Early Detection Of Pathological Changes Research Articles

Atypical Structure of Broca's Area in a Patient with Primary Progressive Atrophy Syndrome at the Onset of Alzheimer's Disease

This article presents a clinical case of Alzheimer’s disease with a debut as primary progressive aphasia syndrome. Insufficient use of routine magnetic resonance imaging in this case in the diagnosis of neurodegenerative diseases and the advantage of such additional neuroimaging methods as positron emission tomography, functional magnetic resonance imaging with a scale assessment of atrophic changes. Additional neuroimaging techniques have been shown to significantly improve the early detection of pathological changes in brain structures and to reveal the location of functional areas involved in the neurodegenerative process.

Biomarkers in aortic dissection: Diagnostic and prognostic value from clinical research.

Aortic dissection is a life-threatening condition for which diagnosis mainly relies on imaging examinations, while reliable biomarkers to detect or monitor are still under investigation. Recent advances in technologies provide an unprecedented opportunity to yield the identification of clinically valuable biomarkers, including proteins, ribonucleic acids (RNAs), and deoxyribonucleic acids (DNAs), for early detection of pathological changes in susceptible patients, rapid diagnosis at the bedside after onset, and a superior therapeutic regimen primarily within the concept of personalized and tailored endovascular therapy for aortic dissection.

Myocardial deformation parameters assessed by CMR feature tracking in chronic heart failure: the influence of an optimal medical therapy on myocardial remodelling

Background Myocardial deformation parameters have been shown to yield early detection of pathological changes in chronic heart failure (CHF). Aim of our study was to evaluate myocardial deformation changes under optimal medical therapy (OMT) in CHF patients. Methods CHF patients were examined longitudinally with two cardiac magnetic resonance imaging (CMR) examinations at a median time interval of 140 days. Left and right ventricular volumes were quantified, and deformation analysis was performed using feature tracking, respectively. Results 57 patients were included into the study. There was a high rate of OMT with a prescription of beta blockers in 98.2% and ACE-inhibitors/Angiotensin receptor blockers in 93.0%. In the total cohort, there were indications of positive remodelling with a significant improvement in left ventricular (LV) ejection fraction (38.9% ± 11.6 vs. 43.0% ± 12.7, p = 0.009), LV enddiastolic volume indexed (92.1 ml/m2 ± 23.5 vs. 87.2 ml/m2 ± 21.2, p = 0.007), LV mass (140.3 g ± 35.7 vs. 128.0 g ± 34.4, p = 0.001) and right ventricular global longitudinal strain (RV GLS) (−18.1% ± 5.1 vs. −20.3% ± 4.5, p < 0.001) during follow-up. Discussion Patients with CHF and OMT show positive reverse remodelling with improvement of LV volumes and function and RV GLS. This has a potential impact on the surveillance of this patient group, which should be further investigated in larger prospective studies.

Modern Aspects of Exercise Tolerance Assessment in Children with Post-COVID Syndrome, Pneumonia, and Obesity

An important and understudied problem is the state of health of children and adolescents who have experienced acute respiratory diseases or suffer from chronic diseases. Suffering from COVID-19 and post-COVID-19 syndrome, pneumonia are complex pathological conditions that significantly affect the functional capabilities of the child’s body and quality of life. Obesity, which is also an important medical and social problem, has no less impact on health. The purpose of the work is to summarize the data from the literature about the value of exercise tests in children with postcovid syndrome, after pneumonia of various etiologies, and obesity; modern aspects for assessing exercise tolerance. It is worth noting that nowadays screening programs for examining the health of children, aimed at prevention and early detection of pathological changes, play an important role. One of these methods of diagnosis, which makes it possible to determine and comprehensively analyze the body’s functional capabilities, is the assessment of exercise tolerance. The diagnostic value of analyzing the tolerance level lies in assessing the impact of various pathological conditions on the child’s health, and quality of life. The obtained results can be used to develop rehabilitation measures to eliminate the symptoms of acute diseases and improve the quality ofi fle. Tests with dosed physical exertion are used to assess exercise tolerance. The «gold standard» of the technique is cardiopulmonary exercise testing. However, world tolerance assessment guidelines include the use of other types of tests, such as office and field tests. The «gold standard» for assessing tolerance is the determination of the maximum oxygen consumption (VO2max), which characterizes the maximum amount of oxygen that is absorbed and used by the body during intense physical exertion involving a large possible part of the muscles. Also, during exercise tests, heart rate, blood pressure, and electrocardiogram recording are monitored, which creates significant diagnostic search opportunities for the pediatrician.

