Background. The problems of diagnostics and treatment of cervical cancer (CC) currently remain relevant due to the increase in morbidity and high mortality from this disease, including patients of reproductive age. The “gold standard” for visualization of cervical tumors is pelvic magnetic resonance imaging (MRI). Data on the efficiency of the method in diagnostics of parametrial invasion are contradictory. At the same time, the successes of modern ultrasound sonography in oncogynecology allowed us to look at the problem of diagnostics of locally advanced СС from a more optimistic standpoint. Objective: evaluation of the capabilities of ultrasound and MRI in the diagnosis of locally advanced СС and dynamic monitoring of structural changes in the cervix during comprehensive treatment. Material and methods. The single-center, retrospective, selective study was carried out. The results of complex ultrasound and MRI were analyzed in 23 patients with CC, including 7 patients of reproductive age. According to the histological structure, squamous cell carcinoma was determined in 20 (87%) cases, endocervical adenocarcinoma in 3 (13%) cases. During comprehensive treatment, 18 patients (78.3%) underwent surgery, 5 (21.7%) patients had only chemoradiation therapy. Surgical treatment (extirpation of the uterus with appendages and pelvic lymphadenectomy) was performed at the first stage in 3/23 (13%) patients with stage IB1, the remaining 20/23 (87%) underwent neoadjuvant polychemotherapy (NAPCT), which was supplemented in 7/20 (35%) cases with uterine artery chemoembolization (UACE). Ultrasound examinations were performed in 23 patients on the eSaote Pro device using high-tech methods according to generally accepted technique: B-mode, Dopplerography in energy mode, 3D reconstruction in angio mode, ultrasound tomography. Pelvic contrast-enhanced MRI was carried out in 21/23 (91%) patients on tomographs with a magnetic field strength of 1.5 T (Canon Vantage Atlas, Siemens Magnetom Aero). Results. During UACE and/or NAPCT, all patients (20/20) showed a decrease in cervical volume, neovascularization loci, and blood flow velocity in most cases. The inclusion of the surgical stage of treatment is possible in the absence of paracervical, parametrial infiltration data based on clinical, magnetic resonance and ultrasound data, taking into account the absence of the ultrasound sign “paracervical vessel +”. The absence of this sign and, accordingly, parametrial invasion, correlated with MRI results. The diagnostic informativeness indicators of ultrasound in detecting parametrial invasion were: sensitivity 89.4%, specificity 91.3%, positive predictive value (PPV) 89.4%, negative predictive value (NPV) 55.2%. Sensitivity, specificity, PPV and NPV of MRI in detecting parametrial invasion were 76.9%, 75.0%, 83.3%, 66.7% for researcher 1 (2 years of experience) and 91.7%, 87.5%, 84.6%, 77.8% for researcher 2 (8 years of experience), respectively. Conclusion. The use of high-tech diagnostic methods (ultrasound and MRI) allows for high diagnostic performance in visualizing parametric invasion in CC.

Background. The growing interest in digital breast tomosynthesis (DBT) is due to its ability to significantly reduce the false-positive rate of mammography due to layer-by-layer imaging, which provides a more detailed analysis of tissue structural features. Objective: to evaluate the effectiveness of DBT in reducing the rate of false-positive mammography results. Material and methods. The data of 82 patients with BI-RADS category 4 on 2D mammography who underwent DBT using Fujifilm FDR MS-3500 device (high resolution mode, slice thickness 1 mm) were retrospectively analyzed. If the detected changes were classified as BI-RADS 4–5 by DBT, a stereotactic biopsy with histological verification was performed. An analysis of the consistency between DBT and mammography in the classification of pathological changes in the BI-RADS category was carried out, as well as an assessment of the positive prognostic value of 2D mammography and DBT. Results. DBT reclassified BI-RADS 4 determined by mammography results to BI-RADS 2 in 59% of cases and to BI-RADS 3 in 8.5% of cases. The positive prognostic value for mammography was 17.1%, for DBT it was 53.8%. In patients with radiologically dense mammary glands (ACR C, D), in 66.7% of cases, BI-RADS 4 were reclassified into BI-RADS 2–3. Conclusion. DBT was proven to be superior to standard mammography in accurately classifying masses according to BI-RADS categories, including in patients with high breast density, providing detailed visualization of the architectonics of pathologies and reducing the incidence of false positives.

