Аim: to describe modern approaches for screening and early diagnosis of hepatocellular carcinoma (HCC).Key points. Screening for HCC in high-risk groups (cirrhosis of any etiology, patients with chronic viral hepatitis B and patients with F3 liver fibrosis) should be organized as regular (every 6 months) liver ultrasound in combination with determination of the serum alpha-fetoprotein (AFP) level. At an AFP level of ≥ 20 ng/ml, even in the absence of changes according to ultrasound data, it is advisable to perform MRI with a hepatospecific contrast agent (gadoxetic acid) which makes it possible to detect very small focal liver lesions. If focal liver lesions of 1–2 cm are detected on ultrasound, additional imaging of the liver using MRI with a hepatospecific contrast agent gadoxetic acid helps to identify HCC at an earlier stage or high degree dysplastic nodes. When planning surgical treatment and liver transplantation, it is preferable to use MRI with a hepatospecific contrast agent, since the presence of the hepatobiliary phase may allow the detection of additional smaller focal liver lesions and assess the nature of the focal liver lesion. When a patient is included in the waiting list for liver transplantation, the optimal frequency of liver MRI is 1 time in 3 months.Conclusion. MRI with hepatospecific contrast agent gadoxetic acid is effective in screening, early diagnosis and treatment planning for HCC.

Background : Comprehensive treatment of locally advanced cervical cancer (CC) requires the use of informative diagnostic methods to assess tumor size, extent of the tumor and other factors that determine prognosis of the disease. Purpose : Determination of diagnostic opportunities of multiparametric magnetic resonance imaging (mpMRI) in the visualization of residual tumor and assessment of the main prognostic factors in patients with stage IB2-IIB cervical cancer (FIGO) after neoadjuvant chemotherapy (NACT). Material and methods : Patients with stage IB2-IIB cervical cancer (n = 120) were prospectively enrolled in the study; they received NACT followed by surgical treatment or chemoradiotherapy (CRT). Patients underwent mpMRI before NACT and not later than 14 days after the 3rd course of NACT. To determine the diagnostic opportunities of mpMRI, MRI-data were compared with pathomorphological results. In the comparative analysis were included the following factors: residual tumor size (maximum diameter), depth of stromal invasion (mm), presence of parametrial invasion. Potential MRI-signs suggestive for lymphovascular invasion (LVI) of the parametrium were also assessed. Results : Obtained MRI-data about the size of the residual tumor and the depth of stromal invasion showed statistically significant correlation with the results of pathomorphological study (p < 0.0001) — R 2 = 0.77 and 0.69, respectively. Difference value in measuring the maximum diameter of the residual tumor was on the average 2.52±6.76 mm. MRI sensitivity in the assessment of parametrial invasion was 71.4 %, specificity — 95.1 %, accuracy — 88.9 %, PVPR — 71.4 %, PVNR — 95.1 %. Potential predictors significantly associated with parametrial LVI were identified: parametrial edema (p = 0.001) and dilatation of parametrial vessels (> 3 mm) (p = 0.015). According to these factors was developed a mathematical model, which predicts the risk of having parametrial LVI before surgery in patients after NACT. Conclusion : Multiparametric MRI is an effective technique in assessing the size of the residual tumor, depth of stromal invasion and parametrial invasion in patients with stage IB2-IIB cervical cancer after NACT. MpMRI makes it possible to assess potential signs, associated with parametrial LVI in patients with locally advanced cervical cancer.

Purpose : To develop algorithms for echographic differential diagnosis of soft tissue tumors containing fat tissue, the data of the complex examination were analyzed, including using various ultrasound techniques, including different types of dopplerography and compression elastography. Material and methods : Echographic studies of verified histologically 221 (63 %) lipomas, 87 (24.8 %) liposarcoma, 43 (12.2 %) hemangioma and lymphangosis of different superficial localizations were performed on Hitachi HI Vision 900, Logiq-400, Aloka-650, Aloka-2000 with 5–13 MHz sensors. Results : It has been established that ultrasonic elastography in a number of clinical situations can be a significant addition in the differentiation of lipomas and highly differentiated liposarcoma, as well as in determining the boundaries of diffuse tumors from adipose tissue. Diagnostic algorithms for differentiating tumors have been proposed. Conclusions : Differential diagnosis of fat-containing soft tissue formations is very complex and requires a multiparametric approach in ultrasound diagnostics.

