The value of computer aided detection system for mammography in the fatty breast: the results of the single-centered, prospective, randomized clinical trial

Aim. To assess the reasonability to use CAD added to mammography with subsequent targeted ultrasound (US) of CAD markings in patients with low-density (ACR A-В) breasts.Materials and methods. In the prospective study we included 2326 women with low breast density. They were randomized for CAD (MammCheck II of our own design) checking with subsequent targeted US (MMG + CAD group) or without CAD (MMG only group). After the initial screening we performed the 3-year follow-up phase.Results. Totally, during the primary screening in the MMG only group we found 77 breast cancers (BCs) (28,57% of them sized less than 1 cm), in the MMG + CAD group – 69 BCs (36,23% of them sized less than 1 cm), р > 0.05. The suspicious lesion was identified only during the targeted US of the CAD marking in 4 of 25 women in the MMG + CAD group, and all these BCs were below 1 cm in size. During the subsequent follow-up in the MMG only group we found 5 additional BCs, with no such cases in the MMG + CAD group (p < 0.05). Three of these five BCs were retrospectively marked by CAD. The only visible BC that was not marked by CAD was 3 mm in size.Discussion. The overall false positive marking rate was 0.31 и 0.28 per film-screen and digital image, respectively (р > 0.05).Conclusion. The CAD usage added to mammography with subsequent targeted US of markings in patients with low-density (ACR A-В) breast is reasonable due to the significant decrease of the BC rate diagnosed during the 3-year follow-up. This combination detected 77 of the 77 (100.00%) BCs compared to 69 of 74 (93.24%) BCs when only mammography used.

Magnetic resonance imaging and computed tomography in the diagnosis of cerebral venous infarction

A clinical observation of the diagnosis of cerebral venous stroke, rare in clinical practice, based on the data of magnetic resonance imaging and computed tomography of the brain, is presented, the semiotics of the revealed changes is described.

Planning of methods of surgical correction of soft tissues of the face and neck

Objective. Role of ultrasound examination in planning surgical correction of age-related changes of the face and neck soft tissues.Methods. A prospective analysis of the study and treatment of 80 patients with involutive changes in the soft tissues of the face and neck who were carried out from 2018 to 2020 in the Mositalmed Clinic. The age of the patients ranged from 24 to 60 years. The mean age was 42 ± 6.89 years (± SE standard deviation mean). There were 67 female patients (83.7%), male patients – 13 (16.3%).Results. The diagnostic value of ultrasound examination in involutional changes in the soft tissues of the face and neck for determining the causes of contour deformities is noted.Conclusion. Ultrasound imaging in an upright position of the patient makes it possible to determine the degree of participation of each tissue in the formation of deformity, which is extremely important for planning various techniques for rejuvenating the face and neck.

Quantitative Computed Tomography, modern data. Review

In the review we discussed about the method of quantitative computed tomography (QCT, quantitative computed tomography). In QCT, X-ray density (HU) is converted to bone mineral density (BMD mg / ml) using linear relationships obtained by scanning calibration standards (phantoms). When compared with the normative age data, it is possible to diagnose osteoporosis (OP). The review presents various QCT techniques and their diagnostic capabilities in accordance with the positions of ISCD 2019 - (International Society for Clinical Densitometry). The results of comparison of QCT and conventional dual-energy X-ray absorptiometry (DXA) are considered. It is noted that in the study of the proximal femur (PF), the results of the methods are well comparable, according to the results of both methods, it is possible to diagnose OP by the T-score. However, when examining the spine QCT, the volume BMD of the trabecular bone of the vertebral bodies is assessed, and with DXA, the projection BMD is assessed. The approaches to the interpretation of the results are also different - diagnosis of OP in DXA of the spine based on the T-score, but in QCT, the ACR (American College of Radiology) criteria are used.We describe the phantoms used in QCT, as well as provide data on radiation exposure during QCT and DXA.The article describes an approach to opportunistic screening of osteoporosis by the QCT based on the results of previously performed CT scans, including its automated work-flow using artificial intelligence technologies. These promising techniques are attractive due to the large number of CT examinations performed and the exclusion of additional examinations.

