ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова» Минздрава России. г. Санкт-Петербург, Россия.читывая влияние вируса SARS-CoV-2 на сосудистую систему легких, проявляющееся развитием эндотелиита, васкулита, тромбозов и коагулопатий, одним из ведущих направлений лучевого обследования может стать исследование микроциркуляции методом ОФЭКТ. Цель исследования. Оценить изменения в микроциркуляторном русле легких у пациентов, перенесших COVID-19, в разные сроки от начала заболевания.Материалы и методы. Проанализированы данные ОФЭКТ-исследований 170 пациентов с перенесенной коронавирусной инфекцией разной тяжести течения с мая 2020 года по июнь 2021 года. Были сопоставлены результаты ОФЭКТ, КТ, ФВД, показатели уровня Д-димера, фибриногена.Результаты. У всех пациентов были выявлены изменения микроциркуляции в легких в постковидном периоде. Степень выраженности нарушений микроциркуляции имела достоверную зависимость (p<0,05, r=0,76) от степени поражения легочной паренхимы и среднюю корреляционную зависимость (r=0,51) от сроков постковидного периода. У пациентов с хроническими заболеваниями легких микроциркуляция снижалась до критических цифр, общий уровень снижения -до 30% и более по сравнению с доковидным периодом (p=0,034). Признаки ТЭЛА/микротромбозов достоверно чаще (p<0,05, r=0,82) встречались у больных с более тяжелым течением заболевания. Выявление мелких, субсегментарного уровня, дефектов микроциркуляции треугольной формы, с частично восстановленным кровотоком, коррелировало в высокой степени (r=0,84) с повышением уровня фибриногена (4,6+1,8 мг/л) и указывало на последствия перенесенной ТЭЛА, а повышение уровня Д-димера (1750+ 215 нг/мл) с наличием треугольной формы дефектов накопления РФП коррелировало в высокой степени (r=0,88) с ТЭЛА.Выводы. Нарушения микроциркуляции в легких сохраняются длительное время. Они выявляются у больных не зависимо от тяжести течения патологического процесса, увеличиваются при динамическом исследовании; дефицит перфузии зависит от степени поражения легочной паренхимы. У пациентов, перенесших COVID-19 с развитием тромбозов, выявляются признаки перенесенной ТЭЛА и формируются зоны локального пневмосклероза.Ключевые слова: вирус SARS-CoV-2, дисфункция эндотелия, микроциркуляция, однофотонная эмиссионная компьютерная томография легких.

Background. Carotid chemodectoma is rare, slow growing, richly vascularized lesion. It is a single unilateral or bilateral tumor, localized mainly in the area of the carotid triangle. Different forms and bilateral cases are also known. A complex of radiological studies, including MRI and CT with intravenous contrast, can help in determining the surgical treatment strategy, as well as treatment monitoring. Objective. To determine the role of MRI and CT with intravenous contrast in the assessment of carotid chemodectoma at the preoperative stage and at post-surgery monitoring. Materials and Methods. We analyzed the results of a comprehensive radiological examination of 12 patients with suspected carotid chemodectoma, including MRI and MSCT with intravenous contrast, and X-ray angiography. All patients got operated, the results were confirmed by histological and immunohistochemical study. Results. Multislice computed tomography, supplemented by CT angiography, allows visualizing chemodectoma, determining its size, shape, structure, and relations with the nearby vessels. In addition to size, shape, structure of chemodectoma MRI can provide a detailed picture of the internal vascular network, the walls of adjacent vascular structures, as well as the soft tissue structures of the peripharyngeal area, which is helpful for vascular surgeons in surgical intervention. It was not possible to determine the histogenesis of the tumor according to the methods of radiation diagnostics. Conclusions. In order to determine the option of surgical treatment of carotid chemodectomas and reduce the risk of intraoperative complications at the preoperative stage, it is necessary to carry out the entire spectrum of radiation diagnostic methods (including ultrasound, MSCT, MRI and X-ray angiography).

