Репозиторий Университета

© 2018 Russian Electronic Journal of Radiology.All Rights Reserved. Purpose. A special place among liver diseases is occupied by various tumors and tumor-like lesions. In recent years in clinical practice the possibilities of correct diagnosis have increased significantly as a result of the introduction of advanced diagnostic equipment and wide usage of various contrast agents at studies of the abdominal cavity using the ultrasound method (US), multislice computed tomography (MSCT) and magnetic resonance imaging (MRI). In addition, the differential diagnosis of benign and malignant lesions has been simplified even when the size of the lesions is less than 1 cm. This scientific review describes the capabilities of the "routine" method of the liver diagnostics – US, as well as the latest techniques that are being introduced into the modern practice such as: US with intravenous contrast enhancement, US elastography and perfusion CT and MRI. The advantages of each method are presented as well as the limitations of their use in clinical practice.

© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: To develop a technique for conducting of complex radiology diagnostics in combination with dynamic MSCT-cystureterography in patients with reconstruction of the urogenital area and to study the possibilities of its application in clinical practice. Materials and methods: At the pre and postoperative stages 8 patients were examined by MSCT, from whom all men were presented with such acquired and congenital diseases of the urogenital area as followings: stricture or obliteration of the urethra, as well as hypoplasia of the penis. The age of the patients varied from 33 to 58 years with the average of 43.8 years. The studies were performed by a multispiral computer tomograph Toshiba Aquilion One. This 640-slice computer tomograph has 320 rows of detectors with 0.5 mm wide, which allows the detector to cover the scan zone at 16 cm by one rotation of the X-ray tube. Results: By studying the data obtained in five cases, hypoplasia of the penis was revealed. In three cases urethral obstruction was diagnosed, its cause and localization were determined. At the pre and postoperative stages the anatomy of the donor and recipient vessels was assessed, surgical intervention was planned, and the dynamic MSCT-cystureterography method allowed avoiding invasive examination of the urethra. The MSCT method with intravenous contrasting in combination with dynamic MSCT-cystureterography surpasses the standard X-ray examination, ultrasound method and endoscopic urethroscopy at terms of accuracy and informativeness. In addition, these methods are separated in time and in the implementation techniques and most of them are not physiological. Conclusions: Analyzing the obtained data, we can confidently state that MSCT with intravenous contrast showed its high informative value in the study of donor and recipient vessels, and the combination with dynamic MSCT-cystureterography in order to assess the patient's urethra further increases the informativeness and value of this study. The proven effectiveness of the developed method suggests that it can become routine in examining patients with diseases of the urogenital area.

© 2018 Russian Electronic Journal of Radiology.All right reserved. In plastic surgery we often have the need for soft tissue volume restoration of different localization, to close congenital or acquired defects as well as associated with agerelated changes in soft tissue. Autologous adipose tissue in many properties is the ideal filler for the correction of the body contour defects. However, despite its advantages, this minimally invasive technique has been secondary to more complex methods of reconstruction - flap transplantation. The main significant drawback of fat grafting is the unpredictable and ineffective survival of transplanted fat (20 to 60%, according to different authors). Currently, factors that can influence the degree of survival of adipose tissue and make it more predictable are being actively studied, in particular, the effect of Leucocyte and Platelet Rich Plasma (L-PRP). Purpose: To prove the stability of transplanted adipose tissue survival with the addition of L-PRP in breast surgery via multispiral computed tomography (MSCT) with the calculation of resorption rate of adipose tissue before transplantation in the early and in late postoperative stages. Materials and methods: In the period from 2013 to 2016, a total of 48 patients underwent surgery at the plastic surgery clinic in I.M. Sechenov First Moscow State Medical University. All patients complained of dissatisfactory appearance of the breast. Patients underwent breast lipofilling in order to correlate contour deformities. Monitoring of adipose autografts consisted of the following methods: MSCT was