MR Signs Research Articles

Возможности магнитно-резонансной томографии в диагностике воспалительных изменений парауретральных желез у женщин.

Introduction. Inflammation of the paraurethral glands (skеneitis) is a complex urological disease, often hidden under the guise of other pathological conditions and causing recurrent lower urinary tract infection (UTI) in women. A significant problem for the diagnosis of skineitis at present is the absence or extremely low sensitivity and specificity of available laboratory, instrumental and radiation methods. Thus, the search for new ways to examine patients with recurrent UTI caused by chronic inflammation of the Skene’s glands is an important clinical and socio-economic task of modern healthcare. Materials and methods. The study involved 30 patients aged from 24 to 51 years who underwent magnetic resonance imaging (MRI) of the pelvis with contrast enhancement and targeted examination of the urethra and periurethral area using a device with a 3T fi ld strength. To study the MR semiotics of chronic inflammation of the gallbladder, in addition to standard MR protocols, high-resolution T2-weighted images with a slice thickness of 2 mm and T2-weighted Space 3D images in a sagittal projection with a slice thickness of 1 mm were used. The first group consisted of 16 urologically healthy women without complaints of dysuria, who underwent an assessment of the MRI anatomy of the normal female urethra. MRI of 14 respondents with chronic infl mmation of the paraurethral glands (second group) was performed to search for recurring (natural) changes characteristic of this disease. Such parameters as the diameter of the urethra, the separate thickness of its anterior and posterior walls, clarity at the boundary of the layers, and the presence of pathological changes and formations were studied. Results. Analysis of the obtained tomograms showed that urologically healthy respondents are characterized by symmetrical thickness of the walls of the urethra without pathological formations in it, as well as evenness and clarity of the contour at the boundary of the layers. When studying the results of examination of patients with chronic skeneitis, all of them (100%) noted the following recurring changes: an increase in the diameter of the urethra due to thickening of its posterior wall, in particular the submucosal layer, impaired differentiation at the border of the submucosal and muscular layers, the presence of small cystic changes in the structure of the posterior wall of the urethra (85.7%) or fragmentarily dilated ducts of the urinary tract (14%). Hypertrophy of the bulbospongiosus muscles, detected in 85.7% of respondents in the second group, is likely an indicator of frequent exacerbations and duration of the disease, and can be considered as an additional nonspecific criterion for this disease. Conclusions. These changes can tentatively, given the small sample, be considered pathognomonic MR signs of chronic skineitis. Thus, MRI of the pelvis with a targeted examination of the urethra and periurethral area can help in the differential diagnosis of patients with suspected inflammation of the paraurethral glands, establishing the correct diagnosis and prescribing adequate treatment.

Primary hepatic neuroendocrine neoplasms: imaging characteristics and misdiagnosis analysis.

To analyze the CT and MR features of Primary hepatic neuroendocrine neoplasms (PHNENs) in order to enhance the diagnostic accuracy of this disease. A retrospective analysis was conducted on patients diagnosed with hepatic neuroendocrine neoplasms, excluding other sites of origin through general examination and postoperative follow-up. The CT and MR signs were analyzed according to the 2018 version of Liver Imaging Reporting and Data System (LI-RADS), along with causes of misdiagnosis. Twelve patients, including 6 males and 6 females, were enrolled in this study. There was no significant increase in liver tumor markers among all cases. Most masses were multiple (9/12), exhibiting low attenuation on pre-contrast CT scans, T1-hypointense signal, T2-hyperintense signal, and restricted diffusion. The majority of these masses (7/10) demonstrated similar rim arterial phase hyper-enhancement as well as peripheral "washout" during venous portal phase and delayed phase imaging. Three cases had incomplete capsules while one case had a complete capsule. Cyst/necrosis was observed in 7 out of all cases following administration of contrast agent, with 5 mainly distributed in the periphery. All masses lacked fat, calcification, vascular or bile duct tumor thrombus formation. The imaging findings associated with PHNENs possess certain specificity, often presenting as multiple masses within the liver accompanied by peripheral cyst/necrosis, similar rim arterial phase hyper-enhancement during venous portal phase and delayed phase imaging.

Bone marrow edema in children: chronic nonbacterial osteomyelitis and its mimickers.

