[Use of multiparametric magnetic resonance imaging in t-staging of prostate cancer: a multicenter study].

AIM: The study aimed to analyze the diagnostic performance of preoperative multiparametric magnetic resonance imaging (mp-MRI) in the staging of prostate cancer (PCa) versus postoperative histological examination and determine the most sensitive pulse sequence from the mp-MRI protocol in estimating the local extent of PCa. MATERIALS AND METHODS: The study comprised 112 men aged 52 to 84 years with a morphologically verified diagnosis of prostate cancer. All patients underwent pelvic mp-MRI before radical prostatectomy (RPE) no earlier than six weeks after the prostate biopsy. Radical prostatectomy was performed within two weeks after mp-MRI. MP-MRI findings and the results of postoperative histology were compared using a binary logistic regression model. RESULTS: The sensitivity, specificity, diagnostic accuracy, positive (PPV) and negative (NPV) predictive values for predicting extracapsular extension were 87.5, 92.6, 91, 84 and 94.3%, respectively; for predicting seminal vesicles invasion, they were 85, 95, 90, 80.9 and 96.7%, respectively. When stratified by the presence or absence of the pseudocapsule invasion, the reliability of detecting the tumor spread for different types of images decreases in the following order: DWI - T2 + DWI - T2 VI - DCE-MRI. CONCLUSION: mp-MRI has high sensitivity, specificity, general diagnostic accuracy, high NPV, and PPV values in detecting an extracapsular extension of prostate cancer. According to the binary logistic regression model, the greatest contribution to the decision on the presence or absence of extracapsular extension is also made by the DWI.

[Abdominal radiology in oncology: The new trends in computed tomography and magnetic resonance imaging].

Paper gives a review of recent technical innovations in computed tomography (CT) and magnetic resonance imaging (MRI) that could be applied in abdominal oncology. Perfusion and dualenergy CT gives new opportunities for tissue characterization. Interactive reconstruction algorythms decrease radiation exposure to patients. Abdominal MRI has some important advantages over CT in detection and staging of abdominal malignancies. Nowadays standard MR protocols include DWI and dynamic 3D sequences with extracellular or liver-specific contrast media. Latest developments in MRI technology could expand its diag- nostic value in abdominal oncology even further.

[Neurologic disturbances in children with cleft lip and cleft palate]. / Nevrologicheskie narusheniya u detei s rasshchelinoi guby i neba.

AIM: Neurological symptoms of genetic syndromes, including congenital cleft lip and palate (CLP) are well-studied while neurological characteristics of patients with non-syndromal CLP are not described. The authors studied neurological disturbances in CLP. MATERIAL AND METHODS: Twenty-one patients with CLP, mean age 12.0±4.7 years (the main group) were compared to healthy people (the control group). RESULTS AND CONCLUSION: Elements of bulbar syndrome (atrophy and deviation of the tongue, sagging of the soft palate, specific speech disturbances) and mimic innervation abnormalities (hypomimia or hypermimia, face asymmetry), microfocal neurological symptoms occurred significantly more frequently (p<0.01) in patients of the main group. Bulbar disorders, identified in 100% of the patients, were most characteristic of CLP. The neurological features of patients with CLP demonstrate the involvement of the brain stem, mimic innervation, bulbar cranial nerves and defects of the development of the neural tube.

[Whole-body diffusion-weighted magnetic resonance imaging by estimating the measurable diffusion coefficient in Hodgkin Iymphoma].

OBJECTIVE: To determine whether the measurable diffusion coefficient (MIC) may be used to differentiate normal and lymphomatosis-altered lymph nodes (LNs) in patients with Hodgkin lymphoma (HL). MATERIAL AND METHODS: Whole-body magnetic resonance (MR) imaging was used to compare the MICs of LNs in 27 apparently healthy individuals and 41 patients with a verified diagnosis of HL. RESULTS: Construction of 95% confidence intervals showed that the MICs of normal LNs were in the range of 1.00 to 1.73 x x10(-3) mm2/sec and significantly higher (p < 0.05) than those of lymphomatosis-affected LNs (MIC, 0.59 to 0.94 x 10(-3) mm2/sec). The cut-off point (for discretization) of normal and lymphomatosis-altered LNs was in the range of 0.94 to 1.00 x 10(-3) mm2/sec. Consequently, the LN with a MIC of less than 0.94 x 10(-3) mm2/sec may be thought of as affected by the lymphomatous process. CONCLUSION: MIC calculation permits differentiation of normal and affected LNs having equal signal characteristics (including those on diffusion-weighted MR images).

