Objective: to compare the image quality at coronary multidetector computed tomography (MDCT) using low-dose and lowiodine protocol study in comparison with the standard protocol.

Material and methods. In study included 60 patients undergoing coronary computed tomography angiography. All examinations were performed with 64-row MDCT using prospective ECG-gating and ASIR 40%. 30 patients were examined using a low-concentration (Iodixanol, 270 mg I/ml) iodinated contrast medium and low tube voltage (80 kV) (group 1), 30 patients – using of high-concentration (Iodixanol, 320 mg I/ml) iodinated contrast medium and standard tube voltage (120 kV) (group 2). Image quality of coronary arteries was evaluated using a fourpoint grading scale, images were randomised. Intra-arterial density was measured for the proximal and distal segments of left anterior descending artery (LAD) and right coronary artery (RCA).

Results. Age, heart rate, BMI and scan parameters were not statistically different between the two groups. Analysis of coronaries visualization revealed the same image quality for group 1 and group 2 (image quality scores were 1,28 ± 0,28 vs. 1,34 ± 0,29, р=0,4). There was no significant difference between mean enhancement values in the distal segments of RCA and LAD for the two groups. Intraarterial density for proximal LAD and proximal RCA for the group 2 were significantly lower (p<0,05) than those values for the group 1.

Conclusion. The use of low-dose and low-iodine protocol can be beneficial for patient safety and for image quality without loss of diagnostic information.

Objective: to preliminarily assess the feasibility of elastography in endobronchial ultrasonography and to compare characteristics via different accesses.

Material and methods. The investigation enrolled 3 patients (malignant, benign mediastinal adenopathy, paratracheal tumor). Elastography was carried out using a Pentax EB-1970UK echobronchoscope with a Hitachi Noblus ultrasound scanner. All the patients underwent fine-needle aspiration biopsy of mediastinal and pulmonary lymph nodes/masses with 22G needles (Cook, Medi-Globe). Sequential study of the same group of lymph nodes through different approaches through the esophagus and trachea was conducted, and its characteristics were compared in one patient.

Results. A total of 8 lymph nodes and one paratracheal mass (Group 4L-7-4R-2R) were assessed in three patients. Reproducible images acceptable for visual assessment were obtained in all cases. The wall of the trachea and bronchi had no significant negative impact on the quality of an obtained image. Both malignant lesion of lymph nodes and paratracheal mass was accompanied by decreased tissue elasticity in the area of interest. Assessment of the same benign lymph node through different approaches revealed a clear discordance between elastographic findings with a drastic decrease in elasticity values via an endobronchial approach.

Conclusion. Endobronchial ultrasonography elastography is technically feasible. The wall of the trachea and bronchi has no significant impact on the quality of an obtained image; elastographic data are reproducible during re-measurements. Comparison of elastographic characteristics through different approaches suggests that there is a tendency to overestimate data on lymph node density during endobronchial examination versus a transesophageal approach. Thus, the direct transfer of the accumulated data and patterns of elastographic diagnosis to an endobronchial approach is impossible and likely to require a revision of criteria to estimate malignancy-associated changes during its application.

Objective: to determine the capacities of multidetector computed tomography (MDCT) to diagnose tongue cancer.

Material and methods. Intravenous bolus contrast-enhanced MDCT was performed in 40 patients with tongue cancer diagnosed during complex clinical and instrumental examination. In all cases, the tumor had a structure of squamous cell carcinoma of varying grades. The results of MSCT were compared with the data of surgery and cytological and histological examinations. Tongue tumor accumulation of a contrast agent was qualitatively analyzed.

Results. In 38 (85%) patients, the tongue tumor actively accumulated the contrast agent and was clearly differentiated in the presence of unaffected portions of the tongue and other adjacent anatomical structures, such as mouth floor, oropharynx, and larynx. Only in two cases, the tumor failed to significantly accumulate the contrast agent, which was associated with that there were massive decay areas in its structure. The sensitivity, specificity, and accuracy of MDCT in the diagnosis of tongue cancer were 95, 80, and 87.5%, respectively. MDCT could reliably differentiate changes in tongue cancer from non-tumor diseases. The result of constructing the curve of diagnostic errors became the following values: the area under the curve was 0.875 and the P-value (Asymptotic Sig.) was 0.0001.

Conclusion. Intravenous bolus contrast-enhanced MDCT has a high diagnostic efficiency in identifying tongue cancer. The technique can establish the location of a tumor and to reveal the extent of the process to the nearby organs.

Objective: to provide X-ray characteristics of mediastinal lymph nodes revealed by computed tomography (CT) in children and adolescents with uninfected Mycobacterium tuberculosis.