Bone marrow is a highly cellular tissue undergoing significant developmental and physiologic changes with age. Indeed, with maturation from pediatric to the adult age there is a progressive, centrifugal conversion from red to yellow bone marrow. Histological characteristics of bone marrow are reflected in MR image signal. MR is therefore extremely sensitive in detecting pathological changes which are mostly characterized by increased free water causing high signal intensity on T2. Among the numerous diseases causing bone marrow edema in children chronic nonbacterial osteomyelitis (CNO) certainly has to be mentioned. This idiopathic inflammatory disorder is characterized by nonspecific migrating symptoms like skeletal pain with phases of exacerbations and relapses with alternating acute and chronic MR signs and it is often a diagnosis of exclusion. Hence, with bone marrow edema, various features at imaging should be considered to differentiate malignancies such as osseous lymphoma, osteosarcoma, and Ewing's sarcoma as well as benign lesions like osteomyelitis, post-traumatic, or post-treatment bone marrow edema. The aim of this review is to recall the main characteristics of CNO and provide an overview of its main mimickers highlighting similarities and differences.

Growing skull fracture of the orbital roof: case report and literature review

Growing skull fracture (GSF) of the orbital roof is a rare complication of head injury in infancy and early childhood. Analysis of the Medline database between 1983 and 2023 identified 17 articles describing 63 children after surgical treatment of GSF of the orbital roof. We present a 2-year-old child with moderate traumatic brain injury (TBI) complicated by GSF of the orbital roof. Neuroimaging and literature data are described. Severe ophthalmological symptoms in acute period of TBI subsequently partially regressed with persistent swelling of the upper eyelid and hypophthalmos. CT and MRI revealed a linear fracture of the frontal bone extending to superior orbital wall and intraorbital collection of cerebrospinal fluid (pseudomeningocele) mixed with blood. MR signs of GSF of the orbital roof with pseudomeningocele shrinkage were found in 5 weeks after injury. After 6 months, CT and MRI revealed signs of more severe GSF. Surgical treatment implied craniotomy, excision of scars, arachnoid membrane and abnormal brain matter, resection of deformed fracture edges, dura mater sealing and orbital roof reconstruction with bone autograft. Ophthalmological symptoms regressed after 6 months. The follow-up period was 6 years. There were no signs of fracture recurrence. In this case, acute intraorbital pseudomeningocele led to GSF of the orbital roof in 5 weeks after injury. Incomplete regression of ophthalmological symptoms, their aggravation or delayed appearance in children with orbital roof fracture requires a thorough examination including high-resolution CT and MRI, and orbital roof GSF should be considered in the differential diagnosis.

Analysis of influence of MR signs on Harris score in ARCO stages 2-4 femoral head necrosis

To analysis and determine MR signs of Harris score ARCO stages 2-4 in osteonecrosis of femoral head (ONFH). Thirty-four patients with ONFH of ARCO stages 2 to 4 who underwent routine MR, T2 mapping, 3D-SPACE sequence examination and Harris score were retrospectively collected from January 2019 to June 2020, and 3 patients were excluded, and 31 patients were finally included, including 23 males and 8 females, aged from 18 to 62 years old with an average of(40.0±10.8) years old. Among them 21 patients with bilateral femoral head necrosis, totally 52 cases, including 17 with ARCO stage 2 patients, 24 ARCO stage 3, and 11 ARCO stage 4. MR imaging signs (femoral head collapse depth, ONFH index, bone marrow edema, hyperplasia, grade and T2 value of cartilage injury, and joint effusion) were scored and measured on the picture archiving and communication system (PACS) workstation, and the cartilage quantitative parameter T2 value was calculated and measured on Siemens postprocessing workstation. Pearson correlation analysis was used to evaluate the correlation between various MR signs and Harris score, and then multiple linear regression analysis was used to examine impact of MR signs on Harris hip score. Femoral head collapse depth(r=-0.563, P=0.000), grade of cartilage injury(r=-0.500, P=0.000), and joint effusion (r=-0.535, P=0.000) were negatively correlated with Harris score by Pearson correlation analysis. Multiple linear regression analysis showed that joint effusion(β=-6.198, P=0.001) and femoral head collapse depth(β=-4.085, P=0.014) had a significant negative impact on Harris hip score. Femoral head collapse depth and joint effusion both had significant negative relationship with Harris hip score. It is recommended to routinely evaluate femoral head collapse depth and joint effusion quantitatively and gradedly, so as to efficiently and accurately assist clinical diagnosis and treatment.