An increase in the level of prostate-specific antigen requires additional examination of the patient in order not to subject him to unnecessary treatment in case of clinically insignificant prostate cancer and, conversely, to carry out the necessary volume of measures in case of clinically significant prostate cancer. The paper presents the modern solutions for effective usage of diagnostic methods in visualization of clinically significant prostate cancer. To assess the advantages and disadvantages of various methods for diagnosing prostate cancer a search of publications for 2014–2020 period was conducted based on the Scopus, Web of Science, PubMed databases. The request included keywords: prostate cancer, multiparametric MRI, multiparametric ultrasound, PSMA PET/CT. We selected 27 articles. The review includes guidelines from the European Association of Urology, the American Urological Society, the American College of Radiology, and one practice recommendation.

Modern ultrasound examination (US), unlike other modalities, allows to assess the stiffness of the lesions, with the help of a new technology named sonoelastography (SEG). According to many scientific studies, with the addition of SEG to the B-mode, the diagnostic efficiency of ultrasound of breast lesions significantly increases. According to Thomas et al. B-mode has a sensitivity of 91,8% and a specificity of 78%. When a compression SEG is added to a diagnostic study, the specificity increases to 91,5%. The purpose of this study was to determine the diagnostic effectiveness of SEG and compare it with the effectiveness of B-mode and color Doppler mapping (CDC) in the primary diagnosis of breast tumors, as well as to identify diagnostically and statistically significant SEG signs of breast cancer ( ВС ). Materials and methods . The study was performed from 2017 to 2019 on the basis of the «NMRC Oncology. named after N. N. Petrov» Ministry of Health of Russia. 277 women with complaints of lump or pain in the breast were included in the study, for all of them there was performed the multiparametric ultrasound examination with application of CDM and SEG. According to our own results, SEG is more effective at detection of malignant and benign lesions, than ultrasoumd examination in B and CDM modes. Results: 0, 1, 2, 3 elastotypes are the highly significant diagnostic signs of benign process, and the elastotype 5 is a reliable diagnostic marker of malignant process. The effectiveness of CDM and SEG in the differential diagnosis of breast lesions showed: sensitivity — 77,6% vs. 85,5%; specificity — 51,7% vs. 84,6%; accuracy — 58,8% vs. 84,8%. Conclusions: according to our own research results, SEG is more effective in detecting malignant and benign tumors than ultrasound in B and CDM modes.

Background. Experimental data suggest that tumor growth depends on angiogenesis. Once the tumor reaches a size of up to a 1 mм in diameter, a further increase in the population of tumor cells requires the growth of new blood vessels. In contrast to benign lesions, a rapid growth of cancer cells results in the formation of pathological vessels of different diameter and chaotic distribution. therefore, determination of the type of vascularization of lesions is an important criterion in the diagnosis of breast cancer (Bc). color Doppler mapping (cDM) is an ultrasound technology that evaluates blood floor through a blood vessel; however, according to data from a variety of literature sources, cDM is not sensitive to slow (week) blood flow as it allows the visualization of only large vessels with a diameter of at least 100 µm. The purpose of the study was to evaluate the diagnostic value of cDM in determining the type of vascularization of malignant and benign breast tumors, as well as to detect their statistically significant Doppler characteristics by comparing with histological findings. material and methods. From 2017 to 2019, a total of 277 women with complaints of breast lump or pain underwent ultrasound examination using cDM. Results. statistically and diagnostically significant us characteristics of benign lesions included the presence of avascular or hypovascular types of blood flow. the most significant characteristic of malignant lesions was the presence of hypervascular mixed blood flow. the diagnostic value of ultrasound B-mode in combination with cDM in differential diagnosis of breast tumors was as follows: 77.6 % sensitivity, 51.7 % specificity and 58.8 %. accuracy. Conclusion. statistically and diagnostically significant signs observed by cDM allow one to use this ultrasound technology in the early diagnosis of breast cancer. However, low diagnostic efficiency of cDM dictate the need to search for new ultrasonic signs.

