MULTIMODAL LOGIT MODEL FOR PREDICTING THE EFFICIENCY OF MYOCARDIAL REVASCULARIZATION BY THE METHOD OF CORONARY ARTERY BYPASS GRAFTING IN PATIENTS WITH CORONARY HEART DISEASE. / MUL'TYMODAL'NA LOGIT-MODEL' PROGNOZUVANNIa EFEKTYVNOSTI REVASKULIaRYZATsIÏ MIOKARDA METODOM AORTO-KORONARNOGO ShUNTUVANNIa U PATsIIeNTIV Z IShEMIChNOIu KhVOROBOIu SERTsIa.

OBJECTIVE: building of a mathematical logit model for possible prediction of the outcome of surgical treatment bythe method of coronary artery bypass grafting (CABG) in patients of different groups with coronary heart disease(CHD) based on myocardial viability (MV) assessment. MATERIAL AND METHODS: To implement the set clinical tasks, 62 patients with coronary heart disease with preservedsystolic function and systolic dysfunction were examined. The mean age of the subjects was (59.6 ± 8.2) years. 35(56 %) patients had a variant of heart failure (HF) with an ejection fraction (EF) of 45 % or less. 27 (44 %) patientshad EF of 46 % or more. 5 (8.0 %) patients denied myocardial infarction (MI). Myocardial scintigraphy (MSG) wasperformed on Infinia Hawkeye combined gamma-camera (GE, USA) with integrated CT. The studies were performedin SPECT and SPECT / CT with ECG synchronization (Gated SPECT) modes. 99mTc-MIBI with an activity of 555-740 MBqwas used. MSG was performed in the dynamics of treatment (before CABG and after CABG) according to One Day Restprotocol. A total of 124 scintigraphic studies were performed. RESULTS: Samples of patients studied «before¼ and «after¼ the treatment were compared using nonparametricWilcoxon test (Wilcoxon Matched Pairs Test). A multivariate regression model, that reflects a statistically significanteffect on the treatment response (MV after treatment) of such cardiac activity indicators as LV EF (%), coronary bedlesion area and MV level (%) before treatment, was built. The above-described regression relationship between thethree above-defined functional factors of cardiac activity before treatment and the therapeutic effect in the formof the change in MV can be construed as a diagnostic model that predicts the treatment outcome. CONCLUSIONS: This scientific study allows to build logit models to predict the expected outcome of coronary heartdisease surgical treatment in patients of different groups. The presented multivariate regression model is characterised by a sufficiently high for biostatistical studies adjusted coefficient of determination (Adjusted R2 = 0,893 (F = 173,4; p < 0,001)).

DIFFUSION TENSOR MAGNETIC RESONANCE IMAGING IN EARLY DIAGNOSIS OF STRUCTURAL CHANGES IN BRAIN WHITE MATTER IN SMALL VESSEL DISEASE ASSOCIATED WITH ARTERIAL HYPERTENSION AND IONIZING RADIATION. / DYFUZIINO-TENZORNA MRT U RANNII DIAGNOSTYTsI STRUKTURNYKh ZMIN BILOÏ REChOVYNY GOLOVNOGO MOZKU PRY ASOTsIIOVANII Z ARTERIAL'NOIu GIPERTENZIIeIu TA IONIZUIuChYM VYPROMINIuVANNIaM KhVOROBI MALYKh SUDYN.

OBJECTIVE: to determine the early signs of structural changes in brain white matter in small vessel disease associated with arterial hypertension and exposure to ionizing radiation using DTI-MRI. MATERIALS AND METHODS: 45 patients (mean age (57.56 ± 6.34) years) with small vessel disease (SVD) associatedwith arterial hypertension (AH) were examined: group I - 20 patients, participants of liquidation of the accident atthe Chornobyl nuclear power plant (Chornobyl clean-up workers); group II - 25 patients not exposed to ionizingradiation. MRI was performed on an Ingenia 3T tomograph («Philips¼). The fractional anisotropy (FA) was determined in the main associative and commissural pathways, periventricular prefrontal areas (fasciculus fronto-occipitalis superior / anterior - f. FO ant., corona radiata anterior - CR ant.) and semioval centers (SC). RESULTS: No signs of cerebral cortex or brain white matter (WM) atrophy, intracerebral microhemorrhages, and widespread areas of leukoaraiosis consolidation were observed in the examined patients. In the Chornobyl clean-up workers a larger number of foci of subcortical leukoaraiosis was visualized (80 %) on MRI images including multiple -8 (40 %), > 0.5 cm - 10 (50 %), with signs of consolidation - 5 (25 %). The results of the FA analysis in semiovalcenters showed its significant decrease in the patients of groups I and II (p < 0,007), regardless of the presence orabsence of visual signs of subcortical leukoaraiosis (ScLA) (III gr.: 253-317, p < 0.00001; IV gr.: 287- 375,p < 0.001). FA indicators in f. FO ant. and CR ant. in the patients of groups I and II differed insignificantly but weresubstantially lower than controls (p < 0.05). FA was significantly lower, compared to reference levels, in visuallyunchanged f. FO ant. (0.389-0.425; p = 0.015) and CR ant. (0.335-0.403; p = 0.05). In patients with AH-associated SVD of middle age, regardless of the effects of ionizing radiation, no significant changes in FA in the mainWM associative and commissural pathways were found (p > 0.05). CONCLUSIONS: DTI-MRI allows to detect early signs of structural changes in the white matter of the brain - a significant decrease in fractional anisotropy indicators in visually unchanged periventricular and subcortical areas. Themain associative and commissural pathways of the brain remain intact in the absence of widespread consolidatedfoci of leukoaraiosis and lacunar infarctions. The negative impact of ionizing radiation on the course of SVD associated with arterial hypertension is manifested by more active processes of WM disorganization: the prevalence andtendency to the consolidation of periventricular and subcortical leukoaraiosis foci, a significant FA decrease in semioval centers.

Detection of breast cancer presenting as a mass in women with dense breasts - digital breast tomosynthesis versus full-field digital mammography.

AIM: To evaluate the sensitivity and specificity of digital breast tomosynthesis compared with full-field digital mammography in detection of breast cancer presenting as a mass in women with dense breasts. Маterials and Methods: This study included 347 asymptomatic and symptomatic patients with dense breasts who underwent full-field digital mammography, digital breast tomosynthesis and hand-held full breast ultrasound. 57 core-needle biopsies were performed. Pathology included 31 invasive cancers and 26 non-cancerous lesions. RESULTS: Sensitivity of full-field digital mammography was 61.3% [0.422-0.789] and sensitivity of digital breast tomosynthesis was 77.4% [0.589-0.904]. Specificity of full-field digital mammography was 92.7% [0.893-0.953] that was 2.2% lower than the specificity of digital breast tomosynthesis - 94.9% [0.919-0.971]. CONCLUSION: Results of our study showed superior sensitivity and specificity of digital breast tomosynthesis compared to full-field digital mammography for detection of malignant masses in women with dense breasts.