[C-methionine PET in assessment of brain lesions in patients with glial tumors after combined treatment]. / PÉT s S-metioninom v otsenke porazhenii golovnogo mozga u bol'nykh s glial'nymi opukholiami posle kombinirovannogo lecheniia.

Positron emission tomography (PET) with amino acid-based radiopharmaceuticals is considered as an effective method to diagnose continued growth of cerebral gliomas, but the variability of 11C-methionine uptake by brain lesions of different genesis after combined treatment still remains poorly understood. The aim of this study was to explore the information value of 11C-methionine PET in delimitating progression of cerebral gliomas and stable disease and to assess the risk of tumor recurrence at different values of the 11C-methionine uptake index. MATERIAL AND METHODS: We performed a retrospective analysis of the results of 11C-methionine PET or PET/CT in 324 patients suspected for continued growth of cerebral tumor based on magnetic resonance imaging (MRI) findings. A quantitative analysis of the results included calculation of the 11C-methionine uptake index (UI). RESULTS: A ROC analysis revealed that the specificity of PET in the diagnosis of continued tumor growth (CTG) was 98%, and the sensitivity was 71% for a UI of more than 1.9. We found that 98% of lesions with a negative level of RP uptake were related to radiation brain lesions (RBLs) or residual tumors combined with radiation pathomorphims. The UI in a range of 1.2-1.6 in 75% of lesions characterized a stable disease, but 25.5% of the lesions represented continued glioma growth. The proportion of recurrences increased to 40% in a UI range of 1.6-1.9, and 95.5% of brain lesions with a UI of more than 1.9 were tumor recurrences. Therefore, high 11C-methionine uptake with the UI above 1.9 in brain lesions characterized by radiological signs of disease progression is a highly specific indicator of CTG; however, the UI may significantly vary during tumor growth, and a substantial fraction of recurrent gliomas may have lower radiopharmaceutical uptake. In the case of borderline UI values, early dynamic control or complementary additional MRI or CT techniques should be used.

[A case-report of Balo concentric sclerosis transformed into definite multiple sclerosis]. / Klinicheskii sluchai kontsentricheskogo skleroza Balo, transformirovavshegosia v dostovernyi rasseiannyi skleroz.

The authors present the results of an 8-year retrospective-prospective follow-up of a patient with Balo concentric sclerosis. The disease meets the diagnostic criteria of remitting-relapsing multiple sclerosis.

[Cortical atrophy in multiple sclerosis]. / Atrofiia kory golovnogo mozga pri rasseiannom skleroze.

Objective. To identify clear patterns of the cerebral cortex atrophy in multiple sclerosis that may provide valuable information for the development of additional paraclinical methods of stages and variants of MS objectification and verification and used for assessing treatment efficacy. Material and methods. The results of morphometric data analysis of 117 patients with different variants of MS and 25 healthy volunteers are presented. The original algorithm for postprocessing MRI images was used. Age, disease duration, type of disease, FS and EDSS scores, morphometric results were the source parameters for the statistical analysis. Results. The correlation analysis showed that the total cortex volume was in inverse correlation with EDSS score, pyramidal and cerebellar dysfunction, but not with disease duration. An analysis of regional changes in 43 bilateral regions of interest (ROI) demonstrated similar results in 7 ROIs in the left (dominant) hemisphere and in 4 ROIs in the right hemisphere. ANOVA revealed atrophic changes in 20 ROIs bilaterally. Deficit of certain functional systems was accompanied by the atrophy of various functional cortex regions. ANOVA of the regional cortical atrophy in groups with varying disease severity showed the presence of significant changes in patients with moderate to severe disability. Duration and type of MS were not predictive for development of atrophy, with the exception of the precuneus bilaterally, the right paracentral lobule and right posterior cingulate gyrus. Conclusion. Regional cortical atrophy is detected in the earliest stages of the disease and increases as the disease progresses. Inconsistency of data across studies can be explained by the lack of generally accepted morphometric standards and pathogenetic heterogeneity of MS. Regional cortical atrophy may be considered as a sensitive neuroradiological biomarker for MS.

[Current possibilities of the comprehensive diagnostic assessment in the differential diagnosis of inflammation and tumors of the spine cord].

The article discusses the differential diagnosis of transverse myelitis. An algorithm for the assessment of patients was given. The authors present two clinical examples demonstrating the role of the integrated neuroradiological approach in the differential diagnosis of difficult cases.