INTRODUCTION: The literature review presents the possibilities of existing methods of radionuclide diagnosis of endogenous ACTH-dependent hypercorticism, which includes Itsenko-Cushing’s disease and ectopic ACTH syndrome. The similar clinical picture of these pathologies significantly complicates their differential diagnosis. Localization of corticotropinoma, especially in patients with persistent Cushing’s disease, and ectopic focus of ACTH hyperproduction also causes difficulties. OBJECTIVE: To analyze the available foreign and domestic literature to determine the possibilities of radionuclide imaging methods in the diagnosis of endogenous ACTH-dependent hypercorticism. MATERIALS AND METHODS: A search of scientifiс publications and clinical recommendations in the information and analytical systems PudMed and elibrary over the past twenty years, dedicated to the diagnosis of Itsenko-Cushing’s disease and ectopic ACTH syndrome using radioisotope diagnostic methods by keywords «Itsenko-Cushing’s disease», «ectopic ACTH syndrome», «radionuclide diagnostics», «scintigraphy», «SPECT», «PET». RESULTS: The presented review demonstrated the broad possibilities and prospects of using modern radioisotope imaging methods in the diagnosis of endogenous ACTH-dependent hypercorticism. Radionuclide imaging methods make it possible to conduct a study in the «whole body» mode, which makes it possible to detect not only the primary tumor focus, but also metastases in patients with ectopic ACTH syndrome in one study. In addition, the use of scintigraphy or positron emission tomography with labeled somatostatin analogues makes it possible to predict the effectiveness of treatment of formations producing adrenocorticotropic hormone with somatostatin analogues, which is important when planning antitumor therapy. CONCLUSION: The use of radioisotope diagnostic methods significantly increases the accuracy of topical diagnosis of a tumor focus, allows for an assessment of the prevalence of the tumor process and the selection of patients for antitumor therapy using somatostatin analogues.

INTRODUCTION: Topical diagnosis of pathologically altered parathyroid glands in patients with primary hyperparathyroidism is a challenge both for specialists of radial diagnostics and for planning the scope of surgical intervention. The choice of diagnostic modality for localization of parathyroid glands depends on the availability of the method for a particular medical center. PET/CT is a promising method to determine the localization of parathyroid adenomaOBJECTIVE: To analyze the experience of using PET/CT with 11C-methionine and PET/CT with 11C-choline for preoperative diagnosis of parathyroid pathology in patients with primary hyperparathyroidism.MATERIALS AND METHODS: 72 patients diagnosed with PHPT and underwent surgical treatment were included in the study. Before surgical intervention all patients underwent laboratory and instrumental investigations in the scope of: blood tests for PTH, TTH, ionized calcium, calcitonin, 25(OH)D, creatinine, phosphorus, ultrasound of the neck, computer tomography of the neck with intravenous bolus contrasting.RESULTS: PET/CT showed the highest rates of DA in the patient group before primary surgery — 90.9%, compared with ultrasound (89.6%) and CT with IV contrast (84.9%). In the group of solitary adenomas of ectopic MTCS, PET/CT also had a higher DA — 92.8% than the other modalities. In patients with relapsed or persistent disease, the informativity rates of CT with intravenous contrast and PET/CT were similar (Se — 100%, Sp — 94.1%, DT — 96.2%).DISCUSSION: The algorithm for preoperative evaluation of patients to identify the location of pathologic parathyroid glands now includes imaging with two modalities: Neck ultrasound and radionuclide imaging: planar scintigraphy (washout/subtraction), SPECT, SPECT-CT. If the results are questionable, a CT scan of the neck with contrast or PET/CT is performed as a second step. None of the modalities has 100% diagnostic accuracy. Our study demonstrated the superiority of PET/CT over ultrasound and CT w/in contrast in a group of patients scheduled for primary surgical treatment. In a small group of patients, high informative rates of PET/CT and CT with contrast were demonstrated before reoperation, confirming the great potential of these techniques in these patients.CONCLUSION: PET/CT with 11C-methionine and PET/CT with 11C-choline have high diagnostic accuracy in patients with primary hyperparathyroidism before reoperation. PET/CT and CT with contrast showed similarly high diagnostic accuracy for the diagnosis of parathyroid adenoma with persistence or recurrence of the disease in patients with primary hyperparathyroidism.

