Objective: to evaluate the current possibilities of diffusion-weighted imaging (DWI) in liver magnetic resonance imaging (MRI) for the diagnosis of alcoholic liver disease (ALD).
Material and methods. The examined patients were at the inpatient and outpatient stages of observation in the gastroenterology department on the basis of the Clinical Hospital No. 1 (Smolensk) and received treatment for diffuse liver diseases of alcoholic etiology. The study included 128 patients: 76 (59%) males and 52 (41%) females, mean age 42.3 ± 4.7 years. Patients were monitored from 2019 to 2022. All of them underwent abdominal organs ultrasound with liver clinical elastography and liver MRI with DWI; in 34 cases liver multi-slice computed tomography was performed.
Results. When comparing the results of a qualitative assessment of liver DWI MRI with the CAGE (Cut, Annoyed, Guilty, Eye-opener) test data and the results of patients and relatives survey about the use of alcoholic beverages, a high correlation was established between the diffusion restriction in the liver during MRI and impaired withdrawal regimen (r = 0.901). The diagnostic and prognostic significance of the developed criteria for liver DWI MRI in patients with ALD at admission was assessed: for qualitative assessment AUROC 0.827 (95% CI 0.792–0.873), for quantitative assessment AUROC 0.949 (95% CI 0.912–0.981); in dynamic observation: for qualitative assessment AUROC 0.958 (95% CI 0.925–0.984), for quantitative assessment AUROC 0.947 (95% CI 0.947–0.981).
Conclusion. The obtained quantitative indicators of liver DWI MRI make it possible to predict the clinical form of ALD: apparent diffusion coefficient for steatosis is 2.66 ± 0.9 × 10–3 mm2/s, for steatohepatitis – 2.14 ± 0.5 × 10–3 mm2/s, for hepatitis – 1.75 ± 0.6 × 10–3 mm2/s, for cirrhosis – 1.15 ± 0.6 × 10–3 mm2/s (AUROC 0.948; 95% CI 0.922–0.983). Qualitative parameters of liver DWI MRI (there is/is not a diffusion restriction) predict violations of the withdrawal regimen in patients with ALD in all its clinical forms (AUROC 0.931; 95% CI 0.822–0.979).

Objective: approbation of the project of mass breast cancer mammographic screening in the Kaluga Region.
Material and methods. From April 2018 to December 2019, screening mammography was performed in 35,439 women aged from 38 to 93 years (mean age 57.33 ± 8.07 years). The study was carried out on mobile mammography complexes assembled on Russian KamAZ vehicles with Russian-made equipment from Amiko company. Mammography was performed in frontal and oblique projections. BI-RADS ACR international classification was used to standardize the identified changes and assess the sensitivity and specificity of the study method.
Results. Out of the total number of women examined, pathological changes (BI-RADS IV–V) were assumed according to mammography data in 778 (2.2%) cases, of which 700 (1.98%) patients appealed to an oncological institution. Benign processes were found in 394 (1.11%) patients, breast cancer in 164 (0.46%). Without verification of the diagnosis, 137 (0.39%) patients remained under the supervision of oncologists. Distribution of detected tumors by stages for 2 years of observation: stage 0 – 7, stage 1 – 73, stage 2 – 56, stage 3 – 13, stage 4 – 3. The stage was not set in 4 cases. The total number of those examined with verification of the diagnosis in the oncological institution was 596. The proportion of correct diagnoses was 94%. The total number of diagnostic errors that would occur in the absence of a true double scan accounted for 36 (6%) cases.
Conclusion. The proposed screening method makes it possible to increase the breast cancer detection in the early preclinical stages of the disease, to provide the available diagnostics for the population due to mobile mammography complexes, and to speed up the process of diagnostics and further hospitalization for examination and necessary treatment according to the disease stage in a specialized oncological institution.

