Lung cancer is a serious medical and social problem. It belongs to the most common cancers. In the past decades, lung cancer has steadily held a leading place in the structure of cancer morbidity and mortality in our country and in the majority of European countries. Cigarette smoking remains to be the major if not only risk factor for lung cancer. Many attempts were previously made to set up systems for the early (timely) lung cancer detection in risk groups through cytological and radiological examinations. Prophylactic fluorography and X-ray study have long been an important screening procedure in Russia and foreign countries. Recently this procedure has transformed into digital lung radiography. However, there have been no conclusive proofs for its efficiency in the early detection of lung cancer for a few decades. In the past decade, large-scale prospective randomized trials of low-dose computed tomography (CT) have been performed to screen lung cancer. These have shown that this technology can potentially reduce mortality from this disease. This encouraging result has caused a substantial change in the tactics of examining people at high risk for lung cancer. CT has fully replaced linear tomography and all others special X-ray procedures in the verified diagnosis of lung cancer. The indications for preexamination CT have been considerably expanded in patients with X-ray detected pathology. The tactics for estimating the small lung tissue foci found at CT has been changed. Availability of CT, clear clinical indications for the study, and observance of the standard procedure have become important elements of the entire system for the early identification of lung cancer. These clinical recommendations largely deal just with organizational and methodological issues. The authors hope that the recommendations will serve as a guide for primary care physicians (therapists, pulmonologists, and radiologists) in the early diagnosis of lung cancer and in the optimization of patient routing from the detection of its early symptoms to surgical, radiation, and drug treatments.

Objective: to improve the differential diagnosis of disseminated pulmonary tuberculosis (DPT) and exogenous allergic alveolitis (EAA) via comparative investigation of their computed tomography (CT) semiotics and identification of the most informative diagnostic criteria. Material and methods. 70 patients, including 40 patients with DPT in a phase of infiltration and 30 patients with acute EAA, were studied using a Somatom Emotion 16 multi-slice spiral CT scanner (Siemens). All the patients underwent spiral scanning from the upper chest aperture to the costodiaphragmatic recesses with a high CT algorithm at 0.8-mm slice thickness and a 1.5-mm step. Results. Analysis of the spread of dissemination foci established that pathological changes were peribronchovascularly located in both nosological entities and characterized by a preponderance of septal and intrabronchial locations in DPT and by a centrilobular distribution in EAA. Centrilobular foci were more commonly poorly defined in EAA and mixed foci were observed in DPT. In the latter, peribronchovascular, centrilobular foci were revealed at a distance from the visceral pleura (the boundary of the deep and superficial lymphatic network, respectively) in 38% and more than half of the cases (62%) with the involvement of the visceral and parietal pleura; in EAA, the centrilobular foci were more often combined with the involvement of the visceral pleura in more than 92% of cases. The tree-in-bud sign was significantly more common in DPT. The latter was mostly characterized by apicocaudal regression of dissemination. In EAA, the foci were more frequently located asymmetrically. Monomorphic foci with destruction, as well as their polymorphism were seen in DPT; those without destruction were predominantly observed in EAA. CT ground glass and mosaic perfusion syndromes were significantly more often in EAA. In DPT, the visceral and parietal pleuras were involved in the process in 62% of cases and changes were also more common in the extrapleural fat. Conclusion. In addition to the peribronchovascular location of foci, the characteristic CT signs for DPT are a preponderance of intrabronchial and septal locations of foci, their apicocaudal regression, the presence of the CT tree-in-bud sign, and thickened extrapleural fat. EAA showed a prevalence of asymmetrical foci with centrilobular location with the involvement of the visceral pleura into the process, with the presence of CT ground glass and mosaic perfusion syndromes, as well as the bronchial lumen visualized in the peripheral segments of the lung.

 

Objective: to specify frequency, patterns and diagnostic significance of extraosseous soft tissue findings in 99mTc-pyrophosphate skeletal scintigraphy. Material and methods. Results of skeletal scintigraphy from 1060 patients (447 men, 613 women) were analyzed. Scanning in "whole body" mode started in 3–4 hours after 740 MBq of radiotracer activity intravenous administration, and performed in anterior and posterior projections in continuous table motion mode at rate of 6–8 cm per minute. Single photon emission computed tomography/ computed tomography (SPECT/CT) was additionally performed when necessary. Results. Extraosseous scintigraphic findings were discovered in 161 (15.2%) patients, they can be divided into three categories: nephrourological (7.7%), soft tissue (5.4%) and artifacts (2.1%). First category included anatomical and functional changes in the urinary system (kidney location anomalies and nonobstructive uropathies). SPECT/CT was performed to differentiate calycostasis in the projection of the upper group of calyces and focal changes of the ribs. Soft tissue extrarenal findings included diffuse or focal RP hyperfixation within breasts (29 patients), thyroid glands (15), myocardium (5), scrotum (4) and abdominal cavity (4). Symmetrical increased RP accumulation in breast or thyroid lobes was accepted as normal. Pathologic soft tissue findings in 11 patients were verified by history or instrumental data: breast cancer (2), testicular cancer (1), nodular goiter (2), uterine fibroids (2), primary cancer with liver metastases (1), association of "hot kidney" phenomenon with chemotherapy (2), and "superscan" phenomenon with myelofibrosis (1). Causes of radiotracer artifacts in the liver and spleen (14) were of radiopharmaceutical factors, in axillary lymph node (7) – partially infiltrative radiopharmaceuticals administration, in the colon (1) – previous myocardial perfusion scintigraphy. Conclusion. Analysis and interpretation of abnormal extraosseous findings in skeletal scintigraphy is an essential component of additional diagnostic information, that can influence subsequent diagnostic and therapeutic tactics.

