2009, vol XVII, # 2
2009, vol 17, # 2, page 131
M.I. Spuzyak, Yu.A. Kolomiychenko, O.P. Sharmazanova, I.O. Vorongev, V.M. Kucin
MRI picture of upper cervical spine in healthy children of early and pre-school age
Objective: To study normal MRI picture of upper cervical spine in children of early and pre-school age.
Material and Methods: Archive MRI findings of 112 children aged from 4 days to 7 years investigated at diagnostic centre of Kharkiv Regional Clinical Hospital were analyzed. The patients were divided into 4 groups: group 1 (22 persons) newborns, children up to 28 days (inclusive), group 2 (31 persons) aged from 28 days to 1 year, group 3 (29 persons) aged 1-3 years, group 4 (30 persons) aged 3-7 years.
The investigation was performed using Concerto unit (Siemens) with an open 0.2T magnet. Besides visual assessment of MR scans metric parameters both absolute and relative were used.
Results: MRI findings analysis revealed different intensity of structural elements of the vertebrae. Thus, in group 1 osseous portion intensity was hypointensive and differed from that in the other groups. Element intensity in groups 2 and 3 did not differ. In group 4 T1 weighted bone structures were almost completely ossified and the signal was weak hyperintensive as well as the signs of nucleus pulposus of the intervertebral disk.
The shape of the ossification of the vertebrae bodies changed depending on the age: from oval (in group 1) to rectangular similar to adults (group 4). The children from group 4 had all elements ossified besides apophyses. MRI metric findings were measured in all groups and entered to a common table.
Conclusion: Normal anatomy of cervical vertebrae in children of first years of life has its peculiarities. MRI distinctly differentiates bony and cartilage portions of the vertebrae, intervertebral disks, nucleus pulposus, soft tissues and other elements. MT-metry findings are auxiliary in making a diagnosis.
Key words: normal anatomy, upper cervical spine, MRI-metry, newborn, early age children.
2009, vol 17, # 2, page 140
R.Ya. Abdullaev, T.A. Dudnik
Shoulder ultrasonography: methodical aspects and normal anatomy
Objective: To systematize the methods of ultrasound investigation of the shoulder, to investigate its echographic anatomy
Material and Methods: The study involved 40 subjects aged 19-59 with healthy shoulder joints, of them 29 men and 11 women. Ultrasonography was done Ultima PA unit (Radmir), Logiq 7 unit (GE), HD3 unit (Philips) with a liner 5.0-12.0 MHz transducer. All patients were performed ultrasound investigation with color and energetic Doppler mapping without additional preparation. Functional load was used to improve visualization of the tendon structure and the place of their fixation.
Results: Optimal approaches for visualization of hyaline cartilage and subchondral plate of the humerus head, tendon of subscapular, supraspinous and subspinous muscles, long head of the biceps, subdeltoid and subacromial bursae, anterior and posterior glenoid lip were determined.
Anterior, anteromedial, anterolateral, posterior, posterolateral, axillary approaches were used.
The hyaline cartilage presented as hypo- or anechoic linear structure on the articular surface. The tendons were linear (or oval-spherical) fibrillar intermittent hyper- and hypoechoic structures (at longitudinal and transverse scanning). Normal bursae looked like a thin hyperechoic band 1-2 mm thick surrounded by hyperechoic lines (bursa walls). Transverse section demonstrated hyaline cartilage, humerus head, the place of fixation of biceps tendon, deltoid muscle, supraspinous muscle tendons, acromion, place of fixation of subscapular muscle tendon, subdeltoid and subacromial bursae.
Longitudinal section demonstrated the place of fixation of supraspinous muscle tendon, biceps tendon.
Supraspinous tendon and posterior glenoid lip were seen in posterolateral section. Anterior glenoid lip was scanned in anteromedial and axillary planes. In persons aged 19-39 the outline of humerus head was smooth, the thickness and structure of hyaline cartilage and tendons were not changes, were homogeneous.
