Doppler Ultrasound and Computed Tomography Angiography Application in Planning of Lower Extremities Perforator Flaps for the Reconstruction of Acquired Maxillofacial Defects (Case Report)

The study describes a clinical case of preoperative planning of an anterolateral femur perforator flap and a peroneal autograft to eliminate a maxillofacial defect. During preparation for the surgery, an anatomical feature of the structure of both extremities circulatory system was found, which did not allow full use of the donor area tissues for subsequent surgical intervention. This feature was identified by Doppler ultrasound, but the final picture became clear only due to the study by computed tomography angiography.

Visualization of Lesions of Metaphyses and Epiphyses of Bones in Newborns and Young Children

The aim of this study was to determine the diagnostic capabilities of various methods of radiological diagnostics for lesions of the metaphyses and epiphyses of bones in newborns and young children.The study involved 108 children in the age group 5 days – 12 months with pathological changes in the pineal gland and bone metaphysis. The possibilities and advantages of standard radiography (СR), ultrasound examination (US) and magnetic resonance imaging (MRI) in the early and differential diagnosis of the osteomyelitis process and epiphyseolysis have been determined. High sensitivity (98 %), specificity (99 %) and accuracy (98 %) for ultrasound and sensitivity (94 %), specificity (89 %) and accuracy (95 %) of MRI in diagnosing osteomyelitis in patients of this age groups. At the same time, the possibilities of standard radiography at the stages of early diagnosis of inflammatory processes in the distal parts of the bones were limited due to a number of factors. The use of diagnostic algorithms greatly facilitates the work of a radiologist and reduces the number of false negative results during the initial treatment of patients.

Possibilities of Early Ultrasound Diagnostics of the Herlin — Werner — Wunderlich syndrome (Case Report)

Herlin — Werner — Wunderlich syndrome or OHVIRA (Obstructed hemivagina and ipsilateral renal anomaly) is a rare type of uterine and vaginal doubling defect (0,1 – 10,0 % of all uterine abnormalities) which is characterized by a triad of symptoms: uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal dysgenesis. The manifestation of the disease usually present after menarche, is accompanied by severe pain syndrome, leads to redoubted complications and organ-carrying operations with decreasing the fertility. At an earlier age, it can manifest itself as an infection of the genitourinary system. The diagnosis is based on clinical and anamnestic data using instrumental methods, the most accessible and safe of which is ultrasound. This article presents three clinical cases of patients 5 – 6 years old with a description of the ultrasound picture of the OHVIRA syndrome.

Radiology Imaging of Bronchiectasis in Children and Adolescents (Literature Review with Own Observations)

Timely detection of bronchiectasis in children is of great prognostic value. The importance of modern bronchiectasis in children is due to their possible reversibility over time with effective treatment, as well as a number of significant differences between bronchiectasis in childhood and onset in children, which may reflect different phenotypes of bronchiectasis. In adult patients with bronchiectasis that began in childhood, the pathological process has a more severe and worse prognosis compared to bronchiectasis that began in adulthood. In 2020, the European Respiratory Society proposed a new formulation of the terminal «bronchiectasis» for children and adolescents, now this term refers to an abnormal expansion of the bronchi by computed tomography (CT) of the chest, which, if detected early, can be reversible. CT is the true «gold standard» for confirming bronchiectasis in children and adolescents. This method is included in the minimum set of tests for children and adolescents with suspected bronchiectasis according to the recommendations of the European Respiratory Society. When conducting CT, it is recommended to perform a continuous spiral scan with a collimation of 1 mm, the study is carried out without intravenous use using low-dose protocols. To assess the state of the bronchi in children and adolescents, it is necessary to use the pediatric norms of the broncho-arterial ratio (> 0.8). At the same time, radiation methods are not decisive in establishing the causes of bronchiectasis and only in rare cases can help in establishing bronchiectasis. Dynamic observation of bronchiectasis for children and adolescents is determined individually. Consideration should be given to repeat chest computed tomography scans to answer the question that will change treatment.

Ultrasound in the Diagnosis of Perinatal Ischemic Strokes (Literature Review with Their Own Clinical Observations)

The issues of early diagnosis of perinatal arterial stroke (PAII) continue to be discussed in the domestic and foreign literature. Along with MRI, the ultrasound method allows to identify foci of ischemia of different localization and sizes in newborns. During ultrasound, we identified 29 cases of PAIA of different localization in children of different gestational and postnatal age. Analysis of our own and published data showed that up to 32 weeks of gestational development, AII develops in the lenticular-striar basin, and later in the cortical-subcortical region. Diagnostic capabilities of ultrasound in PAII can be significantly expanded by using ultrasound duplex scanning of brain vessels. Our observations showed that the nature of changes in Doppler parameters depends on the localization of the affected vascular basin and on the duration of cerebrovascular disorders

