Background. Pancreatic head cancer ranks 6–7th among oncologic diseases and 4–5th among causes of mortality, with only 5% of patients achieving 5-year survival rate to date. Despite the successes of modern diagnostics and surgical treatment, the problem of early detection, staging of oncologic process and, as a consequence, combined treatment of pancreatic head cancer remains actual.
Objective: increasing the accuracy of diagnostics and estimation of resectability of the pancreatic head cancer on the basis of the complex use of the radiation methods of investigation with pancreaticoduodenal zone 3D-reconstructions.
Material and methods. The study included 93 patients (44 (47.31%) males and 49 (52.69%) females) with complicated pancreatoduodenal masses treated from 2019 to 2022 at the Surgical Department of the City Mariinsky Hospital. The patients’ age varied from 44 to 90 years, the mean age was 67±0.74 years. All patients underwent magnetic resonance imaging (MRI) on an Ingenia MR tomograph (Philips Medical Systems, Netherlands) with a magnetic field induction of 3 Tesla. The native examination of the abdomen and retroperitoneum, supplemented with MR-cholangiopancreatography protocol, and dynamic contrast enhancement with data collection in arterial, portal, and delayed phases were carried out. T2-weighted images were then performed using turbospin-echo technology, including fat-suppressed images, to evaluate structural changes and the presence of fluid in fascial spaces. Patients also underwent endoscopic ultrasound of the pancreaticoduodenal zone using the push and pull method, and abdominal multislice computed tomography (MSCT). To build 3D models, we used free 3D-slicer and Mimics programs, which allowed to build semi-automatic model for further evaluation of anatomo-topographic relations.
Results. MSCT 3D modeling revealed tumor invasion into the superior mesenteric vein in 6 (23.06%) patients, whereas MRI models showed tumor invasion in 4 (15.38%) patients, intraoperatively the results were confirmed in 5 patients (19.23%). According to both MSCT and MRI modeling data, the invasion of the ventral trunk occurred in 1 (5.2%) case, which was confirmed intraoperatively. Inferior vena cava invasion on MSCT and MRI models was detected in 3 (11.54%) patients, whereas intraoperatively – in 4 (15.38%) patients. The MSCT and MRI 3D models coincided with the data on invasion of the ventral trunk in 1 (3.85%) patient and the superior mesenteric artery in 2 (7.69%) patients, which was fully confirmed intraoperatively.
Conclusion. 3D modeling on the basis of MRI and MSCT studies is an informative method in preoperative staging of pancreatic head cancer and its resectability. This method allows to objectively determine the localization and prevalence of the tumor process on adjacent anatomical structures, as well as visually demonstrate the metastatic lesion of regional lymph nodes. By the parameters of diagnostic efficiency, 3D models are maximally close to the intraoperative picture, which allows planning both the volume and the course of surgical intervention.

Objective: to study the contribution of regional cerebral blood flow (rCBF) indicators to the diagnosis of early postoperative cognitive dysfunction (POCD) in patients with multifocal atherosclerosis (MFA) with heart and brain revascularization.
Material and methods. The study involved 45 patients with MFA of coronary and precerebral arteries. We analyzed patients’ cognitive indicators and conducted brain scintigraphy before and after revascularization. The criteria for inclusion in the study were: scheduled combined revascularization of coronary and precerebral arteries; signed informed consent to participate in the study. Criteria for exclusion were: refusal to participate in the study, diseases that would prevent examination. The study of cognitive functions was performed using flow was assessed by single-photon emission computed tomography using lipophilic radiopharmaceutical 99mTc-HMPAO “Ceretec”.
Results. The frequency of early POCD in the isolated coronary artery bypass grafting (CABG) group was 73.3%, in the combined carotid endarterectomy (СEA) and CABG group it was 72.5% (p ˃ 0.05). The rCBF index in the isolated CABG group compared with the combined СEA and CABG group was higher in the right and left temporal lobes (p = 0.01 and p = 0.04), in the right frontal lobe (p = 0.03), right parietal lobe (p = 0.005), and in the right and left occipital lobes (p = 0.03 and p = 0.03). In the postoperative period, in the isolated CABG group, right parietal lobe perfusion (p = 0.01), and right and left occipital lobe perfusion (p = 0.01 and p = 0.01) decreased compared to the baseline values. In the combined СEA and CABG group, in the early postoperative period, cerebral perfusion did not change significantly. Right parietal lobe perfusion was higher in the isolated CABG group compared with the combined CABG and СEA group (p = 0.04). The greatest contribution to the development of early POCD in patients after isolated CABG was made by the left temporal lobe perfusion (p = 0.025), in patients after combined CABG and СEA – by the right parietal lobe perfusion (p = 0.04) in the early postoperative period.
Conclusion. Assessment of cerebral perfusion in patients before and after surgery can be used to identify areas affected during surgery, as a method for monitoring the safety of procedure, and as an assessment of the preventive methods against POCD.

Mesenchymal cystic hamartoma, which was first described in 1986, is a very rare pulmonary pathology. To date, a little more than 20 cases have been registered in the literature. The disease usually has an asymptomatic course, but can potentially lead to severe pulmonary bleeding and even death. It has no specific radiological signs, therefore it is necessary to carry out differential diagnosis with other diseases, including malignant neoplasms. We present our own clinical observation of this pathology.

The thyroid nodules (TNs) are widespread throughout the world: according to the pathological studies, they can be found in 50–60% of adults. Currently, ultrasound, computed tomography, magnetic resonance imaging and radionuclide diagnostics, such as positron emission tomography with computed tomography, are usually used to diagnose TNs in clinic. These techniques are mainly used to diagnose the nodile benignity and malignancy, the degree of invasion into adjacent tissues and metastases to lymph nodes. Thanks to the development of artificial intelligence, machine learning and the improvement of medical imaging equipment, radiomics has become a popular area of research in recent years. It allowes to obtain various quantitative characteristics from medical images, highlighting invisible features and significantly expanding the possibilities of identifying and predicting. Radiomics has a high potential in detecting and predicting TNs. We present the information on the development and workflow of radiomics. The article summarizes the application of various imaging techniques to identify benign and malignant TNs, determine invasiveness and metastases to lymph nodes, as well as some new advances in the field of molecular level and deep learning. The disadvantages of radiomics method are also given as well as prospects for its further development.

Hepatobiliary scintigraphy using radiopharmaceuticals (RPh) labeled with short-lived technetium‑99m (99mТс) has been used since the mid‑1970s and still retains its diagnostic value. The lecture focuses on key aspects of the pharmacokinetics of lidocaine analogs based on N-substitutions of iminodiacetic acid. The methodology and diagnostic significance of hepatocholescintigraphy with Bromesida® ^99mTс (mebrofenin), including computer registration of RPh passage, anatomical and functional characteristics of liver, bile ducts, gallbladder and duodenum, are considered. Scintigraphic semiotics in choledochal cysts, acute and chronic cholecystitis, gallbladder and duodenum dyskinesia, are discussed. The presented clinical case illustrates the possibilities of Bromesida® 99mTс scintigraphy in the gallbladder form anomaly.