Risk factors for early intraventricular hemorrhagic complications following lateral ventricular tumor surgery.

The complications anticipated in the postoperative period after surgical resection of lateral ventricular neoplasms (LVN) are hemorrhage, hydrocephalus. At the N.N. Burdenko Neurosurgery Center, 48 patients with LVN underwent surgical resection. We focused on the correlation between approaches to the ventricular system on one hand and the extent of resection and incidence of complications on the other based on anatomical and perfusion characteristics estimated via preoperative magnetic resonance imaging (MRI) with arterial spin labeling perfusion. By eliminating the surgical approach as a potential risk factor, we were able to demonstrate the correlation between the frequency of postoperative hemorrhage, the Evans index value, patient's gender, tumor blood flow (nTBF) and the location of the mass in the anterior horn of the lateral ventricle. The risk of hemorrhage depends on the patient's gender, presence of hydrocephalus, location of the mass and tumor blood flow values. The risk increases along with increase in Evance index and nTBF values.

[Growing skull fracture of the orbital roof: case report and literature review]. / Rastushchii perelom verkhnei stenki orbity. Klinicheskii sluchai i obzor literatury.

BACKGROUND: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.

[Focal cortical dysplasia: visual assessment of MRI and MR morphometry data]. / Fokal'naya kortikal'naya displaziya: sravnitel'nyi analiz vizual'noi otsenki dannykh magnitno-rezonansnoi tomografii i magnitno-rezonansnoi morfometrii.

OBJECTIVE: Assessing the diagnostic significance of MR morphometry in determining the localization of focal cortical dysplasias (FCD). MATERIAL AND METHODS: The study included 13 children after surgery for drug-resistant epilepsy caused by FCD type II and stable postoperative remission of seizures (Engel class IA, median follow-up 56 months). We analyzed the results of independent expert assessment of native MR data by three radiologists (HARNESS protocol) and MR morphometry data regarding accuracy of FCD localization. We considered 2 indicators, i.e. local cortical thickening and gray-white matter blurring. RESULTS: FCD detection rate was higher after MR morphometry compared to visual analysis of native MR data using the HARNESS protocol. MR morphometry also makes it possible to more often identify gray-white matter blurring as a sign often missed by radiologists (p<0.05). CONCLUSION: MR morphometry is an additional non-invasive method for assessing the localization of FCD.

[Analysis of intracranial saccular aneurysm wall: neuroimaging and histopathological correlates]. / Issledovanie stenki intrakranial'nykh meshotchatykh anevrizm: neirovizualizatsionnye i gistopatologicheskie korrelyaty.

BACKGROUND: Contrast enhancement of intracranial aneurysm wall during MRI with targeted visualization of vascular wall correlates with previous aneurysm rupture and, according to some data, may be a predictor of further rupture of unruptured aneurysms. OBJECTIVE: To analyze possible causes of aneurysm contrast enhancement considering morphological data of aneurysm walls. MATERIAL AND METHODS: The study included 44 patients with intracranial aneurysms who underwent preoperative MRI between November 2020 and September 2022. Each aneurysm was assessed regarding contrast enhancement pattern. Microsurgical treatment of aneurysm was accompanied by resection of its wall for subsequent histological and immunohistochemical analysis regarding thrombosis, inflammation and neovascularization. Specimens were subjected to histological and immunochemical analysis. Immunohistochemical analysis was valuable to estimate inflammatory markers CD68 and CD3, as well as neurovascularization marker SD31. RESULTS: Aneurysms with contrast-enhanced walls were characterized by higher number of CD3+, CD68+, CD31+ cells and parietal clots. Intensity of contrast enhancement correlated with aneurysm wall abnormalities. CONCLUSION: Contrast enhancement of aneurysm wall can characterize various morphological abnormalities.

[National and world experience in functioning of centers for collective use of biological resource collections of tumors of the central nervous system]. / Analiz mirovogo i otechestvennogo opyta funktsionirovaniya tsentrov kollektivnogo pol'zovaniya bioresursnymi kollektsiyami opukholei tsentral'noi nervnoi sistemy.