Analysis of the manifestation frequency of different variants of calcifications in the mammary glands in women of mature and old age according to screening mammography data

The relevance of the problem of early diagnosis of pathological changes in the mammary glands (MG) of women of different ages is due to the fact that in the world rankings of neoplasms localization, both benign and malignant, the MG occupies a leading position today. According to multiple information sources, more than 80% of women of reproductive age are diagnosed with various MG diseases. For the purpose of early detection of pathological changes developing in MG today, mammography is widely used, which allows easy visualization of calcifications, MG and obtaining their complete characteristics.The purpose of our study was to determine the frequency of detection and to study the age-related dynamics of different types of calcifications in the mammary glands of mature and elderly women according to the mammography results.Material and methods. In the course of the research, a randomized sample of archival anonymized mammograms of 100 women (50 mature and 50 elderly) who underwent screening or preventive examination was processed. Examinations were performed on the Fujifilm Amulet Innovality device (Japan) in direct (SS) and medial-lateral oblique (MLO) projections. Calcifications were assessed by shape, number, and size.Research results. It was determined that in a randomized sample of examined women, only 34% of adults and 28% of elderly people did not have calcifications in the mammary glands. In 24% of adults and 48% of elderly people, calcifications were detected in the mammary glands bilaterally, in another 42% of adults and 24% of elderly people - in only one of the the mammary glands. Among women of mature age, the largest specific share in the examined sample belongs to persons without calcifications in the mammary glands; among the elderly, the largest share is women with calcifications in both mammary glands. According to the results of the conducted research in a randomized sample of mature and elderly women, the following was found: isolated scattered punctate calcifications (35% of the examined); single punctate/round calcifications (23% of the examined); annular calcifications (11% of the examined); multiple calcifications (19% of the examined); calcifications larger than 1 mm (14% of the examined); calcified vessels (4% of the examined).Conclusions. Digital mammography is a highly informative method of examining the mammary glands, which allows us to visualize calcifications and differentiate them by size, shape and number. According to the results of the analysis of a randomized examination sample of 100 mature and elderly women, various variants of calcifications were found as single, diffuse, punctate; single punctate/round; annular; multiple; greater than 1 mm; as well as calcified vessels. With age, the frequency of mammary gland calcifications increases.

Eye as a window to the brain: Review of retinal changes in Alzheimer’s dementia

Alzheimer's disease (AD) is the most common neurodegenerative disease causing significant morbidity and mortality in the elderly, affecting million worldwide. Diagnosis of AD is mainly by clinical symptoms, use of tests to detect loss of higher mental functions, and confirmed by neuroimaging studies such as magnetic resonance imaging and positron emission tomography. Current research in AD aims at early detection of pathological changes in the brain and development of disease-modifying drugs. Testing the effectiveness of these drugs requires the development of a noninvasive and cost-effective screening tool. Retinal changes in patients with AD mirror those found in the brain and offers a window for early detection of AD before cognitive changes set it. This article reviews the pathological correlation between retinal changes and AD and the current advances in retinal imaging to detect AD.

Význam flexibilní endoskopie s Narrow Band Imaging pro hodnocení recidivy nádorů hrtanu a hypofaryngu po radioterapii

