Vol 49, No 1 (2021)

Cover Page

Full Issue


Specificity of chest computed tomography in COVID-19-associated pneumonia: a retrospective study

Korb T.A., Gavrilov P.V., Chernina V.Y., Blokhin I.A., Aleshina O.O., Mokienko O.A., Morozov S.P., Gombolevskiy V.A.


Aim: To assess the specificity of COVID-19- associated pneumonia detection by radiologists using a chest CT scan.

Materials and methods: From mid-February to early March 2020, 65  patients have been retrospectively selected from the Moscow City Clinical Hospital database; all of them had been treated in an inpatient facility with a  verified diagnosis of COVID-19. In addition, 75  patients from the Unified Radiological Information Service have been randomly selected. In December 2019, these outpatients had been sent by an attending physician for a  chest CT scan with suspected pneumonia. The imaging studies showed non-specific inflammation signs in the lungs. All 140  scans were analyzed by seven radiologists from different Russian cities, who independently categorized each study as “COVID-19” or “Other pneumonia”.

Results: Chest computed tomography had a  92%  specificity in the differential diagnosis of COVID-19-associated pneumonia, and its specificity in the general population is expected to be at least 80% with a high probability. The inter-rater variability was low (coefficient of variation for specificity 12.6%). The sensitivity in our study was 76.2%, and the coefficient of variation for sensitivity 23.5%. These findings are generally consistent with other studies. The primary study limitation is the absence of a sample with confirmed pneumonia caused by other viruses.

Conclusion: Chest CT is highly specific for the detection of COVID-19-associated pneumonia.

Almanac of Clinical Medicine. 2021;49(1):1-10
pages 1-10 views

Magnetic resonance tractography based on the constrained spherical deconvolution in patients with gliomas of the optic pathway

Baev A.A., Pogosbekian E.L., Zakharova N.E., Pitskhelauri D.I., Batalov A.I., Shkatova A.M., Shults E.I., Bykanov A.E., Maryashev S.A., Konakova T.A., Pronin I.N.


Background: The use of magnetic resonance (MR) tractography in neurosurgery is becoming an increasingly common practice for noninvasive imaging of white matter pathways. The most common method of tract reconstruction is the deterministic algorithm of diffusion tensor magnetic resonance imaging (MRI). However, this method of reconstructing pathways has a  number of significant limitations. The most important of them are the lack of the possibility of visualizing the intersecting fibers, the complexity of building tracts in the area of perifocal edema and in the immediate vicinity of the tumor borders. The method of MR tractography, based on obtaining a  diffusion image with a  high angular resolution (High Angular Resolution Diffusion Imaging, HARDI), using the constrained spherical deconvolution (CSD) algorithm for post-processing of data, makes it possible to avoid these disadvantages. Relatively recently, a new algorithm, Single-Shell 3-Tissue CSD (SS3TCSD), has been proposed for processing HARDI data, which has the potential to improve the reconstructing of pathways in the area of perifocal edema or edema-infiltration.

Aim: To evaluate the potential of the new SS3TCSD algorithm compared to ST-CSD (Single-Tissue CSD) in the imaging of the optic radiation and visual tracts in patients with gliomas.

Materials and methods: Diffusion and routine brain MRI was performed in 10 patients with newly diagnosed cerebral gliomas, followed by reconstruction of the optic radiation and visual tracts. We compared new algorithms for postprocessing MR tractography (ST-CSD and SS3TCSD) in imaging of the optic tract and visual radiation in patients with brain gliomas affecting various parts of the visual system.

Results: The SS3T-CSD method showed a  lower mean percentage of false positive tracts compared to the ST-CSD method: 19.75% for the SS3T-CSD method and 80.32% for the ST-CSD method in cases of proximity of the tumor to the tracts, 5.27% for the SS3T-CSD method and 25.27% for the STCSD method in cases of reconstructing tracts in healthy white matter.

Conclusion: The SS3T-CSD method has a number of advantages over ST-CSD and allows for successful imaging of the optic pathways that have a complex structure and repeatedly change direction along their course.

Almanac of Clinical Medicine. 2021;49(1):11-20
pages 11-20 views

The potential of standard technologies for radiological diagnosis of posttraumatic breast abnormalities

Kasatkina L.I., Lezhnev D.A., Smyslenova M.V., Abduraimov A.B., Kaletskaya T.G.