performed in 12 cases (5 patients after transplantation of pure adipose tissue and 7 patients after transplantation of adipose tissue enriched with L-PRP). Results: The study of the sample volumes and thickness of soft tissues after the transplantation was performed both with and without the addition of L-PRP. A steady increase in the soft tissue thickness in the breast region was revealed and an increase in volume was noted in the main group. At the same time, in patients of the control group three months after surgery a decrease in the volume and thickness of the breast soft tissues was revealed. Conclusions: The results of the study show that the improvement of breast contour after transplantation of adipose tissue both with and without the addition of L-PRP provides a steady increase in the thickness and volume of breast soft tissues. The average loss of adipose tissue after transplantation ranges from 11.62% to 17.13%. The results also confirm that MSCT is an adequate method of visualization of adipose autografts and volumetric changes in the late postoperative period.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. This clinical observation emphasizes the importance of a clear interaction between radiologists and surgeons within the treatment of primary spontaneous pneumothorax. Materials and methods. Patient A, 15 years old, was admitted to the thoracic department of the Faculty Surgery Clinic of the Sechenov University with complaints of dry cough, constant pain, uncomfortable sensations and edema in the left chest half, dyspnoea within physical exercises. Results. Based on the patient's complaints, the history of the present disease, data of subjective and objective investigation methods, the patient was diagnosed with a spontaneous primary left-sided pneumothorax complicated by the growing intermuscular emphysema. Controled by X-ray, the patient's pleural cavity was drained with subsequent air aspiration. Conclusion. The observation confirms the high information value of radiology diagnostic methods: thoracic X-ray and computed tomography. These methods allowed checking the effectiveness of each treatment stage, to diagnose such complication of primary spontaneous pneumothorax-increasing intermuscular emphysema and timely performing adequate surgical treatment.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Some pathologic processes compromise renal function and as result worsen glomerular filtration rate (GFR). The CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation was developed in an effort to create a more correct formula to estimate GFR, however, it is not able to assess split renal function. Objective. This paper aims to present how numerical analysis of abdominal multispiral computed tomography (MSCT) results correlate with data of CKD-EPI equation. Materials and methods. In this Institutional prospective cohort study, MSCT scans of 16 patients undergoing multiphasic renal protocol with 3D-reconstruction and numerical estimation were reviewed. Comparison was made by means of Pearson coefficient and Youden index. Results. MSCT-based methods for the calculation of split renal function with 3Dmodels showed strong correlation with CKD-EPI (p<0.001). Conclusion. Data received using the 3D-MSCT in comparison with CKD-EPI equation are equally accurate with low bias in GFR-assessment. However new approach has great advantages, because allows for both acquiring detailed data on clinical anatomy and evaluation of renal function, that made it not only precise but also more informative for decision-making in clinical practice. Such application of high-tech imaging method applied to the field of radiology may alter the course of patients' management when pathologic process is just beginning to correct premorbid conditions.

© 2018 Russian Electronic Journal of Radiology.All Rights Reserved. Purpose. Modern methods of diagnostics and visualization allow timely identifying and sometimes even preventing the development of complications. Our clinical case demonstrates the possibilities and diagnostic algorithm of such serious complication of catheter ablation as pulmonary vein (PV) stenosis. Materials and methods. 61-year old patient after repeated catheter ablations is presented. Results. The use of echocardiography and MSCT allowed determining the stage and characteristics of PVs stenosis. Catheter ablation is one of the most common and effective methods in atrial fibrillation treatment. However, significant increase in number of operations and specialists who perform catheter ablation, leads to appearance of specific complications. Modern methods of visualization and diagnostics allow to timely recognize and sometimes even prevent the development of complications. Conclusion. An echocardiography and MSCT are the main instruments in diagnostics of PVs stenosis.