Background: The dia­gnosis of recurrent upper aerodigestive tumours is difficult, especially in the case of previous curative radiotherapy (RT) or chemoradiotherapy (CRT). Progress in the dia­gnostics of head and neck cancer came with the development of optical endoscopic imaging methods. The aim of this study was to analyse the benefits of flexible Narrow Band Imaging (NBI) in the visualization of suspected recurrence of malignancy in patients after curative RT (CRT). Methods: A total of 58 examined patients in follow-up after curative RT or CRT for laryngeal and hypopharyngeal squamous cell carcinoma were enrolled in the study. All patients underwent transnasal flexible endoscopy in conventional white light and NBI in local anaesthesia. Changes in microvascular architecture (intraepithelial papillary capillary loops – IPCL) have been classified according to Ni. IPCL I–III were considered to be non-suspicious, and therefore no histopathological examination was indicated. IV and V type findings were verified using HDTV NBI intraoperatively with bio­psy sampling and subsequent histopathological correlation was performed. Results: Transnasal videoendoscopic examination with NBI revealed a suspicious finding (IPCL type IV and V) in 23/58 (39.7%) patients, non-suspicious finding (IPCL I–III) in 35/58 (60.3%). Histopathological examination verified the positive finding (precancerous or malignant changes) in 12/23 (52.2%) and negative finding in 11/23 (47.8%) cases. The sensitivity, specificity, positive and negative predictive value of flexible NBI endoscopy were 100%, 76.1%, 52.2% and 100% respectively. According to the Kappa index (K = 0.568), we proved a moderate concordance between flexible NBI endoscopy and histopathological results. Conclusions: Transnasal flexible endoscopy with NBI in outpatient settings contributes to an early detection of pathological changes also in post-radiation altered mucosa of the larynx and hypopharynx, while a correct interpretation of in NBI findings is required to reduce the incidence of false positive results. Keywords: squamous cell carcinoma – Larynx – radiotherapy – narrow band imaging – Ni classification – hypopharynx

P‐tau235: a novel biomarker for staging preclinical Alzheimer’s disease

Alzheimer’s disease (AD) is characterised by a long preclinical phase. Although phosphorylated tau (p‐tau) species such as p‐tau217 and p‐tau231 provide accurate detection of early pathological changes, other biomarkers capable of staging disease progression during preclinical AD are still needed. Combining exploratory and targeted mass spectrometry methods in neuropathologically confirmed brain tissue, we observed that p‐tau235 is a prominent feature of AD pathology. In addition, p‐tau235 seemed to be preceded by p‐tau231, in what appeared to be a sequential phosphorylation event. To exploit its biomarker potential in cerebrospinal fluid (CSF), we developed and validated a new p‐tau235 Simoa assay. Using three clinical cohorts, we demonstrated that (i) CSF p‐235 increases early in AD continuum, and (ii) changes in CSF p‐tau235 and p‐tau231 levels during preclinical AD are consistent with the sequential phosphorylation evidence in AD brain. In conclusion, CSF p‐tau235 appears to be not only a highly specific biomarker of AD but also a promising staging biomarker for the preclinical phase. Thus, it could prove useful tracking disease progression and help enriching clinical trial recruitment.

A study of serum levels of prostate specific antigen, prostate acid phosphatase in prostate cancer patients and its complications on liver

Background: The prostate cancer (PC) is most leading disorders in human beings particularly in males. Prostate specific antigen (PSA) and prostate acid phosphatase (PAP) are tumor markers useful for early detection and diagnosis of PC. In prostate cancer patients more prone to liver and bone cancer metastasis because in these patients elevated levels of serum liver function tests (LFT) and these liver enzymes more specific for early detection of pathological changes in liver and bones.Methods: This is the case control study was carried out the association of serum levels of PSA/PAP inpatients with prostate cancer and healthy controls. Total 120 subjects included in this study in that 60 PC patients and 60 controls was included and blood was collected. The serum PSA levels are estimated by ELISA, PAP estimated by Kinetic method and LFT Was analyzed by commercial kits. Results: The present study evaluates the serum levels of LFT, PSA and PAP in patients with prostate cancer and compared with the healthy controls. The statistically significant difference between the PSA, PAP and LFT levels in patients with PC when compared to controls. The positive correlation in between PSA, PAP with LFT (p=0.001).Conclusions: This study suggesting that the serum PSA, PAP levels sensitive parameters for early detection of prostatic cancer and also for these patients’ frequent measurements of serum liver function tests, useful for early detection of significant pathological changes occurs in the liver and bone cancers metastasis from prostate.

Deep learning for early detection of pathological changes in X-ray bone microstructures: case of osteoarthritis

Texture features are designed to quantitatively evaluate patterns of spatial distribution of image pixels for purposes of image analysis and interpretation. Unexplained variations in the texture patterns often lead to misinterpretation and undesirable consequences in medical image analysis. In this paper we explore the ability of machine learning (ML) methods to design a radiology test of Osteoarthritis (OA) at early stage when the number of patients’ cases is small. In our experiments we use high-resolution X-ray images of knees in patients which were identified with Kellgren–Lawrence scores progressing from 1. The existing ML methods have provided a limited diagnostic accuracy, whilst the proposed Group Method of Data Handling strategy of Deep Learning has significantly extended the diagnostic test. The comparative experiments demonstrate that the proposed framework using the Zernike-based texture features has significantly improved the diagnostic accuracy on average by 11%. This allows us to conclude that the designed model for early diagnostic of OA will provide more accurate radiology tests, although new study is required when a large number of patients’ cases will be available.

Plasma growth differentiation factor 15: a novel tool to detect early changes of hereditary transthyretin amyloidosis.

AimsHereditary transthyretin (ATTRv) amyloidosis is the most frequent and representative form of autosomal dominant hereditary systemic amyloidosis. Disease‐modifying treatments of the disease are more effective during the early stages, and we require biomarkers to detect early pathological changes for prompt diagnosis. This study aimed to investigate whether plasma growth differentiation factor 15 (GDF‐15) levels could aid detection of early pathological changes in ATTRv amyloidosis.Methods and resultsWe retrospectively studied 32 patients with ATTRv amyloidosis, eight asymptomatic TTR mutation carriers, and eight healthy volunteers. We evaluated plasma GDF‐15 levels in these subjects as related to levels of brain natriuretic peptide and high‐sensitivity troponin T, echocardiographic features, 99mTc‐pyrophosphate (PYP) scans, and cardiac magnetic resonance imaging findings. Plasma GDF‐15 levels significantly increased even in asymptomatic TTR mutation carriers compared with healthy volunteers (P < 0.01). Plasma GDF‐15 levels were significantly correlated with plasma brain natriuretic peptide values (P < 0.01), serum high‐sensitivity troponin T values (P < 0.05), and interventricular septal thickness at end‐diastole (P < 0.01) in patients with ATTRv amyloidosis. Plasma GDF‐15 levels in patients with PYP‐positive ATTRv amyloidosis were significantly higher than those in patients with PYP‐negative ATTRv amyloidosis (P < 0.01). Plasma GDF‐15 levels in patients with late gadolinium enhancement‐positive ATTRv amyloidosis were significantly higher than those in patients with late gadolinium enhancement‐negative ATTRv amyloidosis (P < 0.01). Groups of patients with different TTR genotypes manifested different plasma GDF‐15 levels.ConclusionsGrowth differentiation factor 15 may reflect early pathological changes of ATTRv amyloidosis.

Role of Diffusion Tensor Imaging in Functional Assessment of Transplant Kidneys at 3-Tesla MRI

Abstract Objectives The main purpose of this article is to measure the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of cortex and medulla of renal allograft using 3-Tesla diffusion tensor imaging (DTI) in renal transplant patients with normal and graft dysfunction and to assess the correlation between diffusion tensor parameters (ADC and FA) and the estimated glomerular filtration rate (eGFR) value. Materials and Methods Fifty renal transplant recipients who received either living or cadaveric renal allografts were included in the study. Blood samples for serum creatinine and eGFR value were taken on the same day prior to the magnetic resonance study and the patients were assigned to three groups (A, B, C) according to allograft function (eGFR levels). The mean ADC and FA values of the cortex/medulla in upper, mid, and lower poles were calculated from the DTI sequence. Statistical analysis was performed using paired sample Student’s t-test and one-way analysis of variance test. Results The mean ADC values of the cortex were higher than the medulla that was statistically significant. However, the mean FA values were significantly higher in the medulla than the cortex. Mean ADCs and FA of the renal cortex and medulla were significantly higher in group A patients with normal renal function than in group B and C with poor renal functions. The corticomedullary difference in the FA values was more in group A. However, this difference was lower in group B and more so in group C. Conclusion ADC and FA values in the renal cortex and medulla exhibit a good correlation with allograft function and were significantly lower in transplants with dysfunction than those with good function. FA values appear to be more sensitive than eGFR and ADC for detection of early pathological changes in the graft dysfunction.

ДОСЛІДЖЕННЯ ВПЛИВУ ПАРАМЕТРІВ ТПД НА ЕКГ СИГНАЛИ У СТАНДАРТНИХ ВІДВЕДЕННЯХ

For many years, coronary heart disease has remained the leading cause of death in the world. Electrocardiography is a common and cost-effective method for assessing the state of the cardiovascular system, but, unfortunately, routine electrocardiography does not have sufficient sensitivity and specificity to solve modern problems. Therefore, there is a question of developing models and methods for evaluating the ECG signal, which would increase the effectiveness of electrocardiographic studies for early detection of pathological changes. Using the interactive ECGSim program, changes in the node on the anterior surface of the heart were modeled by changing the main characteristics of the transmembrane action potential by ±5 and ±10 percent: the resting potential, amplitude, time of depolarization and repolarization, and the slope of the curve in the "plateau" and repolarization phases. Two indicators are proposed to evaluate the differences between the obtained curves and the ECG curves of the conditional norm: one of them indicates the trend of changes, and the second one uses absolute values and more clearly demonstrates the degree of severity of changes. The results obtained correspond to electrophysiological indicators, which indicates the validity of the proposed indicators for measuring the distances between the adapted and reference ECG curves.

COMORBIDITIES IN PATIENTS WITH MIASTENIA GRAVIS

The purpose of this work was to study comorbid conditions in patients with myasthenia gravis. Materials and methods: 182 patients with myasthenia gravis aged from 18 to 83 were examined. 147 (80.8%) of then were diagnosed to have generalized form of myasthenia and 35 (19.2%) had ocular form myasthenia. Clinical and neurological examination included present complaints, past medical history, social history, neurological examination. To evaluate the clinical form of myasthenia, the MGFA classification was used. For data processing, the methods of parametric and non-parametric statistics were applied. Among the patients there were 128 (70.3%) women and 54 (29.7%) men, the women to men ration was 2.37: 1. Median age was 52.0 (34.0; 65.0) years. The proportion of patients who, in their routine practice, had CT or MRI of the anterior mediastinal system, made up 74.2% of the total sample and did not differ significantly depending on the form, class or subclass of myasthenia.&#x0D; Results: Among patients with the class I of myasthenia gravis, there were no individuals who had thymoma and/or thymectomy, unlike the patients with generalized myasthenia. A significant proportion of thymic and/or thymectomy was recorded in patients with class II (28.9% and 25.0% respectively). The proportion of thymoma and thymectomy in the patients significantly differed based on the myasthenia form (significantly more in patients with generalized form compared to those with ocular form, p = 0.003 and p = 0.009, respectively). The proportion of thymoma and thymectomy history significantly differed among patients with different classes of generalized myasthenia (class II-IV (p = 0.008 and p = 0.018 respectively) and their subclasses (p = 0.006 and p = 0.009, respectively), while they were registered in each class and subclass of generalized myasthenia.&#x0D; Attention should be paid to the fact that the proportion of thymoma in the general sample was greater than the proportion of thymectomy (19.2% versus 15.9%). This suggests an inadequate level of surgical care for myasthenia patients, even to those who are shown with such treatment (patients with thymoma).&#x0D; The proportion of autoimmune diseases among patients with myasthenia class I (ocular form) significantly exceeded the corresponding level in patients with generalized myasthenia - 45.7% vs. 15.0% (p &lt;0.001).&#x0D; The incidence of total concomitant pathology among all patients was 130.8% (95.0% CI 121.6-140.0%) and was slightly higher in the generalized form of myasthenia (134.7% (95.0% CI 123.6 -145.7%)) compared with the ocular form - 114.3% (95.0% CI 100.9-127.7%), p&gt; 0.05.&#x0D; One patient had from 0 to 6 concomitant diseases, on the average of 1.0 (0; 2.0) by the median value.&#x0D; Cardiovascular diseases, 34.1% (95% CI 27.2 - 41.0), rank the first place in the frequency of the concomitant diseases among the examined patients. The diseases of the gastrointestinal tract (namely, gastritis, ulcers of the stomach and duodenum, chronic holistic, chronic pancreatitis at the stage of remission, etc.) and autoimmune thyroiditis (20.9% (95% CI 15, 0-26.8) have the second highest rate, eye diseases (not related to the myasthenia) are (15.9% (95% CI 10.6 - 21.3)) ranked the third.&#x0D; No differences in the incidence of concomitant pathology, apart from autoimmune diseases, between forms, classes and subclasses of myasthenia were detected (p&gt; 0.05).&#x0D; Conclusions. The proportion of visualization of the anterior mediastinum in patients with myasthenia gravis is far from being sufficient. This test is supposed to be done for absolutely all patients with myasthenia gravis for early detection of pathological changes of thymus. In the structure of the comorbidities in patients with myasthenia gravis cardiovascular, gastrointestinal and autoimmune thyroiditis have been found out to prevail. This should be taken into account when selecting treatment. Autoimmune thyroiditis was recorded in 45.7% of patients with ocular and in 20.9% of patients with generalized myasthenia that may indicate a systemic autoimmune disorder whose causative relationships require further in-depth study.

