A case of mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy (MOGHE)

Recently, in the scientist community of specialists dealing with structural epilepsy, it has been noticed an increasing interest in a special form of cortical development disorder not to be included in the ILAE Classification of the epilepsies the 2017 revision. It is so-called mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy (MOGHE). There are a number of publications devoted to the neuroimaging features of MOGHE, which are possible to distinguish from other epileptogenic substrates in comparisons with clinical/anamnestic data and dynamic observation. Our paper describes the case of a patient under 6 years suffering from pharmacoresistant epilepsy with histologically confirmed MOGHE, and having undergone the procedure of epileptic surgery. MRI showed an increased intensity of the T2/FLAIR signal from the white matter in combination with signs of laminar hyperintensivity, regional sulcation disturbance, smoothness of gray-white matter demarcation in the right frontal lobe. A signal intensification from the white matter with the formation similarity of the «transmantl» sign and further pronounced smoothness of the gray-white matter demarcation was observed on dynamic MRI. These changes were estimated as focal cortical dysplasia. Pre-surgical examination revealed a correlation of epileptiform activity with MRI changes. The subtotal resection of the right frontal lobe and the morphological conclusion established the presence of MOGHE was performed.

Ultrasound examination of myometrial changes after conservative myomectomy, with the aim of predicting the course of pregnancy and choosing the optimal method of delivery

Introduction. The article provides a methodology for assessing and predicting complications during pregnancy for selectionof the optimal method of delivery.Goals and objectives. The work assessed the degree of myometrium changes, according to ultrasound studies, after using standard instrumentation and electrocoagulation, in order to predict the course of pregnancy and select the optimal method of delivery.Materials and methods. The details of the surgical anatomy, the plan of the surgeon’s action before the operation, formed according to the data of ultrasound diagnostics and operative surgery, were analyzed. Ultrasound was performed using GE Logiq S8 (USA) and Medisan Accuvix (South Korea) devices with 3,5 MHz convex transducers for transabdominal examination and with a frequency of 5 MHz for transvaginal examination.Research results. Laparoscopic myomectomy was performed in 18 women, 31 patients underwent laparotomic myomectomy, in 11 patients a combined operation technique was used: laparoscopy with minilaparotomy. According to our data, in half of the cases considered, the effects of interventions were absent or minimal. We assigned these results to group I (A — A1, A2, A3). In all other observations, cicatricial changes were revealed — group II (B, C, D, E). To predict the possible consequences, we proposed a point assessment of the ultrasound postoperative changes in the uterus, with the help of which it is possible to assess the degree of risk when planning pregnancy for each patient individually. Each group corresponds to a certain number of points.Conclusions. The presented division according to the degree of severity into groups can make it possible to individualize the approach to each patient and ensure the safest possible management of her during pregnancy and childbirth. This assessment can be used by ultrasound doctors and obstetricians-gynecologists of antenatal clinics and hospitals. The assessment presented by us at the moment is of a recommendatory nature.

The results of approbation of a comprehensive expert assessment of the quality of CT images of the chest obtained on low-dose scanning protocols using iterative reconstruction methods

Introduction. Сomputed tomography (CT) is associated with high individual patient doses. Hence, the process of optimization in CT examinations by developing low-dose scan protocols is important.Purpose of the study. Clinical approbation of low-dose protocols developed by the authors earlier, selection of the most promising protocol, assessment of the applicability of the developed algorithm for expert assessment of the quality of CT images.Materials and methods. The study was based on the data from 96 patients who underwent cardiac surgery with suspected infection in the lungs or sternal wound infection. CT examinations were performed using standard, low-dose and ultra-low-dose protocols (effective dose 3,5±0,9, 1,7±0,1 and 0,8±0,1 mSv, respectively) using two iterative reconstruction algorithms (IMR and iDose). The quality of the obtained data was assessed by 5 radiologists with more than 5-year experience in chest radiology.Results. In terms of the number of misinterpretations, no significant differences were estimated between the standard and lowdose protocols for all reconstruction methods. The ultra-low-dose protocol was characterized by a significantly higher number of missing lesions compared to other protocols.Conclusion. The developed method of assessment of the CT image quality has proven to be informative and reproducible and can be used to assess new scanning protocols.

Diagnostics of cerebral venous thrombosis associated with COVID-19 in young adults: clinical characteristics and imaging patterns

Introduction. Cerebral venous thrombosis (CVT) is relatively rare, but leads to the development of cerebral venous infarction, intracranial hemorrhage, followed by severe disability and death. Due to the epidemiological situation caused by COVID-19, the incidence of CVT is increasing.Aims and objectives: to analyze clinical, laboratory instrumental and neuroimaging (multislice computed tomography (MSCT), MSCT — with intravenous contrast, magnetic resonance imaging of the brain (MRI) and MRI venography) data that confirmed the development of CVT in patients with COVID-19.Methods. Data of 5 young adults with cerebral venous thrombosis (CVT) associated with COVID-19 are presented.Results. Аmong 5 reported cases of COVID-19, two patients presented with venous infarcts (hemorrhagic and ischemic), 3 patients developed encephalopathy syndrome without acute cerebral infarction.Conclusion. Possibilities of modern imaging technologies permitted to timely diagnosis cerebral venous thrombosis associated with COVID-19, that can lead to immediate initiation of therapy and to prevent the development of cerebrovascular complications during the COVID-19 pandemic.

Тhe contribution of computed tomography to the diagnosis of multiple aneurysm in the acute period of aneurysmal intracranial hemorrhage

Introduction. Multiple aneurysms are detected in patients with non-traumatic subarachnoid hemorrhage (nSAH) in 14–45% of cases. The diagnostic algorithm for this pathology can be shortened by performing the non-enhanced CT of head, CT-angiography, and if the localization of hemorrhage according to non-enhanced CT data matches, there is enough evidence to perform direct surgery without obtaining preoperative DCA.Objective. Determination of the diagnostic efficiency of CT and CTA of brachiocephalic arteries (CTA BCA) for planning the surgical treatment in the case of multiple aneurysms of intracranial arteries in the acute period of non-traumatic ICH in an emergency room.Material and methods. Retrospective analysis of the records of radiological examinations in the preoperative period in patients in an acute period of non-traumatic subarachnoid hemorrhage in the acute period performed in an emergency room of the Research Institute — Ochapovsky Regional Hospital no. 1. in the period from September 2017 to July 2018 (cerebral angiography, non-enhanced CT of the brain, CTA BCA).Results. According to the CTA BCA, 60 aneurysms were found: 21 patients had 2 aneurysms each one, 2 patients had 3 aneurysms, one patient had 8 aneurysms, and 4 patients had one aneurysm each. In comparison with DCA, which was performed in 10 patients, additionally there were found 3 miliary aneurysms, one aneurysm was excluded. For patients who did not obtain DCA, CTA scans were compared with intraoperative data on the side of surgical intervention (n=18). According to the CTA BCA, 18 aneurysms were found, according to the intraoperative record were found 17 aneurysms, while in one case a large bilobulated aneurysm was defined by a radiologist as two oppositely directed. The rest of the data was consistent.Conclusion. The presence of nICH on the non-contrast CT of the brain, and the correspondence of the localization of hemorrhage according to the results of CT-angiography, is sufficient for direct surgery without obtaining preoperative DCA, which is especially important in difficult patients. The use of DCA in patients with multiple aneurysms is recommended only in controversial and difficult cases.

Features of the physiological distribution of 68Ga-PSMA and its importance in the differential diagnosis of metastatic lesions of lymph nodes in patients with prostate cancer

Introduction. The appearance of new radiopharmaceuticals based on prostate-specific membrane antigen has significantly increased the accuracy of prostate cancer diagnosis. The physiological accumulation of 68Ga-PSMA in the sympathetic ganglia is important in the diagnosis of metastatic lesions of the lymph nodes. Erroneous interpretation of images can lead to an incorrect choice of tactics for the treatment of prostate cancer.Purpose: improving the diagnosis of prostate cancer with the help of updated data on the physiological accumulation of 68GaPSMA. Identify the sources of potential errors in the interpretation of PET/CT with 68Ga-PSMA.Materials and methods. In order to stage the verified prostate cancer, PET was performed in our center/CT with 68Ga-PSMA in 109 men. All patients were divided into groups by the level of prostate-specific antigen, Gleason sum, and d’Amico.Results. In all patients, we observed the accumulation of RFP in the cervical, abdominal and presacral ganglia. The capture level of the radiotracer was in the range of SUV=1,6–2,3 (median SUV=1,9). In the control PET/CT study after treatment, the accumulation of RFP in the cervical, abdominal and presacral ganglia remained at the same values, which made it possible to identify the detected changes as a variant of the physiological norm.Conclusions. It is necessary to take into account the peculiarities of the physiological distribution and accumulation of radiotracer in organs and tissues, in particular, the capture of 68Ga-PSMA by sympathetic ganglia. This will avoid false-positive cases when describing PET-CT images and will make it possible to increase the informative value of the method.

Functional changes in neural networks of the brain in patients with spastic diplegia after translingual neurostimulation

Introduction. Rehabilitation of children with cerebral palsy is one of the most difficult tasks in modern neurology. One of the promising areas is the combination of physiotherapy with methods of stimulation of various parts of the nervous system, among which functional electrical stimulation of muscles and nerves (FES) is distinguished.Purpose of research. Assessment of changes in the functional connectivity of neural networks in the brain in patients with cerebral palsy before and after translingual neurostimulation using functional MRI at rest.Materials and methods. Analyzed the results of changes in the functional connectivity of neural networks in the brain in 25 patients with cerebral palsy before and after translingual neurostimulation. A clinical examination was carried out with an assessment of complaints, anamnesis and an assessment on neurological scales, followed by standard and functional MRI of the brain at rest.Summary. In children with spastic diplegia, functional changes in neural networks with a predominance of processes of strengthening intra- and interhemispheric connections (p<0,05) were revealed, which correlates with clinical changes in the form of a decrease in spasticity and an improvement in motor skills.

Аpplication of shear wave elastography for differential diagnosis of clinical and morphological types of acute pancreatitis

Introduction. The incidence of acute pancreatitis increases every year. Early diagnosis of the necrotic type of acute pancreatitis is still relevant.Purpose. To reveal the informativeness of Elasticity Imaging Techniques for differential diagnosis of clinical and morphological types of acute pancreatitis.Material and methods. Shear wave sonoelastometry (ElastPQ-pSWE) was performed for 19 patients with acute edematous pancreatitis, and 13 patients with acute necrotizing pancreatitis. The control group consisted of 30 healthy volunteers.Results. In comparison with the control group, the stiffness of the pancreatic parenchyma was 1,3 times higher in the edematous form of AP (p3=0,0013, p6=0,007, p8=0,0024) and 5,3 times in the necrotic form of AP (p3=3,3e-5, p6=8e-07, p8=7,1e-8) and amounted to 5,16±1,34 kPa and 20,55±8,39 kPa, respectively, versus 3,86±1,04 kPa.Conclusions. Elasticity Imaging Techniques with shear wave technology provides an additional criterion for differential diagnosis of clinical and morphological types of acute pancreatitis.