INTRODUCTION: Primary hyperparathyroidism (PHPT) is a common endocrine disorder. Minimal invasive parathyroidectomy (PTX) is favorable surgical approach in PHPT treatment. Its success is highly dependent on accurate preoperative localization of all causative parathyroid adenomas. Despite the fact that wide range of visualization methods are applied in PHPT diagnostics, PHPT persistence occurs. Therefore, the search for additional visualizing tools of parathyroid adenomas remains relevant. Recently, positron emission tomography/computed tomography (PET/CT) has been used in order to improve PHPT diagnostics. OBJECTIVE: To evaluate the diagnostic effectiveness of PET/CT with 11 C-methionine and 11 C-choline in patients with PHPT based on the intensity of both tracers uptake in parathyroid adenomas. MATERIALS AND METHODS: The data of 26 patients diagnosed with PHPT was analyzed. PET/CT with 11 C-choline was performed in 14 patients, with 11 C-methionine — in 10 patients, with two radiopharmaceuticals — in two patients. All patients underwent PTX. Histological examination’s results were compared with the results of PET/CT. Using the software, the standardized uptake value of radiopharmaceuticals in histologically verified parathyroid adenomas/hyperplasias and in the trapezius muscle was obtained, then tumor-to-background ratios (TBR) of 11 C-methionine and 11 C-choline were calculated.Statistics: Software STATISTICA 10 was used in statistical analysis.RESULTS: 11 C-choline TBR median was of 2.3 (1.6; 3.2), median of 11 C-methionine TBR showed slightly higher values — 2.5 (1.9; 3,6). However, no significant difference was found between the two radiopharmaceuticals’ uptake in parathyroid adenomas.DISCUSSION: The scientific impact of current study is determined by the diagnostic effectiveness comparison between PET/CT with 11 C-methionine and 11 C-choline, which is based on the accumulation intensity of both radiopharmaceuticals in parathyroid adenomas.CONCLUSION: The intensity of accumulation of 11 C-methionine and 11 C-choline by hyperfunctioning parathyroid tissue does not differ significantly. Thus both tracers might be successfully applied for topic diagnosis of parathyroid adenomas in patients with PHPT.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

INTRODUCTION: Medullary thyroid carcinoma (MTС) is a rare neuroendocrine malignant neoplasm of the thyroid gland. In most cases, sporadic MTС is diagnosed at late stages due to the absence of specific symptoms. The main method of treatment of MTС is surgical — thyroidectomy and in most cases cervical lymphodissection. Current international guidelines suggest the use of basal calcitonin levels and cancer embryonic antigen (CEA) as markers of biochemical recurrence. In biochemical recurrence of the disease, it is advisable to search for tumor foci regardless of the level of cancer markers. Positron emission tomography combined with computed tomography (PET/CT) has the highest sensitivity and specificity for searching for local recurrence and distant metastases. Anatomical imaging methods (computed tomography (CT), magnetic resonance imaging (MRI)) have suboptimal sensitivity and specificity in detection of a recurrent tumor.OBJECTIVE: To explore the diagnostic capabilities of PET/CT with 18F-DOPA in patients with biochemical recurrence of medullary thyroid carcinoma, depending on the concentration of calcitonin in blood plasma.MATERIALS AND METHODS: To evaluate the diagnostic capabilities of PET/CT with 18F-DOPA in patients with biochemical recurrence of medullary thyroid carcinoma, 81 PET/CT studies were analyzed in patients after thyroidectomy. In most cases (76/81), at the time of the study, patients had elevated basal calcitonin levels (>10 pg/ml, including in 52/81 cases >150 pg/ml), which corresponded to a biochemical recurrence of the disease. In 6 cases, the calcitonin level was <10 pg/ml. PET/CT results were processed by visual image analysis, measurement of a semi-quantitative indicator of the maximal standardized level of radiopharmaceutical accumulation normalized to lean body mass (SUVlbm max) and the total volume of PET-positive tumor tissue (metabolic tumor volume).RESULTS: In 41 studies, foci of pathological accumulation of 18F-DOPA were identified, corresponding to recurrent tumor foci. DOPA-negative results in patients with elevated calcitonin levels were regarded as false negative. The highest sensitivity of the method was achieved at calcitonin levels >150 pg/ml. A noticeable positive correlation was found between the concentration of basal serum calcitonin, the number of pathological foci of 18F-DOPA hyperaccumulation and the total metabolic volume of tumor tissue. In most cases of biochemical recurrence, the PET method was superior to the CT method in detecting recurrent tumor foci.CONCLUSION: PET/CT with 18F-DOPA is the most informative method for molecular and structural imaging in patients with biochemical recurrence of medullary thyroid carcinoma. The results of the study directly correlate with the level of basal calcitonin in the blood.