Intrahepatic splenosis mimicking hepatocellular carcinoma

We present a rare clinical case of a 37-year-old man who had intrahepatic splenosis (IHS) mimics hepatocellular carcinoma on CT/MRI imaging. The patient with a history of splenectomy 14 years ago had no specific complains and the lesion was found incidentally during follow up imaging for the chronic pancreatitis. Definitive diagnosis of IHS was possible with post-operative histopathological analysis of the resected liver.

Diagnostic and prognostic value of a diffusion-weighted image of the liver with magnetic resonance imaging in patients with alcoholic liver disease

The aim of the study was to assess the diagnostic and prognostic value of a diffusion-weighted image of the liver with magnetic resonance imaging in patients with alcoholic liver disease.Material and methods. A total of 113 patients with alcoholic liver disease (ALD) were examined. Among them, 65 (57.5%) are men and 48 (42.5%) are women. The mean age of patients is 46.3 ± 5.2 years. The structure of the instrumental algorithm for examining patients was presented: ultrasound of the abdominal cavity organs with clinical elastography – 98 (86.7%) patients, MRI of the liver with the mandatory inclusion of the DWI liver sequence in the protocol (n = 113). The b-factor values of 100/600/1000 were used for the liver DWI sequence. Liver biopsy was chosen as the reference method in 65 (57.5%) patients.Results. The patients were monitored for 12 months. At the first stage, the qualitative characteristics of the liver DWI sequence were assessed: no or there is a diffusion limitation. At the second stage, the quantitative indicators of the DWI sequence were assessed in the form of calculating the measured diffusion index and coefficient. In order to standardize the technique of liver DWI on MRI in patients with ALD, the results were compared with the data of clinical elastography (p < 0.01) and liver biopsy (p < 0.05). Upon admission and monitoring of patients (after 1, 3, 6, 9 months), a high correlation was found in the assessment of comparing the quantitative indicators of DWI with clinical elastography (r = 0.873) and an average correlation with biopsy data (r = 0.715).Conclusions. There was a high correlation between the limitation of liver diffusion on MRI and negative clinical and laboratory dynamics (r = 0.889) and in the absence of limitation of diffusion in the liver and positive clinical and laboratory dynamics (r = 0.885). DWI of the liver on MRI in patients with ALD has a high diagnostic and prognostic value in assessing abnormal abstinence regimen (AUROC = 0.903 (95% CI 0.871–0.911)). Diagnostic and prognostic significance of the developed criteria for DWI of the liver at MRI in patients with ABD at admission: for a qualitative assessment AUROC = 0.844 (95% CI 0.801–0.869), quantitative – AUROC = 0.908 (95% CI 0.875–0.911); with dynamic observation: for a qualitative assessment AUROC = 0.939 (95% CI 0.901–0.955), quantitative – AUROC = 0.919 (95% CI 0.871–0.931).

Acute aortic thrombosis in a patient with SARS-CoV-2 coronavirus disease (COVID-19)

One of the rare and life-threatening conditions is acute aortic thrombosis. We have described a case of thrombosis of the aorta and iliac arteries in a patient against the background of viral pneumonia COVID-19, with newly diagnosed diabetes mellitus and arterial hypertension.

Comparability of coronary risk assessment methods with chest ultra-LDCT and CT coronography with ECG synchronization