High-resolution computed tomography findings in young infants with cystic fibrosis detected by newborn screening

OBJECTIVE:High-resolution computed tomography (HRCT) allows the early detection of pathological changes in the lung structure, and reproducible scoring systems can be used to quantify chest computed tomography (CT) findings in patients with cystic fibrosis (CF). The aim of the study was to describe early HRCT findings according to a validated scoring system in infants with CF diagnosed by newborn screening (NBS).METHODS:This cross-sectional study included infants with CF diagnosed by NBS who were born between January 2013 and January 2017 and who underwent HRCT scanning within the first year after diagnosis when they were clinically stable. The CT scans were evaluated using the modified Bhalla score.RESULTS:Thirty-two subjects underwent HRCT scanning. The mean total-modified Bhalla score was 3.6±2.1, and 93.8% of the scans were abnormal. Pseudomonas aeruginosa airway colonization was associated with increased modified Bhalla score values. Bronchial wall thickening was the most common feature (90.6%), followed by bronchial collapse/consolidation (59.4%), mosaic attenuation/perfusion (50%), bronchiectasis (37.5%) and mucus plugging (15.6%). Bronchial wall thickening was diffuse in most of the patients.CONCLUSION:A substantial proportion of infants diagnosed with CF after detection by NBS already showed evidence of lung disease. P. aeruginosa colonization was associated with increased Bhalla scores, highlighting the importance of this CF pathogen in early structural lung disease. The presence of bronchial wall thickening at such a young age may reflect the presence of airway inflammatory processes. The detection and quantification of structural abnormalities with the modified Bhalla score may aid in the identification of lung disease before it is clinically apparent.

Role of magnetic resonance imaging as a diagnostic tool in evaluation of painful hip joint, and early detection of pathological changes, helpful to prognosticate and influence therapeutic decisions

Background: Magnetic Resonance Imaging (MRI) is a well-established imaging technique, which are available at most larger hospitals today. Due to the combination of this high contrast and the fact that it is a non-ionizing radiation, MRI is often used for investigation of a large range of pathologies in almost all parts of the body. This study was performed to describe the MRI features in various types of lesions causing painful hip joint, as well as identify the common lesions seen in painful hip joint and to analyse the severity and extent of the underlying lesion in various conditions of hip joint pain, and early detection of pathological changes helpful to prognosticate and influence therapeutic decisions.Methods: This descriptive study was done on 50 patients with complaints of hip joint pain were included into the study. Appropriate MRI sequences and multi-planar imaging performed for every patient.Results: Out of the 50 patients included in the study, 74% of them were males who were predominantly affected with hip pain. The most common age group which was affected was 51-60 years (20%) and 21-30 years (20%). The most common pathology amongst the patients was Avascular necrosis of femoral head seen in 44% of the patients, osteoarthritis was seen in 54 patients, Tuberculosis in 5 patients, 2 had Perthe’s disease, joint effusion was observed in 6 patients.Conclusions: MRI of the hip joint is an informative, diagnostic, non-invasive, rapid and accurate imaging modality for the assessment of hip pain and sufficient imaging modality for delineation of different hip joint pathology.