Objective: to determine the diagnostic significance of computed tomography texture analysis (CTTA) in differentiating head and neck tumors.
Material and methods. The study included 118 patients aged from 4 to 80 years with a verified diagnosis of benign and malignant (37 and 81, respectively) head and neck tumors. CTTA was performed using the LIFEx program, version 6.30. Thirty eight (38) texture indices extracted from routine CT images were tested by regression analysis with creation of logistic texture models with associations of four indices as independent predictors.
Results. The possibility of using derived models – probability textural indices for benign and malignant tumors differentiation was established: area under ROC-curve (AUC) 0.854 ± 0.035 (p < 0.001); for differentiation of locally spread from locally limited tumors: AUC 0.840 ± 0.049 (p < 0.001); for differentiation of moderately, poorly, and undifferentiated cancer (G2, G3, G4) from well-differentiated (G1) head and neck cancer: AUC 0.826 ± 0.085 (p < 0.001).
Conclusion. CT images texture analysis allows to make non-invasive prognosis of benign or malignant nature of a visualized head and neck tumor, as well as to determine the extent and degree of tumor malignancy.

Objective: to study the computed tomography (CT) and magnetic resonance imaging (MRI) manifestations of rhinocerebral mucormycosis (RCM) in patients with diabetes mellitus and new coronavirus infection, to develop attentive attitude of radiologists for early detection of this pathology, rapid surgery and followup examinations.
Material and methods. Totally 53 head (facial skull, soft facial tissues and brain) CT and MRI studies were performed in 13 patients with RCM. The number of CT and MRI studies varied from 1 to 9 per one patient, depending on the severity of his condition and clinical indications; the follow-up period was 1–4 months. All patients received surgical aid; diagnosis was verified by microscopy of surgical samples of excised necrotic tissues. A detailed descriptive analysis of pathological changes on CT and MRI characterizing RCM was carried out. The sequence of pathological signs manifestations was described, the prevalence of the lesion was estimated for planning the scope of surgical intervention. A comparative analysis of the identified RCM signs with the literature data was performed.
Results. Lesions of the nasal cavity and paranasal sinuses in RCM were found in 100% of our observations, with approximately equal single and bilateral lesions of 54% and 46%, respectively. Lesions of the perimaxillar fatty tissue and pterygoid fossa were determined in 77% of patients, unilateral orbital lesions – in 23%, superior orbital vein and cavernous sinus thrombosis – in 31%, facial soft tissue lesion – in 15.5%, intracranial spread through the perineural spaces – in 7.7%, internal carotid artery arteritis – in 15.5%. Brain substance and meninges involvement in the pathological process was observed in the form of cerebritis in 23% of patients and meningitis in 46%. The formation of brain abscess was noted in follow up examinations in 15.5% of patients, skull bones osteomyelitis was diagnosed in 46%. The mortality rate was 15%. In cases of long-term observation, the manifestations of pathological changes started from the nasal cavity, then spreaded in the perimaxillary adipose tissue and orbit, and were followed by the development of intracranial complications.
Conclusion. The accumulated experience in identifying the combination of CT and MRI signs and patterns of RCM combined with clinical and anamnestic data allows to increase the alertness of clinicians and radiologists for earlier diagnosis and selection of the optimal volume of surgical intervention.

Background. The existing variety of approaches to the treatment of temporomandibular joint (TMJ) dysfunction corresponds to the variety of methods for its diagnosing. The absence of a universal technique of updating a particular diagnostic method data makes it impossible to evaluate the effectiveness of treatment.
Objective: to evaluate the universality of magnetic resonance imaging (MRI) in the diagnosis and determination of tactics for the treatment of TMJ pathologies.
Material and methods. One hundred patients of different age groups and genders with and without TMJ pathology were divided into groups according to Angle’s classification: Class 1 – 27 persons, Class 2 – 41, Class 3 – 32. The studies were carried out using Green 18 computer tomograph (Vatech, South Korea), Optima MR450W magnetic resonance tomograph (General Electric, USA), Dentograph digital Roshchin axiograph (Prosystom, Russia), SAM 2PX articulator (SAM Praezisionstechnik GmbH, Germany). The RadiAnt Viewer software was used.
Results. We conducted a comparative analysis of the indicators of articular structures mutual disposition obtained using various methods of TMJ diagnosis. A technique for estimating TMJ parameters using the analysis of MRI data was proposed. A correlation was revealed between the indications obtained using various diagnostic methods.
Conclusion. The developed method of TMJ structures analysis has high accuracy and is applicable in practice.

