Objective: to diagnose and estimate the clinical value of postcholecystectomy sphincter of Oddi dysfunction in patients.

Material and methods. Examinations were made in 100 postcholecystectomy patients without signs of cholestasis; of them 14 postpapillotomy patients formed a comparison group. Hepatobiliary scintigraphy using the radiotracer 99mTC-bromeside was performed for 90 minutes with cholagogue breakfast at 45 minutes. Common bile duct and duodenal functions and duodenogastric reflux (DGR) were evaluated comparing them with clinical, laboratory, and instrumental findings.

Results. Two patient groups were identified according to bile outflow changes. In Group 1 consisting of 20 (23.2%) patients, the time of maximum accumulation (Tmax) of the radiopharmaceutical in the projection of the choledochus coincided with that in the cholagogue test (46.0±1.8 min) and in Group 2 including 66 (76.8%) patients that was shorter than in the cholagogue test (32.9±6.8 min) (p<0.05). In Group 2, Tmax was similar to that in the comparison group (30.9±7.5 min; р>0.05) and there was no significant difference in intestinal imaging time (18.6±6.0 min versus 17.6±0.8) either, which could be indicative of sphincter of Oddi dysfunction. Diarrhea was observed in 73% of the patients with sphincter of Oddi dysfunction and in 86% of the patients in the comparison group versus 10% of the patients with normal bile passage (p<0.01). Statistical data processing showed a correlation of the indicators of sphincter of Oddi dysfunction with those of duodenal evacuator function (r=0.57; p<0.0005) and DGR (r=0.74; p<0.009).

Conclusion. Postcholecystectomy sphincter of Oddi dysfunction assumes the greatest clinical value in patients with duodenal motor-evacuator dysfunction, which should be kept in mind when choosing a treatment policy.

 

Objective: to carry out a quantitative analysis of diffusionweighted magnetic resonance images (DWI) in cancer of the cervix uteri (CCU) and to estimate the possibility of using pretreatment measured diffusion coefficient (MDC) to predict chemoradiation therapy (CRT).

Material and methods. The investigation prospectively enrolled 46 women with morphologically verified Stages IB-IVB CCU. All the women underwent diffusion-weighted magnetic resonance imaging of pelvic organs before and after treatment. A semiautomatic method was used to determine tumor signal intensity (SI) on DWI at b 1000 s/mm2 (SI b1000) and tumor MDC. The reproducibility of MDC  measurements was assessed in 16 randomly selected women. The investigators compared the pretreatment quantitative DWI measures in complete and incomplete regression (CR and IR) groups and the presence and absence of tumor progression during a follow-up. An association of MDC with progression-free and overall  survivals (PFS and OS) was determined in the patients.

Results. A semi-automatic tumor segmentation framework could determine the pretreatment quantitative DMI measures with minimal time spent and high reproducibility. The mean tumor MDC was 0.82±0.14×10–3 mm2/s. CR and IR were established in 28 and 18 women, respectively. The MDC ≤ 0.83×10–3 mm2/s predicted CR with a sensitivity of 64.3% and a specificity of 77.8% (р=0.007). The median follow-up was 47 months (range, 3–82 months). With the MDC ≤ 0.86×10–3 mm2/s, 5-year PFS was 74.1% versus 42.1% with a higher MDC (р=0.023) and

5-year OS was 70.4 and 40.6%, respectively (р=0.021). The survival difference was insignificant in relation to the degree of tumor regression. The pretreatment IS at b1000 was of no prognostic value.

Conclusion. The pretreatment tumor MDC may serve as a biomarker for predicting the efficiency of CRT for CCU.

 

 

Objective: to give the results of a software-based hybrid single photon emission computed tomography/magnetic resonance imaging (SPECT/MRI) in detecting osteomyelitis (OM) in patients with diabetic foot syndrome (DFS).

Material and methods. Seventy-six patients (35 men and 41 women) (mean age, 59.4±7.1 years) with type 1 and 2 diabetes mellitus and suspected OM were examined. The investigation enrolled patients with neuropathic (n=25), ischemic (n=13), and mixed (n=38) DFS. All the patients underwent 99mTc-HMPAO/ 99mTc-technefit labeled leukocyte scintigraphy; magnetic resonance imaging was performed in 30 patients. The results were combined using RView 9.06 software (Colin Studholme).

