Objective: То compare the reproducibility, limitations and capabilities of three hierarchical levels of computed tomography (CT) image analysis in assessing residual changes in lung parenchyma after coronavirus infection: from visual assessment to shearlet transform and quantitative radiomic features. Material and methods. A retrospective analysis of data from 48 patients with confirmed lung damage associated with COVID-19 was conducted. Patients were divided into three groups: complete regression of changes (20 patients; 41.7%), residual lung changes (18 patients; 37.5%), and death in acute phase (10 patients; 20.8%). The analysis included: visual assessment of the lesion volume according to the CT1–4 scale; use of the shearlet transform with color-coded density to improve the perception of structural patterns; radiomics analysis with manual segmentation of regions of interest and extraction of entropy (JointEntropy) and homogeneity (image data matrix, IDM) features using 3D Slicer (PyRadiomics extension). Reproducibility was assessed using Cohen's kappa coefficient (κ) for visual and Shearlet assessments and the intraclass correlation coefficient (ICC) for radiomic features with calculation of confidence intervals (CI). Statistical analysis included the Mann–Whitney test, Spearman’s correlation (ρ), and ROC analysis. Results. The reproducibility coefficients were: κ=0.68 (95% CI 0.59–0.76) for visual assessment, κ=0.83 (95% CI 0.76–0.89) for the shearlet transform, ICC=0.94 (95% CI 0.91–0.97) for entropy, and ICC=0.92 (95% CI 0.88–0.95) for homogeneity. In the areas of residual changes, a significant increase in entropy (6.91±0.42 versus 5.85±0.31 in the intact areas; p<0.001) and a decrease in homogeneity (0.21±0.04 versus 0.29±0.03; p><0.001) were revealed. In patients with fatal outcome, a bimodal density distribution (range >400 HU) and an entropy increase of >0.2 units/day were noted. A decrease in entropy of >0.4 units/year was associated with favorable remodeling (sensitivity 89%, specificity 91%). Entropy demonstrated a moderate positive correlation with the visual volume of the lesion (ρ=0.64; p<0.01), while homogeneity correlated with tissue density (>ρ=0.81; p<0.001). Conclusion. The proposed hierarchy of methods reflects the evolution of the approach to interpreting post-COVID-19 changes: visual assessment provides basic semiotics but is limited by subjectivity (κ<0.70); the shearlet transform increases reproducibility by improving the perception of structural patterns (>κ>0.80); radiomic features (entropy, homogeneity) provide reproducible quantitative markers of remodeling (ICC>0.90). The high reproducibility of entropy confirms its potential as an objective prognostic criterion: stabilization at a level of 6.5–7.0 units predicts the formation of residual changes, a decrease to <6.8 units means complete regression, and an increase to >7.8 units with bimodal density means a high risk of mortality. The integration of quantitative radiomic features into clinical practice expands the possibilities for decision support in the analysis of residual changes after COVID-19.
This article describes a clinical case of bolus contrast-enhanced computed tomography (CT) in a 54-year-old female patient with class III obesity and severe comorbidity, hospitalized in the intensive care unit due to a systemic inflammatory response, progressive multiorgan dysfunction, and urinary tract disorders. Throughout hospitalization, the patient exhibited high levels of inflammation and hypercoagulability, azotemia, anemia, increasing proteinuria and hematuria, and a critical increase in procalcitonin in the pre-mortem period. Despite intensive care, her condition worsened to refractory shock, followed by circulatory arrest and death. A key feature of the case was the performance of contrast-enhanced chest and abdominal CT examinations in extremely unstable hemodynamics. CT revealed signs of pulmonary embolism and systemic hypoperfusion. Pathologically, the immediate cause of death was established to be massive pulmonary embolism, which highlights the diagnostic limitations of interpreting CT angiography in terminal hemodynamics.
