The purpose of work was to determine CECT characteristics of primary juvenile angiofibroma of the nasopharynx and skull base (JNA), as well as determination of the paths of spread for the tumor, search for those of them, which are statistically significantly associated with surgical blood loss of subsequent treatment and search for ways to model possible blood loss on their basis.Materials and methods. The data of 60 patients aged from 8 to 17 years were analyzed retrospectively. All patients were boys. The median age was 14 years. The median duration of the disease at the time of surgery was 7 months. The correlation between each of 45 evaluation criteria and intraoperative blood loss was determined for patients in the study group.Results. CT characteristics of JNA were established. The factors, detected by CECT, statistically significantly influencing intraoperative blood loss in angiofibroma treatment were established. A method for modeling intraoperative blood loss based on imaging data was presented.Conclusion. CT with contrast enhancement allows determining of characteristic radiological signs of JNA as well as its characteristics influencing blood loss during surgical treatment. Based on CT data it is possible to model blood loss potential during the JNA treatment.

Objective. Quantitative assessment of changes in brain myelin content after the first course of chemotherapyMaterials and Methods. T1 and T2 maps as well as myelin water fraction (MWF) and macromolecular proton fraction (MPF) maps, reflecting myelin content, were acquired in 6 patients (mean age — 13.7 ± 2.4 years) before and after the first course of chemotherapy. The study was carried out using on 3T MRI scanner. Statistical data processing was carried out using the GraphPad Prism.Results. MPF and T2 values showed an increase in the thalamus and white matter of the occipital lobes of the brain, while MWF values showed an increase in the cerebellum and a decline in the white matter of the frontal lobes. Significant changes were not found for T1 values.Discussion. According to MWF the structures of the brain which are primarily affected by treatment with toxic drugs — the white matter of the frontal lobes and the cerebellum, were revealed. MWF values decreasing in the white matter of the frontal lobes may indicate the process of demyelination in this area, while increased MWF values in the cerebellum could be caused either by remyelination processes or by incomplete cleansing of myelin residues accumulation by macrophages at the site of degeneration. Conclusion. The results obtained demonstrated high potential of MWF values serve as early changes biomarker of neurotoxicity after the chemotherapy treatment. Along with this, the MPF index, which is more sensitive to cerebral edema, may be a predictor of demyelination.

Von Hippel-Lindau syndrome (VHL) is a rare autosomal-dominant inherited cancer syndrome with different phenotypes caused by variants in the VHL gene.Hemangioblastoma (HAB) is a benign tumor of the central nervous system and may appear as a component of VHL disease.HAB is one of the most common manifestations and a leading cause of morbidity and mortality in patients with BGL, but can also occur as a sporadic form. This tumor often has a cystic component and is multiple in nature. Mainly located subtentorially. MRI is the gold standard for diagnosis; computed tomography and perfusion techniques can also be used to make the correct diagnosis. The definitive treatment for these lesions is surgical resection, followed by SRS if necessary. Stereotactic irradiation is the method of choice for hemangioblastomas, especially with early detection of relatively small lesions, including those with multiple lesions. Radiosurgery is carried out with a high degree of efficiency with low toxicity, which is especially important for patients with minimally severe symptoms and in pediatric patients and also is recommended to patients with limited surgical alternatives (i.e., severe medical comorbidities, surgically unresectable tumors). SRS offered a satisfactory 5-year tumor control of HHB to VHL patients.The article describes a family case of hemangioblastoma, traced over several generations, provides an algorithm for the management of patients with VHL syndrome with recommendations for the required scope of their diagnosis, observation and discussion of approaches to their treatment.Careful collection of family history, genetic and follow up examination carried out systematically and correctly, monitoring of patients with VHL will allow timely establishment of the correct diagnosis and more widespread use of the stereotactic irradiation method.