Time-resolved quantitative inter-eye comparison of cardiac cycle-induced blood volume changes in the human retina.

We describe a low-cost, easy to use binocular instrument to acquire retinal video sequences of both eyes simultaneously. After image registration, cardiac cycle-induced pulsatile light attenuation changes can be measured quantitatively with high spatial and temporal resolution. Parameters such as amplitude, pulse form, and time shift between light attenuation changes can be calculated and compared between eye sides. Deviation from inter-eye symmetry can be not only an early sign of beginning eye diseases such as glaucoma but also a sign of pathological changes in the carotid arteries; hence, this method can improve the early detection of pathological changes. Important features compared to existing monocular instruments are a narrow band light source with the wavelength close to the peak of the blood extinction, and a proportional relationship of image intensity and light intensity, which are the main requirements for quantitative evaluation.

Secondary prevention of Alzheimer\u2019s dementia: neuroimaging contributions

BackgroundIn Alzheimer’s disease (AD), pathological changes may arise up to 20 years before the onset of dementia. This pre-dementia window provides a unique opportunity for secondary prevention. However, exposing non-demented subjects to putative therapies requires reliable biomarkers for subject selection, stratification, and monitoring of treatment. Neuroimaging allows the detection of early pathological changes, and longitudinal imaging can assess the effect of interventions on markers of molecular pathology and rates of neurodegeneration. This is of particular importance in pre-dementia AD trials, where clinical outcomes have a limited ability to detect treatment effects within the typical time frame of a clinical trial. We review available evidence for the use of neuroimaging in clinical trials in pre-dementia AD. We appraise currently available imaging markers for subject selection, stratification, outcome measures, and safety in the context of such populations.Main bodyAmyloid positron emission tomography (PET) is a validated in-vivo marker of fibrillar amyloid plaques. It is appropriate for inclusion in trials targeting the amyloid pathway, as well as to monitor treatment target engagement. Amyloid PET, however, has limited ability to stage the disease and does not perform well as a prognostic marker within the time frame of a pre-dementia AD trial. Structural magnetic resonance imaging (MRI), providing markers of neurodegeneration, can improve the identification of subjects at risk of imminent decline and hence play a role in subject inclusion. Atrophy rates (either hippocampal or whole brain), which can be reliably derived from structural MRI, are useful in tracking disease progression and have the potential to serve as outcome measures. MRI can also be used to assess comorbid vascular pathology and define homogeneous groups for inclusion or for subject stratification. Finally, MRI also plays an important role in trial safety monitoring, particularly the identification of amyloid-related imaging abnormalities (ARIA). Tau PET to measure neurofibrillary tangle burden is currently under development. Evidence to support the use of advanced MRI markers such as resting-state functional MRI, arterial spin labelling, and diffusion tensor imaging in pre-dementia AD is preliminary and requires further validation.ConclusionWe propose a strategy for longitudinal imaging to track early signs of AD including quantitative amyloid PET and yearly multiparametric MRI.

Остеотропный диагностический радио­фармацевтический лекарственный препарат на основе золедроновой кислоты «Резоскан, 99mTс». Предварительные результаты сравнительных клинических исследований