ВОЗМОЖНОСТИ МУЛЬТИПАРАМЕТРИЧЕСКОЙ МАГНИТНО РЕЗОНАНСНОЙ ТОМОГРАФИИ В ОЦЕНКЕ ЭФФЕКТИВНОСТИ НЕОАДЪЮВАНТНОГО ЛЕЧЕНИЯ РАКА ПРЯМОЙ КИШКИ1 П

Objective : to determine CT features of pneumonia depending on the etiological agent in patients with LHP after chemotherapy. Materials and methods. 52 patients with LPD, who developed pneumonia, underwent chest CT. In all patients, the causative agent of lower respiratory tract infection was verified by microbiological diagnostic methods. Results . In the first 48 hours from the onset of the viral pneumonia, thickening of the interlobular septa and of peribronchial interstitium, part-solid and solid nodules, and hydropericardium (p < 0.01) were detected. After 48 hours, ground glass opacity, Intralobular septal thickening, “crazy-paving” pattern and hydropericardium were more often detected (p < 0.001). In the first 48 hours from the onset of invasive pulmonary mycosis, a halo sign (p < 0.01) and the prevalence of changes in the upper parts of the lungs (p < 0.05) were detected. After 48 hours, halo sign (p <0.01), a random distribution of nodules and solid nodules (p < 0.05) were detected. Conclusion . Viral or fungal etiology of lower respiratory tract infection can be excluded according to CT data with sufficient certainty, and that is undoubtedly a fundamental reason for changing further treatment tactics in such patients.

Objective: to determine the predicting factors for the effectiveness of neoadjuvant treatment in colorectal cancer based on the analysis of overall and relapse-free survival, as well as the possibility of multiparametric magnetic resonance imaging (MRI) in stratifying patients into groups with favorable and unfavorable clinical course.Materials and methods. 112 patients who received preoperative chemoradiotherapy (n = 85) and chemoradiotherapy supplemented with neoadjuvant polychemotherapy (n = 27) followed by surgery were enrolled in retrospective study. To determine the most significant predicting factors and criteria for evaluating the effectiveness of treatment that affect overall and relapse-free survival, Kaplan–Meier estimator and Cox regression were used.Results. The relapse-free survival was significantly affected by the presence or absence of extramural venous invasion according to MRI (mrEMVI) (p = 0.0001), circumferential resection margin status according to pathomorphological data (pCRM) (p = 0.031), change in volume of tumor (mrVolumetric analysis) (p = 0.015), tumor regression grade according to MRI (mrTRG) (p = 0.017) and pathomorphological data (pTRG) (p = 0.038). Independent predictors of overall survival were: extramural venous invasion according to MRI (mrEMVI) (p = 0.0001), posttreatment N staging (p = 0.047) and tumor regression grade according to MRI (mrTRG) (p = 0.059). Based on the most significant MR criteria, a mathematical model was developed to predict the risk of relapse after neoadjuvant treatment.Conclusions. MRI allows stratifying patients into groups with a favorable and unfavorable prognosis at the preoperative stage and optimizing the management of patients after surgery taking into account pathomorphological data.

