Purpose. To evaluate the capabilities of whole-body MRI based on accelerated acquisition sequences in assessing the extent of malignancy.Material and methods. The study included 30 patients with malignant, solid tumors of various origins and metastatic lesions of various anatomical structures. All patients underwent WB-MRI, based on accelerated data collection sequences, with subsequent clarifying studies, such as CT, PET/ CT, ultrasound to confirm or refute the malignancy of the detected changes.Results. In 14 out of 30 cases, it was possible to identify additional localizations of metastatic lesions, excluding skeletal bones.Conclusion. In modern conditions, WB-MRI makes it possible to collect comprehensive information for staging a tumor disease in a relatively short period of time.

Purpose: Demonstrate the possible manifestations of SAPHO syndrome. Material and methods: 38-year-old woman with suspected SAPHO syndrome were performed scintigraphy and SPECT/CT for evaluate the localization and abundance of the process. Results: Osteosclerosis and hyperostosis of the left clavicle, osteosclerosis of the L1 vertebra and other, less pronounced changes, accompanied by active accumulation of the 99mTc-MDP, were revealed. Conclusion: It is important to remember the specific complex of symptoms of this nosological entity and the possible isolated onset of individual manifestations, which was also observed in our case.

Aim: To evaluate the possibilities of absolute and relative values of the apparent diffusion coefficient (ADC) in the diagnosis of metastatic lesions of skeletal bones. Material and methods: The study included 12 patients with metastatic bone lesions, before any treatment was applied. The age of the patients ranged from 38 to 73 years, 3 men, 9 women. Among the morphological forms of tumors were presented: cancers of the breast (3), prostate (1) glands, colon (1), lung (2), body (1) and cervix (1) uterus, thyroid (1) and pancreas (2). The detected changes were classified on the basis of Bone scan, SPECT/CT and standard MRI. The ADC values of unchanged bone marrow (n=360), divided by anatomical zones, metastatic foci (n=117), as well as benign changes of various nature (n=19) were analyzed. The ratio of the ADC values of each of the metastatic and benign focal formations to the normal values for each of the localizations was calculated. Results: Unchanged bone marrow, depending on anatomical localization (cervical, thoracic, lumbar spine, pelvic bones, shoulder blades, collarbones, sternum, ribs, proximal humerus and femur bones) from the point of view of ADC, showed statistically significant heterogeneity. Statistical analysis has shown that there is no connection between the groups of ADC indicators in the foci of metastatic lesions, combined depending on the anatomical localization. With a similar comparison, but by belonging to the primary tumor, an even greater intergroup difference was found. ADC values in the foci of metastatic lesions turned out to be dependent on the morphological type of the primary tumor and significantly differ both from metastases of other morphological affiliation and from normal red bone marrow parameters. The use of relative values allowed to increase the specificity from 15 to 19 %. Conclusion: This study showed that knowledge of the range of reference ADC values for unchanged red bone marrow and anomalies of various genesis is important in differential diagnosis. The differentiation of the skeleton into separate anatomical zones probably makes it possible to increase the effectiveness of the isolated application of the technique when it comes to absolute values. The morphological affiliation of metastatic foci is important in the formation of ADC values, rather than the bone marrow microenvironment, which is also supported by the low efficiency of the use of relative values.

