Modern Imaging Techniques and Their Role in Contact Radiation Therapy (Brachytherapy) Planning

The paper considers an algorithm for the diagnostic study of patients with cancer of different localization, the possibility and feasibility of involving imaging techniques in radiation therapy and brachytherapy (BT) planning. The most widely used ultrasound in BT planning does not exclude a subjective assessment of the boundaries of the tumor and organs at risk, as well as the inaccuracies caused by endostatic devices. Magnetic resonance imaging (MRI) provides a high level of achievement of the criteria necessary for BT planning, but it has financial constraints and the need for individual selection of research conditions. Computed tomography (CT) is the most effective technique for visualizing the tumor, endostatic devices, and organs at risk for BT 3D planning. The involvement of MRI and positron emission tomography with CT in BT planning is a promising area that requires equipping with a mathematical tool for double and triple contouring of the tumor and organs at risk and for defining protection priorities. The prescribed and used focal dose should be controlled by direct dosimetry methods to ensure quality assurance

Search for Optimal MRI Protocol for the Diagnosis of Vaginal Tumor

Background. A wide variety of pulse sequences, the possibility of multiplanar imaging significantly increase the capabilities of magnetic resonance imaging (MRI) in diagnosing diseases of the female reproductive system. At the same time, the lack of a regulated scanning protocol, especially in patients who have undergone anticancer treatment, requires standardization of the technique and the search for an optimal set of pulse sequences that allows to visualize the vagina throughout its entire length and to perform differential diagnosis between continued tumor growth and post-radiation changes while maintaining an adequate examination time.Objective: to determine the optimal set of MRI pulse sequences for pelvic organs examination in patients with vaginal tumors and to form an original research protocol based on diagnostic information content.Material and methods. The study included 141 patients with vaginal tumors. A comparative analysis of four MRI protocols was carried out, built according to the principle “from simple to complex” (from native to multiparametric MRI).Results. A significant difference was obtained between all information content indicators of Protocol 4 compared to Protocol 1 (sensitivity p = 0.00006, specificity p = 0.00443, AUC p = 0.00000). Data analysis also showed a significant difference between sensitivity and AUC for Protocols 2 and 4 (p = 0.00150 and p = 0.00087, respectively), and Protocols 3 and 4 (p = 0.01333 and p = 0.01333, respectively).Conclusion. Significant increase in the information content of Protocol 4 compared to other protocols (sensitivity up to 93%, specificity up to 94%, accuracy up to 93%) indicates the expediency of the priority use of multiparametric MRI in the primary diagnosis of vaginal tumor lesions

Giant Renal Angiomyolipoma by the Example of Clinical Cases

The paper presents two clinical cases of patients with giant renal angiomyolipomas (AML), in one of whom its course was complicated by intratumoral hemorrhage. It describes key diagnostic criteria for computed tomography (CT), as well as the distinctive features of other neoplasms that should undergo a differential diagnosis. The similar clinical presentations and morphological characteristics of different renal neoplasms can cause certain diagnostic difficulties; however, the carefully collected historical data and distinctive criteria allow AML to be identified. Due to its high sensitivity and specificity, abdominal contrast-enhanced CT is an effective imaging technique in the detection and differential diagnosis of giant renal AML

Carcinoid of the Operated Stomach: Difficulties in Diagnosis

Gastric neuroendocrine tumors commonly called carcinoids arise from enterochromaffin cells of the stomach and are rare. Recently, their incidence has increased, which may be due to the improvement of diagnostic and therapeutic capabilities. The article describes a rare clinical case of gastric carcinoid 23 years after surgical removal of gastric cardia cancer

A Rare Clinical Case of Urachal Adenocarcinoma: Diagnostic Picture Peculiarities According to Radiological Data

The article presents the clinical observation of a patient born in 1965, who was examined and treated at the Russian Scientific Center of Roentgenoradiology for tumor of anterior bladder wall detected in May 2023 according to the results of radiation diagnostic methods (ultrasound, computed tomography, magnetic resonance imaging). Analysis of biopsy material obtained during cystoscopy revealed a highly differentiated mucinous urachal adenocarcinoma. Based on the diagnosis of malignant neoplasm of primary urinary tract (urachus) pT3N0M0 stage II, the surgical treatment was proposed. In June 2023, the Bricker procedure was performed: laparoscopic anterior pelvic exenteration with formation of intestinal reservoir. Control examination 3 months after showed no progression of the disease. Asymptomatic development of urachal carcinoma in early stages, peculiarities of its location in pelvic cavity and propensity to metastasis, as well as the rarity of such neoplasm indicate the need for earlier and more accurate verification of the diagnosis. This clinical case demonstrates characteristic clinical and imaging features of urachal adenocarcinoma, which may help radiologists, oncologists, and urologists in making diagnosis and choosing correct treatment tactics

To Help the Practitioner: Imaging of Ovarian Masses According to the O-RADS MRI Ovarian Malignancy Categorical Risk Scale

Objective: to study the informativity of the Ovarian-Adnexal Imaging-Reporting-Data System Magnetic Resonance Imaging (O-RADS MRI) in detection of ovarian cancer in the practice of a radiologist.Material and methods. The study included 271 women who underwent pelvic magnetic resonance imaging (MRI) in the period from August to November, 2021. Two radiologists with 6-year (Researcher 1) and 2-year (Researcher 2) experience retrospectively analyzed MR images, in which all ovarian masses were evaluated according to O-RADS MRI categorical risk scale from 0 to 5. The analysis of true positive, true negative, false positive and false negative rates according to MRI data compared to the reference data (histology or 1-year follow-up) was performed.Results. O-RADS MRI categorial risk scale had high diagnostic performance for the characterization of adnexal lesions (sensitivity 87.5% and 87.5%, specificity 97.84% and 96.75%, area under curve (AUC) 0.991 and 0.986 for Researchers 1 and 2, respectively), as well as good interreader agreement (Cohen’s kappa coefficient 0,83). Researchers’ mistakes were analyzed, as well as controversial issues of categorial affiliation of ovarian masses that caused false positive and false negative results. Visual aids for ovarian MRI in accordance with O-RADS MRI classification were made for quick orientation in the system to simplify creating the radiology report.Conclusion. O-RADS MRI categorial risk scale proved to be a reliable working tool for the communication between radiologist and gynecologist-oncologist. However, the question of categorial affiliation of a number of nosological names that are not reflected in O-RADS MRI and require further study continues to be debated

Rare Form of Breast Cancer and Lung Foci: Do We Always Have to Wait for Metastases?

Will the detected lung foci in patients with a burdened oncological history (breast cancer) always be metastatic? In response to the question posed, we present a clinical case of pulmonary sarcoidosis mimicking the metastatic lesion of metaplastic breast cancer. And we remind of the need for a differential diagnosis, despite the oncological history of a patient and radiation diagnostics data

Diagnostic Pitfalls in Patients with Aortomesenteric Duodenal Compression

Superior mesenteric artery syndrome, first reported by Karl Freiger von Rokitansky, is a rare disorder associated with the compression of the horizontal part of the duodenum between the mesenteric artery and the abdominal aorta. A rare clinical observation of the development of the superior mesenteric artery syndrome in a 19-year-old patient is presented to raise the awareness of doctors about this syndrome and the need for early diagnosis and treatment to prevent complications

Возможности компьютерной томографии в диагностике злокачественных образований верхних мочевых путей

Objective. To evaluate the possibility of computed tomography in the diagnostisc and staging of cancer of the upper urinary tract (UUT).Material and methods. The study included 23 patients with cancer of the upper urinary tract. All patients underwent contrast-enhanced MSCT, urine cytology (to detect atypical cells or cancer cells). Upon detection of the tumor of UUT according to MSCT, patients underwent ureteropieloscopy with a biopsy. After the surgery was performed to verify the diagnosis histological examination of surgical material.Results. The leading computer-tomographic finding of UUT cancer is a “defect” in renal pyelocaliceal system, in the ureter in the excretory phase. MSCT allows exactly speak about cancer in the case of accumulation of contrast material, can detect even small-sized neoplasm in patients without an extension renal pyelocaliceal system. Systematized and formulated a computer-tomographic signs of staging of malignant tumors of the UUT.Conclusion. MSCT is the most effective diagnostic method of upper urinary tract cancer, and the method allows to establish the stage of disease. Цель исследования: оценить возможности компьютерной томографии в диагностике и стадировании рака верхних мочевых путей (ВМП).Материал и методы. Обследовано 23 пациента с раком ВМП. Всем пациентам выполняли МСКТ с болюсным контрастированием, цитологическое исследование мочи (для выявления атипических клеток или клеток рака). При обнаружении образования ВМП по данным МСКТ пациентам выполняли уретеропиелоскопию с биопсией опухоли. После хирургического вме- шательства проводили гистологическое исследование операционного материала.Результаты. Ведущим компьютерно-томографическим признаком рака ВМП является “дефект контрастирования” в экскреторную фазу в чашечно-лоханочной системе (ЧЛС) почки, в мочеточнике. МСКТ позволяет однозначно высказаться в пользу опухолевого процесса в случае накопления образованием контрастного препарата, выявлять образования даже небольших размеров у пациентов без наличия расширения ЧЛС. Систематизированы и сформулированы компьютерно-томографические признаки стадирования злокачественных образований ВМП.Выводы. МСКТ является наиболее эффективным методом лучевой диагностики рака ВМП, позволяющим также установить стадию заболевания.