 

 

 

 

 

Objective: to analyze the numerical characteristics of bone metastases according to scintigraphic data. Material and methods. Computer-assisted automated analysis was used to examine planar skeletal osteoscintigrams in patients with breast cancer who had both complete remission and disease progression with skeletal metastases. Brightness in the image was used as an analyzed indicator. Results. Examination of physiological tracer accumulation in patients without skeletal metastases suggests that there is a wide variability of brightness values in the scintigrams of individual skeletal areas. At the same time, the skeletal anatomic areas show significant differences in the average image brightness values (p<0.01). In virtually all skeletal areas, the average brightness values in the pathological tracer hyperfixation foci (HFFs) in the scintigrams are dominant over the similar values of physiological HFFs. Conclusion. There is a direct relationship between the tracer accumulation levels in the skeletal areas without metastatic involvement and the bone metastases occurring in the same areas.

 

The diagnosis of human dirofilariasis is difficult because of the absence of laboratory tests. Up-to-date ultrasound devices have a high resolution that can visualize this subcutaneous helminth. Ultrasonography can improve the timely diagnosis of this helminthism, as demonstrated by the given clinical example.

 

Objective: to optimize surgical treatment in patients with orbital wall defects and deformities. Material and methods. For diagnosis of orbital wall injuries, the patients underwent facial skeletal X-ray study in the semiaxial projection and midfacial spiral computed tomography. Defects were removed via the intrasinus approach in the victims, by applying a combined prosthesis designed at the Department of Oral Surgery and General Dentistry, Novokuznetsk State Institute for Postgraduate Training of Physicians. The design is a combination of a Г-shaped titanium miniplate and a silicone block. Results. Continuity of the inferior orbital wall was restored through the intrasinus approach in all cases (n = 82). There were no early postoperative complications. Late (at 3–6 months postsurgery) complications as the cutting and obvious contouring of a miniplate (in the area of the mucogingival fold at the surgical site) were stated in 6 (7.3%) cases. Enophthalmos was found in 2 (2.4%) cases. During miniplate cutting, the endoprostheses were removed and no other complications were observed during 1-to-3-year follow-ups. The paper describes a clinical case of a female patient with a blowout fracture of the left inferior orbital wall and dislocation of the orbital contents. Computer tomography (CT) findings were used to make a combined endoprosthesis; an inferior orbital wall defect was eliminated via the intrasinus approach. Control CT showed a complete elimination of orbital contents dislocation and restoration of the continuity of the inferior orbital wall. Conclusion. The given clinical case demonstrate that it is necessary to perform spiral CT at all stages of treatment and rehabilitation and it is expedient to apply the intrasinus approach to eliminating orbital wall defects and deformities.

 

Objective – to investigate the pathological physiology of superior mesenteric artery syndrome (SMAS). Material and methods. We selected 35 articles devoted to SMAS, which were published from 1990 to 2014, and performed radiometric analysis of X-rays, CT scans and MRI slices found in these articles. In pictures the narrowing in the third part of the duodenum was measured from the boundary of the expanded segment to the level of the superior mesenteric artery (SMA). Results. Only in 6 (17%) of 35 cases the narrowing portion of duodenum was located directly between aorta and SMA, and its length was about 1 cm. In the remaining 29 cases, the beginning of the narrow segment was 2.5–4.6 cm (average 3.30 ± 0.15 cm) proximal to SMA, ie, most of the narrowed duodenum was out of aortomesenteric angle. Location and length of the narrowed segment of duodenum corresponded to the location and length (3.2 ± 0.15 cm) (P>0.2) of the functional Ochsner sphincter. Conclusion. These data indicate that in most cases of SMAS the sphincter Ochsner dyskinesia causes the disease. It is likely that the disease is triggered by heavy stressful conditions that cause a sharp and sustained reduction in the pH of gastric secretions, which in turn leads to the spasms of the sphincter Ochsner. With time this condition progresses to hypertrophy of the contracted wall of the duodenum with subsequent replacement of the muscle fibers by connective tissue. This can lead to the rigidity of the wall.

 

 

 

Paper gives a review of recent technical innovations in computed tomography (CT) and magnetic resonance imaging (MRI) that could be applied in abdominal oncology. Perfusion and dualenergy CT gives new opportunities for tissue characterization. Interactive reconstruction algorythms decrease radiation exposure to patients. Abdominal MRI has some important advantages over CT in detection and staging of abdominal malignancies. Nowadays standard MR protocols include DWI and dynamic 3D sequences with extracellular or liver-specific contrast media. Latest developments in MRI technology could expand its diagnostic value in abdominal oncology even further.