[Multiparameter magnetic resonance imaging in the diagnosis of cancer of the cervix uteri].

Cancer of the cervix uteri (CCU) ranks third in the incidence of malignancies in women. The choice of CCU treatment mainly depends on the extent of the tumor process, i.e., the stage of the disease. Determining the stage of CCU is based on the clinical classification of the International Federation of Gynecology and Obstetrics (FIGO) (2009) and has a number of substantial limitations in evaluating parametrial invasion, tumor spread to the pelvic wall, and involvement of regional lymph nodes and in determining the true tumor sizes. Magnetic resonance imaging (MRI) is now the method of choice in staging invasive CCU. Multiparameter MRI will be able to enhance the efficiency of diagnosing microinvasive CCU as well (FIGO 2009), to plan surgical and/or chemoradiation treatment, to evaluate its efficiency, and to diagnose locally recurrent CCU.

[Magnetic resonance imaging in the staging of malignant lymphomas].

Computed tomography, 18FDG-PET and the hybrid FDG-PET/CT are the most commonly used diagnostic tools for the initial staging and treatment response assessment of malignant lymphomas. MRI techniques such as whole-body MRI and diffusion-weighted imaging may become good radiation-free alternatives to FDG-PET/CT. Diffusion-weighted imaging is characterized by high sensitivity for the detection of lesions and allows quantitative assessment of diffusion that may aid in the evaluation of malignant lymphomas. This article will review the value of these emerging MRI techniques for the staging and response assessment of malignant lymphoma.

[Chemoradiotherapy for locally advanced cervical cancer].

Cervical cancer takes second place in morbidity and third place in mortality from gynecological cancer. Advanced stages among newly diagnosed cases is still large. The "gold standard" of treatment for locally advanced cervical cancer is chemoradiotherapy with cisplatin that results in a lower risk of death. Improvement of radiotherapy methods allowed to bring optimal dose to the primary tumor with the inclusion of regional metastasis areas with less risk of damage to surrounding healthy tissue and organs. The search for alternative combinations of cytostatics, modes of drug administration, adjuvant chemotherapy after chemoradiotherapy showed an increase in survival of patients with locally advanced cervical cancer.

[Optimization of a whole-body magnetic resonance imaging protocol for Hodgkin lymphoma staging].

OBJECTIVE: To optimize a whole-body magnetic resonance imaging (WBMRI) protocol including diffusion-weighted imaging (DWI) used as a diagnostic complex for Hodgkin lymphoma (HL). MATERIAL AND METHODS: The WBMRI protocol adapted for HL staging and monitoring was tried out on 1.5 T and 3.0 T MRI scanners. The investigation included 128 patients with HL verified by complex clinical, laboratory, and instrumental studies (including computed tomography (CT), positron emission tomography (PET), PET/CT, scintigraphy and radiology of the skeleton, ultrasonography, laboratory tests, and biopsy) and 27 healthy individuals. The diagnostic value of the elaborated protocol was determined comparing with that of 18F-fluorodeoxyglucose PET, the gold standard for diagnosing HL in 63 patients with this condition. RESULTS: WBMRI showed high sensitivity (99.2%) (97.6-100% confidence interval (CI)) and specificity (99.6%) (99.05-100% CI) in determining the foci of lesion in HL. CONCLUSION: The high sensitivity and specificity of WBMRI, which are similar to those of PET, may suggest that this method should be used to estimate the extent of the primary tumor in HL. Within one study, the proposed non-contrast-enhanced WBMRI protocol for 1.5 T and 3.0 T MRI scanners can yield anatomic (T2-WI) and functional (DWI estimating the measured diffusion coefficient) MR images of nodal and extra-nodal lesions in HL, without increasing time and modernizing equipment and software. The proposed protocol improves the quality of HL radiodiagnosis, by concurrently reducing a patient's radiation exposure.

[Estrogens and brain].

Recent data upon molecular mechanisms of pleiotropic action of estrogens in human brain is presented in the article. Given detailed descriptions of properties of classical and membrane bound estradiol receptors, that maintain gene expression regulation, modulation of neurotransmittent systems and signal cascade activation in neuronal cells. Data upon regional distribution of estradiol receptor subtypes in the brain, their participation in main cell population function control (including progenitor cells) is given. Special attention is paid to estrogen participation in neurogenesis, inflammation and apoptosis regulation in central nervous system; in the control of formation and functioning of cerebral vessels.

