Multiple sclerosis remains the most common demyelinating disease of the central nervous system and ranks first among neurological diseases that lead to disability in young people. The most important diagnostic and prognostic marker, especially at an early stage of the disease, is magnetic resonance imaging (MRI), which currently remains the only method that allows to explore the entire central nervous system in vivo.The review presents literature data on modern achievements in MRI-based diagnosis of multiple sclerosis. Key attention is paid to such promising methods as assessment of brain and spinal cord atrophy, brain perfusion MRI, and diffusion tensor imaging. Implementation of these approaches in MRI can help solve the problem of early diagnosis of multiple sclerosis and determine more reliable markers of a response to ongoing therapy.

Over the past decades, lung ultrasound in the diagnosis of lung diseases has become widespread. Ultrasound examination has a number of advantages (no radiation exposure, real-time imaging, clear visualization of the subpleural lung regions and costophrenic angles), which make it possible to use ultrasound to monitor the dynamics of pneumonia in children and pregnant women. Currently, in the context of the COVID-19 pandemic, lung ultrasound is widely used due to its high diagnostic efficiency, which is comparable with classical radiography and X-ray computed tomography (CT) by a number of parameters. The article describes the method of lung ultrasound and the radiographic pattern of COVID-19-associated pneumonia. It also provides a review of the literature, according to which the severity of pneumonia was determined, depending on the radiographic pattern, and the need for a lung ultrasound was identified. The article indicates that information on assessment of the radiographic pattern of the lungs at runtime in different variants of the course of coronavirus infection, as well as many methodological issues, including the frequency of second-look lung ultrasound, has not been sufficiently studied.

A review of current techniques of instrumental and laboratory diagnosis of crystal arthropathies is presented. Advantages and disadvantages of various methods of diagnostic radiology and diagnostic radiologic criteria employed in primary and differential diagnosis of crystal deposits are discussed in relation to their etiology and clinical peculiarities. It is proven from a wide pool of published studies that the method of ultrasonic diagnosis is the most available one, has no contraindications and demonstrates the best sensitivity and specificity in the diagnosis of crystalline arthropathy.

A review of current techniques of instrumental and laboratory diagnosis of crystal arthropathies is presented. Advantages and disadvantages of various methods of diagnostic radiology and diagnostic radiologic criteria employed in primary and differential diagnosis of crystal deposits are discussed in relation to their etiology and clinical peculiarities. It is proven from a wide pool of published studies that the method of ultrasonic diagnosis is the most available one, has no contraindications and demonstrates the best sensitivity and specificity in the diagnosis of crystalline arthropathy.

Introduction. Determination of the cause of cholestasis and treatment of patients with obstructive jaundice syndrome remains challenging owing to the steady rise in diseases of the hepatopancreatoduodenal zone and the high frequency of diagnostic errors. In the differential diagnosis of the causes of obstructive jaundice, diagnostic imaging techniques are of the greatest importance. In the world literature, there are few reports on the assessment of the diagnostic potential of multispiral computed tomography under conditions of direct contrasting of the biliary tree using endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, or through pre-installed palliative drainage in the bile ducts. There is no generally accepted algorithm for determining the causes of biliary obstruction. It leads to ineffective use of various diagnostic imaging techniques, complicating the diagnostic process.The purpose of the study was to evaluate the diagnostic efficacy of contrast-enhanced ct cholangiography (ct-cg) in the differential diagnosis of causes of malignant and benign biliary obstruction in cases with obstructive jaundice syndrome.Material and methods. The study included 55 patients with obstructive jaundice, who were treated in a surgical hospital from july 2016 to july 2019.Results. It was found that contrast ct-cg in diagnosing the causes of biliary obstruction of both malignant and benign genesis is more informative than x-ray endoscopic retrograde cholangiopancreatography. The diagnostic efficacy of ct-cg in detecting causes of malignant biliary obstruction was: 93.3% sensitivity, 92.9% specificity, and 93.1% accuracy. The diagnostic efficacy of ct-cg in detecting causes of benign biliary obstruction was: 92.9%, 93.3% and 93.1%, respectively.Conclusion. Based on the high accuracy, contrast-enhanced ct-cg is a promising imaging technique in cases with bile duct obstruction.