Collective use center is an organization or structural unit with unique resource providing access to this resource for internal and third-party users. Collective use centers are a relatively new phenomenon in bioresource collections, especially collections of human biological material due to some ethical and legal issues. At the same time, the demand for human biological material continues to grow in fundamental and applied researches. The collective use center «Bioresource collection of tissues and cell cultures of tumors of the human nervous system for fundamental and applied researches¼ has worked since October 14, 2022. This center has access to unique collection of the Laboratory of Neurosurgical Anatomy and Conservation of Human Biological Tissues of the Burdenko Neurosurgical Center. OBJECTIVE: To analyze the experience of collective use center and biobank of the Burdenko Neurosurgical Center compared to national and international data on functioning of collective use centers specializing in tumors of the human central nervous system. MATERIAL AND METHODS: We reviewed the PubMed and e-Library databases using the following keywords: core facilities brain tumors, repository of collective use brain tumors, biobank of CNS tumors, central nervous system tumor collection centers. We also analyzed the organizations registered on the portal of scientific and technical infrastructure of the Russian Federation. RESULTS: We analyzed 275 publications devoted to collective use centers and biobanks. These biobanks do not position themselves as collective use centers but actively realize biological material for researches. Structure of institutions presented on the portal of scientific and technical infrastructure of the Russian Federation is characterized. The collective use center «Bioresource collection of tissues and cell cultures of tumors of the human nervous system for fundamental and applied researches¼ has access to biobank of the Burdenko Neurosurgical Center. To date, the biobank contains more than 8478 aliquots of tumor tissue frozen at ultra-low temperature (-196°C) and obtained from 1993 patients. Considering available data, we established the basic principles of work in collective use centers with bioresource collections. CONCLUSION: Collective use centers with bioresource collections of tumors of the central nervous system are rare. There is only one collective use center organized at the Burdenko Neurosurgical Center on the portal of scientific and technical infrastructure of the Russian Federation. At the same time, there is an urgent need to increase their number and activity in Russia and other countries worldwide. You can use the resource of brain tumor collections by leaving a request on the official website of this organization in the «Collective use center¼ section.

Imaging methods in polymyalgia rheumatica: a systematic review.

Polymyalgia rheumatica (PMR) is an inflammatory joint disease in patients over 50 years of age with pain and prolonged morning stiffness in the shoulder and hip girdles and neck. The lack of specific clinical findings, laboratory signs, biomarker and established imaging methods makes it difficult to diagnose patients with this disease. The aim of the systematic review is to present the literature data on the use of imaging methods for early diagnosis, assessment of disease activity and therapeutic response in PMR. At the same time, the advantages, disadvantages and contraindications of each method are considered. A literature search was carried out in PubMed and Scopus up to June 2022. Studies were selected that met the following criteria: (1) English language publications in peer-reviewed journals, (2) cohort or case-control studies and a series of more than five clinical cases, (3) studies of newly diagnosed or suspected PMR patients according to classification criteria or expert opinion, (4) imaging evaluation of articular, extraarticular and vascular impairment in PMR. Out of a total of 1431 publications, 61 articles were selected, which differed in the imaging techniques used: radiography (5), scintigraphy (4), magnetic resonance imaging (14), PET/CT (14) and ultrasound (24). Prevalence of extraarticular involvement (tendons, entheses and bursae) was identified in patients with PMR. In a significant number of cases, subclinical vasculitis of the large vessels was found, confirming the common pathogenetic pathways of the two diseases. The diagnostic, therapeutic and prognostic potential of imaging methods in PMR has been relatively poorly studied and remains to be clarified.

[Magnetic resonance imaging of saccular intracranial aneurysm wall]. / MR-vizualizatsiya sosudistoi stenki meshotchatykh intrakranial'nykh anevrizm.