Poster: ECR 2020 / C-00370 / Comparative diagnostic performance of contrast enhanced dual-energy spectral mammography, digital mammography and (99m) Tc MIBI scintimammography in detecting multicentric breast cancer by: Chernaia1, A. Mishchenko2, S. N. Novikov3, P. Krivorotko3, P. Krzhivitskiy3, R. Ulyanova4, V. Danilov 4; 1Saint-Peterburg/RU, 2St. Petersburg/RU, 3St Petersburg/RU, 4Saint-Petersburg/RU

Background. Experimental data suggest that tumor growth depends on angiogenesis. Once the tumor reaches a size of up to a 1 mм in diameter, a further increase in the population of tumor cells requires the growth of new blood vessels. In contrast to benign lesions, a rapid growth of cancer cells results in the formation of pathological vessels of different diameter and chaotic distribution. therefore, determination of the type of vascularization of lesions is an important criterion in the diagnosis of breast cancer (Bc). color Doppler mapping (cDM) is an ultrasound technology that evaluates blood floor through a blood vessel; however, according to data from a variety of literature sources, cDM is not sensitive to slow (week) blood flow as it allows the visualization of only large vessels with a diameter of at least 100 µm. The purpose of the study was to evaluate the diagnostic value of cDM in determining the type of vascularization of malignant and benign breast tumors, as well as to detect their statistically significant Doppler characteristics by comparing with histological findings. material and methods. From 2017 to 2019, a total of 277 women with complaints of breast lump or pain underwent ultrasound examination using cDM. Results. statistically and diagnostically significant us characteristics of benign lesions included the presence of avascular or hypovascular types of blood flow. the most significant characteristic of malignant lesions was the presence of hypervascular mixed blood flow. the diagnostic value of ultrasound B-mode in combination with cDM in differential diagnosis of breast tumors was as follows: 77.6 % sensitivity, 51.7 % specificity and 58.8 %. accuracy. Conclusion. statistically and diagnostically significant signs observed by cDM allow one to use this ultrasound technology in the early diagnosis of breast cancer. However, low diagnostic efficiency of cDM dictate the need to search for new ultrasonic signs.

This article reviews the correct methodology of MRI in patients with rectal cancer (RC). The technical aspects of scanning, the advantages and disadvantages of the various sequences and methods used, the particularities of preparation and positioning, and their rationale are considered. Compliance with the correct methodology allows to obtain high-quality and high-informative images, thereby allowing to assess the extent of the process, the invasion of adjacent organs and structures with high accuracy.

Purpose. To evaluate the effectiveness of prostate cancer detection with method of cognitive mpMRI/TRUS fusion biopsy using strain sonoelastography.Materials and methods. Cognitive transrectal fusion biopsy of prostate was performed in 32 patients. According to the data of a preliminary conducted mpMRI, 33 foci suspicious of prostate cancer were included (PIRADSv2 = 3–5). Before the biopsy, all patients underwent ultrasound planning using compression sonoelastography.Results. The overall sensitivity was 76% for the targeted biopsy, and 49% for systematic biopsy. The number of biopsy specimens with a clinically significant Gleason grade in the targeted biopsy group was 85% of all columns with cancer specimens, in the systematic biopsy group this number was 68%. On average, the Gleason grade after targeted biopsy was 7.5 ± 0.9, and it was 7.2 ± 0.9 in the columns after systematic biopsy. On average, the percentage of tumor in the columns after targeted biopsy was 72% ± 29% and it was 55% ± 35% in the columns after systematic biopsy. The false positive for mpMRI was 15%. The overall sensitivity for the strain sonoelastography was 69% in this study, clinically significant cancer was detected in 71% of all columns with cancer specimens. False positive for elastography was observed in 18% of cases.Conclusion. Comparing with systematic biopsy, cognitive mpMRI / TRUS fusion biopsy can improve the detection rate of clinically significant prostate cancer and reduce the number of detected cases of clinically insignificant cancer. In cases of a total or subtotal tumor lesion in the peripheral zone detected on mpMRI, it is possible to take fewer columns for morphological verification of the tumor. The use of compression sonoelastography as an additional parameter of navigation in cognitive mpMRI/TRUS fusion biopsy can be considered as a promising way to increase the detection rate of clinically significant prostate cancer.