Magnetic resonance imaging in assessing the staging of intracerebral hemorrhages in children

The purpose of the study was to evaluate the possibilities of MRI in determining the stage of hemorrhagic stroke (HS) depending on structural and perifocal changes in children.Materials and methods. The study included 46 patients (including 19 boys and 27 girls) aged from the 29th day of life to 18 years, with a clinical picture of cerebrovascular accident and the presence of HS in the brain substance (BS) during an MRI study. For statistical analysis, patients were divided into two groups: group 1 – patients examined in the first 48 hours from the onset of neurological symptoms (21 people), group 2 – after 48 hours (26 people). Comparison in two groups was carried out according to MR signs: the presence of perifocal cytotoxic edema, the presence of perifocal hemorrhagic impregnation, the presence of a cytoplasmic rim. Intergroup comparisons on a qualitative basis were carried out using Fisher's exact test.Results. As a result of the study, differential diagnostic criteria for the stages of HS in children were determined by analyzing the MRI semiotics of hematoma in combination with the symptom complex of perifocal changes (CPC) in the form of perifocal cytotoxic edema, perifocal hemorrhagic impregnation and cytoplasmic rim. Statistically significant differences in the frequency of occurrence of signs of perifocal cytotoxic edema and perifocal hemorrhagic impregnation in the groups were found. The presence of perifocal cytotoxic edema was statistically significant (p = 0.027) more common in group 1 (47% (n = 10), 95% CI 26–69) than in group 2 (16% (n = 4), 95% CI 5–36). The presence of perifocal hemorrhagic soaking was statistically significantly (p = 0.003) more common in group 1 (81% (n = 17), 95% CI 57–93) than in group 2 (36% (n = 9), 95% CI 18–57). In addition, a statistically significant (p = 0.005) difference was found in the incidence of CPC, which was observed in group 1 (28% (n = 6), CI 12–52) and was not observed in group 2 (0%, (n = 0), 95% CI 0–17).Conclusions. The use of T2, T1, FLAIR, SWI and DWI modes (b = 1000) in combination with ADC in the protocol of MRI examination of children is mandatory, and only a comparison of the characteristics of the MR signal from a hematoma in combination with an analysis of perifocal changes allows us to differentiate the stage of hemorrhage. HS in the acute and early subacute stages has a similar MRI semiotics, therefore, it is necessary to assess the complex of perifocal changes, which allows to differentiate these stages, as it is determined in patients examined in the first 48 hours (p < 0.05) and is not observed after two days. SWI analysis makes it possible to differentiate the late subacute stage of hematoma from chronic due to different characteristics of the MR signal, and also allows you to establish the presence of perifocal hemorrhagic impregnation, which contributes to the differential diagnosis of hemorrhage in the early stages of the pathological process.

Vestibular schwannomas with neuroimaging signs of spontaneous regression: frequency of continued growth after surgery

Purpose. To determine the frequency of continued growth after surgical treatment in patients with neuroimaging signs of spontaneous regression of vestibular schwannoma. Material and methods. The study included 55 patients with histologically verified vestibular schwannoma. For a comparative assessment of the results of the study, 2 groups were formed: group I included 58.2 % of patients who had no signs of spontaneous regression (gender ratio — 1:4, more often — women), group II included 41.8 % of patients with the presence of one of the MR signs of regression (gender ratio was 1:1.3). The following parameters were analyzed as the studied MR characteristics: the presence of scalloped borders, the filling of the internal auditory canal with cerebrospinal fluid, and the heterogeneity of the accumulation of contrast agent by the tumor. The retrosigmoid access was used for the patients of the studied groups. Results. The patients with these neuroimaging parameters were characterized by a prolonged asymptomatic period which led to the diagnosis of vestibular schwannoma in the late stages — KOOS 4 (𝜒2=4.8; p<0.03). In the patients with MR characteristics of spontaneous regression with any size of vestibular schwannoma, a high frequency of continued growth after surgical treatment was revealed (p<0.05), which demonstrates the «aggressiveness» of the course of the disease. The results obtained indicate the need for increased oncological alertness in these patients. Conclusions. A detailed study of the MR characteristics of spontaneous regression of vestibular schwannomas can improve the patients’ quality of life and treatment outcomes.