[Pharmacological properties of complex iron oxide nanoparticles entering in magnetic resonance tomography contrast agent].

A colloidal solution of iron oxide nanoparticles has been obtained that ensures an increase in the accuracy of diagnostic information from magnetic resonance tomography (MRT) due to the acceleration of proton relaxation in tissues, which improves the contrast of T1- and T2-weighed images. Improved visualization of small vessels in rat brain has been observed after intravenous injection of 0.1 ml solution containing 5.0 mg of contrasting iron nanoparticles. The paramagnetic properties of iron oxide nanoparticles were studied by the method of proton relaxation, and their size was determined by the method of transmission electron microscopy. The toxic properties ofnanoparticles were determined by their effect on cultured HeLa cells (MTT test). It is recommended to use a colloidal solution of superparamagnetic nanoparticles (size, 8.2 nm) for obtaining a pharmaceutical form of the new magnetic-resonance contrast medium Ferotrast.

[Gestagens and the brain].

Modern data on molecular mechanisms underlying intracerebral pleutropic action ofgestagens (progesterone, its metabolites, and synthetic gestagens) are reviewed. Properties of classical and membrane-bound progesterone receptors involved in regulation of gene expression, modulation of neurotransmitter systems, and activation of signal cascades in neurons are described along with data of regional distribution of progesterone receptor subtypes in brain, metabolism, functional activity, and mechanisms of action of progesterone metabolites. Special attention is given to analysis of progesterone and metabolite neuroprotective activity in CNS, such as anti-inflammatory and antiapoptotic effects, and participation in neurogenesis regulation. Clinical application of progesterone-based drugs is discussed with reference to the treatment of brain injuries and prospects for extension of indications for their use in neurologic practice.

[Potentialities of magnetic resonance imaging in the study of renal morphofunctional state in girls with internal genital malformations and space-occupying lesions].

The diagnosis of the anatomic and functional state of urinary organs in girls with internal genital malformations and space-occupying lesions involves magnetic resonance imaging by administering the optimized dose of a magnetic resonance contrast agent (MRCA). The technology makes it possible to evaluate the anatomic features of the urinary tract (magnetic resonance urography), to perform abdominal vascular magnetic resonance angiography, and to draw a conclusion on renal functional status in the use of dynamic magnetic resonance renography. Within a study using one injected MRCA dose, both the anatomic and functional state of the kidney status can be examined, by evaluating MRCA passage singly in the cortical and medullary substances and pelvises, which increases diagnostic accuracy by 46% and promotes the optimization of management tactics in this category of patients.

[Methodological features of magnetic resonance imaging mammography].

By studying 211 females by currently available radiation techniques, such as X-ray study, ultrasonography, and magnetic resonance imaging mammography (MRIM), the authors consider that the specificity of contrast-enhanced MRIM (CE MRIM) is greater than that of MRIM without administering magnetic resonance contrast agents (MRCA). CE MRIM reveals clinically suspicious early-stage breast lesions and defines the stage of a tumorous process, the patients being unexposed to ionizing irradiation. CE MRIM as an auxiliary technique becomes one of the most informative ones, particularly in girls, early reproductive-age females with developed glandular tissue, and pregnant females. In the authors' opinion, the total algorithm of a breast study in this group of patients in specialized medical centers where trained physicians work should differ from the generally accepted algorithm: instead of applying X-ray mammography (XRM) as a basic method of primary diagnosis, ultrasound mammography using Doppler color mapping, followed by MRIM or XRM should be employed.

[Magnetic resonance imaging in the differential diagnosis of chronic endometritis: capacities and methodic features].

By examining 83 females aged 17-48 years by magnetic resonance imaging (MRI), the authors conclude that the specificity and sensitivity of the technique without MR contrast agents in detecting chronic endometritis (CE) and chronic metroendometritis (CME) are 75.3 and 95.9%, respectively. On the MRI scans, hypertrophic and atrophic forms of CE have rather specific MR signs and appear as changes not only in the functional layer of the endometrium and transitional area, but also in the proper myometrium in CME. This all permits evaluating the degree of uterine wall involvement in the pathological process. Overall, the MRI criteria proposed by the authors can identify the signs of a chronic inflammatory process and its sequels and make a differential diagnosis this condition with female genital diseases to a high accuracy.

[Magnetic resonance imaging in the diagnosis of different forms of endometriosis]. / Magnitno-resonansnaia tomografiia v diagnostike razlichnykh form éndometriozov.