Introduction . Primary malignant tumors of the skeletal system mostly develop in young and middle-aged people. Morbidity in this age group amounts to between 75 and 80 % of overall morbidity. Due to low survival caused by patient death in the first 5 years mostly because of metastases of primary malignant tumors, the main focus of treatment was on prolongation of life, study and development of new methods of conservative therapy. Therefore, until the early 1970 amputation surgery was the generally accepted standard of surgical intervention. Positive oncological results required revision of the surgical concept of treatment in this patient group. This problem was solved through active development of oncological endoprosthesis started in the second half of the 1970s and led to shaping of orthopedic oncology into a separate oncological specialty. The study objective is to study long-term oncological results of treatment of patients with primary and metastatic tumors of the locomotor system after oncological endoprosthesis. Materials and methods . The study included 1292 patients with primary sarcomas of the bones, soft tissues and patients with metastatic and benign bone tumors who underwent 1200 bone resections/extirpations of varying scale with endoprosthetic replacement between January of 1992 and January of 2020. In the total group of patients who underwent endoprosthesis, the number of men and women was approximately the same: 677 (52.4 %) and 615 (47.6 %), respectively. At the time of surgery, age of the patients in the total group varied between 10 and 81 years. Mean patient age was 34.7 years. Most commonly, endoprosthetic replacement was performed in patients between the ages of 21 and 30 years (in 29 % of cases). Oncological endoprosthesic replacement was performed in 814 (67.8 %) patients with primary malignant tumors, 143 (11.9 %) patients with metastatic lesions in long bones, and 243 (20.3 %) patients with benign neoplasms. Mean follow-up period after endoprosthesis of different bone segments was 82.8 months (between 0 and 335.7 months). Results . In 27 years of observations, total frequency of recurrences after endoprosthesis for various tumor locations (type V complication per the International Society of Limb Salvage system (2013) (ISOLS 2013)) was 8.8 % (86/979); among them recurrence in the bone (type VA complication) was observed in 1.7 % (17/979) of cases, recurrence in the soft tissues (type VB complication) in 7.0 % (69/979) of cases. Primary endoprosthetic replacement due to recurrence after previous surgical treatment leads to 2.2-time increase in the risk of development of this complication. The obtained results show that repeat recurrence significantly increases the risk of recurrence in soft tissues and does not affect the risk of recurrence in the bone. The most recurrences developed in patients with non-differentiated pleomorphic sarcoma (15.4 % of cases), chondrosarcoma (15.0 % of cases) and parosteal osteosarcoma (14.3 % of cases). Frequency of recurrences in patients with giant cell bone tumors and aneurysmal bone cysts was 4.0 and 3.8 %, respectively. In cases of tumor recurrence after endoprosthesis, limb amputation was the most common treatment: 33.7 % (28/83) of cases. In this study, recurrence mostly developed after femur resection with knee joint endoprosthesis: in 45.8 % (38/83) of cases. Frequency of oncological complications in patients with bone sarcomas who underwent endoprosthetic replacement was 31.9 % (283/886). In the total patient group in 27 years of observations, in 25.3 % (224/886) of patients disease progression in the form of metastases was observed. Local tumor recurrence was accompanied by metastases in 6.7 % (59/886) of cases. Conclusion . Decreased risk of development of local recurrences depends on the effectiveness of complex approach to therapy in this disease group. Changes in surgical endoprosthesis techniques in tumors of varying differentiation levels allowed to achieve significant radicalness of treatment. Progression risk for bone sarcomas, level of response to specialized therapy and, as a result, patient’s prognosis depend on the presence of epigenetic, genetic, molecular and chromosomal abnormalities.

Purpose: To show the additional clinical importance of SPECT/CT method in the complex diagnosis of skeletal system.Material and methods: Patient: male, 75 years. Medical history: At the beginning of July 2021 the patient noticed the presence of blood in urine, and after that he seeked medical assistance from urologist. During medical check up — suspicion on prostate tumor. 09.07.21 PSA > 100 ng/ml. The patient was directed to N.N. Blokhin National Medical Research Center of Oncology for further examination and treatment. Whole body bone scan revealed multiple foci of increased activities of the radiopharmaceutical in the lumbar spine, sacral vertebrae and in the projection of groin and scrotum. After bone scan, SPECT/CT was performed. Metastatic lesions of bone tissue were not confirmed, however, an inguinal scrotal hernia and a nodus in the pelvic cavity (probably of a metastatic) were detected.Conclusion: The use of SPECT/CT made it possible to detect additional changes in the study area. Information about the presence of an inguinal hernia will help prevent complications.