BACKGROUND: Hemorrhage from intracranial aneurysms is associated with high risk of adverse outcomes. In this regard, surgical treatment of unruptured asymptomatic aneurysms has been actively developed in recent decades. One of the objectives is searching for predictors of aneurysm rupture to clarify the indications for surgery. Non-invasive analysis of vascular wall is actively discussed in last years. OBJECTIVE: To evaluate the possibilities of MRI of ruptured and unruptured intracranial aneurysm walls and determine clinical significance of certain morphological patterns. MATERIAL AND METHODS: The study included 111 patients with 158 ruptured and unruptured saccular aneurysms who underwent MRI according to a special protocol between November 2020 and September 2023. We analyzed each aneurysm regarding features of contrast enhancement and changes in SWAN images. After that, we compared these data with ruptures. RESULTS: Wall of ruptured and unruptured aneurysms can accumulate contrast agent. We found 5 types of contrast enhancement. Thick-layer contrast enhancement was accompanied by 9.6-fold higher risk of aneurysm rupture compared to aneurysms without contrast enhancement. Dark MR signal from intracranial aneurysm wall in SWAN imaging is a significant sign of rupture. CONCLUSION: MRI of the vascular wall is valuable to verify ruptured aneurysms. Unruptured aneurysms can accumulate contrast agent inside the wall, and pattern of accumulation differs from ruptured aneurysms. Morphological analysis is needed to confirm contrast enhancement as a marker of aneurysm rupture.

[The first application of intraoperative mri for analysis of cerebral perfusion in surgical brain revascularization]. / Pervoe primenenie intraoperatsionnoi MRT dlya issledovaniya tserebral'noi perfuzii pri khirurgicheskoi revaskulyarizatsii golovnogo mozga.

BACKGROUND: Effectiveness of surgical revascularization in patients with chronic cerebral ischemia depends on restoration of circulation in the damaged artery. Modern methods do not take into account dynamic changes in cerebral perfusion after extra-intracranial microvascular anastomosis (EICMA) and do not allow timely localizing the areas of persistent perfusion deficit. We propose a new method for determining the tactics of surgical cerebral revascularization based on intraoperative MRI (iMRI) perfusion data. This method provides the earliest information on intraoperative brain reperfusion. OBJECTIVE: To develop the principles of dynamic assessment of cerebral blood flow using intraoperative ASL perfusion during surgical revascularization in patients with chronic cerebral ischemia and to determine the indications for additional anastomoses. MATERIAL AND METHODS: Surgical revascularization with intraoperative MRI perfusion was performed in 27 patients between March 2022 and April 2023. There were 10 patients with post-thrombotic occlusion of internal carotid artery, 4 patients with occlusion of middle cerebral artery and 13 patients with moyamoya disease. All patients underwent MRI before surgery. After imposing the first EICMA, all patients underwent ASL perfusion for analysis of residual hypoperfusion zones, signs of local hyperperfusion and indications or contraindications for additional revascularization with the second donor branch. RESULTS: In all cases, iMRI made it possible to determine the tactics of brain revascularization using one or two EICMA. In 17 cases, ASL perfusion confirmed the targeted improvement of cerebral blood flow (CBF) in the entire hemisphere or middle cerebral artery basin. Only one EICMA was imposed in these cases. In 10 cases, a single anastomosis was insufficient for restoration of blood flow. These patients underwent additional revascularization with the second donor branch (35.7%). In all cases, we achieved significant quantitative improvement in CBF and volume of brain tissue with restored blood flow (ASPECTS scale). A single EICMA was followed by increase in CBF and areas of restored blood flow by almost 2 times (22.7±9.6 ml/100 g/min and 4.7±1.8 scores (ASPECTS) before surgery vs. 39.4±16.4 ml/100 g/min and 4.7±1.8 scores after EICMA). In the double EICMA group, these parameters increased by almost 3 times (18±3.1 ml/100 g/min and 3.8±0.9 scores before surgery vs. 57±11.4 ml/100 g/min and 7.7±1.5 scores after double EICMA). All patients had no complications. Neurological status improved immediately after surgery in 9 patients (33.3%), stable postoperative period was observed in 12 cases (44.4%). Six (22.2%) patients had transient neurological deficit associated with hyperperfusion syndrome that regressed within a few days after surgery. There were no persistent ischemic complications. CONCLUSION: Intraoperative ASL perfusion is an effective and informative tool for determining the degree of restoration of blood flow. We can timely adjust surgical strategy, determine the indications or contraindications for additional revascularization and exclude early ischemic complications using this method.

