The paper describes the history of the Russian Research Center of Roentgenology and Radiology set up 90 years ago, the main advances of the researchers of the Institute in roentgenology and radiodiagnosis in historical perspective – from the last century up to the present day. It gives a brief list of the most important procedures and publications on radiodiagnosis, which have been developed and published by the Institute’s researchers.

Objective: to comparatively study the diagnostic capabilities of positron emission tomography (PET) with various tumorotropic radiopharmaceuticals (TRPs) in detecting malignant brain gliomas (BG) and estimating their degree.

Material and methods. One hundred and fourteen patients, including 47 with histologically verified glioblastoma multiforme (GBM), 27 with anaplastic astrocytoma (AA), 23 with benign astrocytoma (BA), and 17 with postoperative cysts, were examined. PET was performed using TRPs: 18F-fluorodesoxyglucose (18F-FDG), 11C-sodium butyrate (11C-SB), 11C-L-methionine (11C-MET), and 11C-choline (11C-COL).

Results. Malignant gliomas (GBM and AA) were clearly visualized by PET using 11C-MET, 11C-CHOL, and 11C-SB. 18F-FDG PET visualization of tumors was difficult because of increased RP accumulation in the cerebral cortex. WHO grades II–III gliomas were completely visualized by 11C-MET PET. Only some tumors were clearly displayed by PET with 11C-CHOL and 11C-SB. The accumulation indices (AI) obtained by 11C-CHOL PET in patients with malignant gliomas were, on average, 4.0- and 5.5-fold higher than those by 11C-MET and 11C-SB PET, respectively. Significant differences (p<0.001) in AI obtained by 11C-CHOL (11C-CHOL-AI) PET were first established between the patients with GBM (WHO grade IV) and those with AA (WHO grade III).

Conclusion. 11C-CHOL PET is the most sensitive method to identify gliomas and estimate their grade. The advantage of 11C-MET PET is the possible imaging of the entire volume of viable tumor tissue.

Objective: to determine the incidence of the persistent trigeminal artery (PTA) and to reveal its relationship to cerebral aneurysms, as well as the concomitant anatomic features of cerebral arteries according to the data of multislice spiral computed tomographic angiography (CTA).

Material and methods. A total of 1041 patients underwent brachiocephalic artery CTA according to different clinical indications. PTA and cerebral arterial aneurysms were found on the computed tomographic angiograms and the anatomic features of the structure of the circle of Willis were assessed.

Results. PTA was identified in 6 (0.58%) of the 1041 patients. Cerebral aneurysm was present in only one patient with PTA and concurrent with hypoplasia of the contralateral A1 segment of the anterior cerebral artery. Hypoplasia of the basilar artery (BA) and both vertebral arteries (VA) was observed in 3 (60%) cases, with the diameter of PTA at its confluence with BA exceeding 3 mm. When the diameter of BA was normal, that of PTA was less than 2 mm. All PTAs were wider at their base, by decreasing in diameters distally.

Conclusion. CTA showed that the incidence of PTA was 0.58% and its lateral type according to the Salas classification and Saltzman’s type 1 were more common (5/6). In 4 cases, PTA was concurrent with VA and BA hypoplasia, with its degree being inversely related to the distal diameter of PTA. There was no convincing evidence for a relationship of PTA to cerebral aneurysms.

Objective: to evaluate the efficiency of ultrasound diagnosis in detecting and staging cholangiocellular carcinoma.

Material and methods. An ultrasound study (USS) was conducted in 120 patients aged 19 to 84 years with cholangiocellular carcinoma. The patients were divided into 3 groups by the location of a tumor process: 1) 47 (39.2%) patients with intrahepatic tumor; 2) 49 (40.8%) with portal duct or Klatskin’s tumor; 3) 24 (20%) with distal one. Ninety (75%) patients were operated on; the others underwent minimally invasive X-ray surgical interventions as percutaneous transhepatic cholangiostomies. The data of ultrasound diagnosis were compared with the results of other studies, intraoperative assessment and morphological examination of a removed gross specimen.

Results. A tumor was detectable by USS only in 90 (75%) patients; its sensitivity was 100% for intrahepatic cholangiocellular carcinoma; 69.4 and 37.5% for portal duct and distal ones, respectively. It is most difficult to diagnose distal carcinomas of the common bile duct. USS reveals no semiotic signs of intrahepatic cholangiocellular carcinoma, which could distinguish the latter from other liver cancers. The specific features of the infiltrative growth of a bile duct tumor, such as hyperechoic infiltration along the external outlines of the ducts or hypoechoic infiltration during thickening of the duct walls, were ascertained. The sensitivity of intraoperative USS in identifying intrahepatic and portal duct cholangiocarcinoma was 100%. That of USS in detecting lymph node metastases was 61%; we developed the semiotics of altered metastatic lymph nodes.

Conclusion. The findings have indicated the high informative value of ultrasound diagnosis in determining the dilatation of the bile ducts and the spread of a tumor to the liver and lymph nodes. It is recommended that the indications for intraoperative USS should be expanded in intrahepatic cholangiocellular carcinoma to define the extent of duct carcinoma.

Objective: to determine whether the lower-density pancreatic parenchymal areas detected by a computed tomography (CT) study in patients with acute pancreatitis correspond to the necrotic portions of the gland or whether these changes may be reversal.