Introduction.The results of using various reconstructive technologies in the 1980–1990’s to replace post-resection bone defects determined oncological endoprosthetics as the most promising onco-orthopedics trend, due to the quality-of-life and functional potential restoration in a short time. Despite the constant improvement of the design and technology of oncological endoprosthesis at the moment, complications such as aseptic instability, mechanical failure and infection of the endoprosthesis significantly affect the reduction of implant survival. It is impossible to reduce the frequency of endoprosthesis aseptic instability without developing a unified strategy for the prevention and treatment of this type of complication.The study objective – to examine the main causes of early and late aseptic loosening, analyze complication rate in various periods after endoprosthesis using literature data and results of treatment of a large patient group who underwent primary and repeat endoprosthesis for different post-resection bone defects.Materials and methods. The study included 1292 patients aged 10 to 81 years with primary bone and soft tissues sarcomas, metastatic, benign lesions of the bone, who since January 1992 to January 2020 were performed 1671 primary and revision endoprosthetics of various bone segments. The age of the patients ranged from 10 years to 81 years. The mean age of the patients was 34.7 years. In the study group of patients, most often endoprosthetics was performed at the age of 21 to 30 years and accounted for 29 % of cases. The mean follow-up period after primary arthroplasty of various segments was 82.8 months (from 0 to 335.7 months). The mean follow-up period after revision arthroplasty was 54.2 months (from 0 to 282.8 months). In 1594 (95.4 %) cases were used bone cement stem fixation.Results. The results of the study show that the optimal shape of the endoprosthesis stem for primary and revision endo-prosthesis replacement is conical and cylindrical figured (made in the shape of the bone marrow canal). The most stable endoprosthesis stems are 60–100 mm long for upper limb arthroplasty and 110–150 mm for lower limb arthroplasty. Endoprosthesis stems longer than 160 mm can only be used in revision endoprosthetics. The length of the bone resection does not affect the incidence of endoprosthesis instability. The quality of the formed cement mantle affects the frequency of endoprosthesis instability. The presence of at least one revision arthroplasty with replacement of the endoprosthesis stem increases the risk of developing subsequent early instability (type IIA) about 4 times and the risk of late instability (type IIB) about 6 times compared with primary arthroplasty. The occurrence of late aseptic instability of the endoprosthesis (type IIB) will lead to the development of breakage/destruction of the endoprosthesis (type IIIA) in a shorter period than the breakage/ destruction of the endoprosthesis will lead to the development of late instability of the endoprosthesis (type IIB).Conclusion. The choice of an endoprosthesis, taking into account the optimal biomechanics of the endoprosthesis design, the shape of the stem, methods of fixation, the introduction of innovative technological solutions, adherence to the principles of oncological endoprosthesis replacement, is a means of reducing the incidence of this type of complications.

Chondrosarcoma is one of the most common tumors in adults. Resectable chondrosarcomas requires surgical treatment, and tend to local recurrence, often repeatedly.A case report of a 38 years old female patient with secondary chondrosarcoma of femur is presented. The role of multidisciplinary team in tactic choice of primary treatment and recurrence treatment is shown.

The purpose of the work was to demonstrate of the possibilities of SPECT/CT in the diagnosis of condylar hyperplasia in a 17-year-old patient. According to the results of bone scan and SPECT/CT, anatomical and metabolic abnormalities were found, confirming the clinical diagnosis. The use of modern diagnostic methods, in particular SPECT/CT, is justified and recommended for suspected condylar hyperplasia.