Rationale: A  standard algorithm for the assessment of patients with breast trauma does not exist, as such trauma usually does not incur any significant health problems. However, according to existing clinical and work-up data and various radiological signs, posttraumatic abnormalities of the breast can mimic cancer lesions and complicate the differential diagnosis for a radiologist.

Aim: To evaluate the potential of digital mammography and breast ultrasound examination in the identification of breast posttraumatic abnormalities and to describe their semiotics.

Materials and methods: The study included 150  female patients aged 40  to 86  years (mean±SD, 60±11.9 years) with a history of breast trauma. Digital mammography with tomosynthesis (combined mode) and multiparametric ultrasound were able to identify breast abnormalities in 62 patients. The results of all assessments (n=62) were interpreted according to BI-RADS. Should any confirmation of the abnormalities be necessary, fine needle aspiration biopsy or core-biopsy with stereotaxic or ultrasound control were performed.

Results: At mammography, the typical posttraumatic abnormality in the breast was fat necrosis (n=54). It was represented as nodular masses with round (20/34; 58.8%) or oval shape (13/34; 38.2%) and circumscribed margins. In most cases, the masses contained eggshell calcification (27/34; 79.4%). In 35.1%  (19/54) of the cases fat necrosis was represented by various calcifications. At ultrasound, fat necrosis could be identified as avascular (40/40; 100%), mostly round (26/40; 65.0%), less frequently oval (12/40; 30.0%), and hypoechoic (19/40; 47.5%) masses with circumscribed margins. Atypical signs of fat necrosis (BIRADS 4) were found in 16.1% (10/62) of the cases, in which  7  (11.2%) core-biopsies with ultrasound control and  3  (4.8%) stereotaxic biopsies were performed. In all the cases, breast fat necrosis was confirmed, with various ratios of fibrous and necrotic fat tissue and lymphoid infiltration.

Conclusion: In most cases, standard radiological methods used in the diagnostic algorithm for posttraumatic breast lesions are sufficient for the diagnosis. In uncertain diagnostic cases, morphological verification seems necessary.

Almanac of Clinical Medicine. 2021;49(1):21-28
pages 21-28 views

Problems in the differential diagnosis of abdominal non-organ tumors

Kolobanova E.S., Medvedeva B.M.


Rationale: The differential diagnosis between lesions requiring surgical intervention and those necessitating medical treatment poses a significant problem for current imaging methods of fat-containing masses in the small intestine mesenterium.

Aim: To identify differential diagnostic criteria for various fat-containing neoplasms of abdominal cavity at the preoperative stage.

Materials and methods: This retrospective study included data from 29  patients (16  women and 13 men, aged 32 to 81 years, mean age 56 years) with fat-containing masses in the small intestine mesenterium who had undergone preoperative examination at N.N. Blokhin National Medical Research Center of Oncology from 2016 to 2020. Abdominal computed tomography (CT) with intravenous contrast enhancement and assessment of the size, contours, structure and involvement of main vessels was performed in all patients. To interpret single soft tissue nodes within the mass, we used our own list of main CT symptoms (number, size, shape, contours and structure of nodes, degree of their contrast enhancement, and maximal amplification).

Results: Fat-containing abdominal masses were morphologically verified as follows: mesenteric panniculitis 13  (45%), well differentiated liposarcoma 10  (35%), lymphoproliferative disorders 4  (14%), lipoma and Castleman disease 1  case each (3%). Twelve (12) of 29  patients (41%) had surgery for various types of tumors, while 17  (59%) patients received appropriate medical treatment after a puncture biopsy-based morphological diagnosis. The CT sensitivity for the detection of fat-containing abdominal neoplasms in our series was 93,1%. The paper describes the radiological signs of the above mentioned mass types with an emphasis on the complexity of their diagnosis.

Conclusion: In most cases, CT data can accurately differentiate abdominal liposarcomas from other benign and malignant masses in the small intestine mesenterium.

Almanac of Clinical Medicine. 2021;49(1):29-40
pages 29-40 views

The potentiality of arterial spins labeling (ASL) magnetic resonance perfusion technique for the diagnosis of glioblastoma residual tissue

Bunak M.S., Stepanova E.A., Stashuk G.A.