Material and methods. The basis of the study was the results of CT in 105 children and adolescents with uninfected with Mycobacterium tuberculosis. All the children and adolescents from a follow-up group underwent X-ray study using a two-slice spiral Somatom Emotion Duo CT scanner (Siemens). The study used a conventional procedure for chest scanning in children, by applying the Thorax Routine program.

Results. The study ascertained that Groups 1–3 intrathoracic lymph nodes were visualized in 73.3% of the children in normalcy and were not in 22.8%. In children, the normal size of the lymph nodes did not exceed 0.8 cm in diameter; they had a homogeneous structure and clearly defined, even outlines; their perinodular fat was unchanged. CT data showed that the sizes and number of visible groups of lymph nodes were unrelated to age.

Conclusion. The upper diameter limit for normal mediastinal lymph nodes may be established to be 8 mm if there were no abnormal changes in the structure of lymph nodes and perinodular fat.

Objective: to give the results of magnetic resonance imaging (MRI) in patients with complicated diabetic foot syndrome (DFS) to rule out or identify osteomyelitis.

Material and methods. Twenty-seven (14 women and 13 men; mean age 60±12.2 years) with type 1 and 2 diabetes mellitus and suspected osteomyelitis that had developed in the presence of DFS were examined. Ankle joint and foot MRI was carried out in T1-weighted MR image, T2-weighed MRI image, and FSat sequences. The soft tissue, tendoligamentous apparatus, and bones were evaluated. The results of MRI were compared with the data of a clinical follow-up study and surgery, followed by morphological examination. The diagnosis of osteomyelitis was validly established in 7 cases; this disease was absent in 20 patients.

Results. MRI showed the highest sensitivity for bone marrow edema (100%), soft tissue swelling (85.7%), and their concurrence (85.7%) and the highest specificity for an extensive wound defect or fistula attached to the bone (100%) and bone marrow edema concurrent with tenosynovitis (90%). With a sensitivity of 14.3% and a specificity of 10%, MRI was of less informative value in assessing bone destruction. It was characterized by moderate sensitivity and moderate specificity for soft tissue destruction (57.1 and 42.9%, respectively) and tenosynovitis (55 and 50%, respectively).

Conclusion. Osteomyelitis MRI demonstrated a polymorphic pattern with different diagnostic efficiency for individual symptoms.

Objective: to define the role of 18F-FDG positron emission tomography (PЕT) performed after 2–3 chemotherapy cycles in the prediction of disease prognosis and to identify a group of patients requiring more intensive treatment.

Material and methods. Seventy-one patients with nonHodgkin lymphoma of different histological types were examined. PET was carried out at different stages of diagnosis and primary treatment in the patients.

Results. The examinations made after 2–3 polychemotherapy (PCT) cycles indicated that 36 (50.7%) patients continued to have signs of metabolic activity of lymphoproliferative disease (a PET-positive group) and 35 (49.3%) patients were found to have no abnormal tracer accumulation foci (a PET-negative group). Twenty-nine (82.9%) patients from the PET-negative group continued to remain in complete remission throughout the follow-up (the median follow-up was 405 days). At late stages, 6 (17.1%) patients were identified to have abnormal tracer hyperfixation foci that were indicative of disease recurrence. Only 8 patients from the PET-positive group were observed to show a complete metabolic response to treatment at the end of first-line PCT. The metabolic activity of the disease was maintained in the remaining patients. The results of PET conducted at the late stages of the follow-up indicated that metabolically active tumor foci continued to be visualized in 20 (55.6%) patients and further treatment resulted in complete remission in 16 (44.4%) patients.

Conclusion. PET findings could predict the further course of the disease and differentiate more intensive treatment-requiring patients at the early stages of chemotherapy.

Even after performed mammary artery bypass surgery, some patients continued to have clinical manifestations of angina pectoris. This may be associated with the development of coronary stealing syndrome due to the fact that the native intrathoracic artery has large lateral branches. Current methods for embolization of arteries of different diameters make it possible to accomplish this task reasonably safely and in full measure. This paper describes a clinical case of reembolization of the lateral branch of a mammary artery shunt with an intravascular coil.

The Breast Imaging Reporting and Data System (BI-RADS) is a practical tool developed by the American College of Radiology to standardize the description of mammography, ultrasound study, and magnetic resonance mammography. BI-RADS includes recommendations for the structure of a protocol to describe radiologic studies; terminology to characterize three major types of lesions (focus, mass, contrasting area); as well as assessment categories and their corresponding recommendations for further patient management. The publication gives general information on the new edition of BI-RADS (2013) and illustrates its use to interpret magnetic resonance mammograms in breast cancer. The wider introduction of BI-RADS at all stages from screening to diagnostic verification will improve the quality of diagnosis and prognosis in breast tumor diseases.