Relevance. Giant cell tumor of the bone is most common in people of working age, which determines the high social significance of successful treatment of this category of patients. The main method of treatment is surgical. Currently, the targeted drug denosumab has appeared, the criteria for evaluating the effectiveness of therapy for which, according to the data of radiation methods, are not clearly defined.Target. To analyze and compare the possibilities of CT and MRI in evaluating the effectiveness of denosumab therapy for giant cell tumors.Materials and methods. The data of CT and MRI of 19 patients with giant cell tumor of tubular bones on the background of denosumab therapy were analyzed.Results. Before treatment, the extraosseous component was determined in 57.9 % (n = 11), after – 31.6 % (n = 6). The decrease occurred in 100 %, the disappearance – in 45 % (n = 11) of cases. The thickness of the extraosseous component before treatment ranged from 4 to 43 mm (Me = 15 mm), after treatment it ranged from 0 to 30 mm (Me = 8 mm). The decrease occurred in the range from 4 to 14 mm (M ± SD = 7 ± 4 mm). In 100 % of cases, a sclerotic rim appeared, the thickness of which after treatment ranged from 1 to 5 mm (Me = 3 mm). In the structure of the tumor, fibrosis occurred in 95 % (n = 18), a decrease in the cystic component occurred in 82 % (n = 9) of cases. Perifocal changes decreased in 100 % of cases. In 100 %, the average tumor density increased. The mean tumor density before treatment ranged from 27 to 65 HU (M ± SD = 42 ± 11 HU), after treatment it ranged from 69 to 500 HU (Me = 150 HU). The increase in density occurred in the range from 41 to 454 HU (Me = 101 HU). All differences are statistically significant (p < 0.05).Conclusions. Evaluation of effectiveness with the definition of quantitative and qualitative indicators is possible according to the data of both CT and MRI; with CT, changes are recorded longer, and more indicators available for quantitative measurement are determined.

Purpose: Comparison of the diagnostic performance of osteoscintigraphy (OSG), X-Ray, the presence of OSG and X-ray, SPECT/CT and a combination of MRI sequences in metastatic lesions of the bones of the skeleton. Material and methods: The study included 24 patients with bone metastases. The above research methods were used. Results: The sensitivity of X-ray, Bone scan, X-ray combined with bone scan, SPECT/CT, T1+DWI, T1+STIR+DWI, T1+T2+STIR+DWI, T1+T2+STIR was 10, 30, 24, 31, 99, 99, 99, 95 % respectively, specificity – 37, 12, 59, 74, 87, 87, 87, 71 % respectively. According to the results of pairwise comparison of true-positive results in groups according to the Wilcoxon test: X-ray < OSG = X-ray + OSG = SPECT / CT < MRI + DWI > MRI. Conclusion: It follows from the results that the choice of diagnostic method for suspected bone metastases should be determined by the clinical context. MRI will help detect bone metastases at earlier stages of development, and the use of other diagnostic methods included in the study should be accompanied by an understanding of the limitations that are imposed in their use.

Purpose. Determining the diagnostic value of magnetic resonance imaging in the accurate definition of chondrosarcoma of bone grade at the pre-surgery examination. Material and methods. We analyzed examination data (magnetic resonance imaging with no contrast enhancement) of 70 patients with chondrosarcoma (35 patients with low-grade chondrosarcoma and 35 patients with high grade chondrosarcoma). Informative weighted coefficients were determined separately for ‘learning’ and ‘examination’ samples. On the basis of weighted coefficients, the decisive rule was created for differentiation between low-grade and high-grade chondrosarcoma. Results. The sensitivity of the method was 87.0%, specificity was 95.6%, total correct classification was 91.03%. Conclusion. Magnetic resonance imaging is a highly informative method for prediction of chondrosarcoma grade at the pre-surgery examination.

Alkaptonuria is a rare autosomal recessive disease. In these patients, melanin-like compounds as the final products of impaired metabolism of homogentisic acid are deposited mainly in connective tissue, including cartilage tissue of intervertebral discs. Similar to other degenerative spine diseases, lumbar segment is often damaged. The authors report a 67-year-old patient with alkaptonuria. Compression of cauda equina by damaged cartilage masses of intervertebral discs and spine ligaments with deposits of ochronotic pigment is described. Previously diagnosed alkaptonuria in this patient was confirmed by surgical findings (black pigmentation) and histological data.

