[The central vein sign in the differential diagnosis of multiple sclerosis]. / Simptom tsentral'noi veny v differentsial'noi diagnostike rasseyannogo skleroza.

OBJECTIVE: To carry out a clinical and radiological assessment of the central vein sign (CVS) as a diagnostic marker for multiple sclerosis (MS) and other demyelinating and non-demyelinating diseases with focal brain damage, using clinical and laboratory examination data, as well as MRI. MATERIAL AND METHODS: The results of clinical and neuroradiological examination of 107 patients diagnosed with MS or with other diseases accompanied by focal brain damage according to MRI data were analyzed. RESULTS: CVS is a sensitive but low-specific diagnostic marker of MS. According to our data, the sensitivity and specificity of 40 and 50% of the threshold of perivenular lesions in the diagnosis of MS are the same and amount to 100% and 39.4%, respectively. Neither the type of MS course, nor the severity of the course, nor the intake of DMT (disease modifying treatment), affect the proportion of foci with CVS. The spread of the proportion of foci with CVS in patients with MS was 60-100%. The proportion of foci with CVS is below 40 and 50% of the threshold in patients with demyelinating and non-demyelinating diseases (NMOSD, migraine, systemic lupus erythematosus, Susak disease, CLIPPERS), which allows for differential diagnosis with MS. The proportion of foci with CVS comparable to MS in patients with acute disseminated encephalomyelitis, small vessel disease, as well as in patients with radiologically isolated syndrome does not allow using this symptom in the differential diagnosis of these conditions. CONCLUSION: The use of CVS as a diagnostic marker of MS is possible only in combination with the already existing diagnostic criteria of MS.

[Possibilities of dynamic phase contrast MRI of cerebrospinal fluid for performing a tap test in a patient with idiopathic normotensive hydrocephalus]. / Vozmozhnosti dinamicheskoi fazovo-kontrastnoi MR-likvorografii pri vypolnenii tap-testa u patsienta s idiopaticheskoi normotenzivnoi gidrotsefaliei.

Idiopathic normotensive hydrocephalus (iNH) is a widespread disease in elderly patients. The effectiveness of iNG treatment and the subsequent quality of patients' lives directly depends on timely and early diagnosis. The criteria for diagnosing iNG that are used in neuroimaging can also be found in patients without clinical manifestations of this disease, and the widely used tap-test is an invasive technique with a rather low sensitivity. The need for early diagnosis and initiation of treatment before the development of irreversible damage to brain structures determines the relevance of the search for an accessible, minimally invasive, accurate and safe diagnostic method. The article presents a clinical observation of the use of phase-contrast MRI of cerebrospinal fluid (CSF) in a female patient with a positive response to the tap test with a quantitative analysis of changes in CSF flow parameters and ALVI and Evans indices depending on the time after CSF evacuation. Phase-contrast MRI of CSF with a quantitative assessment of CSF flow parameters in combination with an assessment of the ALVI index has the potential to increase the accuracy of diagnosing iNH and is of scientific interest for further research.

[New neuroimaging methods in assessing the activity of neuroinflammation in multiple sclerosis]. / Novye metody neirovizualizatsii otsenki aktivnosti neirovospaleniya pri rasseyannom skleroze.

The review presents current data on the use of positron emission tomography and single-photon emission computed tomography in multiple sclerosis (MS) to assess the activity of the pathological process, including neuroinflammation, demyelination, activation of microglia, neurodegeneration and local blood flow disorders. These methodologies are a new approach for studying the mechanisms of action and evaluating the clinical effect of disease modifying therapy of MS, especially those capable of penetrating into brain tissue. Among them, the most attention is attracted by cladribine tablets acting on the mechanism of immune reconstitution therapy, most likely with the modulation of immune reactions directly in the brain tissue.

[First experience of thalamotomy by focused ultrasound under MR-guided navigation in the treatment of tremor. Neuroimaging follow-up. Case report and literature review]. / Pervyi opyt talamotomii fokusirovannym ul'trazvukom s MRT-navigatsiei pri lechenii tremora. Neirovizualizatsiya v dinamike. Klinicheskoe nablyudenie i obzor literatury.