Background: Growing glioblastoma is associated with an impairment of the blood brain barrier and increased hemodynamic parameters (CBV, CBF), which is related to advanced tumor angiogenesis. Arterial spin labeling (ASL) perfusion, an additional study to the routine intravenous contrast-enhanced magnetic resonance imaging (MRI), may be a technique for assessment of hemodynamics and identification of the residual tumor tissue.

Aim: To study the potential of native ASL to assess hemodynamic parameters and detect residual tumor tissue in the patients who had undergone surgical resection of glioblastoma.

Materials and methods: At 2 to 4  weeks after surgery for glioblastoma grade IV, brain MRI with native ASL perfusion and subsequent intravenous contrast enhancement was performed in 63  patients. Cerebral blood flow (CBF) values were measured in three areas of interest: in the presumptive tumor tissue (PTT) with maximal perfusion, in the postoperative scar tissue (PST) and in the deep white matter (DWM) of the contralateral hemisphere.

Results: According to their CBF values, all patients were categorized into two groups. Group 1 included 43  patients (68.3%) with mean CBF in PTT of 135.4±41.3  ml/100  Gr/min (min 73.9, max 255.9). These values were 5 to 6-fold higher than the CBF values in the PST and 6 to 8-fold higher than those in DWM. Group  2 included 20  patients (31.7%) without any areas of abnormal CBF increase in PST, with its mean value of 22.1±5.6  ml/100  Gr/min (min 13.9, max 37.1), which was close to the CBF level in DWM (19.8±4.6  ml/100  Gr/min, p=0.06). There were no between-group differences for the CBF values in PST (p=0.6), and DWM (p=0.7).

Conclusion: ASL MR perfusion technique has good potential for the identification of residual tumor tissue after surgical resection of glioblastoma and can be an alternative to contrast enhancement during long-term follow up.

Almanac of Clinical Medicine. 2021;49(1):41-48
pages 41-48 views

Proton magnetic resonance spectroscopy as an alternative method for quantitative assessment of mineral bone density

Ivantsova A.S., Menshchikov P.E., Polyakova U.A., Manzhurtsev A.V., Ublinskiy M.V., Akhadov T.A., Kupriyanov D.A., Semenova N.A.


Aims: 1) To evaluate an association between the fat fraction (FF) and bone mineral density (BMD) measured by localized proton magnetic resonance spectroscopy (1H-MRS) and quantitative computed tomography (QCT) densitometry, respectively, in healthy vertebrae of children after a compression fracture; 2) To compare the FF and BMD values with the severity of the compression vertebrae fractures.

Materials and methods: Twenty (20) patients (aged 11.1±2.1 years) with a trauma-induced compression vertebral fractures participated in the study. The BMD of L3, L4 vertebrae (mg/cm3) was measured in by QCT (Philips Brilliance 16). FF in the same area was measured from 1H-MR-spectra (STEAM, echo time (TE)=12.8 ms, repetition time (TR)=3000 ms, voxel size=20×15×10 mm) using Philips Achieva TX 3.0T MRI scanner.

Results: Correlation analysis revealed a  significant inverse linear correlation (r=-0.55, p=0.0004) between FF and BMD of L3 и L4 vertebrae. In addition, in the patients with severe compression vertebral fracture (more than 2 fractured vertebrae) there was a  significant increase in FF values and a  BMD decrease, compared to the values in the patients with mild fractures (1–2 fractured vertebrae).

Conclusion: The correlation suggests that the increase of FF in the bone marrow and the decrease of BMD in children go in parallel. Therefore, 1H-MRS could be an alternative to QCT and dual-energy X-ray absorptiometry. The absence of radiation load allows for recommendation to use 1Н-MRS for screening and follow-up, as well as for the control of BMD.

Almanac of Clinical Medicine. 2021;49(1):49-55
pages 49-55 views

Assessment of carotid arteries and brain matter in patients with isolated abnormal tortuosities and those combined with occlusion by computed tomography angiography

Vishnyakova Jr. M.V., Lar'kov R.N., Vishnyakova M.V., Salomatin P.V.