Possibilities of MRI in the differential diagnosis of non-lactative mastitis and cancer

Non-lactational mastitis is an inflammatory process in the breast tissue that is not associated with lactation. The detection of a malignant transformation during inflammation process is often difficult, because it has similar clinical manifestations. Medical approach depends on the characteristics of the processes which are received from the data obtained from radiation diagnostic methods: whether or not there is a nodular formation or infiltrate, cystic cavities, dilatation of the ducts, how the axillary lymph nodes are changed. Diagnostic errors in inflammatory breast diseases are quite common; according to the literature, errors in the interpretation of clinical, mammographic, and ultrasound signs of cancer during inflammation account for up to 53.1% of cases. Inflammation, as well as cancer, in majority of cases is accompanied by a visually detectable increase in blood flow due to proliferation and neoangiogenesis. Magnetic resonance imaging with dynamic contrast enhancement (MRI) is highly sensitive in detecting areas with increased vascularization and makes it possible to assess their nature with a high degree of probability during any changes in the structure of the breast tissue, including edema and inflammatory infiltration. MR signs that allow to make differential diagnosis are a combination of pathological accumulation and lymphadenopathy, which are coded by the BIRADS system as category 4 and only the absence of contrast agent accumulation may suggest an inflammatory nature of the changes. According to the literature, MRI-DCE is a highly sensitive diagnostic method of identifying cancer during inflammation processes. The results of 85 MR studies with clinical manifestations of non-lactational mastitis were analyzed.The purpose of study: is to evaluate the possibilities of magnetic resonance mammography in making a differential diagnosis of non-lactational mastitis and breast cancer.

The MR mammography of phyllodes tumors of different histological grades

Purpose: to evaluate retrospectively the MR data of the breast phyllodes tumors and to perform comparative analysis of the MR signs and the histological grade of the phyllodes tumors.Materials and methods. The analyses enrolled 27 pathologically confirmed phyllodes tumors (mean age of patient 37.8 y.o.). Following features were evaluated: tumor shape and structure, margins, size, type of contrast enhancement, foci of high signal intensity on the T1-WI, foci of hypo- or isointense signal on the T2-WI comparing with intact breast tissue, presence of cystic inclusions and the type of their margins.Results. The study included 18 benign, 4 borderline and 5 malignant phyllodes tumors. The following features showed significant correlation with the tumor grade: irregular margins of the cystic foci (p = 0.003), foci of hypoor isointense signal on the T2-WI compared with intact breast tissue (p = 0.005). Foci of high signal intensity on the T1-WI were often revealed in the malignant (3/5) and borderline tumors (2/4), but this dependence was not significant (p = 0.021). According to pathomorphological correlation the foci of the high signal intensity on the T1-WI corresponded to hemorrhages, while cystic foci with irregular margins were revealed to be foci of necrosis. The foci of hypo- or isointense signal on the T2-WI compared with intact breast tissue corresponded to the hypercellular stroma.Conclusion. Specific features of phyllodes tumors are useful in differentiation of their histological types; furthermore the MR mammography provides accurate data for planning the point of biopsy.

Tactics of Surgical Treatment of Slipped Capital Femoral Epiphysis Associated With Mild Chronic Epiphyseal Displacement

Background. The appearing of data on cam-type FAI in patients with sequelae of slipped capital femoral epiphysis characterized by mild chronic epiphyseal displacement suggests that along with fixation of the proximal femoral epiphysis, modeling of the head-neck transition and restoration of the femoral offsets using arthroscopic techniques should be performed. Meanwhile, it is well known that after epiphyseal fixation, complete remodeling of the epimetaphysis and, consequently, disappearance of the morphological substrate of potential FAI can occur due to the ongoing enchondral and echondral growth. In this regard, the issue of indications for intraarticular interventions in studied patients remains currently open. The aim of the study was to determine the incidence of FAI in the postoperative period in patients with slipped capital femoral epiphysis characterized by mild chronic epiphyseal displacement, and to estimate the requirement of further surgical treatment. Methods. The results of the examination of 32 patients with mild chronic epiphyseal displacement in the typical posterior inferior direction who underwent cannulated epiphyseal screw fixation were analyzed for the severity of epimetaphysis remodeling and the presence of FAI in the postoperative period. Clinical, radiological, magnetic resonance, and statistical methods were used. Results. At the age of 18-19 years, FAI with pain syndrome in everyday life was found in 9 (28.1%) patients 8 of them did not have even partial remodeling of the femoral component of the joint, another 9 (28.1%) patients did not suffer from pain syndrome in everyday life, but had other clinical, radiological and MR signs of cam-type FAI. Complete or almost complete remodeling of the proximal femoral epimetaphysis occurred in 14 (43.8%) patients. Conclusion. In our opinion, therapeutic and diagnostic arthroscopy of the hip joint for the purpose of modeling the head-neck transition at the age of 18-19 years is indicated for more than one quarter (28.1%) of the investigated patients because of the presence of reliable signs of FAI.