Material and methods. The investigation covered 25 patients who had undergone or dynamic CT studies made at different time intervals. Two independent investigators with 4 and 19 years of experience retrospectively analyzed the results of both CT studies. Target estimation was made of the extent (volume) of and CT density changes in the hypodense areas of the gland parenchyma.

Results. Seven (28%) of the 25 patients were noted to have higher CT density in the areas that had decreased density during primary CT studies (more than a 30 HU increase was rated as significant). There was a statistically significant difference between the patient groups when comparing the extent of hypodense areas and the difference in CT density (t-test, p=0.006); Mann–Whitney U-test, p=0.01 for extent difference and t-test, p=0.00; Mann–Whitney U-test, p=0.00 for CT density difference. There was also a correlation between the extent of hypodense areas and the difference in their CT density (Pearson: r=-0.533, p=0.006; Spearman: r=-0.636, p=0.001).

Conclusion. The results of our investigation may suggest that the lower-density pancreatic parenchymal areas cannot always correspond to necrotic changes and may be reversible.

Objective: to show the capabilities of ultrasound monitoring to assess consolidation processes in fractures of long tubular bones in the use of bioactive material-containing implants.

Material and methods. Eighty-two (45.1%) patients whose bone fragments had been fixed with bioactive material-coated plates and 100 (54.9%) patients with bioinert material-coated ones were examined. Consolidation changes were estimated by ultrasound and X-ray studies 2, 4, 6, and 12 months after surgery. Bone metabolic changes were determined by US osteometry 2 months following surgery. Ultrasound data were compared with the biochemical markers: C-terminal telopeptide (CrossLaps) and osteocalcin.

Results and conclusions. Ultrasound monitoring of the rates of consolidation and the time course of changes in bone strength versus the biochemical markers established the positive effect of bioactive plates on the process of consolidation in fractures of tubular bones and made it possible to consider local osteopenic syndrome to be a prognostically favorable sign of timely callus formation.

Objective: to study the capabilities of cone-bean computed tomography (CBCT) in estimating the bone structure when analyzing anthropological findings.

Material and methods. Twenty-four bone fragments (remains) of Napoléon Bonaparte Imperial Army soldiers who had died at a Königsberg military hospital during their retreat from Russia in the War of 1812 were examined by CBCT. A total of 28 tubular bones with different injury healing signs and a skull with maxillofacial trauma marks were investigated. Furthermore, an object from D.G. Rokhlin’s paleopathological collection was used to analyze a complicated humeral infectious process. CBCT was performed by individually selecting the scanning foldings, physicotechnical conditions and regimens in relation to the anatomic location and size of fragments.

Results. Processing of the obtained images reveled fractures of different bones in 19 (65.5%) cases. The signs of ununited fractures were visualized in 20.7% of the samples. Image post-processing showed intraarticular consolidated fractures in 13.8% of the anthropological findings. The CBCT examination of bone fragments exhibited the signs of their fusion. A wound pattern was established in 31% of the samples. The specific features of a bone amputation stump could be characterized in detail in 17.2% of the anthropological findings. 51.7% of the cases were found to have signs of sustained bone inflammatory diseases of various genesis, which in 41.4% of them were presented by linear, bulbar, and assimilated periostal reactions and significantly detectable on CBCT scans. Sequestral cavities were imaged in 31% of the fragments.

Conclusion. The CBCT images are characterized by high informative value (from 7.5 to 10.6 pixels/mm), optimal spatial resolution, definition, and hardness. The software of CBCT involves the parameters and possible postprocessing of images (building of panoramic and mulplanar reconstructions, assessment of the density characteristics of tissues), which allow an analysis of anthropological material, by needlessly destroying them.

The clinical manifestations of myocarditis are extremely variable and it may commonly manifest as acute myocardial infarction. The diagnosis of acute myocarditis is frequently empiric and substantiated by the clinical picture of the disease, ECG changes, elevated enzyme levels, and the lack of any data on coronary heart disease. Until recently, endomyocardial biopsy has been considered to be the most accurate diagnostic method. However, endomyocardial biopsy has a low sensitivity and is associated with the high risk of complications.

This paper describes a clinical case of a patient with cardialgias occurring after acute respiratory viral disease, with ST segment elevation, and higher levels of cardiospecific enzymes. The diagnosis of myocarditis was verified by contrast-enhanced cardiac magnetic resonance imaging.

Objective: to analyze the angiographic results of endovascular treatment for chronic coronary occlusions in patients with coronary heart disease.

Material and methods. In 2009 to 2013 attempted endovascular recanalization of chronic coronary occlusions in 854 patients with coronary heart disease. The patients’ age ranged from 36 to 68 years (mean 52 years). The estimated duration of occlusion was 1 month to more than 3 years. There were 193 (22.6%) females and 661 (77.4%) males. 462 (54.1%) patients had a history of myocardial infarction. 738 (86.4%) and 116 (13.6%) patients had true (TIMI grade 0) and functional (TIMI grade 1) occlusions, respectively. Multi- and univascular lesions were found in 683 (79.9%) and 171 (20.1%) patients, respectively. Silent occlusions with preserved myocardial contractility were identified in 165 (19.3%) patients.

Results. Blood flow could be successfully restored in 616 (72.1%) patients. Recanalization of chronic coronary occlusion failed in 238 (27.9%) patients.

Conclusion. Recanalization of chronic coronary occlusions is a highly effective and relatively safe technique. The efficiency of the procedure largely depends on the duration of occlusion, its X-ray morphological characteristics, and the experience of a physician.