[Metastatic brain lesion following gastrointestinal stromal tumor of the stomach complicated by coma.( A case report and literature review)]. / Metastaticheskoe porazhenie golovnogo mozga gastrointestinal'noi stromal'noi opukhol'yu zheludka, oslozhnivsheesya razvitiem komatoznogo sostoyaniya. (Opisanie sluchaya i obzor literatury).

The authors present an extremely rare case of metastatic brain lesion in a patient with gastrointestinal stromal tumor of the stomach. There are literature data on 23 cases of metastatic lesions of the brain, skull and soft tissues of the head in similar patients. Atypical localization of metastases can lead to some diagnostic difficulties, unreasonable cancellation of chemotherapy and delayed surgical treatment. A feature of our observation was postoperative coma determined by the features of the underlying disease.

[Non-invasive diagnosis of brain gliomas by histological type using neuroradiomics in standardized regions of interest: towards digital biopsy]. / Neinvazivnaya diagnostika gliom golovnogo mozga po gistologicheskomu tipu s pomoshch'yu neiroradiomiki v standartizirovannykh zonakh interesa: na puti k tsifrovoi biopsii.

The future of contemporary neuroimaging does not solely lie in novel image-capturing technologies, but also in better methods for extraction of useful information from these images. Scientists see great promise in radiomics, i.e. the methodology for analysis of multiple features in medical image. However, there are certain issues in this field impairing reproducibility of results. One such issue is no standards in establishing the regions of interest. OBJECTIVE: To introduce a standardized method for identification of regions of interest when analyzing MR images using radiomics; to test the hypothesis that this approach is effective for distinguishing different histological types of gliomas. MATERIAL AND METHODS: We analyzed preoperative MR data in 83 adults with various gliomas (WHO classification, 2016), i.e. oligodendroglioma, anaplastic oligodendroglioma, anaplastic astrocytoma, and glioblastoma. Radiomic features were computed for T1, T1-enhanced, T2 and T2-FLAIR modalities in four standardized volumetric regions of interest by 356 voxels (46.93 mm3): 1) contrast enhancement; 2) edema-infiltration; 3) area adjacent to edema-infiltration; 4) reference area in contralateral hemisphere. Subsequently, mathematical models were trained to classify MR-images of glioma depending on histological type and quantitative features. RESULTS: Mean accuracy of differential diagnosis of 4 histological types of gliomas in experiments with machine learning was 81.6%, mean accuracy of identification of tumor types - from 94.1% to 99.5%. The best results were obtained using support vector machines and random forest model. CONCLUSION: In a pilot study, the proposed standardization of regions of interest demonstrated high effectiveness for MR-based differential diagnosis of oligodendroglioma, anaplastic oligodendroglioma, anaplastic astrocytoma and glioblastoma. There are grounds for applying and improving this methodology in further studies.

3D pseudo-continuous arterial spin labeling-MRI (3D PCASL-MRI) in the differential diagnosis between glioblastomas and primary central nervous system lymphomas.

PURPOSE: The aim of the study was to compare the parameters of blood flow in glioblastomas and primary central nervous system lymphomas (PCNSLs), measured by pseudo-continuous arterial spin labeling MRI (3D PCASL), and to determine the informativeness of this method in the differential diagnosis between these lesions. METHODS: The study included MRI data of 139 patients with PCNSL (n = 21) and glioblastomas (n = 118), performed in the Burdenko Neurosurgical Center. No patients received chemotherapy, hormone therapy, or radiation therapy prior to MRI. On the 3D PCASL perfusion map, the absolute and normalized values of tumor blood flow were calculated in the glioblastoma and PCNSL groups (maxTBFmean and nTBF). RESULTS: MaxTBFmean and nTBF in the glioblastoma group were significantly higher than those in the PCNSL group: 168.9 ml/100 g/min versus 65.6 and 9.3 versus 3.7, respectively (p < 0.001). Arterial spin labeling perfusion had high sensitivity (86% for maxTBFmean, 95% for nTBF) and specificity (77% for maxTBFmean, 73% for nTBF) in the differential diagnosis between PCNSL and glioblastomas. Blood flow thresholds were 98.9 ml/100 g/min using absolute blood flow values and 6.1 using normalized values, AUC > 0.88. CONCLUSION: The inclusion of 3D PCASL in the standard MRI protocol can increase the specificity of the differential diagnosis between glioblastomas and PCNSL.