The present paper examines the capacities of non-invasive MRI in the diagnosis of endometriosis. A standardized study algorithm is proposed, indications and methodology for MRI in different forms of endometriosis (EM) are specified. It is shown that in the diagnosis of different types of EM there are specific changes in the MR pattern of small pelvic organs, which allow one to make a differential diagnosis of this disease with a higher sensitivity (96%) and specificity (87%) as compared with ultrasound study. MRI makes it possible to assess the degree of invasion of endometrioid heterotopies into the wall of the intestine and cervix uteri with a high degree of accuracy and to judge the degree and extent of intestinal luminal narrowing. Diagnostic errors in solving these problems (as well as those associated with the detection of extragenital foci of EM in the small pelvis) are due first of all to movement artefacts a (respiration and intestinal motility) particularly in the presence of a significant adhesive process and/or after surgical intervention. MRI does not virtually yield false-negative conclusions in the diagnosis of different forms of genital endometriosis (less than 3%), which, in the authors' opinion, rather justifies some hyperdiagnosis (about 11%) made by this method in the diagnosis of endometriosis of the rectovaginal septum. MRI is a closing, specifying stage of instrumental diagnosis of not only EM, but also other small pelvic diseases.

[Magnetic resonance imaging and ultrasound study in the diagnosis og facial angiodysplasias in children: competition or collaboration?]. / Magnitno-rezonansnaia tomografiia i ul'trazvukovoe issledovanie v diagnostike angiodisplazii litsa u detei: sopernichestvo ili sodruzhestvo?

This study deals with the capacities of noninvasive magnetic resonance imaging (MRI) with magnetic resonance angiography (MRA) without administration of magnetic resonance contrast substances in the diagnosis of facial soft tissue angiodysplasias in children. Indications for their use are defined. The methodology of the studies is proposed. Their diagnostic role and relationship with the other noninvasive technique of medical visualization--ultrasound study (USS) with Doppler color mapping (DCM) are assessed. As compared with USS, MRI may more accurately and objectively establish the organotopic characteristics of facial soft tissue angiodysplasias and detect lesions of the deep facial parts, maxillary bones, and paranasal sinuses in the diagnosis of these abnormalities. The use of MRI may define the belonging of angiodysplasias to the arterial or venous bed, reveal afferent and efferent vessels, including intracranial ones, and to detect intracranial angiodysplastic changes. USS with DSM was superior to MRI with MRA in defining functional (hemodynamic) parameters of angiodysplasias, which makes this method indispendable in planning treatment and in evaluating its efficiency. Comprehensive examination of patients with large and extensive angiodysplasias of facial soft tissues has indicated that facial angiodysplasias are external manifestations of a more generalized angiodysplastic process in most cases, which, in large and extensive facial angiodysplasias, makes it expedient to perform MRI with MRA of the brain and, if possible, the whole body. The high informative value of MRI with MRA in studying angiodysplasias makes them the method of choice in the diagnosis of this group of diseases.

[The dynamics of antigen-antibody complex formation in the presence of iodine-containing diagnostic agents]. / Dinamika kompleksoobrazovaniia antigen-antitelo v prisutstvii iodosoderzhashchikh diagnosticheskikh sredstv.

A mathematical model is proposed to describe the antigen-antibody complex formation under the immunoassay conditions, which allows the antibody-antigen affinity to be evaluated. In particular, it is established that the dissociation constant of the antigen-antibody complex (for antibodies to a tuberculous Mycobacterium) confidently increases (p > 0.95) in the following sequence of diagnostic kits: omnipak > Ultravist > melitrast > Triombrast. The method suggested for analysis of the influence of xenobiotics upon the antigen-antibody reaction can be used to reveal their possible side effects on the antigen-antibody complex formation in any particular case.

[The effect of x-ray contrast media on the concentration of intracellular calcium in mononuclear cells]. / Vliianie rentgenokontrastnykh sredstv na kontsentratsiiu vnutrikletochnogo kal'tsiia v mononuklearnykh kletkakh.

It was shown by the method of fluorescent probes that iodine-containing radiocontrast agents Triombrast > Omnipaque > Ultravist > Melitrast increase the content of intracellular Ca2+ in macrophages of the abdominal cavity of rats. Increase in the entry of Ca2+ from the external environment is the main factor of the change in the intracellular concentration of Ca2+ ions in the macrophages in interaction with radiocontrast agents.