INTRODUCTION: Medullary thyroid carcinoma (MTС) is a rare neuroendocrine malignant neoplasm of the thyroid gland. In most cases, sporadic MTС is diagnosed at late stages due to the absence of specific symptoms. The main method of treatment of MTС is surgical — thyroidectomy and in most cases cervical lymphodissection. Current international guidelines suggest the use of basal calcitonin levels and cancer embryonic antigen (CEA) as markers of biochemical recurrence. In biochemical recurrence of the disease, it is advisable to search for tumor foci regardless of the level of cancer markers. Positron emission tomography combined with computed tomography (PET/CT) has the highest sensitivity and specificity for searching for local recurrence and distant metastases. Anatomical imaging methods (computed tomography (CT), magnetic resonance imaging (MRI)) have suboptimal sensitivity and specificity in detection of a recurrent tumor. OBJECTIVE: To explore the diagnostic capabilities of PET/CT with 18 F-DOPA in patients with biochemical recurrence of medullary thyroid carcinoma, depending on the concentration of calcitonin in blood plasma. MATERIALS AND METHODS: To evaluate the diagnostic capabilities of PET/CT with 18 F-DOPA in patients with biochemical recurrence of medullary thyroid carcinoma, 81 PET/CT studies were analyzed in patients after thyroidectomy. In most cases (76/81), at the time of the study, patients had elevated basal calcitonin levels (>10 pg/ml, including in 52/81 cases >150 pg/ml), which corresponded to a biochemical recurrence of the disease. In 6 cases, the calcitonin level was <10 pg/ml. PET/CT results were processed by visual image analysis, measurement of a semi-quantitative indicator of the maximal standardized level of radiopharmaceutical accumulation normalized to lean body mass (SUVlbm max) and the total volume of PET-positive tumor tissue (metabolic tumor volume). RESULTS: In 41 studies, foci of pathological accumulation of 18 F-DOPA were identified, corresponding to recurrent tumor foci. DOPA-negative results in patients with elevated calcitonin levels were regarded as false negative. The highest sensitivity of the method was achieved at calcitonin levels >150 pg/ml. A noticeable positive correlation was found between the concentration of basal serum calcitonin, the number of pathological foci of 18 F-DOPA hyperaccumulation and the total metabolic volume of tumor tissue. In most cases of biochemical recurrence, the PET method was superior to the CT method in detecting recurrent tumor foci. CONCLUSION: PET/CT with 18 F-DOPA is the most informative method for molecular and structural imaging in patients with biochemical recurrence of medullary thyroid carcinoma. The results of the study directly correlate with the level of basal calcitonin in the blood.

