Chronic Pulmonary Aspergillosis: Literature Review and Demonstration of Own Observations

Chronic pulmonary aspergillosis (CPA) is a severe disease that develops mainly in patients without obvious immune disorders. Computed tomography is the main instrumental method in the diagnosis of CPA, which is necessary to determine the form of the disease, to choose treatment policy, to combat complications, and to monitor therapy. This makes it important for a radiologist to understand the main aspects of timely and differential diagnosis. There are insufficient Russian studies on this problem. This paper analyzes the 2014–2020 Russian and foreign publications available in PubMed, Web of Science, Elsevier, and eLibrary electronic databases. When searching for information, the following keywords were used: “computed tomography”, “chronic pulmonary aspergillosis”, “aspergilloma”, “air-crescent symptom”, “differential diagnosis”.

Giant Renal Angiomyolipoma by the Example of Clinical Cases

The paper presents two clinical cases of patients with giant renal angiomyolipomas (AML), in one of whom its course was complicated by intratumoral hemorrhage. It describes key diagnostic criteria for computed tomography (CT), as well as the distinctive features of other neoplasms that should undergo a differential diagnosis. The similar clinical presentations and morphological characteristics of different renal neoplasms can cause certain diagnostic difficulties; however, the carefully collected historical data and distinctive criteria allow AML to be identified. Due to its high sensitivity and specificity, abdominal contrast-enhanced CT is an effective imaging technique in the detection and differential diagnosis of giant renal AML.

Comparison of the Main Staging Systems for Assessing the Severity of Lung Injury in Patients with COVID-19 and Evaluation of Their Predictive Value

Objective: to compare the results of staging the severity of viral pneumonia in patients with COVID-19 based on the results of chest computed tomography (CT) using the empirical visual scale CT 0–4 and chest CT severity score (CT-SS) point scale, as well as to assess their prognostic value.Material and methods. Chest CT scans and anamnestic data in patients hospitalized to a non-specialized center repurposed for the treatment of new coronavirus infection, were analyzed. Chest CT analysis was performed by two radiologists using CT 0–4 and CT-SS scales.Results. The time course of changes in the severity of lung parenchymal lesions, by using both scales, was found to be similar: the maximum magnitude of lung tissue changes was recorded on day 5 of the disease. In cases of death, there was a significantly more extensive lung parenchymal involvement at admission to the center than in recovered patients, which was also true for both CT data assessment systems. Bothscales demonstrated comparable diagnostic and prognostic value: there were no statistically significant differences in sensitivity, specificity, and predictive value of a fatal outcome. Both the CT 0–4 scales and the CT-SS are based on the estimation of the volume of the affected lung tissue, but when the CT 0–4 scale was employed, additional criteria were used in some cases: the presence of hydrothorax and the determination of the maximum score for the most affected lung. Not all patients with a pronounced CT picture of viral pneumonia had a fatal outcome, which may indicate the presence of other factors that increase its risk.Conclusion. Both CT 0–4 and CT-SS scales have similar predictive values. The greater severity of parenchymal damage assessed by these CT scales was associated with the higher mortality rate.

Improving the Algorithm for the Management of Patients with Viral Hepatitis Using Contrast-Free Hepatic Arterial Spin Labelling Magnetic Resonance Perfusion

Objective: improving the algorithm for the management of patients with viral hepatitis using contrast-free arterial spin labelling (ASL) magnetic resonance (MR) perfusion.Material and methods. A total of 116 patients with viral hepatitis (VH) B, C and B + C were examined on the basis of Clinical hospital No. 1 (Smolensk): 75 (64.7%) men and 41 (35.3%) women, mean age 49.7 ± 2.3 years. The patients underwent instrumental diagnostic methods: ultrasound, clinical elastography, contrast-free hepatic ASL MR perfusion. Liver biopsy (n = 57) was used as the reference method.Results. The results of ASL MR perfusion had a high correlation with the data of clinical elastography in the diagnosis of fibrotic process; the diagnostic and prognostic significance of ASL liver perfusion in the diagnosis of fibrotic process was: AUROC 0.943 (95% CI, 0.884–0.953). There was a high correlation between ASL MR perfusion with Doppler ultrasound of hepatic blood vessels in the diagnosis of arterial blood flow disorders, but in VH В + C and cirrhosis – diagnostic and prognostic significance of the method: AUROC 0.951 (95% CI 0.932–0.972).Conclusion. ASL MR perfusion in VH patients allows to predict fibrotic changes in the hepatic parenchyma (AUROC 0.934 (95% CI 0.845–0.957)), provides information about changes in blood flow in the parenchymal structure (p < 0.005). The algorithm for the examination of VH patients should include contrast-free ASL MR perfusion at admission (AUROC 0.865 (95% CI 0.843–0.928)) and in dynamic follow-up (AUROC 0.915 (95% CI 0.881–0.946)).