Background. A wide variety of pulse sequences, the possibility of multiplanar imaging significantly increase the capabilities of magnetic resonance imaging (MRI) in diagnosing diseases of the female reproductive system. At the same time, the lack of a regulated scanning protocol, especially in patients who have undergone anticancer treatment, requires standardization of the technique and the search for an optimal set of pulse sequences that allows to visualize the vagina throughout its entire length and to perform differential diagnosis between continued tumor growth and post-radiation changes while maintaining an adequate examination time.
Objective: to determine the optimal set of MRI pulse sequences for pelvic organs examination in patients with vaginal tumors and to form an original research protocol based on diagnostic information content.
Material and methods. The study included 141 patients with vaginal tumors. A comparative analysis of four MRI protocols was carried out, built according to the principle “from simple to complex” (from native to multiparametric MRI).
Results. A significant difference was obtained between all information content indicators of Protocol 4 compared to Protocol 1 (sensitivity p = 0.00006, specificity p = 0.00443, AUC p = 0.00000). Data analysis also showed a significant difference between sensitivity and AUC for Protocols 2 and 4 (p = 0.00150 and p = 0.00087, respectively), and Protocols 3 and 4 (p = 0.01333 and p = 0.01333, respectively).
Conclusion. Significant increase in the information content of Protocol 4 compared to other protocols (sensitivity up to 93%, specificity up to 94%, accuracy up to 93%) indicates the expediency of the priority use of multiparametric MRI in the primary diagnosis of vaginal tumor lesions.

Objective: to analyze the X-ray liver attenuation values in hospitalized patients with novel coronavirus infection (COVID-19) in relation to the time of disease onset, the severity of pulmonary parenchymal involvement, and the disease outcome.
Material and methods. Chest computed tomography (CT) findings in 635 patients hospitalized with COVID-19 were analyzed. CT was performed at various times after the disease onset. The attenuation (CT density) values of the visualized liver upper part were measured by selecting the region of interest on CT images. The extent of the affected lung parenchyma was assessed according to the five-step CT0–4 scale, where CT0 corresponds to the absence of viral pneumonia, CT1 – lung parenchyma involvement less than 25%, CT2 – 25–50% lung volume lesion, CT3 – 50–75% lung volume lesion, CT4 – lung parenchyma involvement more than 75%.
Results. In patients with CT0, the liver attenuation was significantly higher than in those with CT1, CT2, CT3, and CT4 (p < 0.01). During the first week of the disease, there was a decrease in liver CT density followed by its increase and return to the initial values (p < 0.0005). The dynamics of liver attenuation in the group of patients who died did not differ significantly from those who survived and recovered (p = 0.107). In the early stage of the disease (0–4 days), the liver attenuation in the group of patients who subsequently died turned out to be significantly lower than in the survivors (p < 0.05).
Conclusion. The course of COVID-19 is characterized by a transient decrease in liver CT density. The reduction in liver attenuation does not correlate with the volume of the affected lung parenchyma in patients with CT2–4. The dynamics of liver CT density is not associated with the disease outcome. There is a trend towards more pronounced values of liver attenuation decrease in the early stage of the disease in patients who subsequently died, which requires further research.

