Objective. To investigate characteristic magnetic resonance imaging (MRI) findings of the brain in patients with hyperammonemic encephalopathy (HE) and to identify the main neuroimaging features of this pathology. Methods. A prospective study analyzed brain MRI data from 15 patients with sepsis and clinically confirmed HE. Assessment of cerebral changes was performed using a standard MRI protocol. The following parameters were evaluated during the analysis: localization and signal intensity characteristics of the lesions on MRI, presence or absence of diffusion restriction, presence magnetic susceptibility artifacts, as well as reversibility of structural changes. Results. Neuroimaging revealed pathological changes in all 15 patients. In 13 patients (86.7%) had symmetrical lesions of the insular cortex and cingulate gyrus; 1 patient (6.7%) had symmetrical lesions of the basal ganglia; and in 1 patient (6.7%) had cortico-subcortical lesions in the cerebral hemispheres. All detected lesions were characterized by hyperintense signal on T2-weighted and T2-FLAIR images. On diffusion-weighted imaging (DWI), cytotoxic edema was observed in all patients. Follow-up MRI was performed in all patients after treatment adjustment and renal replacement therapy, demonstrating marked regression of all noted changes, concurrent with normalization of serum ammonia, lactate, transaminases, sepsis markers. Conclusion. The present study characterized the MRI semiotics HE in patients with sepsis and identified its key neuroimaging patterns. The bilateral insular‑cingulate pattern should be considered a potentially valuable neuroimaging marker enabling early verification of HE.
Objective: To evaluate the usefulness of the uterine arterial perfusion index (API) and uterine artery Doppler parameters for assessing uterine blood supply in the first trimester of pregnancy in women with a history of chronic endometritis and to determine their prognostic value for adverse outcomes in the first half of pregnancy. Material and methods. Pregnant women (401) in the first trimester were enrolled and divided into a main group (with a history of chronic endometritis) and a comparison group (without evidence of chronic endometritis). Uterine artery Doppler parameters were assessed, and the uterine arterial perfusion index was calculated as an integral measure of uterine arterial blood supply. Analyses were performed separately for gestational windows of 5–7 +6 , 8–10 +6 , and 11–13 +6 weeks. Nonparametric statistical methods with median differences and 95% confidence intervals were used. Prognostic performance was evaluated using ROC analysis. Results. Across all first-trimester gestational windows, women in the main group demonstrated lower uterine arterial perfusion index values compared with the comparison group. The most pronounced differences were observed at 11–13 +6 weeks of gestation, when API demonstrated the greatest magnitude of effect (AUC 0.92), exceeding that for velocity indicators and vascular resistance indices and high prognostic significance in relation to adverse outcomes in the first half of pregnancy. Resistance indices (PI, RI) were less consistent and more operator-dependent than the integral perfusion index. Conclusion. The uterine arterial perfusion index is an informative integral parameter of uterine blood supply in the first trimester of pregnancy. A history of chronic endometritis is associated with reduced API and an unfavorable uterine hemodynamic profile. These findings support the potential use of API as a marker of early placentation conditions and for risk stratification of adverse pregnancy outcomes.