Relevance: Radionuclide bone scan signs of lesions are not specific and require radiological identification. Hybrid tomographic technology is a combination of spatial distribution of radiopharmaceuticals and its anatomical binding. Thus, makes it possible to accurately identify the affected bone structure and also determine the nature of this changes (radiological anatomy). In cancer patients, SPECT/CT method allows to visualize tumor pathology in the bones, but also keeps to a minimum errors and other excessive examinations.Purpose: To demonstrate the most frequent diseases and conditions that simulate tumor lesions in bones on bone scan.Material and methods: We analyzed the results of examinations of 81 patients with various tumor diseases (2015–2020). Bone scan was performed in the whole body 3 hours later, after intravenous administration of 99mTc-phosphotech on a Symbia E, T2 (Siemens, Germany). SPECT/CT was performed after WB Bone Scan.Results: The most frequent reasons for the focal increased uptake of radiopharmaceutical were: reactive increase in metabolism and as a result additional mineral repair: deforming osteoarthritis, osteophytes; post‑traumatic and postoperative changes; fractures (osteoporosis and stress fractures); inflammatory processes; focal uptake due to the benign neoplasms of bones and dysplasia. Combination of highly sensitive but non-specific scintigraphy with highly specific computed tomography makes it especially useful in anatomically difficult areas.Conclusion: SPECT/CT reveals a direct pater of anatomical and structural abnormalities with changes in bone tissue metabolism in case of different injuries and minimizes a number of ambiguous conclusions. SPECT/CT in oncological practice greatly helps nuclear medicine physician in the differential diagnostic process and reduces time of examination for the patient.

Purpose: To conduct a retrospective analysis of the clinical case of metastatic vertebral lesion in prostate cancer and the algorithm for the use of instrumental diagnostic methods.Material and methods: Patient 67 years old. History of prostatectomy for prostate cancer. Suspected metastatic lesion of the left transverse process of the 7th thoracic vertebra based on PET/CT. For clarification, MRI, Skeletal scintigraphy, SPECT/CT were performed.Conclusion: Access to a wide range of instrumental methods does not guarantee correct diagnosis. Modality, research methodology, time between the first and clarifying methods — all these factors affect the correct diagnosis, the choice of the treatment method, the timeliness of the start of treatment and, as a result, the fate of the patient.

Purpose : To demonstrate a clinical case of metastatic lesions of the bones, which clearly reflects the difference in the sensitivity of diagnostic methods SPECT/CT and MRI. Material and methods : A 69-year-old female patient with poorly differentiated gastric adenocarcinoma, which underwent WBS, SPECT/CT and MRI. Results : MRI revealed several metastases that were not reflected on SPECT/CT examination. Conclusion : Despite the high sensitivity and specificity of SPECT/CT, in some cases additional diagnostic methods are required. MRI allows to clarify and, possibly, detect previously undetected metastases.

Purpose: Demonstrate a clinical case of poorly differentiated chordoma, confirmed using a wide range of research methods.Material and methods: A 63-year-old female patient with poorly differentiated chordoma who underwent immunohistochemical examination, MRI, CT and scintigraphy.Results: An immunohistochemical study confirmed the morphological affiliation of the tumor, supplemented by the data of imaging methods.Conclusion: The poorly differentiated type of chordoma has a specific immunohistochemical picture, however, differential diagnosis based on imaging methods is currently a difficult task.

Purpose. To determine the diagnostic value of threephase scintigraphy in the evaluation of the preoperative chemotherapy of soft tissue sarcomas of the extremities on different diagnostic stages. Material and methods. We analyzed the data of 76 patients with extremity soft tissue sarcomas. The study included data from 28 patients who underwent three-phase scintigraphy with Technetril 99m Tc. Scintigraphic data before and after neoadjuvation chemotherapy were analyzed in 16 patients, before and during chemotherapy — in 6 patients, only during chemotherapy — in 1 and only after all courses of chemotherapy — in 5 patients. Results. The sensitivity of the method (prediction of grade III–IV pathologic response) was 100 %, specificity (prediction of grade I–II pathologic response) was 87%. The predictive value of positive and negative results was 63 and 100%, respectively. Conclusion. A three-phase scintigraphy with Technetril 99m Tc is a highly informative method for evaluating the effectiveness of preoperative chemotherapy in patients with sarcomas of soft tissues of the extremities.