Tarlov cysts (perineural cysts) were previously considered incidental findings; however, current evidence indicates their clinical significance: they are detected in 4.18% of the population, predominantly in the sacral spine (most commonly at the S2 level), with a higher prevalence in women than in men (5.84% versus 3.03%). Patient G., a 66-year-old woman, presented with severe right-sided lumbar pain (8–9 points according to numeric rating scale) radiating to the right buttock and shoulder, exacerbated by movement. Her medical history included chronic moderate back pain, dysuria (urinary frequency and sensation of incomplete bladder emptying), and osteoporosis (densitometry T-score –4.8). Physical examination revealed tenderness at paravertebral points of the lumbar spine and trigger points over the right latissimus dorsi muscle. Computed tomography (CT) of the lumbosacral spine showed two fluid-density lesions (+9 to +14 HU) at the S1–S2 level, 34×18×21 and 6×7×7 mm in size, with indentation of the posterior margin of the S1 vertebral body; a 2-mm disc protrusion was noted at L4–L5. Magnetic resonance imaging (MRI) revealed cysts 30×21×25 and 10×9×9 mm in size, hypointense on T1-weighted and hyperintense on T2-weighted images, extending into the left intervertebral foramen with contact involving the nerve root. CT confirmed the fluid nature of the cysts and identified bony indentation. MRI verified characteristic signal features and excluded other differential diagnoses. The size of the dominant cyst (>15 mm) correlated with symptom presence. Following surgical treatment, positive clinical dynamics were observed: resolution of pain and dysuria, confirming a causal relationship. Comprehensive imaging helps avoid diagnostic errors and guides appropriate management in patients presenting with radiculopathy and pelvic floor dysfunction.
Objective: То study the impact of wound damaging factors on the process of thrombus formation in the pulmonary arteries and to evaluate computed tomographic (CT) symptoms of thrombus formation in chest mine-blast (MB) wounds. Material and methods. A non-randomized radiographic examination of 202 patients with chest MB wounds was conducted. MB wounds were defined as multifactorial impacts from projectiles and the blast wave from the munition's explosion. All patients underwent an initial CT on the day of admission, with a repeat scan as clinically indicated. Contrast enhancement was achieved by administering a bolus of non-ionic contrast agent at a dose of 1 ml per 1 kg of patient body weight. Scanning was performed in the native, arterial, and venous phases. CT scans were used to assess the location of thrombi within the pulmonary artery and the area of pulmonary contusion using contrast enhancement. Results. It was shown that in addition to the generally recognized introduction of thrombi from the venous system, there is a potential for primary thrombus formation in the pulmonary arteries in severe lung injuries. This increases the incidence of pulmonary artery thrombosis to 32.7%. Damage to the pulmonary vascular endothelium is a predisposing factor for thrombus formation in small branches of the pulmonary artery. Conclusion. The study confirmed the multifaceted mechanisms of thrombus formation in the pulmonary artery in severe MB lung injuries.
A clinical case of a patient with multiple developmental defects – VACTERL association is presented: V – additional left-sided hemivertebra C7, additional cervical rib, asymmetry of the posterior arches Th1–2 (quality anomaly) with signs of partial conception on the left; A – congenital anal and rectal atresia; C – dextrocardia, coarctation of the aorta, patent ductus arteriosus, atrial septal defect, ventricular septal defect, additional left superior vena cava with atypical drainage into the left atrium; TE – perineal fistula; R – single gall-shaped kidney on the right; L – hypoplastic phalanges of the first finger of the right hand. Diagnosis, differential diagnosis and therapy are discussed.