Hemolytic — uremic syndrome (HUS) is one of the most severe conditions in pediatric practice. Acute kidney failure (AKF), which is a component of HUS, requires the earliest diagnosis and emergency medical care. Most of the young patients suffer from diarrhea-associated (D+) HUS, so ultrasound marks of kidney injury very important for young patients with severe hemocolitis. In this article we present the observation of preclinical diagnostics AKF the child 2 years and 11 month old with hemocolitis, when HUS’s marks (such as structure’s changes of the renal parenchyma and critical changes of renal hemodynamics) were detected before clinical manifestation AKF. This observation is illustrated with echograms and accompanied by a brief review of the literature.

Despite the widespread application of MRI in brain tumor MR-imaging, the standardized MRI protocol has not yet been approved. This fact creates obstacles for interpreting of the obtained data and even limits the diagnostic power of MRI. Standardization of MRI studies facilitates successful planning of surgery, chemotherapy, or radiation therapy and provides more reliable follow-up. In this regard, unification of image acquisition parameters and protocols remains relevant. We propose a standard MRI protocol that includes axial and coronal T2-weighted images, axial or 3D T2-FLAIR, 3D T2* (gradient echo), diffusion-weighted imaging, axial T1-weighted images, contrast-enhanced spin-echo T1-weighted images (either axial or three planes) and obligatory subsequent isotropic 3D T1 images. The following combination of sequences facilitates the correct diagnosis and follow-up. The least magnetic field strength should be 1.5 T.

Magnetic resonance (MR) relaxometry, or measurement of tissue magnetic relaxation properties, is a technology intended to quantitatively depict the physical basis of structural MR imaging. This review is devoted to perspective directions of studies and application of MR relaxometry in brain glioma preoperative and pretherapeutic diagnosis. The current data advocate for emerging capabilities of relaxometry in glioma grading (despite possible overlap between different grades) and differentiating between gliomas and tumors of other origin. Some studies showed features of relaxometric values within the perifocal infiltrative edema zone possibly related to glioma infiltrative growth. We separately reviewed the works aimed at searching for the most aggressive and malignant foci in glioma tissue and extremely useful for tumor biopsy or removal. No less important are capabilities of relaxometry in radiogenomics, first of all, in IDH status prediction. The relaxometric method possesses perspective in multiparametric brain glioma diagnostics.

Background. Recent studies suggest that accumulation of contrast agent in the aneurysm’s wall may predict a high risk of aneurysm growth or rupture.Objective. To compare the enhancement of the aneurysm wall with other characteristics that affect at the risk of rupture.Materials and Methods. The study included 95 patients with 132 previously identified saccular aneurysms, who underwent magnetic resonance imaging (MRI) according to a specialized protocol using 3.0 Tesla MRI scanner. The presence or absence of aneurysm’s wall enhancement compared with the following characteristics: gender and age of the patient, the size and shape of the aneurysm, the presence of arterial hypertension, and the PHASES score.Results. Accumulation of contrast agent by the aneurysm’s wall was associated with the aneurysm dome size (p < 0,001, Sp = 78,1 %, Se = 72,1 %) and PHASES score (p < 0,001, Sp = 64,1 %, Se =57,1 %). No relationship between age, gender, arterial hypertension, shape, and aneurysm location and contrast enhancement was found (p > 0,05).Conclusion. Contrast enhancement of the aneurysm wall on MRI can be considered an additional risk marker of its rupture.

This study aimed to assess the feasibility of radiomic features derived from diffusion kurtosis imaging (DK MRI) in identifying microstructural brain damage in diffuse axonal injury (DAI) and predicting its outcome. We hypothesized that radiomic features, computed from parametric DK MRI maps, may differ between healthy individuals and those with trauma, and may be related to DAI outcomes. The study included 31 DAI patients and 12 healthy volunteers. A total of 342,300 radiomic features were calculated (2282 features for each combination of 10 parametric DK maps with 15 regions of interest). Our findings suggest that the set of radiomic features effectively distinguishes between healthy and damaged brain tissues, and can predict DAI outcome. A broad spectrum of radiomic parameters based on DK MRI data showed high diagnostic and prognostic potential in DAI, presenting advantages beyond the traditionally used average values for the regions of interest on parametric DK MRI maps.