Purpose: To develop the method of experts’ quality evaluation of the PET images as an additional quality control method for accurate, comparable, and reproducible PET diagnostics results, and to conduct image quality evaluation in different PET departments used this method. Material and methods: 60 PET images (without CT) of the patients who underwent whole body PET/CT with 18F-FDG were collected from 12 PET/CT scanners in 9 PET departments. Experts’ quality evaluation was conducted with questioning of the experts. Each expert evaluated the image quality by five-point scale and filled out the special form which include three image quality criteria: image clarity, artefacts, and general image quality. There were 28 experts from 8 different PET departments who have work experience in radiology from 1 to 32 years. The results of experts’ quality evaluation of the PET images were examined for correlations with parameters of acquisition and reconstruction protocols, examination methods. The results were also examined for dependance of subjective factors such as work experience and work conditions of experts. The minimum required number of experts were defined. The results were analyzed used statistical methods. Results: The PET images obtained by 8 PET/CT scanners had mean quality value more than 4 points (good quality). PET/CT scanners, which had the lowest quality value, have the obsolete or unusual settings and reconstruction parameters. The correlations between experts’ quality evaluation of the PET images and acquisition parameters (acquisition time per bed, multiplication of injected activity and acquisition time per bed), and examination methods (injected activity and uptake time) were established. The results of experts’ quality evaluation of the PET images were dependent on work experience and work conditions of experts. Conclusion: The method of experts’ quality evaluation of the PET images of the patients based on the questioning of the experts working in PET was developed and demonstrated in the current study. The results showed this method has the potential to compare the PET images obtained by different acquisition and reconstruction protocols, and it can be applied during the optimization of examination method and for the determination of obsolete and unusual settings of PET/CT. Experts’ evaluation of the PET images should include the opinion of at least six experts with different work experience in PET from several PET departments.

The article is devoted to the analysis of the current status of nuclear cardiology in the Russian Federation. The data on the number of facilities performing radionuclide investigations for the diagnosis and monitoring of the treatment of cardiovascular diseases, their staffing and equipment are given. The statistics of the conducted nuclear cardiology tests for 2018-2020 are given, as well as their methods, features and diagnostic significance are described.

INTRODUCTION: During the development of CTEPH maladaptive mechanisms in the right ventricle are accompanied by disturbances in myocardial energy metabolism and perfusion. These changes can be assessed visually and quantitatively using the molecular imaging method — PET with [18F]-FDG and [13N]-NH3.OBJECTIVE: Using cardiac PET/CT investigate the relationship between perfusion and metabolism of the right ventricular myocardium and the results of other instrumental examination methods in patients with CTEPH of different severity, as well as to calculate the threshold PET values to determine the group of patients with an unfavorable clinical course of the disease.MATERIALS AND METHODS: The study included 36 patients with a verified diagnosis of CTEPH, who were examined using a standard diagnostic protocol. Patients underwent cardiac PET/CT examinations with two radiopharmaceuticals: with [18F]-FDG to study the metabolism of the ventricular myocardium and with [13N]-NH3 to assess cardiac perfusion. For each radiopharmaceutical semi-quantitative accumulation indices (SUV) and the ratio of the levels of radiopharmaceutical uptake in the right and left ventricles (SUV RV/SUV LV) were obtained. Statistics: Shapiro-Wilk test, Student’s t-test, and Mann-Whitney U-test, Pearson correlation analysis, linear regression analysis, ROC analysis.RESULTS: The level of [18F]-FDG accumulation in the right ventricular myocardium is higher in patients with a high functional class of PH than in groups I, II (p<0.01). All indicators of SUV RV/SUV LV for [18F]-FDG demonstrate a direct linear relation-ship with the level of mean PAP (r=0.691, p<0.0001), PVR (r=0.715, p<0.0001), right ventricular size (r=0.658, p<0.0001), PASP (r=0.581, p<0.001) and inverse linear relationship with the functional parameters of the right ventricle CI (r=–0.555, p=0.001), CO (r=–0.488, p=0.005), TAPSE (r=–0.552, p<0.001), TAVS (r=–0.537, p<0.001), and SvO2 (r=–0.666, p<0.0001). A correlation was found between the accumulation of [13N]-NH3 and the main hemodynamic parameters used to assess the severity of the disease (СI, SvO2). The threshold values of [18F]-FDG and [13N]-NH3 accumulation indices have been obtained, which with high sensitivity (69.2–83.3%), specificity (68.4–94.7%) and diagnostic accuracy (0.73–0.83) make it possible to identify patients with a low cardiac index and an unfavorable prognosis.DISCUSSION: The obtained results confirm the presence of glucose hypermetabolism in right ventricular cardiomyocytes in the development of pulmonary hypertension and the association of these metabolic changes with the severity of PH. A significant correlation was demonstrated between the accumulation of both radiopharmaceuticals in the heart and the results of other examination methods characterizing the severity of disease and the prognosis of patients with CTEPH. Using a non-invasive PET/CT procedure, threshold values of PET parameters were obtained, which in the future can be used to identify patients with an unfavorable clinical prognosis.CONCLUSION: Cardiac PET/CT with [18F]-FDG and [13N]-NH3 is a promising non-invasive imaging technique that can be used to study metabolic and perfusion changes in the right ventricular myocardium in CTEPH, as well as to identify patients with a high risk of adverse events.

