[Possibilities of instrumental methods of diagnosis of unstable atherosclerotic plaques of carotid arteries].

Today there exists a wide variety of laboratory and instrumental methods aimed at diagnosing an unstable carotid aortosclerotic plaque. Assessment of the laboratory indices is not sufficiently effective since it does not allow of revealing the fact of the formation of an unstable plague at early stages and to determine its localization. The instrumental methods employed (ultrasonographic study, magnetic resonance imaging, multiplanar computed tomography, positron emission tomography) were focussed on detecting pathomorphological markers of instability - thickness of the fibrous coating, structural plaques, the presence of erosions, ulcerations, haemorrhages, calcifications, lipid nucleus, activity of the cellular processes inside the plaque. The revealed signs promote early diagnosis of unstable atherosclerotic plaque with the determination of its localization. Nevertheless, they do not provide evidence about the danger of its rupture, whereas the overwhelming majority of acute vascular catastrophes including acute impairments of cerebral circulation is directly associated with arterial thrombosis resulting from rupture of the atherosclerotic plaque. Therefore, search for new methods aimed at prediction of complications of the atherosclerotic plaque which would be employed in routine clinical practice still remain urgently important today. The most promising is the study of the state of the atherosclerotic plaques of carotid arteries for prediction of acute impairment of cerebral circulation.

[Comparison of morphological features of carotid arteries atherosclerotic plaques with clinical-instrumental data in symptomatic and asymptomatic patients with severe carotid atherosclerosis].

A complex histomorphometric and clinical-instrumental analysis of atherosclerotic lesions of the carotid arteries obtained during carotid endarterectomies (CEE) of patients with hemodynamically significant stenoses was conducted. Two groups of patients were compared: symptomatic, which earlier underwent cerebral vascular accident (CVA) or transitory ischemic attacks (TIA), and asymptomatic ones with no complications of the disease. Statistical analysis of clinical and laboratory data showed no significant differences between two groups except for the level of lipoprotein(a) [Lp(a)] in the blood plasma, which was higher (p<0.05) in asymptomatic patients compared with symptomatic ones. Statistical analysis of carotid arteries ultrasound duplex scanning (USDS) in the preoperative period did not reveal significant differences in the degree of maximum vessels stenosis between the compared groups of patients. Surface defects of atherosclerotic plaques (ASP) were shown to be significantly more common (p<0.05) in the group of symptomatic patients compared with asymptomatic ones. According to histological analysis 88% of extracted ASP was unstable in symptomatic patients and 77% of ASP - in asymptomatic patients. This may indicate high risk of CVA/TIA in both groups of patients. Statistical evaluation of magnetic resonance tomography (MRT) and USDS techniques in comparison with abilities of the most reliable histological analysis showed that both non-invasive diagnostic methods are highly sensitive in detecting unstable ASP, though MRT showed higher level of specificity compared with USDS.

[Experience in noninvasively quantifying hydrogen magnetic resonance imaging spectroscopic hepatic fat concentrations in patients with fatty hepatosis before and after treatment with Eslidin].

OBJECTIVE: To define the role of liver magnetic resonance (MR) spectroscopy in the evaluation of therapy for fatty hepatosis. MATERIAL AND METHODS: Spectra were studied in 49 patients (30 men and 19 women) whose mean age was 54+/-11 years. A study group consisted: 1) healthy volunteers (n = 10) and 2) patients with fatty hepatosis (n = 39) identified by clinical data. The patient group had two points: before and 6 months after treatment with Eslidin (based on polyunsaturated fatty acids). The lipid-to-water content ratio in the liver parenchyma was calculated for each patient. If its value was over 6.5%, the diagnosis of fatty hepatosis was considered verified. RESULTS: The findings showed that the ratio was not more than 3.2% in the group of healthy volunteers, which completely excluded hepatic fatty infiltration. In the patient group, the ratio was 15, 10, and 8.5% in 15, 20, and 4 cases, respectively. Reexamination revealed a reduction in fat concentrations to normal values (56,4%) in 22 patients and a more than twice (31%) decrease in 12 patients. No reduction in fat content was found in 5 (12,8%) patients. CONCLUSION: Proton MR spectroscopy is a reproducible procedure that may be used to evaluate the efficiency of treatment for fatty hepatosis. H1-spectroscopy can be used to evaluate the efficacy of some drugs for the treatment of this pathology.

[Comparative characteristics of the possibilities of imaging techniques (magnetic resonance imaging and 3D ultrasound study) in the qualitative estimation of atherosclerotic plaque volume].