Purpose. To assess the comparability of coronary calcium values measured on ultralow-dose computed tomography studies without ECG-synchronization versus a) non-contrast computed tomography with ECG synchronization, b) CT coronography with ECG synchronization.Materials and methods. The study comprised 283 studies: 68 patients who underwent contrast-free ultra-LDCT without ECG synchronization and contrast-free CT with ECG synchronization performed in a single visit, and 49 patients with contrast-free ultra-LDCT without ECG synchronization, non-contrast CT with ECG synchronization, and CT coronography with ECG synchronization and intravenous injection of contrast agent, also carried out in one visit, meeting all inclusion and exclusion criteria of the study.Quantitative coronary calcium values were calculated with the Agatston score and the CAC-DRS scale (score of calcification degree from 0 to 3 and the number of affected arteries from 0 to 4 points). The degree of coronary artery stenosis was analyzed with CAD-RADS scale (0-5).The above parameters were compared using visual/quantitative assessment of coronary calcium on ultra-LDCT without ECG synchronization and visual/quantitative assessment for CT with ECG synchronization, as well as the degree of stenosis on CT coronography in the same patients.Results. Based on the results of accuracy indices comparison, the possibility to use quantitative scale (Agatston score, CAC-DRS quantitative scale) to assess coronary calcification in the lung cancer screening in comparison with ECG-synchronized CT was determined during interpretation of ultra-LDCT without ECG synchronization. The correlation matrix to assess correlation between visual, quantitative scales of coronary artery changes and calcification at ultra-LDCT without ECG synchronization and quantitative scale at CT with ECG synchronization vs. CT coronography identifies very strong positive statistically significant correlations.Conclusion. Methods of coronary calcinosis assessment with chest ultra-LDCT and CT with ECG synchronization are comparable, therefore it is possible to assess coronary calcium in lung cancer screening by ultra-LDCT data at a reliable-high level using both quantitative and visual CAC-DRS scales.

Functional and diagnostic significance of the fMRI-response type to motor loads in patients after traumatic brain damage

Aim of the study. Clarification of the functional and diagnostic significance of topography, or the type of fMRI-response recorded during active and passive hand movements in patients after traumatic brain injury.Material and methods. fMRI-responses gained during active and passive hand movements were analyzed in 40 patients with posttraumatic motor function disturbances and compared with results gained from 17 healthy volunteers (control group ).Results. In analyzed patients the increase of percentage of diffuse fMRI-response has been shown along with the areas of activation not typical for movement activation pattern typical healthy volunteers. The fMRI response type being it local or multifocal does not clearly correlate with the presence of motor function impairment (hemiparesis). However, it was found that with greater severity of hemiparesis there is a larger percentage of multifocal fMRI-response.The transition from a multifocal form of a motor fMRI-response to a local one observed in a dynamic study is accompanied by an improvement of patient’s general condition, a shift towards normalization of a number of morphofunctional indicators of the central nervous system, the tendency of regression of motor disorders.Conclusion. The increase of multifocal fMRI-responses in patients after traumatic brain injury is one of the signs of cerebral dysfunction. Dynamically observed transformation from multifocal to local fMRI-responses is associated with current or long-term improvement in motor activity as well, wit the regression of other clinical impairments and can be considered as prognostically positive sign of the course of post-traumatic illness.

Сomputed tomography for fractures of the ankle joint in children

Introduction. Correct diagnosis is based on visualization and knowledge of fracture patterns characteristic of children. Traditionally, radiography is used to visualize bone damage. In fractures in children due to the high risk of damage to the germinal zones, it is necessary to have clear and reliable information about their condition, which cannot always be obtained by x-ray method. For these purposes and the requirements of modern surgery, CT is used, which with high diagnostic accuracy clarifies the degree of displacement of fragments, present a qualitative characteristic of fractures and reveals associated damage.Purpose: to show the capabilities of computed tomography in diagnosis of fractures of ankle joint.Materials and methods. The results of computed tomography (CT) are presented in 226 children and adolescents aged 3 to 17 years. There were 142 boys (62.8%), 84 girls (37.2%). Scanning was carried out depending on the weight and age of the patient with the minimum indicators of kV and mAS, a slice thickness of 0.75 mm.Results. Average time for seeking medical help was 32 hours from moment of injury. Among causes of injury in the first place was domestic injury (73, 8%), followed by sports injury (22, 3%) and traffic accidents (3.9%). Right-sided ankle fractures were found in 147 (65.1%), left-sided – in 79 (34.9%) children. The most common types of tibial fractures were metaepiphysiolysis of the distal tibia and metaepiphysiolysis of the distal tibia of both tibia, which together accounted for 67.7% (n = 153) of all tibial fractures.Conclusion. Computed tomography should be performed in all cases of intraarticular fractures of the ankle joint. It is especially important for evaluating fractures with damage to germ zones. Scanning must be carried out with a cutting thickness of not more than 1 mm. CT with multi-planar data reformatting is an important factor in determining whether a patient needs surgical treatment. As a result of CT, a final diagnosis was established and a decision was made on treatment tactics.