Background. Access to an objective quantitative assessment of esophageal transport function (ETF) is significantly limited in clinical practice due to two main factors: the insufficient availability of specialized equipment in healthcare institutions and the lack of adequate analysis techniques. The development of approaches utilizing conventional fluoroscopy with a liquid barium sulfate suspension contrast combined with automated processing has the potential to significantly increase the accessibility and objectivity of metric evaluation for patients with conditions involving swallowing disorders and esophageal motility impairments.Objective: to develop and validate a proprietary algorithm for computer-based quantitative analysis of fluoroscopic images obtained from conventional esophageal fluoroscopy for the assessment of ETF in patients with related disorders.Material and methods. A prospective comparative study included 34 patients with dysphagia (mean age 52.1±9.2 years). Each patient underwent modified fluoroscopy (a 60-second lateral video recording of the first swallow of 15 ml of standard barium suspension, corresponding to the first stage of contrast) and dynamic esophageal scintigraphy (DES) with 99mTc-technephyte, which was used as the reference method for quantitative parameters of mean esophageal transit time, based on our own results and literature data on quantitative ETF assessment. Fluoroscopic DICOM sequences were processed using the developed computer-based quantitative analysis of fluoroscopic images (QAFI) to generate intensity-time curves in selected regions of interest. The agreement between QAFI and DES results was assessed using dynamic time warping (DTW), cross-correlation, Bland–Altman analysis, and the intraclass correlation coefficient (ICC). Results. QAFI demonstrated high concordance with DES: mean DTW distance 0,055±0.012; synchronous crosscorrelation 0.925±0.06; ICC 0.915 (95% confidence interval 0.886–0.941). Bland–Altman analysis revealed no systematic bias (mean difference –0.01; limits of agreement –0.079 to 0.059). The diagnostic characteristics of QAFI were high: the area under the ROC curve was 0.94, with sensitivity of 0.90 and specificity of 0.88. The method's reproducibility was also high: intra-operator ICC>0,98, inter-operator ICC>0,97.Conclusion. The developed proprietary algorithm for computer-based QAFI obtained by conventional fluoroscopy enables the acquisition of quantitative ETF parameters, demonstrating excellent diagnostic characteristics and good reproducibility. The obtained data confirm that QAFI could be a promising and widely accessible tool for use in routine clinical practice, as it is based on widely available fluoroscopy. The implementation of QAFI in clinical practice will facilitate a more objective and reproducible quantitative assessment of ETF in patients with esophageal motility disorders, expanding the capabilities of metric diagnostics without resorting to expensive techniques.
Background. Liver fibrosis represents a structural manifestation of chronic liver diseases and, with progression, leads to the development of cirrhosis and related complications. Native liver T1 mapping is considered a quantitative magnetic resonance imaging (MRI) technique reflecting the severity of fibrotic changes; however, its diagnostic performance may be influenced by liver tissue composition, including steatosis.Objective: to evaluate the diagnostic performance of native T1 mapping for liver fibrosis staging and to assess the impact of steatosis on its diagnostic characteristics.Material and methods. This retrospective study included 241 patients who underwent abdominal MRI with acquisition of native liver T1 relaxation maps using the MOLLI 4(1)3(1)2 and MOLLI 5(3)3 protocols with pulse-triggered cardiac synchronization during a single breath-hold. Reference fibrosis staging (METAVIR F0–F4) was established based on integrated clinical, laboratory, and instrumental data. An additional stratification was performed according to the presence of hepatic steatosis, determined based on proton density fat fraction values. Patients with evidence of hepatic iron overload were excluded from the analysis. The relationship between native liver T1 values and fibrosis stage was assessed using correlation analysis, and intergroup comparisons were performed across fibrosis stages. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis for the identification of clinically significant fibrosis (≥F2), advanced fibrosis and cirrhosis (≥F3), and cirrhosis (F4). Statistical analysis was performed using nonparametric methods. Multiple comparisons were controlled using the Benjamini–Hochberg procedure, and results were considered statistically significant at false discovery rate (FDR) <0.05.Results. A statistically significant positive correlation was observed between native liver T1 values and fibrosis stage (ρ=0.779 for MOLLI 4(1)3(1)2 and ρ=0.792 for MOLLI 5(3)3; p<0.001; FDR<0.05). Median T1 values increased progressively from F0 to F4, and differences between all adjacent stages remained significant after FDR correction. ROC analysis demonstrated high diagnostic performance of native T1 mapping for fibrosis stratification: AUROC values for ≥F2 were 0.909 and 0.919; for ≥F3, 0.946 and 0.954; and for F4, 0.972 and 0.981 for MOLLI 4(1)3(1)2 and MOLLI 5(3)3, respectively. In the presence of steatosis, diagnostic performance decreased for ≥F2, whereas no statistically significant differences between subgroups were observed for ≥F3 and F4 (p>0.05). These findings indicate a modifying effect of steatosis primarily at early stages of fibrosis discrimination.Conclusion. Native liver T1 mapping using MOLLI 4(1)3(1)2 and MOLLI 5(3)3 protocols is an informative quantitative MRI technique for fibrosis staging. Diagnostic performance increases from ≥F2 to ≥F3 and reaches its highest level in cirrhosis. The presence of steatosis reduces discriminatory performance for ≥F2, thereby defining the limitations of the technique and supporting its use as part of a multiparametric MRI approach in patients with chronic liver diseases.