Objective: to study associations between laboratory and radiological biomarkers of COVID-19, to develop prognostic model of deterioration and lethal outcome in a patient with COVID-19.
Material and methods. The study included 162 patients with COVID-19 stratified according to the presence or absence of deterioration during hospitalization. We evaluated chest computed tomography (CT) data, assessed empirically and using a semi-quantitative scale, blood cell counts and parameters of biochemical blood test. The predictive model was built using gradient boosting and artificial neural network with sigmoid activation function.
Results. Both CT signs (crazy-paving pattern, bronchial dilatation inside a lesion, peripheral distribution of symptoms, absence of a predominant distribution pattern, lesion grade and extent), and most of laboratory markers were associated with deterioration and its criteria. The CT severity index correlated positively with the levels of leukocytes, neutrophils, urea, aspartate aminotransferase, lactate dehydrogenase, creatine phosphokinase, glucose, C-reactive protein, and negatively with the concentrations of albumin, calcium and the number of lymphocytes. Based on the results of the selection and training of classifying models, the optimal method for stratifying patients with COVID-19 on the basis of deterioration during hospitalization, the need for transfer to the intensive care unit, mechanical ventilation, and adverse outcome was gradient boosting.
Conclusion. The prognostic model obtained in our study, based on a combination of radiological and laboratory parameters, makes it possible to predict the nature of COVID-19 course with high reliability.

Will the detected lung foci in patients with a burdened oncological history (breast cancer) always be metastatic? In response to the question posed, we present a clinical case of pulmonary sarcoidosis mimicking the metastatic lesion of metaplastic breast cancer. And we remind of the need for a differential diagnosis, despite the oncological history of a patient and radiation diagnostics data.

Pancreatic adenocarcinoma is the most pervasive form of cancer with high mortality rates. Being obscure at the early stages, non-specific symptoms and their onset only in the late stages of the disease lead to detection of the III–IV stages cancer on initial diagnistics. Gastrointestinal stromal tumor (GIST) is an intramucosal tumor of gastrointestinal tract, which is a derivate of interstitial cells of Cajal. The unicity of the presented clinical case is the rareness of GIST, which was an incidental finding during diagnostics of pancreatic adenocarcinoma. Diagnosed by intravenous contrast computed tomography, synchronous pancreatic and duodenal double cancer was confirmed histologically after Whipple surgery. The opportunities of intravenous contrast computed tomography in diagnostics of synchronous cancer were demonstrated.

Meningoencephalocele is a rare pathology. By origin, it can be congenital and acquired. As a rule, congenital menigoencephaloceles are combined with various congenital skull structure anomalies, and are rarely asymptomatic. This pathology is most often solitary, and cases of multiple meningoencephalocele in one patient are extremely rare. The presented clinical case demonstrates an accidental finding: an unusual variant of symmetrically located bilateral naso-orbital meningoencephalocele with asymptomatic course in a 17-year-old patient.

Thyroid scintigraphy is a method that formed more than 60 years ago and retains its importance for the diagnosis and assessment of the risk of nodular malignancy. The review examines the use of the scintigraphic method in functional and metabolic assessment of nodular goiter. Prerequisites for functional thyroid nodes screening with short-lived 99mTc-pertechnetate are outlined. Information is provided on the principles of its preparation and pharmacokinetics, as well as variants of the thyroid nodes functional activity, their possible malignant potential and indications for metabolic screening. The characteristic of metabolic activity allows to assess the risk of functionally “cold” thyroid nodes malignancy. The main stages of the use of nonspecific tumorotropic radiopharmaceuticals, the mechanism of their accumulation and metabolism in the thyroid tumors, the possibilities of the differential diagnosis of various types of nodular formations are presented. Modern views on the diagnostic capabilities of two-phase scintigraphy with 99mTс-methylisobutylisonitrile are reflected taking into account the relationship of radiopharmaceuticals accumulation with factors of proliferative activity and ultrastructural cell types, a variant of oncocytic pathology and multidrug-resistant protein expression.