The Role of Gray-Scale Ultrasound in the Diagnosis of Postnatal Testicular Torsion in Children

Testicular torsion is a severe variant of postnatal gonad pathology in children. The speed of development of irreversible ischemic disorders determines not only the medical, but also the social significance of the problem and determines the need for accurate and rapid diagnosis and prompt provision of adequate care to the patient. The only objective method for diagnosing testicular torsion in children is ultrasound. At the same time, the characteristics of the child’s body: the small size of the object of study, low rates of intratesticular blood flow and restless behavior during the study sharply reduce the diagnostic value of the Doppler study or make it technically impossible. Thus, seroshkal ultrasound is the first stage of diagnosis of this complex emergency pathology, based on the results of which it is possible to diagnose testicular torsion with great accuracy. The publication summarizes our own experience of 110 echographic observations of postnatal testicular torsion in children older than 2 months, all cases were verified intraoperatively. A quantitative method for estimating the deformity of a twisted testicle is proposed and its statistical reliability is proved. The options presented for gray-scale changes in the structure of damaged gonads and determined their prognostic significance. The publication contains a review of the literature and is extensively illustrated.

Ultrasound Diagnostics of the Kidney Carbuncle (Brief Literature Review and Case Report of the Girl 5 Years Old)

The article presents a case of preoperative diagnostics of a rare variant purulent-inflammatory kidney disease in children – the kidney carbuncle. The rarity of the pathology and the early child’s age (5 years old) determined complexity of clinical diagnostics and the importance of radiation research methods. The diagnosis was suspected by ultrasound diagnostics and confirmed by CT. The child was operated on (resection of the upper pole of the kidney), and clinical recovery was achieved. The article includes illustrative material and a brief review of the literature on this problem.

The Role of Doppler Ultrasound in the Diagnosis of Postnatal Testicular Torsion in Children

The diagnostic significance of the color Doppler study of testicular blood flow in testicular torsion has been studied for about 40 years, however, the prognostic value of the results obtained is ambiguous, as are the actual imaging capabilities of the technique. Our own experience of 110 observations of testicular torsion in children older than the neonatal period allows us to draw statistically reliable conclusions. Made on equipment premium-class research made it possible to evaluate how visualization intratesticular vascular pattern, and whirpool-sign and submit the primitive model of the actual inversion, explaining the impossibility of rendering whirpool-sign with the greatest tight inversion. The dynamics of testicular blood flow was studied immediately after successful and unsuccessful manual detorsion and in the long term after operative detorsion and orchopexy. The publication contains a brief analysis of the literature and is extensively illustrated.

Secondary Iron Overload in Pediatric Hematology: the Priority of Free-Breathing Liver Study at 3.0 T Magnetic Resonance Scanner in Children with Severe Iron Overload

The aim of the study was to compare the effectiveness and scanning features of iron detection in the liver based on 3T MR scanner data using a breath holding and free breathing sequences in children with iron overload. 108 patients aged of 3 to 17 years with secondary iron overload associated with the regular blood transfusions underwent an MRI study on a 3.0 T MR scanner using specialized sequences for obtaining relaxometric maps: 3T-mGRE and 3T-uTE. The quality of the images received by the 3T-mGRE and 3T-uTE sequences was assessed by determining the signal-to-noise ratio (SNR). The SNR of 3T-uTE was found to be 8 times higher than the SNR of 3T-mGRE. In addition, it was found that for patients with an iron overload less than 25 mg/g the 3T-mGRE and 3T-uTE sequences showed the same efficacy in iron detection in the liver (r = 0.99, p = 0.54). The concentration of iron in the liver in patients with extremely severe iron overload could be calculated only using 3T-uTE relaxometric maps due to the high approximation error of the results obtaining by 3T-mGRE maps. These data demonstrate the possibility of using the 3T-mGRE sequence to determine the concentration of iron in the liver below 25 mg/g. However, with extremely severe iron overload, it is better to use the 3T-uTE sequence.

Cardiac and Visceral Signs of Connective Tissue Dysplasia in Children with Juvenile Rheumatoid Arthritis According to Ultrasound Examination Data

To study the cardiac and visceral signs of connective tissue dysplasia in children with juvenile rheumatoid arthritis, a comprehensive ultrasound examination of the abdominal cavity organs and echocardiography examination were conducted according to the standard protocol in 52 children aged from 5 to 16 years with the diagnosis of juvenile rheumatoid arthritis. The reference group consisted of 26 patients with autonomic dysfunction (vegetative-vascular dystonia). The incidence of such visceral dysplasia types as duodenogastric reflux, gastroesophageal reflux, and gallbladder malformations among children with juvenile rheumatoid arthritis was shown higher than in the reference group. The main cardiac sign of connective tissue dysplasia in patients with juvenile rheumatoid arthritis are an excessive chord of the left ventricle.