Infiltrative pulmonary tuberculosis remains one of the most pressing problems in modern phthisiology due to its high prevalence, variability of clinical manifestations, and difficulties in early diagnostics. This clinical case demonstrates an algorithm for the diagnosis and treatment of infiltrative pulmonary tuberculosis in an adolescent. The criteria for differential diagnosis with pneumonia, the role of immunological and microbiological methods, and the dynamics of X-ray changes during tuberculosis therapy are considered.
Background. Kawasaki syndrome is a systemic vasculitis that mainly affects children under 5 years of age. Coronary aneurysms, which develop in 15–25% of untreated patients and can lead to myocardial infarction and sudden cardiac death, are particularly dangerous. The introduction of intravenous immunoglobulin reduced the incidence of this complication to 3–5%, however, 10% of patients show resistance to therapy. The growth of atypical forms and the appearance of multisystem inflammatory syndrome in children associated with COVID-19 increase the importance of accurate and timely diagnosis.Objective: determining the role and place, studying the informative value of imaging methods in the diagnosis of Kawasaki syndrome and its complications in children.Material and methods. For the period of 3 years from January 1, 2022, a retrospective analysis of the data of 16 patients with Kawasaki syndrome (mean age 3.5±1.8 years) was conducted. Echocardiography (EchoCG) was performed on a Philips EPIQ 7 ultrasound scanner using S5-1 (1–5 MHz) and S8-3 (3–8 MHz) sensors. The diameter of the coronary arteries and blood flow characteristics were evaluated. Computed tomography angiography (CTА) was carried out on a Canon Aquilion ONE 640-slice tomograph with bolus contrast agent injection and synchronization with electrocardiography. For suspected concomitant myocarditis, individual patients underwent heart magnetic resonance imaging (MRI) using a Siemens Aera 1.5 T device, which included obtaining T1and T2-weighted images, as well as assessing late contrast enhancement in myocardium after intravenous injection.Results. EchoCG was performed in all 16 patients, CTА in 7, and heart MRI in 5. The proportion of patients with coronary aneurysms was 75% (12 out of 16). Combined lesion of several arteries was most often observed (58.3%). Dynamic follow-up after 6–12 months revealed a generally favorable prognosis: 27.3% of medium and 70% of small aneurysms remained without dynamics or regressed. However, 10% of small coronary aneurysms progressed, which underscored the need for careful, long-term monitoring of even small changes. The incidence of acute cardiac complications (acute coronary syndrome – 18.8%) in our cohort indicates a continuing risk of ischemic events. The differences in aneurysm sizes measured by CTА and EchoCG were not statistically significant (paired Student’s t-test: t(13)=1.09; p=0.297). At the same time, CTА revealed details critical for prognosis and tactics that were missed by EchoCG: an anomaly of the right coronary artery, mural thrombosis and calcification, as well as (in 1 case) the true extent of the lesion. Myocarditis was verified in 1 patient according to MRI data, namely, manifestations of left ventricular dilation and decreased contractile function, as well as edema signs by T2-tirm and late gadolinium enhancement, delayed accumulation of paramagnetic contrast agent of a characteristic non-coronary pattern.Conclusion. EchoCG remains the method of choice in the acute period due to the early age of children. CTА is the most informative for assessing the distal sections of the coronary arteries and detecting complications (thrombosis, calcification, stenosis), while heart MRI is used to diagnose a combined inflammatory process. The optimal diagnostic strategy is aimed at detecting and dynamically monitoring the identified changes and should be based on a rational combination of these methods, taking into account the phase of the disease and age.