OBJECTIVE: To estimate the possibilities of using three-dimensional ultrasound study (3D USS) in the diagnosis of the sizes and structure of an atherosclerotic plaque (ASP). MATERIAL AND METHODS: The data obtained by examination of 20 heterogeneous ASPs in the carotid artery wall, by applying 3D USS and magnetic resonance imaging (MRI), were compared. Intra- and interoperator reproducibilities were assessed by the Bland-Altman method; the volume of each plague was measured by two (contour and ellipse) methods. The contour method was used to estimate all plagues; the ellipse method was applied to 13 of the 20 plagues, which was due to the shape of ASPs that rarely had an ellipsoid shape. RESULTS: Intra- and interoperator reproducibilities in ASP volume estimation by 3D USS was as follows: with the use of contour and ellipse algorithms, the coefficient of variation was 7.72 and 3.77%, respectively; with these algorithms, the interoperator reproducibility was 8.18 and 6.21%, respectively; the derived values were not greater than those allowed for medical studies (10%). The coefficients of variations for MRI in the estimation of ASP sizes were significantly higher for inter- and intrareproducibilities (68.82 and 43.4%, respectively). CONCLUSIONS: The results of this investigation agree with thedata available in the literature and support that 3D USS is an effective diagnostic me-hod in evaluating the magnitude of an ather-sclerotic process.

[Comparison of characteristics of atherosclerotic plaques in patients with acute coronary syndrome and stable ischemic heart disease: data of multispiral computed tomography].

AIM: To elucidate possibilities of multispiral computed tomography (MSCT) for assessment of morphology of atherosclerotic plaques in coronary arteries of patients with acute coronary syndrome (ACS) or stable ischemic heart disease (SIHD). MATERIAL AND METHODS: Assessment of internal relief of coronary arteries and composition of atherosclerotic plaques was carried out in 85 patients with ACS and 41 patients with SIHD. MSCT was performed with the use of computed tomograph. Visual assessment included determination of plaque type (calcified, soft, and heterogeneous) and contour (regular, irregular). Quantitative assessment included determination of plaque density and index of remodeling. RESULTS: Among patients with ACS we found 194 plaques (60--soft, 72--heterogeneous, and 62--calcified). Plaques in symptom related compared with non-symptom related arteries had higher index of remodeling (1.4 +/- 0.3 and 1.2 +/- 0.2, respectively, p < 0.0001), and more frequently had irregular contour (60.0 and 12.8%, respectively, p < 0.0005). Soft plaques and plaques with irregular contour prevailed in ACS group (68.0%) while calcified plaques were more frequent in SIHD group (66.4%). Plaques with irregular contour were more frequent and index of remodeling was higher in ACS compared with SIHD group (33.5 vs 7.2%, p < 0.0005, and 1.3 +/- 0.2 vs 1.0 +/- 0.2, p < 0.001, respectively). CONCLUSION: According to MSCT data main characteristics of atherosclerotic plaques in patients with ACS were low density and inclusions of microcalcinates. Specific features of plaques in symptom related arteries were irregular contour and positive remodeling index.

[Proton magnetic resonance spectroscopy in the diagnosis of breast cancer].

Magnetic resonance spectroscopy (MRS) is used in mammalogy to specify the data obtained by traditional radiodiagnostic techniques and provides a possibility of estimating the molecular composition of pathologically altered breast tissues. This information is employed for the differential diagnosis of malignant and benign neoplasms, as well as for monitoring and predicting the efficiency of chemotherapy for breast cancer. Some technical problems and the lack of a standardized approach to the procedure of a study and interpretation of its results hinder the wide introduction of spectroscopy into clinical practice. This paper reviews the data available in the literature on proton MRS and the technical and clinical aspects of application of this technique.

[Renal artery stenosis in patients with type 2 diabetes mellitus: clinical signs, diagnosis, prognostic value].

