 × 10–3 mm2/s when differentiating between residual tumor tissue and healthy cervical tissue after chemoradiation therapy at a high sensitivity and specificity. Keywords: diffusion-weighted magnetic resonance imaging, apparent diffusion coefficient, cervical cancer, chemoradiation therapy

In this article, a method is proposed for analysing the thermovision-based video data that characterize the dynamics of temperature anisotropy of the heart tissue in a spatial domain. Many cardiac rhythm disturbances at present time are treated by applying destructive energy sources. One of the most common source and the related methodology is to use radio-frequency ablation procedure. However, the rate of the risk of complications including arrhythmia recurrence remains enough high. The drawback of the methodology used is that the suchlike destruction procedure cannot be monitored by visual spectra and results in the inability to control the ablation efficiency. To the end of understanding the nature of possible complications and controlling the treating process, the means of thermovision could be used. The aim of the study was to analyse possible mechanisms of these complications, measure and determine optimal radio-frequency ablation parameters, according to the analysis of video data, acquired using thermovision.