Страница 77 СРАВНЕНИЕ ДИАГНОСТИЧЕСКИХ ВОЗМОЖНОСТЕЙ МАГНИТНО-РЕЗОНАНСНОЙ ХОЛАНГИОПАНКРЕАТОГРАФИИ И СПИРАЛЬНОЙ КОМПЬЮТЕРНОЙ ТОМОГРАФИИ, СОЧЕТАННОЙ С ПРЯМЫМ КОНТРАСТИРОВАНИЕМ ЖЕЛЧНЫХ

Obstructive jaundice (OJ) is a syndrome characterized by bile staining of the skin, mucous membranes, and sclera as a complication of pathological processes that lead to disruption of the bile ducts at various levels of the biliary tract. Obstructive jaundice represents various diseases with different onset, course, and outcome, as well as etiology, which implies the difficulties of the diagnostic process. Identification of a cholestasis cause and treatment of patients with OJ remain urgent and difficult tasks due to the steady rise in diseases of the hepatopancreatoduodenal zone (HPDZ) and the high frequency of diagnostic errors. The latter can lead to the progression of liver failure, as well as to the development of severe complications, which, in turn, are fatal. A significant role in detecting HPDZ pathology belongs to the radiological methods of studies, such as transabdominal ultrasonography (TUS), endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), endoscopic ultrasound (EUS), intraductal ultrasonography (IDUS), magnetic resonance cholangiopancreatography (MRCP), helical computed tomography (hCT), and helical CT cholangiography (hCT-CG). However, it should be noted that, as of today, there is no well-established conventional radiological algorithm for determining the causes of biliary obstruction. This, in turn, leads to repeated or sequential inefficient administration of all possible methods of visualization, complicating the diagnostic algorithm. In this regard, it is advisable to perform an in-depth study of the Russian and foreign literature sources, highlighting the problem of an early and highly effective diagnostics of the causes of biliary obstruction in patients with OJ.

Capabilities of 199Tl-chloride and 99mTc-MIBI scintigraphy in the non-nonspecific indications of bone and soft tissue sarcomas in overall 31 patients (34 lesions) were studied. Sensitivity of these methods in the detections of neoplasms reached 96.0 % and 100.0 %, respectively. It described positive, negative and mixed types of sarcomas visualizations on the both 199Tl-chloride and 99mTc-MIBI scintigraphy. There are preconditions for the 199Tl-chloride scintigraphy in the successful differentiations between bone and soft tissue sarcomas and benign tumors or non-tumor diseases, primarily inflammations.

Doppler mapping is used along with the B-mode to identify the vascularization of the periosteum in patients with suspected osteomyelitis. Objective: to estimate the information content in duplex scanning mode, color and power Doppler mapping (DSM and PDM) in diagnosing different phases of acute hematogenous osteomyelitis in children. Material and methods. The study included 23 children aged from 2 to 15 with acute hematogenous osteomyelitis who came by way of ambulance to the children's surgical hospital in Tomsk in the period 2009-2015 in the period from 1 to 14 days after the onset of clinical signs of disease. Ultrasonography (ultrasound scanner Mindray M7 with multifrequency linear transducer 9-12 MHz) was performed on5the day of receipt of all the children (n = 23; 100%) in B-mode and using color and power Doppler imaging. Results. Ultrasound picture of intramedullary phase of acute osteomyelitis was detected on 1-3 day from the onset of the disease and is a combination of hypo echogenicity of the periosteum and increased vascularization in the form of multiple loci and increased reactive vascularization of the adjacent soft tissues. Ultrasound data have the highest sensitivity for acute hematogenous osteomyelitis in extramedullary phase with subperiosteal abscess in B-mode, and in the color and power Doppler in connection with a clear visualization of the fluid, demarcated exfoliated periosteum and high vascularization of the periosteum. Osteomyelitis due to melting periosteum phlegmon, liquid accumulations adjacent to bone is accompanied by poor vascularization that color and power Doppler mapping increases the false-negative results and thus - to reduce sensitivity (87.5%) compared with the picture subperiosteal abscess (100%). Conclusion. Diagnostic significance during all phases of the osteomyelitic process can increase the information content of indicators method in comparison with the B-mode and shorten the diagnostic phase of the study.

This article is a review of scientific researches in a radiologist's school of Tomsk. It represents main radiological achievements obtained in major scientific centers of Tomsk (Siberian State Medical University, Tomsk Cardiology Research Institute, and Tomsk Cancer Research Institute). Scientific and practical problems marked in article are radionuclide indication of inflammatory processes, diagnostics of osteoporosis, diabetes mellitus complications, rheumatological, cardio-vascular, onkological and other socially significant diseases.