Background. Primary hyperparathyroidism (PHPT) is an endocrine disorder characterized by autonomous production of parathyroid hormone (PTH). Currently, parathyroidectomy (PTX) is considered the main method of PHPT treatment. Its outcome is largely depended on precise preoperative localization of the parathyroid adenoma. Traditional visualization techniques include ultrasound (US), scintigraphy and computed tomography (CT), each of which has its own limitations. In order to improve visualization results positron emission tomography/ computed tomography (PET/CT) with 11C-methionine is used. Objective. To compare the sensitivity and specificity of 11 C-methionine PET/CT with those of conventional imaging techniques for parathyroid adenomas localization.Design and methods. The data of 91 patients diagnosed with PHPT was analyzed. Ultrasound, scintigraphy with 99mTc-sestamib i/99mTc-pertechnetate and CT were performed in 91, 56, and 86 patients, respectively. Since 2020, 11C-methionine PET/CT has been used as the final diagnostic method in 45 patients. Histologу results were used as the benchmark in order to evaluate the diagnostic accuracy of the studied methods.Results. Histological examination confirmed parathyroid adenoma/ hyperplasia in all patients. Multiple adenomas/hyperplasia were found in 5 cases. Ectopic adenomas were detected in 19 patients. The sensitivity of PET/CT with 11C-methionine was 98 %, CT, scintigraphy and ultrasound — 75 %, 79 %, 67 %, respectively. Specificity — 93 %, 73 %, 75 %, 70 %, respectively.Conclusion. 11C-methionine PET/CT showed higher sensitivity and specificity than traditional methods.

INTRODUCTION: Medullary carcinoma is a rare malignant neuroendocrine tumor of the thyroid gland. Medullary thyroid carcinoma (MTC) has no specific clinical symptoms. Due to the absence of specific symptoms, the disease is usually diagnosed at the stage of metastatic lesions of regional lymph nodes, and sometimes, internal organs. The five- and ten-year survival after detection of distant metastases is 25% and 10%, respectively. OBJECTIVE: To analyze the available foreign and domestic literature to determine the role of PET/CT with various radiopharmaceuticals in the complex radiological diagnosis of MTC. MATERIALS AND METHODS: A search was made for scientific publications and clinical recommendations in the information and analytical systems PudMed, elibrary over the past ten years, dedicated to the diagnosis of MTC, including PET/CT with 18 F-DOPA, 18 F-FDG, 68 Ga-DOTA peptides, etc. by keywords «medullary thyroid cancer», «medullary thyroid carcinoma», «PET/CT», « 18 F-L-dihydroxyphenylalanine», « 18 F-DOPA», « 18 F-DOPA», « 68 Ga-DOTA peptides», « 68 Ga-DOTA-peptides», «theranostics», «theranostics». RESULTS: The analysis of publications demonstrated the prospects for the use of PET/CT with various radiopharmaceuticals for the diagnosis of recurrent tumors and the prevalence of the process in biochemical recurrence of MTC, as well as the possibility of peptide-receptor radionuclide therapy for the treatment of advanced forms of the disease. The choice of radiopharmaceuticals is based on the results of laboratory diagnostics and conventional methods of anatomical imaging. PET/CT with 68 Ga-DOTA peptides is performed to predict the effectiveness of peptide-receptor radionuclide therapy. CONCLUSION: PET/CT with various radiopharmaceuticals makes a significant contribution to the diagnosis of recurrent tumors, assessment of the prevalence of the tumor process and selection of patients for peptide-receptor radionuclide therapy.