[Crossed aphasia in neurosurgical practice: case report and literature review]. / Perekrestnaya afaziya (Crossed aphasia) v neirokhirurgicheskoi praktike: opisanie sluchaev i obzor literatury.

BACKGROUND: Crossed aphasia in dexstral (CAD) is an extremely rare disorder. To date, about 200 cases have been described in the literature. MATERIAL AND METHODS: The authors report 4 cases of CAD. Luria's neuropsychological examination was carried out. Functional asymmetry in the arm was analyzed using the Annett questionnaire. MRI and intraoperative findings confirmed localization of lesion in the right hemisphere in all patients. RESULTS: A 59-year-old right-handed man developed frontotemporal aphasia after previous resection of right-sided glioblastoma of fronto-insular-temporal region. In a 31-year-old right-handed man, crossed aphasia occurred after extensive hemorrhage from arteriovenous malformation into the right frontotemporoparietal region. A 39-year-old right-handed man developed severe combined aphasia after resection of diffuse glioma of the right insular-temporal region. A 10-year-old right-handed boy developed aphasia with word forgetting after resection of a large tumor of the right temporal lobe. All patients had impaired dynamic praxis. Other cognitive functions were intact. CONCLUSION: The authors discuss possible combinations of functions in one hemisphere for both right-handers and left-handers and emphasize diverse types of functional asymmetries described in the literature. Different localizations of functions in right-handers and left-handers indicate that local zones with different methods of information processing (successive or simultaneous) can coexist in one hemisphere. Therefore, the functions requiring different processing of information (for example, speech with praxis or spatial functions) can develop in one hemisphere. Cognitive impairment depends not only on the type of functional asymmetry, but also on localization of lesion. Crossed aphasia in right-handers indicates the rarest normal type of functional brain asymmetry with localization of speech functions in the right hemisphere. Possible aphasia in right-handers following damage to homologues of speech zones in the right hemisphere can require additional examination of these patients.

[Radiological biomarkers of brain gliomas]. / Radiologicheskie biomarkery gliom golovnogo mozga.

The most important objective of modern neuroimaging is comparison of data on genotype and phenotype of brain gliomas. Radiogenomics as a new branch of science is devoted to searching for such relationships based on MRI and PET/CT parameters. The 2021 WHO classification of tumors of the central nervous system poses the most important tasks for physicians in assessment of biological behavior of tumors and their response to combined treatment. The review demonstrates the possibilities and prospects of preoperative MRI and PET/CT with amino acids in assessing the genetic profile of brain gliomas.

[Spinal CSF-venous fistula: case report and literature review]. / Spinal'naya likvoro-venoznaya fistula kak prichina sindroma spontannoi vnutricherepnoi gipotenzii: sluchai iz praktiki i obzor literatury.

Syndrome of spontaneous intracranial hypotension is increasingly described in the literature as a multifactorial disease with impairment of the quality of life and risk of mortality. CSF-venous fistula as a cause of intracranial hypotension syndrome is extremely rare and requires complex diagnosis and timely surgical treatment. OBJECTIVE: We present a 55-year-old patient with acute spontaneous intracranial hypotension and spinal CSF-venous fistula. Literature data are also analyzed. RESULTS: Algorithm for diagnosis and efficacy of microsurgical resection of CSF-venous fistula is demonstrated. CONCLUSION: Intracranial hypotension following spinal fistula requires careful examination. Accurate understanding of pathophysiological and anatomical features of this disease is necessary to select an effective treatment method.

[Anaplastic pleomorphic xanthoastrocytoma - single-center analysis of 42 patients]. / Anaplasticheskaya pleomorfnaya ksantoastrotsitoma ­ analiz 42 nablyudenii iz odnoi kliniki.

Anaplastic pleomorphic xanthoastrocytoma is a rare tumor. There are still no objective data on the incidence of its diagnosis. OBJECTIVE: To study neuroimaging, morphological features of tumors, as well as factors affecting treatment and prognosis. MATERIAL AND METHODS: 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). RESULTS: 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. CONCLUSION: 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.