Clinical and diagnostic observation of transitional cell carcinoma recurrence in the ureteral stump: a case report

Urothelial cancer of the upper urinary tract is quite rare and accounts for 5–10% of all cases of urothelial cancer. Radiation research methods, primarily computer and magnetic resonance imaging, are leading in monitoring and detecting recurrence after surgery on the organs of the urinary system. A rare clinical case of recurrence of transitional cell carcinoma of the upper urinary tract in the ureteral stump is presented. The article, with an emphasis on radiodiagnosis, outlines a step-by-step follow-up of a patient with primary cancer of the upper third of the ureter (рT2N0M0), who was hospitalized in the city clinical hospital for pain in the right lumbar region. During dynamic contrast enhancement multiparametric MRI, a recurrence of the disease was established with a lesion of the non-removed stump of the right ureter. Semiotic MR signs of recurrence of transitional cell carcinoma of the upper urinary tract are described. The recurrent tumor of the ureteral stump was characterized by a moderate hyperintense T2WI MR signal and an isointense T1WI MR signal. Our data indicate lower ADC values in the tumor when measured by a large ROI (937 mm2, versus 796 mm2 ROI with a small size). The dynamic contrast enhancement performed in our study showed intensive accumulation of the contrast by the recurrent tumor.

Anti-MuSK myasthenia after allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia

Anti-MuSK myasthenia is a chronic autoimmune disease caused by violation of the function of the agrin-MuSK-Lrp4 complex, accompanied by the development of pathological muscle fatigue and often muscle atrophy. The disease can be a primary, as well as a complication of immunosuppressive therapy and hematopoietic stem cell transplantation. We present a case of anti-MUSK myasthenia gravis that developed after allogeneic HSCT due to acute myeloid leukemia in a 44-year-old patient (born in 1975). A distinctive feature of the case was a generalized injury, including not only extraocular, but also paravertebral muscles, dropped head syndrome in the evening. In addition, laboratory, electroneuromyographic and neuroimaging (MRI of muscles, MR-spectroscopy) data indicating the neurogenic reversible nature of changes in the involved musculature are presented.Results. This study presents MRI and EMG signs of neurogenic damage of axial musculature in a patient with weakness and swelling of the paravertebral muscles (edematous changes according to STIR, corresponding to MR signs of early functional denervation) for a period of 2–4 months, due to anti-MUSK myasthenia gravis. Clinical manifestations, as well as edematous neurogenic changes in the paravertebral muscles, regressed after pathogenetic therapy. Conclusion. The article presents up-to-date data on the clinical and instrumental characteristics of myasthenia gravis. The considered clinical example confirms the presence of neurogenic changes at an early stage of anti-MUSK myasthenia gravis and indicates the need for immediate initiation of pathogenetic therapy to avoid the development of atrophy and fatty infiltration of muscles.

Noninvasive Determination of the IDH Status of Gliomas Using MRI and MRI-Based Radiomics: Impact on Diagnosis and Prognosis.

Gliomas are the most common primary malignant brain tumors in adults. The fifth edition of the WHO Classification of Tumors of the Central Nervous System, published in 2021, provided molecular and practical approaches to CNS tumor taxonomy. Currently, molecular features are essential for differentiating the histological subtypes of gliomas, and recent studies have emphasized the importance of isocitrate dehydrogenase (IDH) mutations in stratifying biologically distinct subgroups of gliomas. IDH plays a significant role in gliomagenesis, and the association of IDH status with prognosis is very clear. Recently, there has been much progress in conventional MR imaging (cMRI), advanced MR imaging (aMRI), and radiomics, which are widely used in the study of gliomas. These advances have resulted in an improved correlation between MR signs and IDH mutation status, which will complement the prediction of the IDH phenotype. Although imaging cannot currently substitute for genetic tests, imaging findings have shown promising signs of diagnosing glioma subtypes and evaluating the efficacy and prognosis of individualized molecular targeted therapy. This review focuses on the correlation between MRI and MRI-based radiomics and IDH gene-phenotype prediction, discussing the value and application of these techniques in the diagnosis and evaluation of the prognosis of gliomas.

