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Aim: to analyze the diagnostic value of the digital rectal examination, colonoscopy, MRI and ERUS for detecting occult adenocarcinoma in rectal adenomas.Patients and methods: the study included 100 patients with newly identified epithelial rectal neoplasms, which undergone transanal endoscopic microsurgery from December 2019 to December 2020. All the patients underwent digital rectal examination, colonoscopy, ERUS with sonoelastography, and pelvic MRI. The diagnostics value of this methods was estimated with determination of sensitivity and specificity.Results: the study included 67 (67%) females and 33 (33%) males. The mean age of the patients was 64.4 ± 10.7 years. The median distance from the tumor to the anal verge was 6.0 ± 2.9 cm. The sensitivity of the digital rectal examination in the occult malignancy verification was 0.44 (95% CI 0.24–0.65), specificity — 0.93 (95% CI 0.85–0.97). The sensitivity of the colonoscopy — 0.56 (95% CI 0.34–0.75), the specificity — 0.84 (95% CI 0.73–0.91). The sensitivity of MRI — 0.40 (95% CI 0.21–0.61), specificity — 0.89 (95% CI 0.80–0.95). The sensitivity of ERUS was 0.48 (95% CI 0.27–0.68), the specificity — 0.73 (95% CI 0.61–0.82). Pair wise comparison of diagnostic methods revealed the absence of significant differences in their diagnostic value (p > 0.05).Conclusion: at least one of diagnostic methods allows to verify the presence of malignant transformation in 100% of cases. So, only combination of diagnostic methods can help to choose the optimal treatment option.

AIM: to determine the diagnostic efficiency of magnetic resonance enterocolonography using inflammation indices (CDMI, MEGS) in assessing activity of the inflammatory process in the colon and small intestine in Crohn's disease.PATIENTS AND METHODS: the study included 42 patients with Crohn's disease (age ranged from 19 to 47 years). All patients underwent magnetic resonance enterocolonography (MRE) with intravenous contrast and diffusion-weighted images. According to the results of MRE, were determined MR indices of inflammation activity in the small and large intestine - CDMI and MEGS. The MR inflammatory activity indices CDMI and MEGS were compared with the endoscopic inflammatory activity index SES-CD.RESULTS: the MR inflammation activity index CDMI did not show a statistically significant diagnostic efficiency (p>0.05). The MR inflammation activity index MEGS showed a statistically significant diagnostic efficiency (p<0.0001). According to the nomogram, the MR inflammation activity index MEGS demonstrated a high predictive ability to determine the true activity of the inflammatory process in the small and large intestine. Correlation demonstrated direct strong relationship between the quantitative values of the MEGS inflammation indices and the endoscopic inflammation index (SES-CD) (r=0.843, p<0.0001).CONCLUSION: magnetic resonance enterocolonography using the MEGS activity index has a high diagnostic efficiency in assessing the activity of the inflammatory process in the small and large intestine in Crohn's disease. The MR inflammation activity index CDMI did not show statistically significant diagnostic efficacy. The results of the study should be considered preliminary and require further study of the possibilities of these indices of inflammation activity in a larger sample of patients.

Aim.Investigation of possibilities of magnetic resonance imaging as a whole, as well as different modes of MR scanning (without intravenous contrast, with intravenous contrast, with the use of diffusion-weighted imaging) in the diagnosis of cryptogenic fistulas of the rectum.Materials and methods. In the study were included 50 patients with cryptogenic fistulas of the rectum (21 women and 29 men). All patients underwent magnetic resonance imaging of the pelvic organs.Results.The sensitivity of MRI in the diagnosis of the primary fistulas was 100%. With regard to secondary fistulas MRI sensitivity was 91.7%, specificity was 94.3%. The sensitivity of MRI in the diagnosis of chronic abscesses paraproctitis was 82.6%, specificity was 95.2%. The sensitivity of the method in the visualization of internal opening was 95.5%, specificity was 80.0%. The sensitivity of the method in the diagnosis of external openings was 91.7% and specificity was 100%. In the analysis of separates MR scanning mode we didn’t find statistically significant differences between them (p < 0.05). Conclusions.Magnetic resonance imaging has a high diagnostic efficacy in the diagnosis of cryptogenic perianal fistulas. We didn’t find statistically significant differences between MR scanning modes.