BACKGROUND: Congenital hyperinsulinism (CHI) is a rare life-threatening disease characterised by persistent hypoglycaemia as a result of inappropriate insulin secretion, which can lead to irreversible neurological defects in infants.AIM: To evaluate neurophysiological characteristics of central nervous system in children with congenital hyperinsulinism treated according to the international protocol in Russian Federation.MATERIALS AND METHODS: Our retrospective, prospective cohort study included 73 patients who received treatment for CHI according to the current international protocol at different departments of the Almazov National Medical Research Centre from 2017 to 2022. All patients underwent a comprehensive examination, including electroencephalography (EEG).RESULTS: Among 73 patients with CHI, 35% (23) had focal form of the disease, 65% had non-focal form (49% (39) — diffuse form, 16% (11) — atypical form). All patients with focal form of CHI had a recovery as an outcome.Analysing the EEG data we found that paroxysmal activity was recorded in 23 patients (32%), 50 patients did not have paroxysmal activity (68%). Diffuse changes were observed in 47 patients (64%), whereas 26 patients (36%) were absent of it. By constructing Kaplan-Meier curves we found that the alpha rhythm is formed significantly (p=0.026) earlier in patients with a focal form of CHI.CONCLUSION: CHI patients treated according to the international guidelines in Russian Federation show rather positive neurological outcome. We established that alpha rhythm earliest formation is associated with focal form of CHI.

Background. Topical diagnosis of primary hyperparathyroidism (PHPT) remains an urgent problem due to the high incidence of persistence and recurrence after surgical treatment. At the preoperative stage, a search for the parathyroid hormone hyperproduction source is performed using instrumental methods: ultrasound, scintigraphy of the parathyroid glands (PTG) and multislice computed tomography (MSCT). The cause of PHPT persistence and recurrence after parathyroidectomy may be the multiple nature of PTG lesions or their ectopic location. Additional methods of visualization of PTG adenomas can be used to improve diagnosis (PET/CT). Objective. To compare the sensitivity and specificity of PET/CT with 11C-choline with the traditional visualization techniques. Design and methods. 16 PHPT patients were analyzed. All patients underwent US, subtraction scintigraphy with 99mTc-technetril/99mTc-pertechnitate and CT were performed in 12 and 16 patients, respectively. 11C-choline PET/CT was used for all patients. Imaging results’ coincidence of two methods were labeled as the true one. Results. The sensitivity of PET/CT with 11C-choline was 94 %, CT, subtraction scintigraphy with 99mTc-technetril/99mTc-pertechnitate and US — 75 %, 69 % and 63 %, respectively. The specificity of PET/CT with 11C-choline, CT, scintigraphy with 99mTc-technetril/99mTc-pertechnitate, and US was 100 %, 84 %, 76 %, and 68 %, respectively. Conclusion. PET/CT with 11C-choline demonstrated best sensitivity and specificity among all methods and can become an alternative in PHPT diagnostics in case of negative or inconvclusive results of previous visualization.

The article offers the latest view on possibilities of diagnostic algorithm to identify cervical cancer (CC), one of the most incidental tumor of the woman’s reproductive system. The algorithm is described as a consensus of leading expert in imaging diagnostics, as well as oncogynecologysts, investigating diagnostic challenges and cervical cancer therapies. The article sets forth the principal trends in using imaging methods, their role and possibilities for staging CC, planning and assessing the efficacy of applied therapy, on-going surveillance over patients, who have undergone specialized anti-cancer treatment.