The possibilities of magnetic resonance imaging in the differential diagnosis of diabetic osteoarthropathy and osteomyelitis

Introduction. The problem of differential diagnostics of diabetic osteoarthropathy (DOAP) and osteomyelitis (OM) of the foot bones for patients with diabetes mellitus is still not finally solved, even with the use of MR imaging.The aim of the study. To find the MR signs that most accurately indicate the development of osteomyelitis (OM) of the foot bones in patients with diabetic osteoarthropathy (DOAP).Materials and methods. The study included 62 patientswho successfully completed treatment of uncomplicated or complicated DOAP and had the whole set of diagnostic criteria. They were divided into three groups: acute form of DOAP (n=31), DOAP+soft tissue infection (STI) (n=11) and DOAP+OM (n=20). There were identified6 MR-signs, which could become significant independent classifiers for the differential diagnostics of complicated and uncomplicated forms of DOAP. The diagnostic significance of MR symptoms was assessed in several steps with the use of various methods of statistical analysis.Results. There was revealed that the groups differ among themselves by 4 MR signs: characteristics of bone marrow edema (p=0.003); swelling of the supporting surfaces (p=0.006); restriction of diffusion in the bone marrow (p=0.001); fistulous course (p=0.001). Points were assigned to these MR criteria. According to the total MR score, groups 1 and 3 (p<0.001); 2 and 3 (p=0.001) differed among themselves. With the use of logistic regression and ROC analysis, we determined the significance of the total MR score for the diagnostics of osteomyelitis. Conclusion. The use of the MR-score summation system helped in the diagnosis of OM. The sum of MR scores ≥3 in the developed scoring system allowsto diagnose OM with high sensitivity (94.1%) and specificity (83.3%). >˂0.001); 2 and 3 (p=0.001) differed among themselves. With the use of logistic regression and ROC analysis, we determined the significance of the total MR score for the diagnostics of osteomyelitis.Conclusion. The use of the MR-score summation system helped in the diagnosis of OM. The sum of MR scores ≥3 in the developed scoring system allowsto diagnose OM with high sensitivity (94.1%) and specificity (83.3%).

Primary signs of pituitary macroadenomas of diff erent hormonal activity and specialists to whom patients referred at the fi rst time

Purpose: evaluate the fi rst complaints of patients with pituitary macroadenomas, as well as the specialization of doctors, to whom they referred at the fi rst time.Material and methods: data of medical records of 343 patients with pituitary macroadenomas (at least one tumor size >10 mm) were analyzed: non-functioning pituitary adenomas (NFPA, n=143), prolactinomas (n=67), somatotropinomas (n =133). Patients were examined prior to any treatment.Results: In total, the most common fi rst complaints of patients with pituitary macroadenomas were: headache - 137/343 (40%), visual impairment - 86/343 (25%), general weakness and fatigue - 69/343 (20.1%), in female patients of reproductive age - menstrual irregularities. Headache did not depend on tumor size and volume, while visual disturbances were more common in patients with larger tumor volume and MR signs of chiasm compression. Th e most oft en patients with pituitary macroadenomas referred to: a neurologist 91/343 (26.5%), an ophtalmologist 44/343 (12.8%), 44/265 (16.6%) a gynecologist and a general practitioner – according to 41/343 (12%).Conclusions: A neurologist, ophthalmologist, gynecologist, and general practitioner should be aware of a pituitary macroadenoma in patients with headaches, visual disturbances, menstrual disorders (in women of reproductive age) and non-specific general complaints that may be a marker of the presence of a pituitary tumor macroadenoma.

Anaplastic pleomorphic xanthoastrocytoma - single-center analysis of 42 patients

To study neuroimaging, morphological features of tumors, as well as factors affecting treatment and prognosis. A retrospective study enrolled 42 patients operated on at the Burdenko Neurosurgery Center between 2003 and 2020. MR characteristics of anaplastic pleomorphic xanthoastrocytoma were analyzed. All patients underwent resection of tumor (total resection in 83.3% of cases). Redo surgeries were performed in 1/3 of patients. Mutational status of BRAF V600E was assessed in all patients. Adjuvant radio- and chemotherapy was performed in more than 80% of cases. Tyrosine kinase inhibitors were administered in 19% of cases. The follow-up period was 152 months (median 34 months). We found no pathognomonic MR signs of this disease. Indeed, anaplastic pleomorphic xanthoastrocytoma have the same signal characteristics as other malignant gliomas. The BRAF V600E mutation status was positive in 54.8% of cases. None patient had IDH-1 mutation. Mean Ki-67 index was 12.5%. The overall survival was 79 months (range 4-152). Seven (17%) patients are alive for more than 90 months. Only Ki-67 index and BRAF mutation significantly influenced the treatment prognosis and overall survival regardless the use of tyrosine kinase inhibitors. Such well-known factors for malignant glioma as patient age, total resection and adjuvant therapy did not significantly affect overall survival. Perhaps, searching for new molecular genetic features will reveal additional significant factors of prognosis in patients with anaplastic pleomorphic xanthoastrocytoma.