Longevity Without Aging (to the 95th Anniversary of Joseph Rabkin)

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Modern Imaging Techniques and Their Role in Contact Radiation Therapy (Brachytherapy) Planning

The paper considers an algorithm for the diagnostic study of patients with cancer of different localization, the possibility and feasibility of involving imaging techniques in radiation therapy and brachytherapy (BT) planning. The most widely used ultrasound in BT planning does not exclude a subjective assessment of the boundaries of the tumor and organs at risk, as well as the inaccuracies caused by endostatic devices. Magnetic resonance imaging (MRI) provides a high level of achievement of the criteria necessary for BT planning, but it has financial constraints and the need for individual selection of research conditions. Computed tomography (CT) is the most effective technique for visualizing the tumor, endostatic devices, and organs at risk for BT 3D planning. The involvement of MRI and positron emission tomography with CT in BT planning is a promising area that requires equipping with a mathematical tool for double and triple contouring of the tumor and organs at risk and for defining protection priorities. The prescribed and used focal dose should be controlled by direct dosimetry methods to ensure quality assurance.

Carcinoid of the Operated Stomach: Difficulties in Diagnosis

Gastric neuroendocrine tumors commonly called carcinoids arise from enterochromaffin cells of the stomach and are rare. Recently, their incidence has increased, which may be due to the improvement of diagnostic and therapeutic capabilities. The article describes a rare clinical case of gastric carcinoid 23 years after surgical removal of gastric cardia cancer.

Pharmacoeconomic Study on the Application of Magnetic Resonance Imaging with Gadoxetic Acid in Addition to Contrast-Enhanced Computed Tomography in Diagnosis of Hepatocellular Carcinoma

Objective: to evaluate pharmacoeconomic advantages of the application of magnetic resonance imaging (MRI) with hepatobiliary-specific contrast agent – gadoxetic acid in addition to contrast-enhanced computed tomography (CT) in the diagnosis of hepatocellular carcinoma (HCC).Material and methods. We performed the modeling and obtained the results of the pharmacoeconomic study: effectiveness analysis, cost analysis, and cost-effectiveness analysis. The cost analysis included only direct medical costs (the cost of contrast-enhanced CT, gadolinium-based contrast agent (GBCA) for MRI, and therapy per a patient with verified HCC diagnosis after diagnostic procedures). The financing was performed from the Compulsary Health Insurance Fund. The calculations were made per 1 patient.Results. The effectiveness analysis showed that the diagnostic scheme CT + MRI with gadoxetic acid was the most effective complex for the diagnosis of HCC because its application provided 50% of patients with 5-year overall survival (4.8 years), which was significantly higher than in patients who were diagnosed HCC with CT + MRI with extracellular GBCA (2.3 years) or CT (3.7 years). The cost-effectiveness analysis showed that the diagnostic scheme with gadoxetic acid was dominant because each disability-adjusted life year required fewer costs (14 862 rubles) in comparison with CT + MRI with extracellular GBCA (25 293 rubles) or CT (46 540 rubles). According to the results of the incremental cost-effectiveness ratio analysis, the application of the diagnostic complex with gadoxetic acid was characterized by the lowest rate of additional costs per 1 disability-adjusted life year.Conclusion. The pharmacoeconomic study showed that the application of MRI with a hepatospecific contrasting agent – gadoxetic acid in addition to contrast-enhanced CT was an effective and economically beneficial method of early HCC diagnosis.

FLASH Radiotherapy: a Promising Direction in the Fight Against Cancer

At the present stage of scientific and technological progress, high-dose radiotherapy has become a common way to combat severe cancers. However, this treatment option is limited by normal tissues radiosensitivity. The developed technology of ultrashort pulse delivery of a dose of ionizing radiation to the zone of interest (FLASH radiotherapy) can achieve a high local control over tumor growth while sparing healthy tissues. This review summarizes the experimental findings supporting the possibility of transitioning to clinical studies of FLASH radiotherapy.

Topical Issues of Rational Use of Iodine-Containing Contrast Agents in X-Ray Diagnostics

The possibilities of rational use of iodine radiopaque agents in computed tomography and percutaneous coronary interventions are considered, taking into account the route, method of their administration and the viscosity of their solutions. When fixing the rate of iodine administration and the temperature of the injected solution, the required injection pressure of the contrast media is determined by the solution viscosity.