Background. Breast cancer remains the leading oncological pathology among the female population, which underscores the critical importance of methods for its early and accurate detection. Stereotactic biopsy (STB) is one of them: it is a minimally invasive procedure that provides histological confirmation of a diagnosis based on mammographic findings. However, its diagnostic performance when working with different subcategories of Breast Imaging Reporting and Data System (BI-RADS) requires further clarification in real-world clinical practice.Objective: to evaluate STB diagnostic efficacy in detecting breast cancer in patients with suspicious mammographic findings (BI-RADS 4a, 4b, 4c, 5) in the context of correlation between radiologic conclusions and histological diagnosis.Material and methods. A retrospective single-center study analyzed data from 102 patients who underwent STB. In 54 cases, STB results were compared with postoperative histological analysis findings. Key diagnostic performance indicators and the Cohen's kappa (κ) agreement coefficient were calculated.Results. According to STB, malignant, precancerous, and benign processes were identified in 18.6% (19/102), 11.8% (12/102), and 69.6% (71/102) of cases, respectively. When compared with excision biopsy data (n=54), STB demonstrated the following metrics: diagnostic accuracy 90.7%, sensitivity 84%, specificity 100%, positive and negative predictive values 100% and 81.4%, respectively. The false negative rate was 9.2% (5/54). Agreement between the methods was very high (κ=0.85). The highest frequency of cancer confirmation was associated with the BI-RADS 4c subcategory.Conclusion. STB has proven to be a highly accurate and effective method for the morphological verification of suspicious breast lesions categorized as BI-RADS 4–5, contributing to a reduction in the number of unjustified surgical interventions. The primary direction for further improvement of the technique is to reduce the frequency of false negative results by optimizing the tissue sampling procedure.
Objective: to prove the possibility of detecting pericardial contusion using computed tomography (CT) performed in the normal mode of chest examination.Material and methods. The preliminary phase of the study examined the CT appearance of the intact pericardium, identified symptoms characteristic of contusion, and the likelihood of detecting these symptoms. The final phase assessed the potential of chest CT for detecting cardiac contusions in mine-explosive chest wounds.Results. The ability to diagnose gunshot pericardial contusion using chest CT was established. Pericardial contusion was diagnosed in 45.1% of cases of mine-explosive chest wounds. The primary CT signs of contusion were pericardial edema and hemopericardium. Edema corresponded to pericardial leaflet thickening up to 2–3 mm. Pericardial thickness exceeding 3 mm indicated blood accumulation.Conclusion. Detection of pericardial contusion by CT will help determine indications for in-depth examination of intracardiac structures.