The authors describe dynamic MRI and clinical data after non-invasive treatment of tremor in the upper extremity. Thalamotomy by high-intensity focused ultrasound under MR-guided navigation was performed. A 57-year-old patient with Parkinson's disease underwent treatment with focused ultrasound. MRI of the brain was performed 1 and 48 hours, 47 days, 3 and 6 months later. Features of natural course of focal brain changes after treatment, data of MR tractography necessary for correction of target zone are described. The authors conclude that MR changes are characterized by presence of a focus in the area of focused exposure. Peak severity is observed on the second day after procedure with subsequent regression. MR-based analysis of predictors is promising to forecast treatment outcomes.

[Diagnostic utility of positronic emission tomography in recurrences of prostate cancer].

An analysis of national and foreign literature dedicated to recurrence of prostate cancer, is presented in the article. The diagnostic utility of positronic emission tomography, fused with computer tomography and magnetic resonance tomography in case of biochemical recurrences of prostate cancer is discussed.

[Capabilities of 18F-FET PET/CT in a patient with brain glioma (a case report and literature review)]. / Vozmozhnosti PÉT/KT s 18F-FÉT u patsienta s gliomoi golovnogo mozga (sluchai iz praktiki i obzor literatury).

Positron emission tomography combined with computed tomography (PET/CT) enables assessment of not only anatomical and structural but also metabolic changes in tumor mass. 18F-fluoroethyl tyrosine (18F-FET) PET/CT is based on evaluation of transport of 18F-labeled tyrosine in tissues. We present a clinical case of a patient with a newly diagnosed brain tumor, demonstrating the capabilities of 18F-FET PET/CT in assessing the reliable volume and degree of tumor anaplasia, which is important when choosing the treatment approach for a patient.

Perfusion CT and PET with 18F-FDG and 18F-FCh in the complex diagnosis of hepatocellular carcinoma.

BACKGROUND: The purpose of the study to evaluate possibilities of CT-perfusion and PET methods with 18F-FDG and 18F-fluorocholine in the complex diagnosis of hepatocellular carcinoma. The study included the results of PET/CT with 18F-FDG, 18F-FCh and CT-perfusion of the liver in 18 patients with histologically confirmed diagnosis of hepatocellular carcinoma (HCC). Depending on the degree of tumor differentiation, all patients were divided into 3 groups - patients with highly differentiated (6 patients), moderately differentiated (4 patients), and low-differentiated HCC (8 patients). RESULTS: Average values of maxSUV in the group of patients with highly differentiated HCC in PET/CT with 18F-FDG and 18F- fluorocholine in a solid component of tumor reached 3.51 and 18.24, respectively; in patients with moderately differentiated HCC - 3.91 and 12.32, respectively; in patients with low-differentiated HCC - 9.58 and 9.70, respectively. Average values of CT perfusion imaging in a solid component of the tumor in the group of patients with highly differentiated HCC were the following: BF - 55,33 ml/100 ml/min, BV - 13,71 ml/100 ml, ALP - 52,41 ml/100 ml/min, PVP - 10.81 ml/100 ml/min (p ≤ 0,05), in the group of patients with moderately differentiated HCC: BF - 52,78 ml/100 m /min, BV - 12,23 ml/100 ml, ALP - 47,26 ml/100 ml/min, PVP - 9,10 ml/100 ml/min (p ≤ 0.05), in the solid component of low-differentiated HCC: BF - 46,96 ml/100 ml/min, BV - 9,49 ml/100 ml, ALP - 40.54 ml/100 ml/min, PVP - 7,66 ml/100 ml/min (p ≤ 0,05). CONCLUSIONS: The diagnostic capabilities of the complex of PET/CT techniques with 18F-FDG and 18F-FCh and CT perfusion in a single-scan mode for hepatocellular carcinoma were evaluated for the first time. The obtained data allow to assume that the integrated use of PET with 18F-FDG and 18F-FCh and CT perfusion in a single scan improves the differential diagnostic possibilities of PET/CT diagnostics, which can find application in planning and prognosis of the disease. Due to the small number of patients further study of the problem is required.

