The review provides information on the possibilities and significance of computed tomography (CT) angiography as a method of postoperative control of cerebral aneurysms after treatment (surgical clipping or endovascular embolization). The comparison of the diagnostic value of CT and cerebral angiography as a routine method of postoperative control is shown. The possibilities of improving the methods of scanning and post-processing in the framework of CT angiography are described for better visualization of the completeness of aneurysm shutdown, as well as minimizing artifacts from surgical clips and coils.

Aim. To study the features of contrast enhancement of malignant neoplasms of the liver in patients with and without cirrhosis (LC), to study the differences in the dynamics of contrast enhancement of liver are metastatic lesions (MTS) and hepatocellular carcinoma (HCC).Material and methods. A retrospective analysis results 58 patients with HCC (group 1) and 51 patients with liver metastases (group 2) was carried out based on morphological data. According to the criterion for the presence of LC, group 1 was divided into two subgroups. The main method of radiological diagnostics was contrast enhancement ultrasound (CEUS).Results. The indicators of the dynamics of the Wash-in of an ultrasound contrast agent into the HCC node and the dynamics of the drug WASH-OUT from the focus in patients with LC did not significantly differ from those in patients without cirrhosis. HCC is characterized by the onset of leaching of the ultrasound contrast agent after 62 seconds from the beginning of the study, which significantly differs from MTS (p <0.05). The parameters in predicting the G3 stage of the tumor were as follows: the parameter “onset of WASH-OUT” of the from the focus ><79 sec, the parameter “time of maximum WASH-OUT” of the ultrasound contrast agent ><270 seconds. In our opinion, certain difficulties are presented by the diagnosis of highly differentiated carcinomas due to the absence of the WASH-OUT phenomenon in 50% of patients. Differential diagnosis of metastases should be based on a combination of a number of signs, the most important of which, in our opinion, are: early onset of elution of ultrasound contrast agent, “black hole” symptom, peripheral ring-shaped enhancement in arterial phase.>Conclusion. The data obtained with the help of CEUS confirm the effect of “arterialization of hepatic blood flow” in patients with LC. Differences in the parameters of contrasting HCC nodes in subgroups of patients with and without LC are not statistically significant. The polymorphism of the signs detected in MTS in the liver is due to the morphology of the primary tumor and the size of the neoplasms. Differential diagnosis should be based on a combination of signs of the dynamics of ultrasound contrast agents.

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.

Purpose. To identify and evaluate the effectiveness of sonographic signs of intestinal ischemia in patients with strangulated small bowel obstruction.Materials and methods. For the period 2017–2019, 115 patients with SIO were treated at the N.V. Sklifosovsky Federal Research Institute of Emergency Medicine. There were 64 women (55.6%) and 51 men (44.4%). The mean age was 62 ± 15 years. In all patients, the diagnosis was verified intraoperatively. All patients underwent ultrasound examination of the abdominal cavity in B-mode with the assessment of blood flow of the intestinal wall in the mode of CDI. Patients were divided on the basis of intraoperative data into 2 groups. The first group: 63 (54.8%) patients with signs of ischemia of the strangulated loop of the intestine. The second group consisted of 21 (18.1%) patients in whom intestinal necrosis was detected. The comparison group included 31 (26.7%) patients with adhesive small bowel obstruction without intestinal strangulation.Results. The most informative signs of ischemia of the strangulated intestine of the loop are infiltrative changes of its mesentery. In the second and third groups 9 (14.3%) and 12 (57.1%) participants, respectively, showed severity of intestinal ischemia, compared with 1 participant (3.2%) in the first group. The next informative criterion is the thickening of more than 0.4 cm and edema of the intestinal wall. In the second and third groups 30 (47.6%) and 14 (66.6%), in the comparison group 4 (12.9%), akinesis of the strangulated loop and paresis of the entire small intestine also directly correlated with intestinal ischemia. The absence of differentiation of intestinal wall layers occurs in (23.8%), the absence of blood flow in the intestinal wall in the CDI mode (19%), gas inclusions in the intestinal wall (4.3%).Conclusion. The assessment of sonographic symptoms allows to diagnose the presence of ischemic changes in the intestinal wall and perform surgery before the development of necrosis in the early period. In cases of late admission of the patient to the hospital, with the onset of intestinal necrosis and the associated erased clinical picture, ultrasound allows to establish indications for surgery before the development of peritonitis.