© 2018 Russian Electronic Journal of Radiology. All Rights Reserved. Urolithiasis (ICD) is one of one the most actual health problem in the world. The significant prevalence of urolithiasis in the population (at least 5% of the population in industrially developed countries) forces us to constantly investigate the etiology and pathogenesis, look for effective prevention mechanisms, improve diagnostic methods and develop new technologies for conservative and operative treatment. The relevance of urolithiasis in connection with global demographic shifts has become especially important in recent years. The constant displacement of the age pyramid of the developed countries society towards the proportion of elderly and senile populations leads to an increase in the ICD frequency. The development of endoscopic equipment, the creation of new contact lithotripotors improving the methods of nephrolithotripsy have made it possible to solve the problem of ICD. Currently, one of the topical issues is the choice of diagnostic method to predict and evaluate the effectiveness of treatment in patients with ICD. Studies have shown that urolithiasis directly affects intracellular hemodynamics. The change in renal blood flow in ICD patients depends on the nature of urodynamic disturbances, localization and size of the calculus, the duration of the disease, the presence of complications and the age of the patient. Therefore, evaluation of perfusion is necessary in studying of kidney function.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Purpose: to elucidate predictors of development of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary artery thromboembolism (PTE). Material and methods. We included in this study 210 patients hospitalized with diagnosis of submassive and massive PTE from 2013 to 2017. In 1 to 3 years after initial hospitalization these patients were invited for control examination. According to results of this examination patients were divided into two groups: with (group 1, n=45) and without (group 2, n=165) signs of CTEPH. Severity of pulmonary artery vascular bed involvement was assessed by multislice computed tomography (MSCT) angiography and lung scintigraphy. For detection of thrombosis in the inferior vena cava system we used ultrasound angioscanning. Examination also included echocardiography. Results. In the process of mathematical analysis, the following risk factors for the development of CTEPH embolism were determined: duration of thrombotic history (group 1 - 13.70±2.05 days, group 2- 16.16±1.13 days, p=0.015), localization of venous thrombosis in the lower extremities (the most favorable - shin veins, popliteal, and common femoral veins, unfavorable - superficial femoral vein). The choice of the drug for thrombolytic and anticoagulant therapy: streptokinase and urokinase were significantly more effective than alteplase, rivaroxaban was superior to the combination of unfractionated or low molecular weight heparins with warfarin. Also, risk factors for the development of CTEPH were the initial degree of pulmonary hypertension and tricuspid insufficiency, as well as the positive dynamics of these indicators at the background of thrombolytic or anticoagulant therapy. Of concomitant diseases, significant risk factors for development of CTEPH were grade 3 hypertensive disease, diabetes mellitus, postinfarction cardiosclerosis. On the other hand, age, gender, degree of severity at the time of admission, presence of infarction pneumonia, surgical prevention of recurrent pulmonary embolism, number of pregnancies and deliveries, history of trauma and malignancies, cardiac arrhythmias produced no significant impact on the development of CTEPH.

© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: To assess the possibilities of radiology diagnostics in patients with orbital trauma in postoperative period. Materials and methods: From 2015 to 2018 years in the clinic of Sechenov University 72 patients (100%) with traumatic injuries were examined. All patients (n = 72, 100%) were diagnosed with orbital trauma. After the admission all patients (n = 72, 100%) underwent multispiral computed tomography (MSCT) before and after the operation using Toshiba Aquilion One 640 modality, volume mode, slice thickness - 0.5 mm, bone and soft tissue reconstruction. Results: According to MSCT data in postoperative period with orbital volumes were reconstructed and symmetrical compared to the other side in 48 patients (64%). In 24 cases (33%) orbital volumes weren't reconstructed with remaining prolapse of orbital soft tissue structures in the maxillary sinus through the inferior orbital wall defect. Insufficient implantation of the inferior orbital wall prosthesis occurred in 7 patients (10%). Conclusion: MSCT is a method of choice in examining the patients with injuries of the midface. Computed tomography allows detailed determination of performed surgical treatment, to reveal the risk of postoperative complications and assess the dynamic of a patient in late periods.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Introduction. Instrumental methods of examination may alter the course of treatment and patients' management. Several studies have shown that interobserver variability in values obtained with renal scintigraphy (RS) can be as high as 10%, however, RS remains the standard investigation for the assessment of split renal function. Objective. This paper aims to present how numerical analysis of abdominal MSCT results can be used to evaluate split renal function. Materials and methods. A prospective study was launched in a Research Institute for Uronephrology and Reproductive Health from November, 2015 to May, 2017. 88 patients were enrolled into the study (2 with hydronephrosis, 10 with hypertensive kidney disease, 5 with stone kidney disease, 2 with kidney anomalies, 69 with renal tumors). Comparison made between renal scintigraphy data and 3D MSCT-based models. Results. CT-based methods for the calculation of split renal function with 3D-models showed correlation with renal scintigraphy (p<0.004). Conclusion. A new approach for split kidney function assessment based on contrast-enhanced CT with 3D-models and mathematical analysis allows for both acquiring detailed data on clinical anatomy and evaluation of renal function to promote preoperative decision-making. It showed strong correlation with no significant difference in comparison with RS in terms of glomerular filtration rate, perfusion and plasma flow.