Objective: to compare the diagnostic effectiveness of computed tomography performed according to the standard protocol and using a perfusion program in the detection of chronic pseudotumoral pancreatitis complicated by obstructive jaundice and in the differential diagnosis with  pancreatic head adenocarcinoma.

Material and methods. The investigation enrolled 153 patients with obstructive jaundice treated at the Saint Petersburg Hospital for War Veterans from 2016 to 2020. The cause of jaundice was chronic pancreatitis in 52 (34%) cases and pancreatic head adenocarcinoma in 101 (66%).  Endoscopic ultrasonography-guided histological verification using biopsy and examining the drugs after organ-sparing and radical resection interventions was obtained in all 101 patients (100%) with pancreatic  adenocarcinoma, and in 32 (61.5%) with chronic pancreatitis. A control group consisted of 30 patients with no anamnestic, clinical, or laboratory evidence of pancreatic diseases. All patients underwent abdominal computed  tomography according to the standard protocol and using a perfusion program.

Results. The diagnostic effectiveness of the standard computed tomography protocol in the differential diagnosis of chronic pancreatitis and pancreatic adenocarcinoma was: sensitivity 95.5%, specificity 97.3%, and diagnostic accuracy 96.4%; whereas perfusion computed tomography had sensitivity  98.7%, specificity 99.3%, and diagnostic accuracy 98.6%.

Conclusion. Perfusion computed tomography is a highly informative method for the differential diagnosis of chronic pancreatitis and pancreatic head adenocarcinoma in patients with obstructive jaundice.  

 Background. The chief goal in assessing the Her2/neu status in clinical practice is to identify indications for targeted therapy. The main methods for determining the Her2/neu status are an immunohistochemical method and fluorescence in situ hybridization (FISH); however, despite their widespread use, they have a number of significant disadvantages. Over the past few years, radionuclide diagnosis using a new class of alternative scaffold proteins that meet all the requirements for optimal radionuclide delivery to tumor cells has become widespread.

Objective: comparative analysis of the effectiveness of radionuclide imaging of Her2-positive breast cancer using 99mtechnetium-labeled recombinant molecules in different dosages. 

Material and methods. The investigation enrolled 22 patients with breast cancer (T1-4N0-2M0) before systemic therapy: 11 had Her2/neu overexpression; 11 had no marker expression. The patients’ mean age was 50.7 ± 2.3 years. Morphological and immunohistochemical studies were  performed in all cases. FISHanalysis was carried out in the presence of the  Her2/neu 2+ value. The agent was prepared immediately before using in dosages of 500 and 1000 µg, after which it was slowly administered intravenously to the patient. Whole-body scintigraphy and chest single-photon emission computed tomography were conducted at 2, 4, 6 and 24 hours after administration.

Results. The radiochemical yield and radiochemical purity values were 77 ± 9% and 99 ± 1%, respectively. The activity of the agent immediately before administration was 416 ± 135 MBq for the 500 µg group and 349 ± 133 MBq for 1000 µg group. Analysis of the findings indicated that the higher uptake of the agent by organs without tumor lesion was observed in the kidneys, liver, and lungs. The highest renal absorption of the agent was observed in both study groups (0.135 ± 0.042 and 0.191 ± 0.047 mGy,  respectively). The effective dose was 0.009 ± 0.002 mGy for the 500 µg group and 0.010 ± 0.003 mGy for the 1000 µg group. The better distribution between the tumors with Her2/neu positive and negative statuses was  observed 2 hours after administration in the 500 µg group with the mean tumor/background value of 37 ± 19 for Her2-positive tumors, and 5 ± 2 for Her2-negative tumors (p < 0.001).

Conclusion. The findings suggest that the test radiopharmaceutical agent at  a dose of 500 µg can be considered as a new additional method to diagnose Her2-positive breast tumors. 

 Neurofibromatosis type 2 is a rare genetic disease that occurs with a frequency of approximately 1 in 50,000 newborns and is characterized by benign tumors, mainly bilateral schwannomas of the VIII cranial nerve. It is inherited by an autosomal dominant type without sex. Clinical symptoms are associated with damage to the VIII pair of cranial nerves, skin manifestations are less common than with neurofibromatosis type 1. The tumor can be one-sided and can be combined with neurofibromas, meningiomas (intracranial and spinal), schwannomas of other cranial nerves, astrocytomas and ependymomas of the spinal cord. In detecting tumors and making a primary diagnosis, the leading role is played by instrumental diagnostic methods: magnetic resonance imaging (MRI) and computed tomography (CT). The final diagnosis is made after genetic analysis. The article presents the possibilities of CT and MRI in imaging and  diagnosis of type neurofibromatosis type 2. 

 The paper describes a clinical case of pulmonary and right orbital injuries in granulomatosis with polyangiitis in a 38-year-old male. The case is of considerable interest due to the rarity of this pathology, especially because of the localization in the orbital region. The information provided in this paper can help in the early and accurate diagnosis of granulomatosis with polyangiitis, which, in turn, will improve the prognosis of the disease. 

 The review discusses the effectiveness of endovascular embolization of intracranial aneurysms in subarachnoid hemorrhage (SAH) in the first 24 hours after rupture. The need for this study is dictated by the medical and social significance of the disease, in particular, the high degree of mortality and disability in SAH of aneurysmal origin, including in young patients. The choice of embolization timing for SAH remains a subject of discussion in the professional community since the introduction of the technique into clinical practice. Performing embolization on the first day after the onset of the  disease, the so-called “ultra-early embolization” has a potentially positive effect on the outcomes of SAH, reducing the number of deaths and increasing the number of favorable outcomes. The main advantage of this tactic is to prevent repeated rupture of the aneurysm, the probability of which is highest in the first day of  the disease, as well as the possibility of starting intensive therapy for SAH at the earliest possible time. 

 Magnetic resonance imaging (MRI) is presently one of the main methods in the diagnosis of diseases associated with impaired fluid dynamics. Rapidly developing MRI technologies allow us to get more and more information about the functional organization of both individual components and the entire cerebrospinal fluid system (CSF) as a whole. One of the most common diseases accompanied by impaired CSF flow, where the superiority of MRI among other non-invasive methods is especially obvious, is hydrocephalus.  The review considers the current capabilities of MRI in assessing CSF flow in various forms of hydrocephalus.  

 Breast vascular calcifications are a manifestation of calcinosis of the medial layer of the artery walls. This type of calcifications is well visualized on mammograms. Mammography is a widespread and affordable screening test for breast cancer. The studies published in recent years demonstrate a relationship of breast vascular calcifications to cardiovascular risk factors, coronary heart disease. Identification of the correlation of breast vascular calcifications with coronary artery calcifications will be able to improve cardiovascular risk stratification in the group of women with an asymptomatic course.