AIM: To define the prevalence, clinical features, risk factors, and prognostic value of atherosclerotic renal artery stenosis (RAS) in patients with type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS: One hundred and fifty-seven T2DM patients (63 males and 94 females) aged over 50 years were examined. Screening for RAS was carried out by duplex ultrasound scanning (DUSS); the diagnosis was verified by multispiral computed tomography and magnetic resonance imaging. Moreover, the detection rate of RAS was analyzed from the selective angiographic readings of 30 patients with T2DM and 26 coronary angiography patients without DM who had undergone coronary angiography (CA). RESULTS: In the total group of T2DM patients, the RAS detection rate was 36.9%, as evidenced by DUSS and 43.3% by selective renal artery angiography in the patients who had undergone CA. The factors associated with the development of RAS were smoking (relative risk (RR) = 3.3; p < 0.001); atherosclerosis of coronary (RR = 4.28; p < 0.001) and peripheral (RR = 3.38; p < 0.02) arteries, isolated systolic hypertension (RR = 3.9; p < 0.01), and anemia (RR = 6.4; p < 0.001). In patients with T2DM, RAS was one of the important factors of progressive renal and cardiac diseases and increased mortality determined by the combined end point: death, emergency hospitalization for heart failure, myocardial infarction, double creatinine, and end-stage renal failure (RR = 6.28; p < 0.001). CONCLUSION: The optimization of prognosis in T2DM patients with RAS requires its timely clinical identification in combination with other types of renal lesion, aggressive correction of the mechanisms of the progressive process, and development of medical and endovascular therapies.

[MRI of penis and pelvic floor in examination of erectile dysfunction pathogenesis in patients after perineal blunt injury and choice of treatment policy]. / IaMR-tomografiia polovogo chlena i tazovogo dna v patogeneze i vybore taktiki lecheniia érektil'noi disfunktsii u bol'nykh posle tupoi travmy promezhnosti.

Since 1995 we have treated 18 patients (age 17-52 years) after blunt perineal injury. 14 of them suffered from erectile dysfunction (ED). All the patients underwent examination which consisted of the standard tests and modern techniques: pharmacological dopplerography, electromyography of the penis with pharmacological loading, NMR-tomography of the perineum and the penis. NMR-tomography helped in identification of anatomic structures of the penis and pelvic fundus, pathological tissue processes (hematomas, damaged tissues, fibrous scars) after blunt injury of the perineum responsible for ED. The latter resulted from arterial (100%), venous (33.3%) and neurogenic (11.1%) lesions. Basing on the formulated pathogenetic conception it was possible to design diagnostic algorithm and policy of combined treatment of patients with ED following perineal blunt injury allowing for the time of the trauma and characteristics of the injury.

[Magnetic resonance tomography in hydronephrotic transformation, cystic lesions and tumors of the kidneys in patients with arterial hypertension]. / Magnitno-rezonansnaia tomografiia pri gidronefroticheskoi transformatsii, kistoznykh porazheniiakh i opukholiakh pochek u bol'nykh arterial'noi gipertoniei.

MR tomography was carried out on MR tomographs Tomicon 1100 (Bruker, 0.23 T) and Magnetom SP 63 (Siemens, 1.5 T) in 126 hypertensive subjects (66 had cysts, 20 HT and 31 renal tumors) and 27 healthy controls. MR tomography proved highly specific and sensitive in diagnosis of renal new growths. In complicated cases additional information can be provided by paramagnetic contrast examinations. MR tomography as an on demand diagnostic method is recommended for use in a two-stage check-ups of patients with arterial hypertension.

[Clinical use of MR tomography with a paramagnetic contrast medium Magnevist in patients with kidney cysts, tumors and hydronephrotic transformation]. / Klinicheskoe primenenie MR-tomografii s paramagnitnym kontrastnym sredstvom "Magnevist" u bol'nykh s pochechnym kistami, opukholiami i gidronefroticheskoi transformatsiei.

The authors analyze diagnostic potentialities of Magnevist, a paramagnetic contrast agent (Shering, Germany) used in magnetic resonance (MR) tomographic examination of patients with renal cysts, hydronephrotic transformation, and tumors. Thirty-five patients aged 17 to 64 were examined, 16 of these with cysts, 8 with hydronephrotic transformation, and 11 with kidneys. Ten normal subjects were examined in whom quantitative parameters (signal intensity) were assessed before and after Magnevist administration. The diagnosis was verified on the basis of x-ray computer-aided tomography, ultrasonic examination, urography, and aortography, as well as histologic findings. T1-suspended images and respiration delay method were found the most informative for the diagnosis of volumic formations of the kidneys. Improved image contrast during the use of Magnevist is observed, according to our data, immediately after the agent administration and attains the maximum by the 20th-25th minute gradually decreasing starting from the 45th minute. Magnevist improves the informative value of MR tomography, helps a more precise assessment of the pathologic process type, localization, relationships with intra- and extrarenal structures, and, moreover, permits revising the previous diagnosis made on the basis of other methods, including noncontrast MR tomography.