Purpose: Clinical trials involving study of functions, assessment of drug and radiation safety of the radiopharmaceutical drug “Rezoscan, 99mTc” in comparison with the “Technefor, 99mTc”.&#x0D; Material and methods: Clinical studies of RP “Rezoscan, 99mTc” were carried out using a diagnostic gamma camera Toshiba. The study involved 25 patients: 2 patients diagnosed with prostate cancer, 3 patients diagnosed with cervical cancer, 15 patients diagnosed with breast cancer and 5 patients diagnosed with coronary artery disease without cancer, who underwent osteoscintigraphy to identify osteoporosis foci and who signed an informed consent to participate in the study. To study the functional properties of RP “Rezoscan, 99mTc”, we studied its pharmacokinetics and evaluated the quality of visualization of pathological foci in bone tissue. To assess drug safety the patient was monitored for 15 days with an assessment of acute and delayed reactions to intravenous administration. Radiation safety of the RP was estimated using values of absorbed radiation doses of organs and effective doses to patients [1]. To the same patients the radiopharmaceutical preparations “Rezoscan, 99mTc” and “Technefor, 99mTc” were injected sequentially in one day.&#x0D; Results: According to the pharmacokinetics study, the accumulation of RP “Rezoscan, 99mTc” in the skeleton in 2 hours reaches 40 % of the administered amount. At the same time, a relatively rapid excretion of the drug from the soft tissues takes place, which makes it possible to clearly visualize the condition of the bone system and to reveal pathological changes with coefficients of differential accumulation (CDA) bone/soft tissues of about 10. Comparative studies of the functional characteristics of RP “Rezoscan, 99mTc” and “Technefor, 99mTc” showed the advantage of the new drug in the early detection of pathological changes in bone tissue with the metastatic skeletal lesion. In all cases in the study with RP “Rezoscan, 99mTc”on scintigrams in 15 patients with a verified diagnosis of breast cancer, the pathological foci of hyperfixation RP, which are typical for metastatic bone lesions, were visualized. In the same patients, examined with the help of the RP “Technefor, 99mTc”, pathological foci in the skeleton were visualized only in 13 cases.&#x0D; According to the results of studies of patients with RP “Rezoscan, 99mTc” accuracy was 0.8, sensitivity – 0.9, specificity – 0.6. According to the study of patients of the same group with RP “Technefor, 99mTc” defined: the accuracy is 0.8, sensitivity – 0.8 and specificity – 0.4.&#x0D; Based on the results of monitoring the condition of patients for 15 days, acute and delayed reactions to intravenous administration of the drug were not detected. The estimate of the absorbed radiation dose values of RP “Rezoscan, 99mTc” in organs and tissues of patients, as well as effective doses of irradiation allow us to suggest that the introduced RP activity and patient dose do not go beyond the previously established reference levels.&#x0D; Conclusions: The radiopharmaceutical “Rezoscan, 99mTc” can be used for the early detection of pathological foci of bone tissue.

COMPARISON OF THE DIAGNOSTIC ACCURACY OF MAGNETIC RESONANCE IMAGING AND ULTRASOUND EXAMINATION FOR X-RAY NEGATIVE STAGE OF KNEE JOINTS OSTEOARTHRITIS

Purpose. To compare of the diagnostic accuracy of ultrasonography (US) with magnetic resonance imaging (MRI) as a reference in the assessment of pathological changes of the soft tissues at the X-ray negative stage of knee joint osteoarthritis (OA). Materials and methods. Nineteen patients with X-ray negative stage of knee OA diagnosed in 2015 underwent US and MRI of the knee joints. We estimated the sensitivity and specificity, positive and negative predictive values for pathological changes in 7 distinct anatomical areas on US comparing to MRI. Results. There were no false positive results. The findings of US and MRI coincided for the presence of an excess amount of free fluid in the joint cavity and suprapatellar bursa synovitis and the presence of Baker’s cyst, 15 (79%) and 4 (21%) patients, respectively. More o‡ en, false-negative results on US have been seen in assessing changes in the lateral meniscus and osteophytes: 2 (11%) diagnosed cases vs 15 (79%) for MRI, respectively. The degenerative changes in the medial meniscus were found in 10 (52.6%) on US compared to 15 (79%) for MRI, respectively. Method of US showed the low sensitivity in the detection of early pathological changes of the knee ligaments: sensitivity and predictive value of negative results accounted for the cruciate were 47% and 18%, for collateral ones only 24% and 13%, respectively. Conclusion. Ultrasound examination is highly effective in the diagnosis of synovitis, free fluid in the joint cavity and suprapatellar bursa and Baker’s cysts in patients with X-ray negative stage of knee OA. It helps to identify the group of patients with the highest risk of progression of OA. The method of ultrasound is significantly inferior to MRI in the diagnosis of early degenerative changes in ligaments, the menisci and cartilage of the joint.