The aim of the study: To determine the risk factors and likelihood of developing postoperative atrial fibrillation (POAF) after aortic valve replacement (AVR) for severe aortic stenosis (AS). Materials and methods. A multicenter retrospective-prospective study was conducted among 181 patients with severe AS who underwent isolated valve replacement using biological prostheses in 2019–2025. The subjects were divided into two groups: with postoperative AF (POAF) (n = 75) and a group without POAF (n = 106). The median age was 72 [67, 75] and 70 [67, 73] years (p = 0.206), respectively. Female gender was 49 (65.3%), 62 (58.5%) (p = 0.438). Results. Risk factors for AF development in the early postoperative period were assessed using multivariate analysis. Statistically significant factors included: left ventricular diastolic dysfunction (LVDD) grade 2 (β = 0.90, p = 0.020, OR 2.5 (1.2–5.4)) and grade 3 (β = 1.4, p = 0.006, OR 4.0 (1.5–11.0)), presence of rhythm disturbances in the anamnesis before surgery (β = 4.04, p < 0.001, OR 57 (7–67)), and replacement of the aortic valve using implanted bioprostheses (β = 0.90, p = 0.028, 2.5 (1.1–5.6)). For further analysis of risk factors and calculation of the probability of occurrence of postoperative AF, the group including patients with POAF was divided into two subgroups: individuals with the presence of cardiac arrhythmia in the anamnesis before surgery (n = 32), and without arrhythmia in the anamnesis in the preoperative period (n = 43). In the group of patients with no preoperative cardiac arrhythmia, the presence of grade 2 LVDD, grade 3 LVDD before surgery, a biological suture prosthesis, and female gender were statistically significant risk factors for developing POAF. In the group with in the anamnesis preoperative cardiac arrhythmia, there were no other statistically significant risk factors for developing POAF, and the odds of developing POAF increased 57-fold at baseline. If a patient had grade 3 LVDD at baseline and a biological suture prosthesis was used, the risk of developing POAF increased regardless of gender. Conclusion. Preoperative risk factors for the development of AF in the early postoperative period in individuals who underwent surgical correction of severe AS and did not have cardiac arrhythmia preoperatively were: LVDD grades 2 and 3, female gender, and bioprosthetics using implanted prostheses. The presence of paroxysmal AF or frequent atrial extrasystoles before surgery is the main risk factor for the development of POAF. The likelihood of developing AF in the early postoperative period after coronary artery bypass graft replacement for severe AS significantly increases in the presence of the above-mentioned risk factors.
Objective. To systematize the ultrasound features of various fibrous cap (FC) states of carotid atherosclerotic plaques that determine the risk of ischemic stroke, based on an analysis of the morphological changes in its surface that occur during plaque destabilization. Content. This manuscript summarizes data both from literature and the authors' own experience. The FC separates the lipid-necrotic plaque core from the vessel lumen and is the most vulnerable to damage structure. Its thinning, rupture, and ulceration reflect different states of plaque destabilization and underlie the new Carotid Plaque-RADS stroke risk classification. The morphological features of each state are described, the threshold values for FC thickness are discussed. Ultrasound criteria for thick and thin plaque caps, plaque rupture, and healed ulceration are presented. Conclusion. In routine practice, FC thickness on ultrasound is assessed qualitatively using the “seen/not seen” basis without quantitative measurement. Ultrasound detects cap ruptures with high accuracy and ulcerations with moderate accuracy. Contrast enhancement, three-dimensional reconstruction, and low-velocity blood flow mapping could improve diagnostic accuracy. Assessing the plaque’s FC status together with plaque structure and degree of stenosis is advisable for improving risk stratification and personalizing patient treatment.
Background . Modern hybrid PET/CT technology with 2-[ 18 F]fluoro-2-deoxy-B-glucose ( 18 F-FDG) is widely used in multiple myeloma (MM) patients. However, a number of issues in the evaluation of PET/CT results require further analysis and systematization. Aim: To investigate the role of FDG PET/CT in the diagnostics of MM. Materials and Methods. The analysis included the results of 40 18 F-FDG PET/CT examinations performed in 40 patients with MM before therapy. To systematize the description of PET/CT findings, based on the analysis of fused images (including abnormalities on CT, PET or both) three types of lesions were identified: focal, diffuse, and diffuse-focal. The analysis included visual and semiquantitative assessment. Results. In analyzed group (n = 40) 18F-FDG PET/CT showed focal lesions in 72% (n = 29) of cases, diffuse lesions — in 13% (n = 5), and diffuse-focal lesions in 15% (n = 6). In 33% (13/40) cases PET/CT results were 18 F-FDG-negative – all focal lesions. In the subgroup with focal and diffuse-focal type (n = 40), bone marrow lesions, according to 18 F-FDG increased uptake without corresponding structural abnormalities on CT, were detected in 5% (2/40). In the subgroup with osteolytic foci and plasmacytomas structural lesions showed significant differences in 18 F-FDG uptake intensity – SUL max values ranged from 1.6 to 22.2. This was observed both in the subgroups with focal and diffuse-focal type as a whole, as well as in individual patients, including lesions of comparable size. Conclusion . The obtained results demonstrate significant polymorphism of changes detected by 18 F-FDG PET/CT in MM patients at the diagnostic stage. Analysis of three PET/CT types of images – PET, CT, and fused – allowed for the identification of the main types of lesions: focal, diffuse, and diffuse-focal. The use of the proposed classification will allow for the standardization of PET/CT result descriptions and increase the accuracy of their assessment during follow-up studies in the course of MM patient treatment.