In this article are reviewed the most recent diagnostic methods for patients with probable and verified rectal cancer, in different stages of treatment. The importance of high quality visualization of rectal cancer, opportunities of magnetic resonance imaging in primary diagnosis and restaging of the disease after neoadjuvant chemotherapy, optimal examination methods and interpretation of images in routine are discussed.

The study objective is to evaluate the results of using the Petrov Thyroid Cancer Score (PTCS) in 2018 and assess the diagnostic value of the original PTCS and modified PTCS.Materials and methods. PTCS, proposed in the N.N. Petrov National Medical Research Center of Oncology in early 2018, was tested in this institution in 310 patients, 99 of whom underwent surgery, mainly due to suspected malignancy of thyroid nodules or at the request of patients.Results. According to the standard histological evaluation, in 35 cases the process was considered benign (group Д), while in 61 cases — after exclusion of 3 medullary carcinomas — regarded as highly differentiated (according to previous classification) thyroid cancer (group Р). The average values of such components of PCTS as BethesdaScore, TI-RADSScore, ElastoScore and body mass index (BMI) in group Р were significantly higher than in group Д. The sum of the scores of the used four parameters was not only higher in group Р, but also at a magnitude of ≥5.0 (62.3 % of observations in this group) it always corresponded to the diagnosis of thyroid carcinoma. At the same time, a similar histological conclusion was made, in particular, in respect of 14 patients (23 % of the group Р contingent) with the value of the mentioned sum <3.5. Of note, according to the preoperative cytological study, among these 14 cases 11 follicular neoplasms and 3 colloid nodules were found.Conclusion. A high value (≥5.0) of the sum of four selected parameters (3 from PTCS + BMI_Score) indicates an extremely high probability of detecting a tumor process, while in other cases (and not only under the assumption of follicular neoplasia presence), an additional diagnostic methods of research are needed.

High relevance of bladder cancer is determined not only by high morbidity rates, but a wide range of therapeutic measures that depend on the exact definition of the degree of invasion and the prevalence of tumor disease. Although transurethral resection and subsequent pathological study plays crucial role opportunity of preliminary assessment and treatment monitoring by using MRI open up broad prospects. In this regard, were developed the criteria of MRI in the access of the bladder tumor. Rules of carrying out scanning, and interpretation of the images are consolidated in recommendation VI-RADS. It has been approved by authoritative societiesof radiologists and urologists. The use of these recommendations will avoid many mistakes and increase understanding among radiologists as well as urologists.

The article discusses the current principles of diagnostic radiology in theevaluation of suspected and verified cervical cancer (CC). Possibilities of magnetic resonance imaging in the primary diagnosis of the disease and effect evaluation of neoadjuvant treatment are described.Conditions and optimal MR-technique, as well asprinciples of data interpretation are discussed. The main prognostic factors for CC are consideredand, also, a brief review of treatment methods for various diseases stages is given.

The study performed failed to reveal any reliable differential-diagnostic ultrasound and sonoelastography signs of the lobular or ductal carcinomas. Lobular carcinomas and inflammatory lesions had similar sonography patterns. The infiltrative ductal carcinomas and nodal mastopathy had similar sonographic patterns as well. Sonography allowed differentiation of the data obtained owing to difference in harshness indices of the inflammatory, benign and malignant tumors.

Radiological imaging is the main diagnostic technique of infectious pulmonary complications in patients with hematological malignancy. Disturbance of the immune system in this group of patients causes uncommon epidemiology, nonspecific clinical manifestation and rapidly progressive development of the infectious process. Modern diagnostic methods allow to reveal inflammatory changes in the lungs with high efficiency. In the current clinical practice, the most actual problem is rapid identification of pathogens using the wide-spread method. This possibility results in faster and more accurate patient treatment. The article reviews different imaging techniques and focuses on the preferable method for diagnosing pneumonia in immunocompromised patients and presents a recent view of russian and foreign researchers on the advantages and limitations of computed tomography in the differential diagnosis of lower respiratory tract infections.