Objective: То compare the reproducibility, limitations and capabilities of three hierarchical levels of computed tomography (CT) image analysis in assessing residual changes in lung parenchyma after coronavirus infection: from visual assessment to shearlet transform and quantitative radiomic features.

Material and methods. A retrospective analysis of data from 48 patients with confirmed lung damage associated with COVID-19 was conducted. Patients were divided into three groups: complete regression of changes (20 patients; 41.7%), residual lung changes (18 patients; 37.5%), and death in acute phase (10 patients; 20.8%). The analysis included: visual assessment of the lesion volume according to the CT1–4 scale; use of the shearlet transform with color-coded density to improve the perception of structural patterns; radiomics analysis with manual segmentation of regions of interest and extraction of entropy (JointEntropy) and homogeneity (image data matrix, IDM) features using 3D Slicer (PyRadiomics extension). Reproducibility was assessed using Cohen's kappa coefficient (κ) for visual and Shearlet assessments and the intraclass correlation coefficient (ICC) for radiomic features with calculation of confidence intervals (CI). Statistical analysis included the Mann–Whitney test, Spearman’s correlation (ρ), and ROC analysis.

Results. The reproducibility coefficients were: κ=0.68 (95% CI 0.59–0.76) for visual assessment, κ=0.83 (95% CI 0.76–0.89) for the shearlet transform, ICC=0.94 (95% CI 0.91–0.97) for entropy, and ICC=0.92 (95% CI 0.88–0.95) for homogeneity. In the areas of residual changes, a significant increase in entropy (6.91±0.42 versus 5.85±0.31 in the intact areas; p<0.001) and a decrease in homogeneity (0.21±0.04 versus 0.29±0.03; p><0.001) were revealed. In patients with fatal outcome, a bimodal density distribution (range >400 HU) and an entropy increase of >0.2 units/day were noted. A decrease in entropy of >0.4 units/year was associated with favorable remodeling (sensitivity 89%, specificity 91%). Entropy demonstrated a moderate positive correlation with the visual volume of the lesion (ρ=0.64; p<0.01), while homogeneity correlated with tissue density (>ρ=0.81; p<0.001).

Conclusion. The proposed hierarchy of methods reflects the evolution of the approach to interpreting post-COVID-19 changes: visual assessment provides basic semiotics but is limited by subjectivity (κ<0.70); the shearlet transform increases reproducibility by improving the perception of structural patterns (>κ>0.80); radiomic features (entropy, homogeneity) provide reproducible quantitative markers of remodeling (ICC>0.90).

The high reproducibility of entropy confirms its potential as an objective prognostic criterion: stabilization at a level of 6.5–7.0 units predicts the formation of residual changes, a decrease to <6.8 units means complete regression, and an increase to >7.8 units with bimodal density means a high risk of mortality. The integration of quantitative radiomic features into clinical practice expands the possibilities for decision support in the analysis of residual changes after COVID-19.

Objective: То study the impact of wound damaging factors on the process of thrombus formation in the pulmonary arteries and to evaluate computed tomographic (CT) symptoms of thrombus formation in chest mine-blast (MB) wounds.

Material and methods. A non-randomized radiographic examination of 202 patients with chest MB wounds was conducted. MB wounds were defined as multifactorial impacts from projectiles and the blast wave from the munition's explosion. All patients underwent an initial CT on the day of admission, with a repeat scan as clinically indicated. Contrast enhancement was achieved by administering a bolus of non-ionic contrast agent at a dose of 1 ml per 1 kg of patient body weight. Scanning was performed in the native, arterial, and venous phases. CT scans were used to assess the location of thrombi within the pulmonary artery and the area of pulmonary contusion using contrast enhancement.

Results. It was shown that in addition to the generally recognized introduction of thrombi from the venous system, there is a potential for primary thrombus formation in the pulmonary arteries in severe lung injuries. This increases the incidence of pulmonary artery thrombosis to 32.7%. Damage to the pulmonary vascular endothelium is a predisposing factor for thrombus formation in small branches of the pulmonary artery.

Conclusion. The study confirmed the multifaceted mechanisms of thrombus formation in the pulmonary artery in severe MB lung injuries.

Objective: To determine the diagnostic efficacy of proton magnetic resonance spectroscopy (¹H-MRS) in the management algorithm for critically ill patients with chronic hepatitis of various etiologies.

Material and methods. This prospective study (2023–2025, Clinical Hospital No. 1, Smolensk) included 30 intensive care unit (ICU) patients with chronic hepatitis (main group) and 21 conditionally healthy volunteers (control group). All participants underwent abdominal ultrasound and magnetic resonance imaging (1.5 T) with ¹H-MRS (PRESS, TE 35 ms, TR 1600 ms, voxel size 17×17×17 mm) for quantitative assessment of N-acetylaspartate (NAA), lipids (Lip), lactate (Lac), aspartate (Asp), and choline (Chol). Patients in the main group underwent ¹H-MRS twice: at admission and after 6 months of therapy. Statistical analysis included the Mann–Whitney U test, Spearman’s correlation (ρ), ROC analysis, logistic regression, and Fisher’s exact test; the significance level was set at p<0.05.