Feasibility of generalised diffusion kurtosis imaging approach for brain glioma grading.

PURPOSE: An accurate differentiation of brain glioma grade constitutes an important clinical issue. Powerful non-invasive approach based on diffusion MRI has already demonstrated its feasibility in glioma grade stratification. However, the conventional diffusion tensor (DTI) and kurtosis imaging (DKI) demonstrated moderate sensitivity and performance in glioma grading. In the present work, we apply generalised DKI (gDKI) approach in order to assess its diagnostic accuracy and potential application in glioma grading. METHODS: Diffusion scalar metrics were obtained from 50 patients with different glioma grades confirmed by histological tests following biopsy or surgery. All patients were divided into two groups with low- and high-grade gliomas as grade II versus grades III and IV, respectively. For a comparison, trained radiologists segmented the brain tissue into three regions with solid tumour, oedema, and normal appearing white matter. For each region, we estimated the conventional and gDKI metrics including DTI maps. RESULTS: We found high correlations between DKI and gDKI metrics in high-grade glioma. Further, gDKI metrics enabled introduction of a complementary measure for glioma differentiation based on correlations between the conventional and generalised approaches. Both conventional and generalised DKI metrics showed quantitative maps of tumour heterogeneity and oedema behaviour. gDKI approach demonstrated largely similar sensitivity and specificity in low-high glioma differentiation as in the case of conventional DKI method. CONCLUSION: The generalised diffusion kurtosis imaging enables differentiation of low- and high-grade gliomas at the same level as the conventional DKI. Additionally, gDKI exhibited higher sensitivity to tumour heterogeneity and tissue contrast between tumour and healthy tissue and, thus, may contribute as a complementary source of information on tumour differentiation.

Spleen elastography in patients with Systemic sclerosis.

Systemic sclerosis (SSc) is an autoimmune inflammatory connective tissue disease. It is characterized by varying degrees of fibrosis of the skin and internal organs. Tissue fibrosis is the final phase of a complex biological process of immune activation and vascular damage. The spleen is one of the organs thought to be involved in a systemic fibrosing process. Yet, there is a lack of research that provides evidence about splenic involvement in patients with SSc through objective instrumental techniques. Ultrasound elastography is a modern method which detects changes in the stiffness and elasticity of different organs. To assess the elasticity and stiffness of the spleen in healthy subjects and patients with SSc, the study included 34 patients with SSc and 35 healthy volunteers. Point SWE spleen elastography was performed on all participants in the two study groups through an Esaote MyLab 9 eXP with a C1-8 iQ appleprobe transducer. The mean age in the SSc patient group was 47.35 ± 11.48 years vs. 46.20 ± 14.55 years in the healthy controls, with no significant age difference, p = 0.717. The mean Body Mass Index (BMI) in the SSc patient group was 22.42 ± 2.12 kg/m2 vs. 24.23 ± 4.29 kg/m2 in the healthy control group with no significant difference, p = 0.410. Among the SSc patients, 18(53%) were with dcSSc and 16 (47%) with lcSSc. The mean disease duration was 59 ± 28 months, ranging between 18 and 118 months. Spleen stiffness median was significantly higher in the SSc patient group (3.19 m/s) in comparison with the healthy controls (2.40 m/s), p < 0.001. Spleen size was normally distributed and did not differ significantly between the SSc patients (105.84 ± 7.87 mm) and the healthy controls (104.16 ± 8.99 mm), p = 0.410. A significantly higher mean of spleen stiffness was observed in the dcSSc patients (3.38 ± 0.20 m/s) in comparison with the lcSSc group (2.81 ± 0.38 m/s), p < 0.001. Spleen size did not show a significant association with the type of SSc. Spleen size in the dcSSc subgroup had a mean value of 103.45 ± 5.56 mm vs. 108.51 ± 9.30 in the lcSSc subgroup, p = 0.071. pSWE is an objective, reliable, and easy-to-implement method for detecting early fibrous changes in the spleen in patients with SSc. A good approach in patients with SSc could be the search for similar processes in other internal organs, such as the liver and thyroid gland.