ЦЕЛЬ: оценить диагностические возможности позитронно-эмиссионной томографии, совмещенной с компьютерной томографией, (ПЭТ/КТ) с использованием 11С-холина у больных первичным гиперпаратиреозом (ПГПТ) в сравнении с традиционными методами визуализации. МАТЕРИАЛЫ И МЕТОДЫ: проанализированы данные 25 больных ПГПТ. Для топической диагностики ПГПТ всем пациентам были выполнены ультразвуковое исследование (УЗИ) и мультиспиральная компьютерная томография (МСКТ). Субтракционная сцинтиграфия с 99mTc-технетрилом/99mTc-пертехнитатом была выполнена у 18 больных. ПЭТ/КТ с 11С-холином использовалась в качестве завершающего визуализирующего метода у всех пациентов. При оценке чувствительности и специфичности методов за истинно положительный результат принимались случаи совпадения результатов как минимум двух исследований. У пациентов с выполненной паратиреоидэктомией (ПТЭ) результаты гистологического исследования были сопоставлены с данными визуализирующих методов. РЕЗУЛЬТАТЫ: медиана возраста больных составила 61 (55; 69) год. Среди включенных пациентов большинство были женщины (84%). Клиническая картина ПГПТ была представлена поражениями костной системы (остеопороз, патологические переломы, фиброзно-кистозный остит) у 52%, мочевыделительной системы (нефролитиаз, нефрокальциноз) у 56% и желудочно-кишечного тракта (эрозивный гастрит, эрозивный рефлюкс-эзофагит, язвенная болезнь, желчнокаменная болезнь) у 44%. ПТЭ выполнена у 8 больных, остальным 17 больным запланировано оперативное лечение на ближайшее время. У 25 больных при помощи УЗИ было выявлено 18 аденом ОЩЖ, при помощи субтракционной сцинтиграфии – 15, при помощи МСКТ – 21, при помощи ПЭТ/КТ с 11С-холином – 27. В 14 случаях было выявлено совпадение результатов трех методов визуализации. У трех больных выявлена парная аденома ОЩЖ. Чувствительность ПЭТ/КТ с 11 С-холином составила 96%, МСКТ, субтракционной сцинтиграфии с 99mTc-технетриллом/99mTc-пертехнитатом и УЗИ – 75%, 71% и 64%, соответственно. Специфичность ПЭТ/КТ с 11C-холином, МСКТ, сцинтиграфии с 99mTc- технетриллом /99mTc-пертехнитатом и УЗИ составила 100%, 83%, 74% и 68%, соответственно. ВЫВОДЫ: таким образом, значения чувствительности и специфичности ПЭТ/КТ с 11С-холином превысили аналогичные показатели традиционных методов топической диагностики ПГПТ, что позволяет рекомендовать использование данного метода при визуализации аденом околощитовидных желез.

Aim . To analyze clinical and paraclinical data in patients with documented cardiac sarcoidosis, outlining the key points of diagnosis and selection of the optimal treatment. Material and methods . For the period from 2016 to 2021, 63 patients (50,4±14,1 years) were included in the cohort study on negotiability. Based on a standard examination, 15 patients (41±13 years old) were selected, who continued the examination to confirm the diagnosis of cardiac sarcoidosis. Contrast-enhanced cardiac magnetic resonance imaging (MRI) was performed in 10 patients, while endomyocardial biopsy in 7 patients. All patients underwent 18F-fluorodeoxyglucose positron emission tomography (PET). Results . The most common (53%) electrocardiographic abnormality was right bundle branch block. Ventricular arrhythmias and high-grade atrioventricular block were recorded mainly in patients with documented activity. Regional contractility disorders were predominantly detected in patients with cardiac fibrosis. Delayed contrast enhancement according to cardiac MRI was recorded mainly intramurally in the interventricular septum and subepicardial area of left ventricular (LV) lateral wall. When analyzing the PET results, we found the predominant radiopharmaceutical accumulation in the interventricular septum (56%), lateral (44%) and anterior (33%) LV walls. There was no significant improvement in global LV contractility against the background of immunosuppressive therapy, especially in patients with reduced ejection fraction: initially 49,2±10,1% vs 46,9±14,9% during therapy (p=0,658). Conclusion . A certain apprehensive attitude of the doctor and adherence to the algorithm for early diagnosis of cardiac sarcoidosis allows minimizing the risks of fatal cardiovascular events. On the contrary, in the case of late diagnosis, even the use of aggressive immunosuppressive therapy does not lead to an improvement in global myocardial contractility, and fibrosis zones can cause life-threatening bradyarrhythmias and ventricular arrhythmias.

ИССЛЕДОВАНИЕ ПЕРФУЗИИ И МЕТАБОЛИЗМА ПРАВОГО ЖЕЛУДОЧКА МЕТОДОМ ПОЗИТРОННОЙ ЭМИССИОННОЙ ТОМОГРАФИИ ПРИ ХРОНИЧЕСКОЙ ТРОМБОЭМБОЛИЧЕСКОЙ ЛЕГОЧНОЙ ГИПЕРТЕНЗИИМолокова Е