Objective: to evaluate the capabilities of computed tomography (CT) in the diagnosis and differential diagnosis of early postoperative complications in the treatment of lung cancer. Material and methods. In the Department of Thoracic Oncology, Pavlov First Saint Petersburg State Medical University, 564 patients were operated for lung cancer from 2014 to 2025. The mean age of patients was 64±0.7 (from 29 to 90) years. Surgeries performed included 426 (75.6%) anatomical lung resections (lobectomy, bilobectomy), and 138 (24.4%) pneumonectomies. All patients in the early postoperative period (up to 30 days) were prescribed a chest survey radiography. To diagnose postoperative complications, CT was performed in 77 cases (13.6%). Results. Serious postoperative complications (IIIB and higher according to the Clavien–Dindo–Strasberg classification) after anatomical lung resections occurred in 27 (6.3%) patients, after pneumonectomy – in 50 (36.2%). Based on CT data, diagnostics and differential diagnostics of postoperative complications in surgical treatment of lung cancer were carried out. The variants of complications in patients who underwent open or video-assisted thoracoscopic surgery for lung cancer in the early postoperative period were considered. Conclusion. CT allows identifying pathognomonic signs of different variants of early postoperative complications in the treatment of lung cancer, which is of significant importance for the tactics of patient management, their survival and prognosis of the disease course.

Background. Accurate identification and analysis of lung nodules via computed tomography are pivotal for lung cancer diagnosis and the detection of genetic alterations, such as epidermal growth factor receptor (EGFR) mutations. While conventional radiomics has become a cornerstone of medical imaging, its predictive power for determining EGFR mutation status remains limited, necessitating innovative approaches to improve diagnostic reliability. Objective: to enhance the accuracy of EGFR mutation status prediction in lung nodules by introducing and integrating novel texture-based radiomics features into conventional radiomics analysis. Material and methods. Three novel radiomic features were developed: Adaptive Texture Contrast (ATC), Directional Texture Uniformity (DTU), and Co-occurrence of Texture Transitions (CTT). They were designed to capture complex texture patterns associated with EGFR mutations. Integrating these features, a classification model was employed to differentiate EGFR mutant from wild-type lung nodules. Results. The incorporation of ATC, DTU, and CTT into the radiomics feature set improved the classification accuracy by 4%. The Minimum Redundancy Maximum Relevance (MRMR) feature selection method further validated the significance of these features, ranking them as the top contributors to the model’s predictive performance. Conclusion. The findings underscore the potential of advanced texture analysis in improving the diagnostic capabilities of radiomics for lung nodule classification. By enabling more accurate predictions of EGFR mutations, the study supports the advancement of personalized medicine and targeted treatment strategies in lung cancer, highlighting the importance of continuous innovation in feature engineering.

A pericardial echinococcal cyst is a rare manifestation of hydatid echinococcosis, which can be diagnosed only through the use of advanced imaging techniques. The article describes a clinical case where a space occupying formation in the anterior mediastinum was discovered incidentally during a routine fluorographic examination in a 61-year-old patient. Comprehensive imaging diagnostics including thoracic computed tomography and magnetic resonance imaging suggested that the cyst had an echinococcal origin. The key diagnostic indicators were the multicameral structure of the formation, the presence of calcifications in the walls and septa, as well as the absence of contrast agent accumulation. Video-assisted thoracoscopic removal of the cyst followed by histological examination confirmed the diagnosis of echinococcosis. This case report highlights the importance of using multimodal imaging techniques for the precise diagnosis of rare forms of echinococcosis and selecting the optimal treatment strategy.

Superior mesenteric artery syndrome (SMAS) is a rare condition found in approximately 2.67% of patients hospitalized with suspected duodenal obstruction. The average age of affected individuals is 23 years, with female-to-male ratio of 3:2. SMAS occurs due to compression of the middle third of the horizontal (third) portion of the duodenum between the aorta and the superior mesenteric artery, often developing in the context of rapid and significant weight loss. We present a case of a 32-year-old female patient who, after significant weight reduction and in otherwise good general health, developed complaints of nausea, heartburn, and epigastric pain. During the diagnostic process, differential diagnoses included gastroesophageal reflux disease, peptic ulcer disease, megaduodenum, aberrant pancreatic tissue, neoplasms, and SMAS. To establish the diagnosis, fluoroscopic examination with barium contrast was performed in the prone position to assess the degree of duodenal compression, along with a functional maneuver involving elevation of the upper body while resting on the elbows and knees. Fluoroscopy in the prone position revealed a narrowing of the duodenal lumen at the level of the inferior horizontal portion, from 3.5 to 0.8 cm in diameter over a 3.2 cm segment. The functional maneuver resulted in dilation of the narrowed segment to 3.0 cm, with restoration of evacuatory function. SMAS was confirmed by contrast-enhanced abdominal computed tomography (CT), which demonstrated a reduction in the aortomesenteric angle and distance – from 25° to 6° and from 8 to 2 mm, respectively. It was shown that fluoroscopy with barium contrast and functional testing is an effective diagnostic tool for SMAS. In cases with positive radiographic findings, the diagnosis should be confirmed by contrast-enhanced abdominal CT.