Objective: to elaborate differential diagnostic criteria for recurrent gliomas after combination treatment, by using dynamic contrast-enhanced magnetic resonance angiography (DCE-MRA) and T2*-weighted perfusion magnetic resonance imaging (MRI).

Material and methods. The retrospective study enrolled 16 men and 7 women (mean age 34.6±15.4 years) who had undergone multiparametric magnetic resonance imaging of the brain to prevent cancer recurrence after combination treatment. The study used the following protocols: 1) static contrast-enhanced MRI, including T2- and T1-weighted MRI, and post-contrastenhanced T1-weighted images at 5–8 minutes after DCE-MPA); 2) DCE-MPA at a dose of 0.2 mmol/kg; 3) in the presence of precontrast-enhanced T2*-weighted perfusion MRI at a dose of 0.1 mmol/kg. A morphological diagnosis was done in all cases. Tumor hemodynamics was evaluated by DCE-MRA using contrast ratios (CR or CBR) in each scanning phase, as well as contrastenhancement ratios (ER or CER) and a venous-arterial ratio in the first venous phase (VAR1). Relative Cerebral Blood Volumes (rCBV) were estimated on the contrast-enhanced T1-weighted perfusion maps. Statistical processing of the results was performed using ROC analysis.

Results. According to T2*-weighted perfusion MRI and the results of a follow-up using the RECIST criteria, the investigators formed two comparison groups: 1) progressions (n = 7 (30.4%)) with increased rCBV (>1.75) and 2) stabilization (n = 16 (69.6%)) with reduced rCBV (<1.75). Based on the found threshold values of hemodynamic parameters at DCE-MPA (VAR1 = 1.59) and T2*-weighted perfusion MRI (rCBV = 1.75), they were compared with operational characteristics, which could classify 5 types of hemodynamics (G0–G4) in relation to rCBV and VAR1. A relapse was detected when the category of tumor malignancy coincided with the type of hemodynamics (VAR1 > 1.59), stabilization was found with a decrease (VAR1<1.59), as demonstrated by DCEMRA with 64% sensitivity and 94% specificity.

Conclusion. The developed classification of types of hemodynamics at DCE-MRA allows the differential diagnosis of recurrence from stabilization.

Objective: to investigate the possibility of enhancing the efficiency of complex magnetic resonance (MR) imaging, including MR mammography with dynamic contrast-enhanced MRI and MR spectroscopy for the differential diagnosis of breast tumors.

Material and methods. The investigation enrolled 87 patients with breast tumors and 15 healthy volunteers. The mean age of the examinees was 55.7±3.5 years. MR mammography with dynamic contrast-enhanced MRI and subsequent morphological diagnosis verification were performed in 100% of cases. MR spectroscopy was carried out in 93.1% of the patients with breast tumors.

Results. There were 189 breast tumors, including 154 (81.5%) and 35 (18.5%) hypervascular and avascular ones, respectively. MR mammography could reveal only 36% of the hypervascular masses. The sensitivity of contrast-enhanced MR mammography was 97.1%, and the specificity was variable. Its specificity was 96.9% for BIRADS 2 and BIRADS 5 and 45% and 55% for BIRADS 4 and BIRADS 3, respectively. MR spectroscopy in addition to MR mammography could increase the overall specificity of the technique up to 98.3%.

Conclusion. Comprehensive MR examination that involves MR mammography with dynamic contrast-enhanced MRI and MR spectroscopy makes it possible to visualize breast tissues, to identify additional masses, to investigate not only the morphological, but also chemical structure of the identified tumors, which allows the most precise differential diagnosis between benign and malignant lesions. 

Objective: to determine the efficiency and safety of manual thrombus aspiration (TA) in patients with acute ST-segment elevation myocardial infarction.

Material and methods. The investigation enrolled 200 patients with ST-segment elevation myocardial infarction. According to prehospital therapy, all the patients were divided into life-saving (n = 100) percutaneous coronary intervention (PCI) (lsPCI) and primary (n = 100) PCI (pPCI) groups. After coronary angiography the patients were randomized into manual TA (n = 50) and non-manual TA (n = 50) groups. The endpoints took into consideration myocardial reperfusion and the impact of TA on immediate results and in-hospital prognosis.

Results. The pPCI subgroup with TA as compared to the non-TA subgroup more commonly achieved TIMI-3 flow (82 and 54%, respectively; p = 0.003) and myocardial blush grade 3 or 4 (60 and 36%, respectively, p = 0.016). ECG also showed the achievement of the indirect signs of infarct-related artery reperfusion (pPCI + TA, 44%; and pPCI – TA, 76%; p = 0.001). On the contrary, in the lsPCI group, the best antegrade blood flow was recorded in the non-manual TA patients, as shown by both the TIMI scale (48 and 70%, respectively; p = 0.025) and the myocardial blush grade (24 and 50%, respectively, p=0,007). A larger number of patients from the non-TA subgroup were noted to have a decrease in the ST segment, as evidenced by ECG (slPCI + TA, 34% and slPCI – TA, 54%; p = 0.044).

Conclusion. According to angiographic and electrocardiographic findings, coronary blood flow effectively restored in the pPCI + TA group while manual TA did not show any advantages over routine PCI in the slPCI group.

Objective: to search for the possibility of lowering a dose burden on a patient during preventive chest radiography.

Material and methods. The investigation was carried out in two hospitals (City Mariinsky Hospital, Saint Petersburg, Russia) and (Skane University Hospital, Malm ° ö, Sweden) in 2013–2015. The existing protocols for this type of investigation were corrected by changing the anode voltage, the thickness of complete filtration, and the refusal to use a raster to determine the optimal dose/image quality ratio.

Results. The investigation showed the possibility of reducing the values of the products of the dose per area (PDA) by 47% and lowering the effective dose (ED) by 33%, by increasing the tube voltage (up to 125 or 150 kV) and decreasing the thickness of full filtration of direct beam radiation (to 3 mm Al). The refusal to use a raster could further reduce the value of PDA and ED to 75%.

Conclusion. Comparison of the dose values of Russian and Swedish X-ray apparatuses showed that the absolute values of PDP and ED are 10 times lower for Swedish devices in the same modes of chest radiography. This fact can be explained by the use of various image receivers and automatic exposure control settings.

The paper describes a clinical case of planning knee arthroplasty using up-to-date radiological methods. The possibilities and advantage of multislice computed tomography (MSCT) are assessed. MSCT allows the careful planning of knee replacement and also estimation of the position of components after arthroplasty with smaller amounts of radiation of the patient for a short time. 

The paper describes the possibilities of visualizing the coronary veins in natural conditions via modifications of conventional CT and MRI protocols. It shows changes in the venous bed in acquired heart defects. The paper depicts a statistically significant correlation between the sizes of the coronary sinus and the volumes of the right ventricle and right atrium, as well as mitral and tricuspid regurgitation.

The current approaches to diagnosis and management of groove pancreatitis, а rare form of chronic pancreatitis, are being discussed. The pathology, clinical presentation and radiological features of different imaging modalities (computed tomography, magnetic resonance imaging) have been described. Difficulties of differential diagnosis of groove pancreatitis with some malignant tumors are reviewed.