Objective: to clarify and systematize the causes of focal and non-organ artifacts capable of acting as diagnostic pitfalls in lung perfusion scintigraphy using 99mTc macroaggregated albumin (MAA), as well as their semiotics, principles, and methods for differentiating from pathological changes.Material and methods. The outcomes of lung perfusion scintigraphy were analyzed in 1,025 patients who underwent examinations to rule out pulmonary embolism (PE) or thromboembolic factors contributing to diagnosed pulmonary hypertension. The procedure was carried out in a multiplanar mode using twodetector single-photon emission computed tomography (SPECT) scanners while the patient was lying supine, 4–5 minutes after intravenous injection of a radiopharmaceutical (RPh) with an activity level of 111–148 MBq. Lung images were captured in six projections, including anterior, posterior, and four oblique planes. If required, additional screening was performed in combined SPECT/CT mode. The term “artifact” was used to describe isolated perfusion defects that simulate PE, as well as extrapulmonary findings resembling signs of a right-to-left shunt.Results. Artefact scintigraphic findings corresponding to the above criteria were found in 634 (61.8%) patients. Focal changes (n=618) were classified into “cold” and “hot” based on their scintigraphic presentation. Single “cold” lesions (n=611) were most commonly due to the shielding effect of altered anatomical structures (heart – 493, pulmonary artery trunk – 72, pleural effusion and elevated diaphragm – 41), as well as implanted pacemakers (n=5). “Hot spot” (n=7) obscured thromboembolic perfusion defects because of their high specific radioactivity. The main reason for this artifact is blood ingress into a syringe with 99mTc-MAA during intravenous administration of RPh. Extrapulmonary signs of right-to-left shunt were observed in 14 patients with congenital heart defects and were characterized by concurrent visualization of the kidneys and other organs in the systemic circulation (spleen, liver, thyroid gland). The reason for artefactual intestinal imaging (n=2) was residual radioactivity following prior myocardial perfusion scintigraphy with 99mTc methoxyisobutyl-isonitrile.Conclusion. Examining the reasons behind the occurrence of focal and extra-organ artifact findings in lung perfusion scintigraphy, as well as associated diagnostic and interpretive pitfalls, will enable the development of an appropriate quality control strategy to reduce the likelihood of false-positive interpretations of PE and systemic pulmonary shunts.
Yuri N. Kasatkin is a famous scientist in the field of nuclear medicine, the pioneer of introducing and using scintigraphy methods in domestic clinical practice. As a talented organizer and teacher, he headed the Department of Medical Radiology at the Central Institute for Advanced Medical Studies for 35 years and was the its Vice-Rector for Academic Affairs. He made a great contribution to the formation of a postgraduate training system for specialists in radionuclide diagnostics and healthcare in general. The individual components of this organizational and pedagogical work are considered in this work.
Developmental venous anomalies (DVA) are among the most common malformations, accounting for about 55% of all cerebral vascular anomalies. Most of them are asymptomatic, detected incidentally by brain magnetic resonance imaging and do not require treatment. Complications in DVA are rare. Cases of DVAassociated hemorrhage, venous congestion, and epilepsy have been described in literature; however, most cases of complications are due to other malformations, such as cavernous and lymphatic malformations, focal cortical dysplasias. We present a rare clinical case of infratentorial venous infarction resulting from DVA thrombosis, which was triggered by thrombosis in contralateral sigmoid and transverse venous sinuses.
Background. In current clinical practice, the information contained in computed tomography (CT) images of lung cancer is not used to its full extent – only a few semantic characteristics (e.g. size, contours, nature of contrast agent accumulation, etc.). Today, researchers are attempting to transform CT image data into quantitative indicators describing the shape and texture of lung cancer, as well as to link these indicators with clinical data. This approach is called “radiomics” and is a developing field in medicine.Objective: to analyze publications on differential diagnosis of non-small cell lung cancer (NSCLC) using texture analysis as well as to assess the possibilities and prospects of this method in increasing information content of CT studies.Material and methods. The literature review presents data obtained from available sources in PubMed, ScienceDirect and Google Scholar databases, published up to and including the end of 2024, found using the key words and phrases in Russian and English languages: “NSCLC”, “lung adenocarcinoma”, “squamous cell lung cancer”, “computed tomography”, “radiomics”, “texture analysis”, “differential diagnostics”.Results. The literature review describes the methods of texture analysis at all stages. Based on the results of the studied scientific works, the authors conclude that the use of texture analysis allows non-invasively predicting the histological form of NSCLC with sensitivity 72–83%, specificity 67–92%, and accuracy 74–86%. Conclusion. The use of texture analysis, according to published studies, is a promising method for differential diagnosis of histological forms of NSCLC (up to AUC ~0.7–0.9), however, the difference in methods and the lack of standardization of texture analysis require additional research.