Purpose: assessrnent of 99m Tc-MIBI SPECT and SPECT/ CT capabilities in diagnoses of sternurn osteornyelitis in patients after sternotorny. Material and methods. 28 patients with (suspected postsurgical sternurn osteornyelitis (n = 21, 75.0%) and patients with neoplastic, inflarnrnatory or other diseases of lungs or rnediastinurn without sternurn involved (n = 7, 25.0%) were undergone 99m Tc-MIBI SPECT and SPECT/CT Results. Scintigraphic sign of sternurn osteornyelitis was pathological intraosseous accurnulation 99m Tc-MIBI in sternurn. On basis of this sign sensitivity, specificity, positive and negative predictive values, accuracy of 99m Tc-MIBI SPECT were 88.9%, 100.0%, 100.0%, 83.3% and 92.9%, respectively; sensitivity, specificity, positive and negative predictive values, accuracy of SPECT/CT were 94.4, 100.0, 100.0, 90.9 and 96.4%, respectively. Cause of the false-negative results of 99m Tc-MIBI SPECT were connective tissue growth in chronic inflarnrnation’s area, and incorrect congruence also between focus of rnarker hyperfixation and soft tissue of anterior chest wall due wide sternurn diastasis in patient with fixation sternurn failure. Through the use of SPECT/CT second false-negative result was avoided. Conclusion. 99m Tc-MIBI SPECT and SPECT/CT are perspective and available tools for indication of sternurn osteornyelitis in patients after sternotorny. But sensitivity of SPECT/CT is higher than 99m Tc-MIBI SPECT due better spatial congruence between inflarnrnatory focuses and anatomical structures.

OBJECTIVE:To give the results of a software-based hybrid single photon emission computed tomography/magnetic resonance imaging (SPECT/MRI) in detecting osteomyelitis (OM) in patients with diabetic foot syndrome (DFS).MATERIAL AND METHODS:Seventy-six patients (35 men and 41 women) (mean age, 59.4 +/- 7.1 years) with type 1 and 2 diabetes mellitus and suspected OM were examined. The investigation enrolled patients with neuropathic (n = 25), ischemic (n = 13), and mixed (n = 38) DFS. All the patients underwent (99m)Tc-HMPAO/ (99m)Tc-technefit labeled leukocyte scintigraphy; magnetic resonance imaging was performed in 30 patients. The results were combined using RView 9.06 software (Colin Studholme).RESULTS:Labeled leukocyte SPECT to Diagnose OM yielded 255 true positive (TP), 38 true negative (TN), 12 false negative (FP), and 1 false negative (FN) results. The accuracy of the technique was 82.9%. The FP results were due to the low resolution of the technique and to the small sizes of the object under study. One FN result was detected in a patient with ischemic DFS because of reduced blood flow. MRI to identify OM in patients with DFS provided 20 TP, 16 TN, 4 FP, and 2 FN results. Its diagnostic accuracy was 85.7%. The relative low specificity of MRI was associated with the presence of FP results due to the complexity of differential diagnosis of bone marrow edema and inflammatory infiltration. Assessing 42 hybrid SPECT/MR-images revealed 21 TP, 17 TN, 3 FP, and I FN results. The diagnostic accuracy was equal to 95.9%.CONCLUSION:Thus, comparing MRI (90.9% sensitivity and 80.0% specificity), labeled leukocyte scintigraphy (96.2% sensitivity and 76.0% specificity), and hybrid SPECT/MRI (95.5% sensitivity and 85.0% specificity) showed the high diagnostic efficiency of the latter.

Aim of a research diagnostic aspects of acute haematogenic osteomyelitis (AGO) represent a significant problem due more frequent occurrence of multiple osteomyelitis.Objective. Reveal the clinical and ultrasound features of multiple osteomyelitis in purulent-septic form of AGO in children.Material and methods. 59 children aged from birth to 15 years with local (47 peoples) and purulent-septic (12 peoples) form of AGO were studied. Multiple osteomyelitis was diagnosed in four children with purulent-septic form of AGO (11 lesions). Multiple purulent-septic foci were located in the tibia more frequently (4 peoples; 36.4%).Results: Purulent-septic and local forms of AGO were presented qualitatively by intra- and extramedullar inflammatory phase, and extramedullar phase was prevailed (p = 0.181). Purulent-septic form of AGO comparatively local form was observed more frequent in younger children (p = 0.038) and at a later date of disease manifestation (p = 0.009). Multiple osteomyelitis with several septic intra- and intraosseous foci (33.3% and 66.7%, respectively) was observed in children with purulent-septic form of AGO only. The same child could have bone septic foci in one, and in the different phases of the disease.Conclusion. Multiple osteomyelitis occurs in 30-35% of children with purulent-septic form of AGO and it is more frequent in younger children and in later periods from the beginning of the disease clinical manifestation. Multiple osteomyelitis is characterized by polymorphism of ultrasound manifestations.

The present study was designed to estimate the informative value of three-phase scintiography and scintiography with labeled lymphocytes for the detection of the pyoinflammatory process in the patients presenting with the neuropathic, ischemic, and mixed forms of diabetic foot syndrome.