Computed tomography and endovascular occlusion in diagnosis and treatment of spontaneous bleeding into soft tissues of abdominal, chest wall and retroperitoneal space in patients with COVID-19

To investigate the results of therapeutic and prophylactic endovascular hemostasis of spontaneous bleeding into soft tissues of abdominal, chest wall and retroperitoneal space in patients with COVID-19. We retrospectively studied 35 patients with COVID-19 complicated by spontaneous bleeding into soft tissues of abdominal, chest wall and retroperitoneal space. According to CT data, the volume of hematoma was 1193.4±706.1 ml. In all patients, CT signs of ongoing bleeding were detected. Moreover, contrast agent extravasation in all phases of examination was established in 15 patients. In other ones, extravasation was detected in late phases or study phase was not identified. All patients underwent angiography. Ongoing bleeding was detected in 12 (34.3%) patients (group 1). They underwent embolization of the target vessel. In 23 patients, bleeding was not established during angiography. Of these, 13 ones underwent prophylactic embolization (group 2). No embolization was carried out in 10 patients (group 3). All groups differed in hematoma localization and COVID-19 severity. Fourteen (40%) patients died in postoperative period. Mortality was similar in all groups. The most common cause of death was progressive respiratory failure following pneumonia. The last one was established by autopsy in 10 (71.4%) patients. Angiography confirmed MR signs of contrast agent extravasation in 34.3% of patients. In case of extravasation in all CT phases, ongoing bleeding was confirmed in 66.7% of patients. Endovascular embolization is effective for arterial bleeding into soft tissues. However, large-scale studies are needed to assess the effect of this technique on survival.

Analysis of MR Signs to Distinguish Between ARCO Stages 2 and 3A in Osteonecrosis of the Femoral Head.

MRI is the most effective diagnostic tool of osteonecrosis of the femoral head (ONFH), especially for early diagnosis, but its detection of subchondral or cortical fractures is less accurate than CT. Therefore, it is difficult to accurately stage ONFH in the peri-collapse period by MRI. To improve the accuracy of MR for distinguishing between Association Research Circulation Osseous (ARCO) stages 2 and 3A in ONFH. Retrospective. One hundred and fifty five cases of ARCO stage 2/3A of ONFH underwent MR examinations, M/F=72/83. CT was used as reference standard for collapse, which was decided by an orthopedist and a radiologist in consultation. 3 T/axial and coronal T1 -weighted Turbo Spin Echo (T1 W TSE) sequence, axial T2 -weighted fat-saturated (T2 W FS) TSE sequence, and coronal proton density-weighted imaging (PDWI)-FS-Dixon fat/water image. Five potential MR signs (the maximum width of the necrotic-viable interface, bone marrow edema (BME), irregular articular surface of the femoral head, T2 heterogeneous high signal, and the absence of a necrotic-viable interface with the morphology of closed loop) were evaluated blindly by five radiologists independently and the total scores of different combinations of MR signs were calculated. Mann-Whitney U test and Chi-square test were used to evaluate age, gender, and MR signs differences between the two groups. ROC curve was used to access the distinguishing value of MR signs. The consistency of the five radiologists was analyzed by intraclass correlation coefficient. The area under the curve of the combined MR signs 2 for distinguishing between ARCO stages 2 and 3A was the greatest (0.967), sensitivity and specificity were 100.00% and 88.71% respectively, and greater than 1 was the threshold. Combined MR signs 2 has great values in distinguishing between ARCO stages 2 and 3A in ONFH, thus helping clinical therapy. 4 TECHNICAL EFFICACY: Stage 2.