[Stereotactic radiotherapy for cerebral metastases using CyberKnife].

During recent decade development of frameless techniques of fixation enabled introduction of stereotactic radiation therapy in metastatic brain lesions and made possible irradiation of large foci involving or proximal to eloquent and critical brain areas. This paper focuses on comparative analysis of effectiveness of hypofractionation (HRST) and radiosurgery (SRS) using CyberKnife system in cerebral metastases. Since November 2009 till June 2011 54 patients with cerebral metastases were treated using CyberKnife system. Age of patients ranged between 25 and 77 years (mean 54 years). 16 patients received radiosurgical treatment (mean total dose was 22.5-35 Gy, number of fractions varied from 2 to 7, mean volume of irradiation was 22.69 cm3) and 8 patients were treated by HRST with RS of selected foci (mean total dose reached 23 and 30 Gy, mean volume of irradiation was 1.02 cm3 and 11.19 cm3, respectively). Indices of overall regression and stabilization of disease for HRST and SRS groups were 81% and 79%, respectively. With mean follow-up period of 12.3 (1-16.1) months median survival for SRS and HRST reached 6.38 (1-15.8) and 6.2 (0.2-16.1) months and median recurrence-free survival was 3.6 (1-13.6) and 5.5 (2-14.2) months, respectively. Obtained results confirmed biological advantages of fractionated stereotactic radiotherapy of large cerebral tumors in comparison with radiosurgery. Prospective studies with rigid criteria of inclusion are required to determine optimal dose/volume/fractionation interrelations in stereotactic radiation treatment of cerebral metastases.

[Application of SPECT/CT in neurosurgical practice].

The paper presents the experience of application of single-photon emission computed tomography (SPECT) and CT in neurosurgery. Combination of these two techniques in the single system provides higher precision of both methods. The novel technique allows assessment of tumor spread in the brain, differential diagnosis of tumor regrowth and radiation-induced necrosis, evaluation of cerebral perfusion in epilepsy, traumatic brain injury (TBI), and diagnostics of secondary CNS lesions. Examples of primary diagnosis, dynamic follow-up and differential diagnosis of cerebral neoplasms, localization of epileptogenic foci in planning of surgery, prediction of outcome after TBI and evaluation of spread of metastatic skeletal involvement and further application of acquire data are presented.

[Application of "Gamma-knife" radiosurgery in treatment of intracranial metastases of extracranial malignant tumors].

Treatment of intracerebral metastases is one of the key problems in neurooncology. Modern methods of combined treatment do not significantly affect terms of survival. Quality of life during the whole period of treatment depends on selected tactics. We summarized our experience of treatment of 119 patients with cerebral metastases of extracranial tumors with "Gamma-knife" stereotactic radiosurgery (GKSRS) during 2005 and 2006 years. "Leksell Gamma-knife C" was used for treatment procedures. Primary tumor was located in lung in 35 cases, in breast in 32 cases. Renal cancer metastases were less common (15 cases) as well as skin melanoma (14), colon cancer (8) and other localizations (6 cases). Total amount of treated metastases was 628. Marginal doses ranged between 15 and 24 Gy. During followup 77 patients were examined 153 times by contrast-enhanced MRI every 3 months. Mean follow-up period was 194.6 days (6.5 months). In 68 cases (88.3%) GKSRS provided total tumor control of 446 irradiated lesions (92%). Median survival after GKSRS was 8.2 months. All patients were assessed using RPA prognostic criteria. The best prognosis for life ( > 1 year) was observed in RPA I class patients. Median survival in patients with initial Karnofsky performance level < 70% (RPA III class) did not exceed 3.5 months. Presence of circumscribed brain involvement (less than 10 foci) is associated with more favorable prognosis (median survival is increased to 9.4 months). In patients with disseminated brain involvement (more that 10 metastases) survival median was 3.8 months (p < 0.05). GKSRS is minimally invasive, safe and effective method for treatment of intracerebral metastases of all main histological types of extracranial tumors. Local tumor control is observed in 88% of patients. Life expectancy prognosis depends on activity of extracranial process, initial condition of patient by the moment of treatment and initial spread of metastatic brain involvement.