Results. ICU patients showed statistically significant (p<0.01) metabolic changes compared to controls: increased Lip (11.5 [9.8; 13.2] c.u.; 86.7% of patients), Lac (49.8 [48.5; 51.2] c.u.; 100%), Asp (4.0 [2.5; 5.0] c.u.; 60%); decreased NAA (–0.8 [–1.5; –0.1] c.u.; 73.3%), and Chol (0.9 [0.2; 2.1] c.u.). The NAA/Lip ratio was below 1 c.u. in 80% of patients (median 0.32 [0.21; 0.48]). ROC analysis showed that NAA/Lip predicts the development of cirrhosis (F4) at 6 months with AUC 0.94 (95% confidence interval (CI) 0.85–0.98); the optimal cut-off value was ><0.95 c.u. (sensitivity 95.8%, specificity 83.3%). All 24 patients with baseline NAA/Lip below the cut-off developed cirrhosis F4 at 6 months. The correlation between NAA/Lip and fibrosis stage was strongly negative (>ρ=–0.89; 95% CI –0.95...–0.77). Chol <1.8 c.u. was also associated with cirrhosis development (AUC 0.88; odds ratio 19.0; 95% CI 2.8–128; p=0.003). Elevated Asp (>2.5 c.u.) was found in 18 (60%) patients; among them, 10 (55.5%) subsequently developed hepatocellular insufficiency (p=0.003, Fisher’s exact test; ρ=0.64).

Conclusion. ¹H-MRS is a valuable non-invasive method for assessing metabolic disorders in ICU patients with chronic hepatitis. The NAA/Lip ratio (cut-off <0.95 c.u.), as well as Chol and Asp levels, have high prognostic value for the risk of fibrosis progression to cirrhosis and the development of hepatocellular insufficiency. The method can be used to personalize therapy in situations where invasive biopsy is contraindicated.><0.95 c.u.), as well as Chol and Asp levels, have high prognostic value for the risk of fibrosis progression to cirrhosis and the development of hepatocellular insufficiency. The method can be used to personalize therapy in situations where invasive biopsy is contraindicated.

This article describes a clinical case of bolus contrast-enhanced computed tomography (CT) in a 54-year-old female patient with class III obesity and severe comorbidity, hospitalized in the intensive care unit due to a systemic inflammatory response, progressive multiorgan dysfunction, and urinary tract disorders. Throughout hospitalization, the patient exhibited high levels of inflammation and hypercoagulability, azotemia, anemia, increasing proteinuria and hematuria, and a critical increase in procalcitonin in the pre-mortem period. Despite intensive care, her condition worsened to refractory shock, followed by circulatory arrest and death. A key feature of the case was the performance of contrast-enhanced chest and abdominal CT examinations in extremely unstable hemodynamics. CT revealed signs of pulmonary embolism and systemic hypoperfusion. Pathologically, the immediate cause of death was established to be massive pulmonary embolism, which highlights the diagnostic limitations of interpreting CT angiography in terminal hemodynamics.

Tarlov cysts (perineural cysts) were previously considered incidental findings; however, current evidence indicates their clinical significance: they are detected in 4.18% of the population, predominantly in the sacral spine (most commonly at the S2 level), with a higher prevalence in women than in men (5.84% versus 3.03%). Patient G., a 66-year-old woman, presented with severe right-sided lumbar pain (8–9 points according to numeric rating scale) radiating to the right buttock and shoulder, exacerbated by movement. Her medical history included chronic moderate back pain, dysuria (urinary frequency and sensation of incomplete bladder emptying), and osteoporosis (densitometry T-score –4.8). Physical examination revealed tenderness at paravertebral points of the lumbar spine and trigger points over the right latissimus dorsi muscle. Computed tomography (CT) of the lumbosacral spine showed two fluid-density lesions (+9 to +14 HU) at the S1–S2 level, 34×18×21 and 6×7×7 mm in size, with indentation of the posterior margin of the S1 vertebral body; a 2-mm disc protrusion was noted at L4–L5. Magnetic resonance imaging (MRI) revealed cysts 30×21×25 and 10×9×9 mm in size, hypointense on T1-weighted and hyperintense on T2-weighted images, extending into the left intervertebral foramen with contact involving the nerve root. CT confirmed the fluid nature of the cysts and identified bony indentation. MRI verified characteristic signal features and excluded other differential diagnoses. The size of the dominant cyst (>15 mm) correlated with symptom presence. Following surgical treatment, positive clinical dynamics were observed: resolution of pain and dysuria, confirming a causal relationship. Comprehensive imaging helps avoid diagnostic errors and guides appropriate management in patients presenting with radiculopathy and pelvic floor dysfunction.

A clinical case of a patient with multiple developmental defects – VACTERL association is presented: V – additional left-sided hemivertebra C7, additional cervical rib, asymmetry of the posterior arches Th1–2 (quality anomaly) with signs of partial conception on the left; A – congenital anal and rectal atresia; C – dextrocardia, coarctation of the aorta, patent ductus arteriosus, atrial septal defect, ventricular septal defect, additional left superior vena cava with atypical drainage into the left atrium; TE – perineal fistula; R – single gall-shaped kidney on the right; L – hypoplastic phalanges of the first finger of the right hand. Diagnosis, differential diagnosis and therapy are discussed.