The feasibility of SPECT CZT measurement of myocardial blood flow and reserve in patients with acute coronary syndrome: comparison with cardiac magnetic resonance

Abstract Funding Acknowledgements Type of funding sources: None. Background. Myocardial infarction with non-obstructive coronary arteries (MINOCA) is currently of interest in terms of diagnostic and treatment strategy. The diagnosis of MINOCA has been included in the STEMI guidelines of the European Society of Cardiology. However, there is lack of data regarding the relationship between myocardial damage according to cardiac magnetic resonance (CMR) and myocardial blood flow (MBF), myocardial flow reserve (MFR) obtained by dynamic SPECT. Purpose. To elucidate impairment of myocardial perfusion, MBF and MFR in patients with MINOCA. Methods. The study included 31 patients (21 men, age 62(56;70) years) with ASC. According to electrocardiography, cardiac biomarkers, invasive coronary angiography two groups were identified: with non-obstructive coronary arteries MINOCA (n = 10); MICAD (n = 21). Within 7-14 days after admission to the hospital all patients underwent dynamic SPECT on CZT gamma-camera with the assessment of standard indices of myocardial perfusion (SSS, SRS, SDS) and quantitative parameters (stress/rest myocardial blood flow (s/r MBF), myocardial flow reserve (MFR)). All patients underwent CMR with late gadolinium enhancement as well. Infarct size (IS), microvascular obstruction (MVO) and myocardial edema size (ME) were evaluated. Results. SSS and SRS differed significantly (p < 0.05) in MINOCA and MICAD patients: MINOCA: SSS 5.0(3.0;5.0), SRS 2.0(1.0;3.0); MICAD: SSS 9.0(5.0;13.0), SRS 6.0(3.0;11.0). However, SDS did not differ significantly in these two groups 2.5(1.0;4.0) vs 4.0(2.0;5.0). Moreover MINOCA patients in comparison with those with MIACD had higher values of quantitative parameters (p < 0.05): sMBF 2.02 (1.71;2.37) vs 0.86 (0.72;1.02) ml/min/g, rMBF 0.68 (0.66;0.86) vs 0.49 (0.4;0.57) ml/min/g, MFR 2.61 (2.23;3.14) vs 1.67 (1.1;1.9), respectively. Based on CMR, a total of 93 left ventricular vessel territories were analyzed. A total of 36(39%) vessel territories were considered as having acute myocardial injury (5 in MICAD, 31 in MINOCA). In patients with MICAD the values of IS, ME were significantly higher as compared to those with MINOCA (IS: 19.4(10.4;29.7)% vs1.8(0.0;6.9)%, ME: 19.5(12.0;30.0)% vs 3.0(0.0;12.0)% - p < 0.01). Based on regional analysis sMBF and MFR were significantly lower in vessel territories considering as CMR positive compared to those without MR signs of myocardial injury: regional sMBF 0.98(0.73;1.79) vs 1.33(0.94;2.08); regional MFR 0.58(0.43;0.9) vs 0.71(0.57;0.88), respectively. Conclusion. SPECT CZT is feasible in identifying both global and regional disturbances of myocardial blood flow and reserve in patients with acute coronary syndrome. MINOCA patients are characterized by mild reduction of myocardial blood flow and perfusion assessed visually and quantitatively. Therefore despite the absence of obstructive coronary artery lesion this group of patients has more pronounced risk of cardiac events and need more aggressive observation and treatment.

Семейные случаи подострой некротизирующей энцефаломиелопатии (синдрома Ли)

Mitochondrial diseases are not uncommon. However, their genetic diagnosis is challenging for practitioners and requires up-to-date hightech methods. Early accurate diagnosis in first probands provides early preclinical genetic testing in all born children in compromised families and prenatal testing in future pregnancies, thereby allowing a differential planning of future pregnancies. This paper discusses a progressive central nervous system disorder, a congenital mitochondrial disease, subacute necrotizing encephalomyelopathy (Leigh syndrome). First, the authors briefly review etiology, prevalence, clinical presentations, diagnostic techniques, and treatment for this disease in children. Then, unique familial cases describing the diversity of clinical presentations are described. The diagnosis was genetically verified in all patients. MR signs always accompany the gradual loss of motor skills at early stages. Blood biochemistry identifies lactic acidosis. KEYWORDS: children, mitochondrial diseases, subacute necrotizing encephalomyelopathy, lactic acidosis, Leigh syndrome, diagnosis, mutations in the SURF1 gene. FOR CITATION: Shishkina E.V., Bazilevskaya T.N., Novikova I.V. et al. Familial cases of subacute necrotizing encephalomyelopathy (Leigh syndrome). Russian Journal of Woman and Child Health. 2021;4(4):370–374 (in Russ.). DOI: 10.32364/2618-8430-2021-4-4-370-374.