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. To demonstrate the effectiveness of volumetric multispiral computer tomography at the planning of focal liver masses treatment. To present visual 3D reconstructions of the liver, its vessels and focal masses. Material and methods. A group of patients included 25 patients with different focal liver masses. The age of the patients was from 29 to 83 years (mean age 62.1 years). Each patient had MSCT of abdomen with intravenous contrast injection. The following diagnoses were made according to the results of the examination, most of which were subsequently confirmed histologically: hemangioma-3 (12%), focal nodular hyperplasia-2 (8%), abscess-1 (4%), hepatocellular carcinoma-2 (8 %), cysts-4 (16%), metastases-13 (52%) cases. Results. Three-dimensional modeling allows effectively and without distortion to combine all the phases of contrasting in a single image, which gives complete information about the anatomical features affected by the pathological process of the liver. Conclusion. Processing DICOM images with the construction of 3D models of the liver helps the surgeon at the planning of surgical treatment, improves the spatial perception of the anatomical relationship of the organ, its vessels and pathological formations. However, three-dimensional modeling requires additional time and its clinical significance remains insufficiently studied.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. To improve the diagnosis of urolithiasis using the latest technique-dualenergy computed tomography (DECT). Materials and methods. A prospective study of a group of 91 (100%) patients was conducted at the department of radiology and urology at the Russian-Japanese Center in Sechenov University. All patients underwent a dual-energy CT scan to predict the chemical composition of urinary stones "in vivo". All patients underwent surgical treatment after diagnostics: distance lithotripsy (DLT), percutaneous nephrolithotripsy (PHNLT), contact ureterolithotripsy (CULT). All the stones after operations were subjected to physico-chemical analysis (X-ray phase analysis, infrared spectroscopy) in order to verify the composition. Further, the diagnostic value of the dual-energy computed tomography was assessed by comparing the DECT results with the physico-chemical analysis data. Results. Using DECT in the preoperative period, the following results were obtained: 40 patients had vevellit stones, 34 patients had Ca-containing stones without vevellit, 10 patients had stones with uric acid, in 7 patients stones were classified in the group of cystine/struvite. After verification studies in the postoperative period, the following urinary stone composition was determined: 42 stones-vevellit, 34 stones-Ca-containing stones without vevellit, 10 stones with uric acid, 5 stones-struvite stones. At the same time the following results were obtained incorrectly using DECT: 7 stones with vevellit from which 4 stones were postoperatively confermed to the group of Ca-containing stones without vevellit, 3 stones-struvite/cystine stones; 4 Ca-containing stones without vevellite were classified in the group of the vevellite; 2 struvite stones: 1 stone was incorrectly assigned to the group of uric acid, 1 stone-to the group of the vevellite; 1 stone uric acid was incorrectly assigned to the group of struvite stones. It should also be noted that 1 stone had a mixed composition (uric acid 70% + vevellit 23% + veddellite 7%), according to the results of DECT it was incorrectly assigned to the group of stones from uric acid, at the same time the prevailing component was determined correctly. Conclusions. In order to predict the chemical composition of the stone "in vivo" with a high degree of reliability DECT in the preoperative period can differentiate not only the urate and Ca-containing stones, but also separately identify the stones in which vevellit is the predominant component. The detailed differentiation of Ca-containing stones, as well as of more rare stones, such as struvite and cystine, requires further studies with more significant groups of stones.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. To assess the possibilities of functional multispiral computed tomography (fMSCT) in orbital tumors. Materials and methods. The patient M, 55 years old, was admitted to ENT doctor with complaints of difficulty in nasal breathing and nasal discharge. After clinical and in-strumental examination, orbital tumor in the posterior part near the oculomotor muscle and optic nerve was found. To clarify the state of the optic nerve and its involvement in the pro-cess, the patient was referred by an ophthalmologist to an additional orbit examination us-ing functional MSCT. Functional MSCT was performed on a multispiral computer tomograph Toshiba Aq-uilion One 640, with slice thickness 0.5 mm, in the soft-tissue mode. During the study, the patient made eye movements from the central position upwards, then down, to the right, to the left, with a return to the central position. The time of functional eye movement study was 7 seconds. Results. During the functional MSCT the optic nerves were symmetrical: the left and right optic nerves with distinct smooth contours have a smooth course and differentiated to the orbital apexes. The movements of the optic nerves were symmetrical, in full volume. Taking into account the results of FMSCT, the tactics of conducting and surgical treatment of the patient was changed due to the lack of connection between the orbit tumor and optic nerve. The patient underwent surgical treatment and removal of left orbit tumor. Histologi-cal examination revealed cavernous hemangioma. Conclusion. Functional MSCT is a new promising method in examining patients with neoplasm of orbit. There is an opportunity to obtain additional diagnostic information on the relationship between orbital bone and soft tissue structures with neoplasms within the preoperative planning and postoperative control.