The study objective : using a clinical example to demonstrate possibilities of single photon emission computerized tomography (SPECT) in combination with computed tomography (CT) in identifying latent bone metastases, taking into account the dynamics growth of serum basal calcitonin. Materials and methods . Patient S., 60 years old, visited N.N. Blokhin National Medical Research Center of Oncology for consultation on multiple lung metastases of cancer of unknown primary. Results. Taking into account basal calcitonin level, immunohistochemistry, ultrasound investigation andfine-needle aspiration biopsy of the node in the right thyroid lobe a diagnose of medullary thyroid cancer was made. CT revealed multiple metastases in both lungs. Specialist erformed thyroidectomy with central lymphadenectomy and facial neck dissection on both sides. During next four months basal calcitonin level increased twice. Control contrast CT lung screening showed the growth of previously identified metastases and the appearance of multiple new ones. Bone scan showed focuses of increased radio-pharmaceutical accumulation in the area of 7 h left rib, left iliac wing, in the left bones of cranial vault, in C 7 , Th 6 , Th 9 , Th I2 vertebrae and right foot bones. Additional examination using SPECT/CT (from the skull base to the hip joints) revealed metastases in corpuses of Th 9 , Th I2 vertebrae and the left iliac wing, and suspicion for metastasis in 7 h left rib. Magnetic resonance imaging (MRI) confirmed metastasis in Th 9 , Th I2 , L 3 vertebral bodies and in the left iliac wing. Conclusion. Conclusion . In this clinical example, SPECT/CT allowed to correctly detect metastases in both Th 9 and Th I2 vertebrae while bone scan was questionable, and MRI showed an additional damage of L 3 vertebra. Changes in the 7 h left rib could not be verified using CT, although this changes may be an emerging metastasis. Obviously, extensive use of radiation methods does not guarantee complete identification of all pathological focuses, it therefore allows assessing the prevalence of the pathological process. It is crucially important to control calcitonin level in these patients, since its rapid growth allowed suspecting additional distant metastases.

The study objective : using a clinical example to demonstrate possibilities of single photon emission computerized tomography (SPECT) in combination with computed tomography (CT) in identifying latent bone metastases, taking into account the dynamics growth of serum basal calcitonin. Materials and methods . Patient S., 60 years old, visited N.N. Blokhin National Medical Research Center of Oncology for consultation on multiple lung metastases of cancer of unknown primary. Results. Taking into account basal calcitonin level, immunohistochemistry, ultrasound investigation andfine-needle aspiration biopsy of the node in the right thyroid lobe a diagnose of medullary thyroid cancer was made. CT revealed multiple metastases in both lungs. Specialist erformed thyroidectomy with central lymphadenectomy and facial neck dissection on both sides. During next four months basal calcitonin level increased twice. Control contrast CT lung screening showed the growth of previously identified metastases and the appearance of multiple new ones. Bone scan showed focuses of increased radio-pharmaceutical accumulation in the area of 7 h left rib, left iliac wing, in the left bones of cranial vault, in C 7 , Th 6 , Th 9 , Th I2 vertebrae and right foot bones. Additional examination using SPECT/CT (from the skull base to the hip joints) revealed metastases in corpuses of Th 9 , Th I2 vertebrae and the left iliac wing, and suspicion for metastasis in 7 h left rib. Magnetic resonance imaging (MRI) confirmed metastasis in Th 9 , Th I2 , L 3 vertebral bodies and in the left iliac wing. Conclusion. Conclusion . In this clinical example, SPECT/CT allowed to correctly detect metastases in both Th 9 and Th I2 vertebrae while bone scan was questionable, and MRI showed an additional damage of L 3 vertebra. Changes in the 7 h left rib could not be verified using CT, although this changes may be an emerging metastasis. Obviously, extensive use of radiation methods does not guarantee complete identification of all pathological focuses, it therefore allows assessing the prevalence of the pathological process. It is crucially important to control calcitonin level in these patients, since its rapid growth allowed suspecting additional distant metastases.