[Anaplastic astrocytoma and anaplastic oligodendroglioma of the brain: current state of the problem]. / Anaplasticheskie astrotsitomy i anaplasticheskie oligodendrogliomy golovnogo mozga: sovremennoe sostoyanie problemy.

This review is devoted to the problem of anaplastic cerebral gliomas. The authors consider classification, neuroimaging of these tumors including comparison of magnetic resonance imaging and positron emission tomography data. Clinical manifestations of anaplastic gliomas, issues of their histological and molecular genetic classification are discussed. Moreover, the authors compare the data of neuroimaging and genetic examinations of tumors. Other issues are multicomponent treatment and prognosis in patients with anaplastic glioma of the brain.

[Radiosurgery for recurrent glioblastoma]. / Radiokhirurgicheskoe lechenie retsidivov glioblastom.

BACKGROUND: Despite the combined treatment in accordance with modern standards, recurrent glioblastoma usually occurs within several months after resection and causes low relapse-free and overall survival. One of the most effective methods for malignant glioma progression is repeated radiotherapy. Indications for this approach have expanded after introduction of stereotactic irradiation into routine clinical practice. OBJECTIVE: To evaluate the results of radiosurgery in patients with recurrent glioblastoma and to identify the factors determining its effectiveness. MATERIAL AND METHODS: Radiosurgery has been carried out in 168 patients with relapses of glioblastoma between 2005 and 2021. This study enrolled 88 patients with 180 foci of local and distant progression. Mean age of patients was 42.8±2.1 years (range 4-73). Mean period between diagnosis and repeated irradiation was 12.7 months. Mean volume of focus was 2.4 cm3, mean dose - 20 Gy. Median follow-up period after radiosurgery was 11.2 months. RESULTS: Repeated irradiation with correction of systemic therapy improved progression-free survival and overall survival with insignificant radiation-induced toxicity. Annual overall survival was 62.2%, median of overall survival after radiosurgery - 15.1 months. Significant factors of local control were marginal dose of at least 18 Gy and distant relapse. Median of progression-free survival in the group of distant progression of glioblastoma was only 3.6 months vs. 9.1 months in patients with local recurrence. CONCLUSION: Repeated irradiation in radiosurgery mode with a dose of 18 Gy and higher is an effective option for local treatment increasing progression-free and overall survival in patients with progression of glioblastoma.

[Phosphorus MR spectroscopy and 18F-FDG PET/CT in the study of energy metabolism of glial tumors]. / Fosfornaya MR-spektroskopiya i PET/KT s 18F-FDG v izuchenii energeticheskogo metabolizma glial'nykh opukholei.

OBJECTIVE: To study energy metabolism in glial tumors using dynamic MR spectroscopy and 18F-FDG PET/CT. MATERIAL AND METHODS: The study included 19 patients (9 women and 10 men) with newly diagnosed supratentorial glial tumors WHO Grade I-IV (diffuse astrocytoma - 4 cases, oligodendroglioma - 4 cases, anaplastic astrocytoma - 5 cases, glioblastoma - 6 cases). All patients underwent examination and surgical treatment at the Burdenko Neurosurgery Center. Dynamic MR spectroscopy and 18F-FDG PET/CT were applied in each patient. RESULTS: We found multiple correlations between the ratio of bioorganic phosphate peaks and parameters of glucose uptake by tumor tissue. These relationships were more significant in patients with high-grade tumors: positive significant correlation between SUVtumor and PME/PCr ratio (RS=0.75, p=0.01), T/Nmix and ßATP/Pi ratio (Rs=0.76, p=0.02), SUVpeaktumor and aATP/Pi ratio (RS=0.77, p=0.008). Moreover, there were negative correlations between SUVtumor and PCr/bATP ratio (RS= -0.66, p=0.05), T/Nmix and PDE/bATP ratio (RS= -0.83, p=0.006), SUVpeaktumor and PDE/aATP ratio (RS= -0.76, p=0.009). CONCLUSION: High-grade gliomas were characterized by higher glucose consumption, ATP release (intensification of energy metabolism) and faster cell membrane synthesis. These processes indicate enhanced proliferation of tumor cells (intensification of plastic metabolism).