Results. Labeled leukocyte SPECT to diagnose OM yielded 25 true positive (TP), 38 true negative (TN), 12 false positive (FP), and 1 false negative (FN) results. The accuracy of the technique was 82.9%. The FP results were due to the low resolution of the technique and to the small sizes of the object under study. One FN result was detected in a patient with ischemic DFS because of reduced blood flow. MRI to identify OM in patients with DFS  provided 20 TP, 16 TN,4 FP, and 2 FN results. Its diagnostic accuracy was 85.7%. The relative low specificity of MRI was associated with the presence of FP results due to the complexity of differential diagnosis of bone marrow edema and inflammatory infiltration. Assessing 42 hybrid SPECT/MR-images revealed 21 TP, 17 TN, 3 FP, and 1 FN results. The diagnostic accuracy was equal to 95.9%.

Conclusion. Thus, comparing MRI (90.9% sensitivity and 80.0% specificity), labeled leukocyte scintigraphy (96.2% sensitivity and 76.0% specificity), and hybrid SPECT/MRI (95.5% sensitivity and 85.0% specificity) showed the high diagnostic efficiency of the latter.

 

 

Objective: to determine the specific features of the development of metachronous tumors and survival rates in patients with metachronous primary and multiple cancers after radiotherapy for the first tumor.
Material and methods. The archival data of the Chelyabinsk Regional Oncology Dispensary on the treatment of 232 patients, in whom metachronous primary and multiple tumors occurred after radiotherapy for primary tumor, were studied.
Results. The patients’ mean age at the diagnosis of the first tumor was 60.23 years (95% CI 58,75–61,72). The time from the first tumor to the second one averaged 91.81 months (95% CI 80,57–103,05). The patients survived for an average of 129.41
months (95% CI 116,55–142,28) after the diagnosis of the first tumor and 37.64 months (95% CI 31,92–43,35) after the occurrence of the second tumor. Overall, the patients survived for an average of 127.03 months (95% CI 114,02–140,03) following
radiotherapy for the first tumor. According to the classification, the authors identified three metachronous tumor subgroups: multicentric multiple tumors in one organ (16.0%), systemic tumors and tumors of paired organs (15.5%), and nonsystemic multiple tumors of different organs (68.5%).
Conclusion. Patients with multicentric metachronous multiple tumors in one organ are younger and have the shortest time from the diagnosis of the first tumor to the emergence of the second one and the longest survival after the diagnosis of the first
tumor, that after the detection of the second tumor and that after the initiation of radiotherapy. Patients with nonsystemic multiple tumors in different organs are
older and have the longest time from the diagnosis of the first tumor to the occurrence of the second one and the shortest survival.

Boron neutron capture therapy (BNCT) that is of the highest attractiveness due to its selective action directly on malignant tumor cells is a promising approach to treating cancers. Clinical interest in BNCT focuses in neuro-oncology on therapy for gliomas, glioblastoma in particular, and BNCT may be used in brain metastatic involvement. This needs an epithermal neutron source that complies with the requirements for BNCT, as well
as a 10B-containing agent that will selectively accumulate in tumor tissue. The introduction of BNCT into clinical practice to treat patients with glial tumors will be able to enhance therapeutic efficiency.

Cancer of the cervix uteri (CCU) ranks third in the incidence of malignancies in women. The choice of CCU treatment mainly depends on the extent of the tumor process, i.e. the stage of the disease. Determining the stage of CCU is based on the clinical classification of the International Federation of Gynecology and Obstetrics (FIGO) (2009) and has a number of substantial limitations in evaluating parametrial invasion, tumor spread to the pelvic wall, and involvement of regional lymph nodes and in determining the true tumor sizes. Magnetic resonance imaging (MRI) is now the method of choice in staging invasive CCU.
Multiparameter MRI will be able to enhance the efficiency of diagnosing microinvasive CCU as well (FIGO 2009), to plan surgical and/or chemoradiation treatment, to evaluate its efficiency, and to diagnose locally recurrent CCU.