Artificial intelligence (AI) is currently developing very efficiently, and its applications are valuable in many fields of science, including medicine, mainly because of its ability to ensure accuracy, objectivity and automation, in particular, in the diagnostic process. Rapid development of diagnostic technologies provides an opportunity to introduce innovative solutions into modern medicine through the use of AI, which makes it possible to relieve medical workers by speeding up the diagnostic process and improving its quality as well as effectiveness of subsequent special treatment based on its results. This review briefly presents the current state of knowledge and a number of existing AI models applied in everyday practice in medical imaging. AI has great potential to transform X-ray diagnostics and other areas of medicine, especially in the analysis of medical images. Despite the difficulties associated with AI implementation in practice, such as the need for proper staff training and ethical issues, the advantages of its application are very significant. AI can help improve diagnostic accuracy, speed up the diagnostic process itself, and reduce medical costs. Further development of AI technologies combined with the constant cooperation between Russian AI developers and medical professionals will contribute to even greater advances in healthcare, which will undoubtedly benefit both patients and staff of medical institutions.
Levamisole is an antihelminthic drug that is widely used in clinical practice. One of its rare side effects is the development of levamisole-associated multifocal inflammatory leukoencephalopathy, which progresses 2–8 weeks after treatment and is characterized by brain demyelination and white matter damage. The article describes a case of levamisole-induced leukoencephalopathy, which should be differentiated from multiple sclerosis, acute disseminated encephalomyelitis, and neuromyelitis optica.
Objective: to study the dynamic and patterns of atherosclerotic changes in the aortic arch using computed tomography data.Material and methods. The computed tomography data of 158 patients obtained at the Philips Ingenuity CT scanner without contrast were studied. The aortic arch was divided into three parts: Part I – up to the brachiocephalic artery, Part II – up to the left subclavian artery, and Part III – distal to the left subclavian artery. The position of the local atherosclerotic lesions was determined by dividing the aorta into 24 segments. The data were grouped and statistically analyzed.Results. Three age groups were identified: Group 1 – up to 55 years, Group 2 – 56–70 years, and Group 3 – over 70 years. The severity of aortic wall changes was assessed quantitatively by calculating the total number of affected segments among participants in each group. The significance level was p<0.05. Similar patterns of aortic atherosclerosis were found, but the location was not related to gender. The least number of lesions was in Part I of the arch, and the greatest was in Part III. There was an increase with age.Conclusion. Atherosclerotic disease of the aortic arch is most commonly found in the upper half (segments 22–24) of Part I. In Part II, it was more frequent in the right half (segments 15–22). In Part III, the lesions were most pronounced in lower segments and on the left (segments 6–14). The location of lesions in men and women was slightly different.
The article presents four clinical observations of patients who underwent contrast-enhanced magnetic resonance imaging (MRI) after treatment for cholelithiasis complicated by choledocholithiasis. Abdominal MRI was performed using Amira 1.5T MR tomograph (Siemens, Germany) according to standard protocols with subsequent injection of contrast agent in the form of 20 ml of paramagnetic (Omniscan®) diluted in 50 ml of saline solution: in three patients – into the common bile duct drainage tubes, and in one patient – through a probe inserted into the fistulous tract of the anterior abdominal wall. It was shown that dilution of 20 ml of Omniscan® in 50 ml of saline solution to increase the volume of the contrast agent does not significantly affect MR properties of the paramagnetic. The technique allowed identifying the patency of extrahepatic bile ducts and showed high potential in detecting bile discharge as a complication of surgical treatment for choledocholithiasis, but it did not visualize directly the lumen of drainage tubes and fistula passages, which requires further improvement.