Establishing informative of 3-phase scintigraphy in the evaluation of blood flow and identify pyo-inflammatory process in patients with neuropathic, ischemic, and mixed forms of diabetic foot. This study includes the results of three-phase scintigraphy of 76 patients with diabetes mellitus and with suspicion of osteomyelitis in diabetic foot. Results were verified with morphological study in 39 patient.In patients with diabetic foot the depression of the main vessels blood flow and blood flow prevalence the changes intraos­seous blood flow. Comparison of scintigraphy and morphological studies confirmed the highly informative three-phase scintigraphy in the evaluation of main and peripheral blood flow. 3-phase scintigraphy revealed a lower specificity (66.7%) in the diagnosis of osteomyelitis in patients with diabetes mellitus at the sensitivity (94.7%) and accuracy (73.7%).Three-phase scintigraphy is high-performance method in revealing the arterial and peripheral blood flow disorder in patients with diabetes mellitus. The low specificity of the three-phase scintigraphy with high sensitivity indicate the limited possibilities of the method in the identification of pyo-inflammatory process in patients with diabetes mellitus. The observed preservation of blood flow makes it possible to expand the employment of methods of nuclear medicines and apply scintigraphy with labeled leukocytes for indicating purulent infection in patients with complicated course.

Introduction. 199Tl-chloride scintigraphy is used for visualization of malignant tumors and benign lesions including inflammation. Differentiating of them is performed by permanent and independent retention index, but not always effective. Purpose: improve the differentiating of malignant tumors from benign lesions using 199Tl-chloride scintigraphy. Materials and methods. Results of 97 patients’ 199Tl-chloride scintigraphy with 119 regions of hyperfixation in malignant tumors (n=68) and benign lesions (n=51) were studied. Lesions were localized in musculoskeletal system (n=89), in lungs and mediastinum (n=25) and other organs (n=5). Results. Sensitivity, specificity, positive, negative predictive value and accuracy 199Tl-chloride scintigraphy in differentiating of malignancies from benign lesions were 75.0%, 86.3%, 58.1%, 93.2% and 84.0%, respectively using optimal value of permanent and independent retention index RI=0.89 (RI=DR/ER). Significant correlations between retention index (RI) and 199Tl-chloride hyperfixation in early phase of scintigraphy (ER) in group with malignancies (r=-0.70, p=0.00001) and benign lesions (r=-0.76, p=0.00001) were revealed. As a consequence, method for differentiating malignant tumors from benign lesions with optimal dependent relative retention index RI(relative)=RI+0.055-ER and cut-off value RI(relative)=0.98 4 was proposed (sensitivity, specificity, positive, negative predictive value and accuracy 199Tl-chloride scintigraphy in differentiating of malignancies from benign lesions were 83.8%, 86.3%, 73.8%, 92.0% and 85.5%, respectively). Statistically significant (p=0.01) improvement of efficiency of 199Tl-chloride scintigraphy diagnostics in differentiating of malignant tumors from benign lesions using relative retention index (RI(relative)) compared with independent retention index (RI) were revealed by ROC-analysis. Conclusion. The optimal value of permanent and independent retention index for differentiating of malignant tumors from benign lesions are RI=0.89. Efficiency of 199Tl-chloride scintigraphy diagnostic in differentiating of these processes improves using of relative retention index.

Potential use of nonspecific tumorotropic indicators 99mTc-MIBI, 67Ga-citrate and 199Tl-chloride for the differential diagnosis of malignant tumors and benign processes in 151 patients with 191 lesions were studied. 199Tl-chloride scintigraphy, but not 99mTc-MIBI and 67Ga-citrate scintigraphy can be used in differentiating of these lesions. The optimal value of 199Tl-chloride retention index (RI) for their differentiating is RI (199Tl-chloride)=0,89. The use of relative retention index RI (relative) with the boundary value RI (relative)=0,98 improves the differentiating of malignant tumors from benign pathological processes

BACKGROUND:201Tl chloride scintigraphy allows malignant tumors of the locomotor apparatus to be diagnosed. The capacities of scintigraphy with 199Tl chloride, a 201Tl chloride analog, in addition to routine visualization of malignant tumors of the locomotor apparatus, have revealed its untypical variants.OBJECTIVE:to study the specific features of 199Tl chloride scintigraphic visualization of malignant tumor processes in the locomotor apparatus.SUBJECTS AND METHODS:199Tl chloride scintigraphy was performed in 85 patients having 107 foci of involvement presented with malignant (n = 57) and benign (n = 50) tumor processes.RESULTS:Malignant tumors were scintigraphically visualized in 98.1% of cases. Three types of their visualization were identified and studied; these included positive (82.4%) and rare: negative (7.8%), and mixed (9.8%) types associated with the specific features of the histological structure, metabolism, and blood supply of neoplasms and with the pharmacodynamic features of 199Tl chloride. The negative and mixed types, unlike metastatic neoplasms, were highly specific to primary or recurrent malignant tumors.CONCLUSION:Consideration of the negative and mixed types of scintigraphic visualization in addition to routine positive one permitted the sensitivity of diagnosis of malignant locomotor tumors to be increased from 90.4 to 98.1%, without reducing the specificity of 199Tl chloride scintigraphy.