Rationale: The prevalence of malformation of internal carotid arteries (ICA) in the population amounts to 46%. In 4 to 16% of the cases, it is associated with clinical manifestations of cerebrovascular insufficiency. Hemodynamic changes in the abnormal arterial vasculature and neurological symptoms are the main indications for surgical intervention. Computed tomography (CT) angiography has shown its high information value in the assessment of ICA occlusions; however, its informativity in the diagnosis of ICA malformations has not been established.

Aim: To assess ICA and brain matter in the patients with abnormal tortuosities, both isolated and combined with occlusion, by CT angiography.

Materials and methods: We performed a  retrospective analysis of medical files of 58 inpatients, who underwent ultrasound examination and CT angiography of extra and intracranial parts of brachycephalic arteries with 256  slice multidetector computer scanner (Philips iCT). CT angiography included native imaging, and contrast-enhanced arterial and venous phases. We assessed the impact of ICA abnormalities on the degree of brain matter lesions in patients with isolated ICA malformations (n=27) and with combination of ICA malformations with its occlusion (n=31).

Results: In the group of the patients with isolated ICA malformations, there were no brain focal lesions in 14, small vessel focal lesions and single liquor cysts in 9, and areas and zones of cystic and glial abnormalities in 4. The most frequent in this group were S-like and C-like malformations, together with 2  saccular aneurysms (one of them true and one false). In the group of patients with combination of abnormal ICA tortuosities and occlusions, there were areas and zones of cystic and glial abnormalities in 7, various degrees of small vessel disease and few liquor cysts in 18, and no abnormal brain matter foci in 6. No ICA malformations in combination with true or false aneurysms were found. The patients with combination of ICA malformations and stenosis, the signs of chronic brain ischemia were more advanced, compared to those in the patients with isolated ICA malformations (p=0.012).

Conclusion: CT angiography is a highly informative method for the assessment of carotid arteries and brain matter in patients with ICA malformations. The combination with ICA malformations and occlusion is associated with more advanced lesions of brain matter.

Almanac of Clinical Medicine. 2021;49(1):56-60
pages 56-60 views

Cardiac visceral fat volume estimation from low-dose chest computed tomography: a study with a designed beating heart phantom

Chernina V.Y., Kulberg N.S., Aleshina O.O., Korb T.A., Blokhin I.A., Morozov S.P., Gombolevskiy V.A.


Background: Since 2017, a pilot project for lung cancer screening by chest low dose computed tomography (LDCT) has been implemented in Moscow. Patients to be included into the screening have risk factors for ischemic heart disease (IHD). The association between epicardial adipose tissue (EAT) volume and coronary artery atherosclerosis, IHD, and atrial fibrillation has been demonstrated previously.

Aim: To demonstrate the feasibility of LDCTbased EAT volumetry using a  dynamic (contracting) heart phantom.

Materials and methods: The study was performed with the designed dynamic heart phantom and chest phantom in two stages. At stage I, two adipose tissue pieces were scanned inside and outside the chest phantom using CT and LDCT. At stage II, the dynamic heart phantom was scanned outside and inside the chest phantom. In addition, we scanned the heart phantom with a  coronary calcium phantom. The contracting heart phantom was developed within three months. All scans of the phantom were performed within one day. We determined the adipose tissue thresholds in LDCT and the EAT volumetric error with both chest CT and LDCT. Measurements of the adipose tissue volumes were performed by the radiologist twice with semi-automatic software.

Results: The results of stage I helped to identify optimal density thresholds for LDCT-based adipose tissue volumetry in lung cancer screening, ranging from -250 HU to -30 HU. The stage II results showed that for all heart phantom scanning variants, the average EAT volumetry error did not exceed 5%, except for the case of contracting heart phantom with added coronary calcium in a chest phantom with body mass index (BMI) 29 (-5.92%). Adding the coronary calcium phantom to the heart phantom in LDCT increased the error by an average of 4% in BMI 23 and BMI 29 chest phantoms.

Conclusion: LDCT-based EAT volumetry with fat density threshold from -250 HU to -30 HU is feasible in lung cancer screening, including patients with coronary calcium. However, considering the phantom design, further patient studies, and correlation of EAT volumes between LDCT for lung cancer screening and сoronary CT angiography are required.