Background. Sinonasal diseases are widespread in childhood. Radiological studies, including computer tomography, are an optimal and effective method of diagnosis. The child's body is more sensitive to radiation exposure than adults. The threshold of exposure, which may induce internal organs injury in children, requires a precise selection of the radiological method with minimal radiation dose. There is currently no unified position in the professional community on the appropriateness of the use of ultra-low-dose computed tomography in pediatrics.We reviewed the data on the appropriateness and effectiveness of paranasal low-dose computed tomography in pediatrics.Materials. 57 domestic and foreign publications, for the period from January 2001 to November 2019. In order to achieve the objective, we analyzed relevant domestic and foreign publications in scientific libraries e-LIBRARY, PubMed, Google Scholar per the keywords: “low-dose CT”, “children”, “paranasal sinus”, “pediatric”, “diagnosis”, “children”, “low-dose computed tomography”, “sinusitis”, “paranasal sinuses”.Results. The analysis of the available literature allowed summarizing the current data on pediatric paranasal disease diagnostics and the use of computed tomography, as well as to identify possible options for reducing radiation dose.Conclusions. Conducting many radiological examinations in a child leads to the risk of cancer. However, these examinations are an effective way to diagnose paranasal diseases, and a CT scan is the “gold standard”. The actual task is to develop a CT technique with reduced radiation exposure without compromising image quality. The need to review and optimize the standard protocols of radiological studies to determine the efficacy and feasibility of studies with minimal radiation exposure to children is justified.

The article discusses the modern possibilities of identifying inflammatory bowel diseases using methods of radiation diagnosis. Methods of radiation diagnostics help determine the stages of inflammatory bowel diseases helping in timely diagnosis, prescription and timely correction of therapy. The use of an adequate amount of diagnostic measures allows early detection of complications requiring immediate surgical treatment, such as fibrostenotic lesions, fistulae, and abscesses.The sources of the review were publications included in peer-reviewed databases E-library, PubMed, GoogleScholar, conference materials and non-indexed publications, including web pages of conferences and repositories of scientific data from universities.

In view of the rare occurrence, the small spectrum of clinical manifestations and the non-specificity of changes in instrumental and laboratory data, the diagnosis of ganglioneuroma at the moment is a very difficult task for the routine of a doctor. Ganglioneuromas have a slow growth, which leads to a long asymptomatic course and, as a result, complicates its early diagnosis. In most cases, ganglioneuroma is random. Complaints in these patients are non-specific and are directly dependent on localization.One of the available methods for imaging retroperitoneal tumors is ultrasound (ultrasound)., which makes preventive and regular ultrasound an indispensable method for early detection of extraorgan formations. This article describes the clinical case of ganglioneroma in a young man with the pathology of the upper gastrointestinal tract.

Metastases in the pancreas are rather rare tumor lesion of this organ. According to different data, the incidence of metastatic pancreatic lesions varies from 1.8 to 4% of all pancreatictumors.The article presents three clinical observations of metastases of melanoma, renal clearcell cancer, lung cancer in the pancreas. All patients were treatedusing cryosurgical methods with positive dynamics in the postoperative period.A brief review of the literature discussing metastatic lesions of the pancreas is also done, and the management treatment tactics of these patients is described.

Purpose. Our study aimed to identify an optimal full-cleanse bowel preparation scheme for patients undergoing CT colonography.Material and methods. The final sample included 118 patients: 81 females (68.6%), with the median age being 75 years (IQR 675-80 years). For bowel preparation 39 (33.1%) patients used PM/Ca, 36 (30.5%) – 2 L PEG + Asc, 19 (16.1%) – 3 L PEG, 24 (20.3%) – 4 L PEG. Otherwise, the preparation did not differ in all four groups. Visual assessment of residual stool, residual fluid, and distension degree was performed using a 4-point Likert scale. The patient’s subjective tolerance assessment was executed according to the survey results using a 5-point Likert scale.Results. There were no statistically significant differences in quality of bowel preparation in all four groups. Mean value of the total residual stool score in groups was 46.2 ± 2.87 for PM/Ca; 46.9 ± 2.34 for 2 L PEG + Asc; 46.5 ± 1.98 for 3 L PEG; 45.9 ± 3.18 for 4 L PEG (p > 0.05). The median of the total residual fluid score in groups was 36 (33–38) for PM/Ca; 36.5 (34–39) for 2 L PEG + Asc; 37 (36–39) for 3 L PEG; 36 (34–40) for 4 L PEG (p > 0.05). Mean value of the total distention degree score in groups was 43 ± 4.34 for PM/Ca; 44.6 ± 3.13 for 2 L PEG + Asc; 44.2 ± 3.98 for 3 L PEG; 43.5 ± 4.9 for 4 L PEG (p > 0.05). There was a statistically significant difference in the patient tolerance total score, depending on the laxative (p = 0.001). The total preparation score was significantly lower for PM/Ca when compared with 2 L PEG + Asc. (p = 0.021), 3 L PEG (p = 0.001), and 4 L PEG (p = 0.043).Conclusion. Use of PM/Ca in CTC preparation lowers the burden of full cleanse exam preparation and can be recommended as a safe laxative choice, including senior age patients.

Despite the fact that most vascular surgeons in Russia rarely use magnetic resonance imaging (MRI) in their daily practice, today interest in this method of imaging among specialists in the world is steadily increasing. This is due to the desire of clinicians to have another non – invasive method for diagnosing hemodynamic disorders of both the arterial (Magnetic Resonance Angiography – MRA) and venous vascular bed (Magnetic Resonance Venography – VRA). The development of these methods today is associated with the solution of many technical problems, the development of special pulse sequences and post-processing methods for the resulting image. This literature review analyzes published scientific data on the methodology of MRI in relation to the vascular system and the choice of optimal scanning modes. Taking into consideration the fact that this material is intended primarily for vascular surgeons and phlebologists, and not radiologists, the first part summarizes the basic understanding of the physical phenomena underlying the MRI image, without which a thoughtful analysis of the advantages and disadvantages of MR-Angiography and the search for the most optimal scanning mode for MR-Venography is not possible. Based on the constant desire of clinicians to be self-educated, it seems that this part of the presented material will not be difficult to understand. When describing the developed contrast-free and contrast-free MRA methods, attention is paid to the traditional methods of image processing in 2D mode (TOF, PC) using pulse sequences: spin echo (SE), multi-echo (SE T2), turbo spin echo (TSE), fast Advanced Spin Echo (fast Advanced Spin Echo-FASE), gradient echo (Gradient Echo-GE, GRE) and inversion recovery (Inversion Recovery-IR). In addition, the focus is on the most modern solu tions, including: multiplantar reformatting (MPR), maximum intensity projection (MIP), subvolume maximum intensity, surface rendering (SR), volume rendering (VR) and virtual intraluminal endoscopy (VIE). For all the methods used today, MR-Angiography is shown to be specific and informative, with a detailed analysis of the advantages and disadvantages. The nuances of understanding the resulting angiographic image in T1 and T2-weighted images and the phenomena of “bright blood” and “black blood” are shown. Since the absence of information or a brief mention only about the possibilities of using MRI in the diagnosis of hemodynamic disorders in patients with vascular pathology in Russian scientific literature it seems that this material is relevant and will arouse some interest from various specialists. Of particular interest is the potential use of contrast-free and contrast – free MR Angiography in the study of venous pathology of the lower extremities and pelvis, especially with regard to timely and accurate diagnosis of deep venous thrombosis (deep Vein Thrombosis-DVT) and venous thromboembolism (Venous Thrombosis – Embolism – VTE), which occupy a special position in the structure of patients with chronic venous Disorders of the lower extremities (Chronic Venous Disorders-CVD).