Introduction. Algorithms of the early detection of lung cancer remain a topic of discussion and the problem of timely assessment of the expansion of lung cancer remains unresolved.Objective – to determine if the combined use of contrast­enhanced MDCT and 99mTc­MAA SPECT and Gallium‐67 citrate SPECT is effective in assessing the expansion of lung cancer in the determination in the intervention tactics.Material and methods. In the study, radiologic examination was performed to 81 patients with lung cancer. Combined examinations included bolus contrast­enhanced computed tomography (n = 81 patients), 99mTc­MAA SPECT (n = 62 patients) and Gallium‐67 citrate SPECT (n = 9 patients).Results.According to MDCT data in most cases (n = 65 patients; 80 %) this method was able to diagnose the T­stage of the tumor; in some cases, the stage of malignancy was overestimated (n = 8 patients, 10 %), or underestimated (n = 8 patients, 10 %). According to the results of 99mТc­МАА SPECT, it was possible to reliably determine the microcirculation disorders that were observed in the whole group of patients, while in 12 cases the impaired blood flow was recorded only according to the results of 99mTc­MAA SPECT and in 50 cases the severity of changes in blood flow was more signifcant than according to MDCT. When analyzing Ga­67 citrate SPECT data, in all 9 cases whole­body Ga­67 citrate SPECT showed intense hot areas at the tumor region. It was also possible to show several mildly increased foci in the hilar lymph nodes in 6 cases, but in 3 cases the result was false positive.Conclusions. Bolus contrast­enhanced computed tomography in most cases allows to correctly determine the T­stage of lung cancer and show tumor invasion into the surrounding tissues and vessels. At the same time, an additional 99mTc­MAA SPECT study allows to clarify the degree of disturbance of the microvasculature in more detail. It is possible to supplement the assessment of regional metastasis by Gallium‐67 citrate SPECT, however, it is necessary to take into account the inflammatory nature of lymph node changes as a cause of false­positive data.

Leukemia-associated myelitis is a rare but underestimated complication. It has a different etiology associated with both, the main disease and its treatment methods. It requires differential diagnosis with funicular myelosis, polyradiculoneuropathy, tumor and hemorrhagic formation, stroke, dysmetabolic manifestations, as well as with the consequences of treatment of the underlying disease using radiation, cytostatic, targeted therapy.It should also be differentiated from paraneoplastic myelopathy and progression of the underlying disease. However,with the help of neuroimaging methods, it can be detected more recently than a detailed clinical picture appears. A case report of myelopathy in a 31 year old patient with acute lymphoblastic leukemia is presented. Treatment of the underlying disease was carried out with the use of chemotherapy, radiation therapy, allogeneic hematopoietic stem cell transplantation and targeted therapy. The nature of the disease,i.e. recurrent course of acute lymphoblastic leukemia, the variety of treatment methods, and the absence of focal changes in neuroimaging in the zone that determines clinical manifestations, made it necessary to consider a wide range of possible etiological factors for the development of myelopathy. Myelopathy was confirmed by MRI 2.5 months after the debut of neurological symptoms, which corresponds to modern concepts and time criteria for visualization in neurooncology. The article presents the criteria for diagnosing myelopathy, a complication of acute lymphoblastic leukemia. It should also be differentiated from However, with the help of neuroimaging methods, it can be detected more recently than a detailed clinical picture appears.

In patients with chronic lymphocytic leukemia, pneumonia and tuberculosis are the dominant complications that play a major role in the outcome of the disease and lead to a fatal outcome. The purpose of the study: to carry out an analysis of computer tomographic complications semiotics in comparison with clinical and pathomorphological data. Results: A patient with chronic immunodeficiency diagnosed with 2-sided pneumonia, H1N1 influenza was verified. At the time, tuberculosis was not verified and pathogenetic treatment was not initiated, which led to a fatal outcome. Conclusion: the complexity of clinical and radiation pattern against the background of immunodeficiency state (CLL) cause difficulties in diagnosing. It is necessary to remember the possibility of rapid development of caseous pneumonia against the background of a combined pathology in immunodeficient conditions requiring phthisiatric consultation for the timely administration of anti-tuberculosis therapy.