Almanac of Clinical Medicine. 2021;49(1):61-71
pages 61-71 views


Contrast-enhanced magnetic resonance imaging in the diagnosis of Meniere’s disease: vague future or tangible reality?

Stepanova E.A.


Meniere's disease is characterized by vertigo, inconsistent hearing loss and progressive deterioration of audiological and vestibular functions. The attacks of Meniere's disease occur without obvious triggers and disrupt social adaptation of patients. Radiation diagnostic methods have not been included into the list of diagnostic criteria by the European Consensus on Diagnosis and Management of Meniere's disease (2018). However, a  number of studies have been published recently that indicate the feasibility of in vivo anatomical identification of endolymphatic hydrops, as the main disease substrate seen using contrast-enhanced magnetic resonance imaging. Due to the progress in radiological visualization of the inner ear, some patterns have been identified and new data obtained for Meniere's disease. The choice of the best route for contrast administration (intratympanic or intravenous) is a matter of active debate. There is no consensus on the criteria for the assessment of hydrops' grade. Future developments of the technique are associated with improvements of diagnostic procedures and protocols, use of new contrast agents and diagnostic algorithms developed with consideration of the otological problem of patients.

Almanac of Clinical Medicine. 2021;49(1):72-79
pages 72-79 views

Imaging modalities in the planning of transcatheter aortic valve implantation (standardization of scanning, measurements and reporting protocols)

Bulanova M.V., Kokov L.S., Muslimov R.S.


This review describes the state of the art on the role of various imaging modalities in pre-operative preparation to transcatheter implantation of biological aortic valve prosthesis, based on the literature data published from 2012 to 2020. One of the key source documents is the consensus of the European Society of Cardiovascular Radiology (ESCR) from 2019, providing the standardized protocols for scanning, measurements and description of the abnormalities identified. The final decision on the procedure of transcatheter aortic valve implantation should be based on the combination of all available diagnostic methods, clinical data and results of imaging by different modalities. Given the most comprehensive information content, the main diagnostic method is computed tomography. The radiologist and the multidisciplinary team should form a single entity, combining clinical and technical knowledge, discussing all the images and conclusions with other team members.

Almanac of Clinical Medicine. 2021;49(1):80-88
pages 80-88 views


Magnetic resonance imaging in the diagnosis of non-tumorous multifocal brain lesions mimicking multiple sclerosis

Krotenkova I.A., Bryukhov V.V., Konovalov R.N., Zakharova M.N., Krotenkova M.V.


The diagnosis of multiple sclerosis (MS) is quite challenging due to its variable clinical manifestations and lack of a  definitive test. Magnetic resonance imaging (MRI) is one of the tools to confirm the diagnosis and also helps in differential diagnosis with other disorders and in exclusion of MS-mimicking diseases. In this article, based on the analysis of clinical cases, we discuss the differential diagnosis of MS with the following non-tumorous multifocal brain lesions: vascular abnormalities caused by hypoxia and ischemia, cerebral autosomal dominant angiopathy with subcortical infarctions and leukoencephalopathy, Susac syndrome, primary angiitis of the central nervous system, and neurosarcoidosis. We present both MRI criteria for MS and disorders that have similar MRI signs, and additional clinical and laboratory data that is essential for correct diagnosis.

Almanac of Clinical Medicine. 2021;49(1):89-97
pages 89-97 views


Erratum: Correction of the authors' list and affiliations to “Specificity of chest computed tomography in COVID-19-associated pneumonia: a retrospective study“


Herewith we would like to inform our readers that the final version of the article doi: 10.18786/2072-0505-2021-49-001, published online on 02.03.2021, was replaced with a  corrected version on 15.03.2021. The corrected version, according to the authors request, includes the following changes: the author list and the affiliations, authors' contributions, acknowledgements sections.

The article should be cited as “Korb TA, Gavrilov PV, Chernina VYu, Blokhin IA, Aleshina OO, Mokienko OA, Morozov SP, Gombolevskiy VA. Specificity of chest computed tomography in COVID-19-associated pneumonia: a  retrospective study. Almanac of Clinical Medicine. 2021;49. doi: 10.18786/2072-0505-2021-49-001.

Almanac of Clinical Medicine. 2021;49(1):98
pages 98 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies