ОДИНОЧНЫЕ ОЧАГИ И ОБРАЗОВАНИЯ ЛЕГКИХ: ЭФФЕКТИВНОСТЬ ДИНАМИЧЕСКОЙ КТ ПРИ ДИФФЕРЕНЦИАЛЬНОЙ ДИАГНОСТИКЕ

The differential diagnosis of solitary pulmonary nodules remains a challenge in oncology. Dynamic contrastenhanced CT is a potentially valuable tool capable of detecting malignancy. The purpose of the study was to evaluate the value of dynamic CT in the differential diagnosis of solitary pulmonary nodules. Material and methods. Fifty two patients with solitary pulmonary nodules underwent CT examination using a GE Optima CT660. The CT protocol included: 1) scan volume from the jugular notch to the end of the diaphragmatic dome; 2) location of the nodule in the lung; 3) scanning time for 30 sec, 1 min, 2 min, 4 min and 6 min following contrast agent injection. The image processing was carried out on an Advantage Workstation for Windows (AW4.5, GE Healthcare). The CT findings were verified by histology after CT-guided transthoracic biopsy of lung lesions and lung surgeries. Results. The sensitivity, specificity and accuracy of dynamic contract-enhanced CT were higher than those without dynamic CT (85, 95 and 92 % versus 71, 95 and 88 %, respectively).Введение. Актуальной проблемой современной онкологии остается дифференциальная диагностика одиночных очагов и образований в легких. Одной из методик, способных определить признаки опухолевого кровотока и тем самым выявить злокачественный процесс, является компьютерная томография с динамическим контрастным усилением (динамическая КТ). Цель исследования – оценить диагностическую эффективность динамической КТ при дифференциальной диагностике одиночных очагов и образований легких. Материал и методы. Динамическая КТ была выполнена 52 больным с одиночными очагами и образованиями в легком. КТ-исследование выполняли на мультиспиральном компьютерном томографе GE Optima CT660. Протокол КТ-сканирования включал: 1) нативное исследование от уровня яремной вырезки до уровня диафрагмальных синусов; 2) определение локализации очага в легком; 3) сканирование области очага на 30 сек, 1 мин, 2 мин, 4 мин и 6-й мин после введения контрастного препарата. Обработку полученных данных проводили на рабочей станции Advantage Workstation 5.0. КТ-данные были верифицированы путем сравнения с гистологическим заключением, полученным после трансторакальной трепан-биопсии под контролем КТ и хирургических вмешательств на легких. Результаты. Без использования данных динамической КТ чувствительность метода при выявлении злокачественного процесса составила 71 %, специфичность – 95 %, точность – 88 %, тогда как с использованием результатов динамической КТ – 85, 95 и 92 % соответственно

ЛОКАЛИЗОВАННЫЙ РАК ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ: ВОЗМОЖНОСТИ МАГНИТНО-РЕЗОНАНСНОЙ ТОМОГРАФИИ С ГИБКОЙ МАТРИЧНОЙ КАТУШКОЙ В ВЫЯВЛЕНИИ МИНИМАЛЬНОГО ЭКСТРАКАПСУЛЯРНОГО РАСПРОСТРАНЕНИЯ ОПУХОЛИ

Retrospective assessment of preoperative magnetic resonance imaging (MRI) data in 37 patients with prostate cancer, who had undergone radical prostatectomy, established the most diagnostically valuable MRI signs of minimal extracapsular spread (ECS): asymmetry of neurovascular fascicles (72 % accuracy, 93 % sensitivity, 77 % specificity, 73 % positive and 94% negative predictive values) and iron outline deformity/irregularity (66/80/64/60/82 %, respectively); as well as their higher diagnostic efficiency versus the clinical and laboratory predictors of ECS: total Gleason scores (58/87/55/57/86 %, respectively) and serum PSA levels (uninformative), which permits their consideration while choosing a more or less radical prostatectomy modality.При ретроспективной оценке дооперационных магнитно-резонансных (МР) томограмм 37 больных раком предстательной железы, которым была выполнена радикальная простатэктомия, установлены наиболее диагностически эффективные МР-признаки минимального экстракапсулярного распространения (ЭКР): асимметрия сосудисто-нервных пучков (точность 72 %, чувствительность 93 %, специфичность 77 %, прогностичность положительного и отрицательного результатов 73 и 94 %) и деформация/неровность контура железы (66/80/64/60/82 % соответственно) и установлена их более высокая диагностическая эффективность в сравнении с клинико-лабораторными предикторами ЭКР: суммой баллов по шкале Глисона (58/87/55/57/86 % соответственно) и уровнем простатспецифического антигена в сыворотке крови (неинформативен), что позволяет учитывать их при выборе более или менее радикального варианта иссечения предстательной железы

РЕЗУЛЬТАТЫ ДООПЕРАЦИОННОГО ОПРЕДЕЛЕНИЯ МЕСТНОЙ РАСПРОСТРАНЕННОСТИ РАКА ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ С ПОМОЩЬЮ МАГНИТНО-РЕЗОНАНСНОЙ ТОМОГРАФИИ У ПАЦИЕНТОВ, КОТОРЫМ БЫЛА ВЫПОЛНЕНА РАДИКАЛЬНАЯ ПРОСТАТЭКТОМИЯ

The values of the diagnostic efficiency and consistency of preoperative evaluations of locally advanced prostate cancer (PC) by magnetic resonance imaging (MRI) with a matrix coil were estimated in 37 patients with PC who had undergone radical prostatectomy. The accuracy of differentiation of T3 and T2 stages in prospective and retrospective assessments was 59 and 73 %; the sensitivity was 7 and 40 %, and the specificity was 96 and 9 %, respectively; with the moderate consistency of evaluations.Определены показатели диагностической эффективности и согласованности дооперационных оценок местной распространенности рака предстательной железы (РПЖ) с помощью магнитно-резонансной томографии с матричной катушкой у 37 больных РПЖ, которым была выполнена радикальная простатэктомия. Точность дифференциации Т3 и Т2 стадий при проспективнойи ретроспективной оценках составила 59 и 73 % , чувствительность 7 и 40 %, специфичность 96 и 96 % соответственно, при умеренной согласованности оценок

MINI-INVASIVE INTERVENTIONS UNDER MAGNETIC RESONANCE GUIDANCE IN THE CLARIFYING DIAGNOSIS OF SMALL PELVIC TUMORS

Objective: to perfect and estimate the possibilities of using a mini-invasive diagnostic procedure under magnetic resonance (MR) guidance in the complex anatomic situations in cases of pathological small pelvic changes of unknown origin.Material and methods. Ten small pelvic interventions were made under MR guidance. The indications for bone biopsy under MR guidance were poor visualization of bone changes or their absence during radiography, including computed tomography. Small pelvic organ and soft tissue biopsies were carried out in the situations of complex location of pathological changes adjacent to critical organs, large vascular and neural structures. All interventions were done using a high-field MR scanner. Freehand biopsy was performed in a stepwise fashion under axial and sagittal T2-weighted image control.Results. Informative histological material was obtained in 100% of cases. No complications were observed.Conclusions. It became possible to verify the diagnosis based on morphological findings and to timely determine management tactics only by target biopsy under MR guidance in these 10 patients with small pelvic changes of unknown origin

Diagnosis and monitoring of bone marrow involvement in Hodgkin's lymphoma using magnetic resonance imaging

In 42 patients with verified Hodgkin lymphoma and confirmed metastatic skeletal lesion possibility of using specific pulse sequences in imaging of bone marrow involvement have been established. MRI pattern of bone marrow lesion, signal localization, distribution and intensity were revealed. In 33 patients with newly diagnosed bone lesions the MR images of the affected and intact bone marrow during chemotherapy were assessed during 10 months. In 2 patients MR images were assessed after radiotherapy. Several MRI patterns changes of affected bone marrow after 2, 6 and 8 chemotherapy cycles were identified.</p

Cancer of the cervix uteri: magnetic resonance and clinical factors of prognosis

Based on their observations, the authors have made univariate and multivariate analyses of the prognostic importance of a number of magnetic resonance and clinical factors in cancer of the cervix uteri

Role of magnetic resonance imaging in the diagnosis of recurrent cancer of the cervix uteri

Objective: to define a role of magnetic resonance imaging (MRI) in the follow-up of patients with cancer of the cervix uteri (CCU), who have undergone radiation therapy and chemoradiation therapy and to describe the types of the MRI pattern of recurrent CCU in the pelvic region.Materials and methods. The results of a follow-up of 82 patients with a 4-47- (median 12 months) month history of invasive CCU were analyzed.Results. Out of the 82 patients with invasive CCU, 25 were found to have pelvic recurrences; in 23 cases MRI revealed the latter (in the cervix uteri (n = 6), corpus uteri (n = 2), vagina (n = 2), parametrium (n = 2), iliac (n = 10), paraaortic (n = 5) lymph nodes, and pelvic wall (n=5).Conclusion. The findings suggest that pelvic MRI is an effective technique to detect and estimate the extent of a pelvic recurrence and it is expedient to incorporate it into the scope of a follow-up after radiation therapy and chemoradiation therapy in patients with invasive CCU

CLINICALLY LOCALIZED PROSTATE CANCER: CAPACITIES OF MATRIX COIL MRI TO DETECT MINIMAL EXTRACAPSULAR TUMOR SPREAD

<p><em>Retrospective assessment of preoperative magnetic resonance imaging (MRI) data in 37 patients with prostate cancer, who had undergone radical prostatectomy, established the most diagnostically valuable MRI signs of minimal extracapsular spread (ECS): asymmetry of neurovascular fascicles (72 % accuracy, 93 % sensitivity, 77 % specificity, 73 % positive and 94% negative predictive values) and iron outline deformity/irregularity (66/80/64/60/82 %, respectively); as well as their higher diagnostic efficiency versus the clinical and laboratory predictors of ECS: total Gleason scores (58/87/55/57/86 %, respectively) and serum PSA levels (uninformative), which permits their consideration while choosing a more or less radical prostatectomy modality.</em></p

SOLITARY PULMONARY NODULES: EFFECTIVENESS OF DYNAMIC CT IN THE DIFFERENTIAL DIAGNOSIS

The differential diagnosis of solitary pulmonary nodules remains a challenge in oncology. Dynamic contrastenhanced CT is a potentially valuable tool capable of detecting malignancy. The purpose of the study was to evaluate the value of dynamic CT in the differential diagnosis of solitary pulmonary nodules. Material and methods. Fifty two patients with solitary pulmonary nodules underwent CT examination using a GE Optima CT660. The CT protocol included: 1) scan volume from the jugular notch to the end of the diaphragmatic dome; 2) location of the nodule in the lung; 3) scanning time for 30 sec, 1 min, 2 min, 4 min and 6 min following contrast agent injection. The image processing was carried out on an Advantage Workstation for Windows (AW4.5, GE Healthcare). The CT findings were verified by histology after CT-guided transthoracic biopsy of lung lesions and lung surgeries. Results. The sensitivity, specificity and accuracy of dynamic contract-enhanced CT were higher than those without dynamic CT (85, 95 and 92 % versus 71, 95 and 88 %, respectively)