In persons aged 40-59 the thickness of hyaline cartilage wass diminished, the outlines were wavy, echosonography demonstrated small hyperechoic inclusions. The thickness of the tendons was diminished, the structure was uneven, zones of increased echogenicity prevailed. The above changes were considered age-related.
Conclusion: Being an objective method, ultrasound investigation can successfully be used to investigate anatomical-physiological and functional characteristics.
Key words: shoulder joint, tendons, ultrasonography, methodical aspects.
2009, vol 17, # 2, page 146
M.I. Spuzyak, V.V. Shapovalova, I.O. Vorongev
CT changes in the lungs at bronchopulmonary dysplasia in children
Objective: To study the capabilities of computed tomography in diagnosis of bronchopulmonary dysplasia.
Material and Methods: Chest CT findings of 22 children with bronchopulmonary dysplasia (13 boys, 9 girls) aged 10 days - 4.5 years were analyzed. Of them, 17 were born before the term (mean gestation age 32 weeks), 5 were born in term. All children were kept on artificial pulmonary ventilation for an average 24 days (min - 5, max - 38). Ten children required several applications of artificial ventilation.
Chest CT was done using Somatom Emotion (Siemens) and Asteion (Toshiba) with 512x512 template. Standard investigation was completed by high definition algorithm.
Results: CT analysis at BPD showed polymorphic picture in the form of changes in the lung picture due to transpulmonary bands of interstitial fibrosis (86.3%), thickening of interlobular septa (31.8%), thickening and deformity of bronchial walls (22.7%) and bronchietases (22.7%), changes in the density of the lung tissue due to increased transparency in the anterior portions (40.9%), air traps (31.8%) and emphysema bullas (68.2%), reduction of pneumatization due to rough fibrous changes (31,8%) which in 22.7% of children were accompanied by inconsiderable reduction of the volume of the involved segments, mosaic pneumatization (22.7%), thickening and deformity of the adjacent pleura (27.3%), changes in the v of the anatomical structures in the form of subsegmental atelectases (9.1%). The signs of pulmonary hypertension were present as right pulmonary artery dilation in 86.4% of the patients. The analysis of the obtained findings allowed to reveal 4 main symptom-complexes of pathological BPD CT changes.
Conclusion: Chest CT in children with BPD allows to reveal the details of the morphological changes in the lung structure, localize them, assess their degree and depth which is important when treating this disease.
Key words: bronchopulmonary dysplasia, computed tomography, children.
2009, vol 17, # 2, page 152
L.A. Suhanova, O.P. Sharmazanova
X-ray and CT signs of connective tissue dysplasia in patients with primarily diagnosed infiltrative pulmonary tuberculosis
Objective: To investigate x-ray signs of connective tissue systemic dysplasia (CTSD) in patients with primarily diagnosed pulmonary tuberculosis.
Material and Methods: Fifty-four patients (28 med and 26 women aged 18-70) with primarily diagnosed infiltrative pulmonary tuberculosis underwent x-ray study. The following procedures were performed: survey radiography of the chest, chest x-ray, lung tomography, chest CT. Depending on the presence of phenotypical signs of CTSD the patients were divided into two groups. Group 1 (main) comprised 43 patients with phenotypical signs of CTSD. Group 2 (comparison) involved 11 patients without phenotypical signs of CTSD.
Results: Three-four main phenotypical signs of CTSD were revealed in 74.7% of the patients from group 1. 25.6% had two signs. CT demonstrated diminishing of the lung area on the axial slices in patients from the main group which allowed calculating coefficient of lung area reduction (CLAR). As these patients did not have a history of lung diseases which could promote fibrosis and later cirrhosis development in the lung parenchyma, and had a high degree of stigmatization we considered that specific process in the lungs had developed against a background of congenital changes. The degree of lung area reduction was determined to be directly proportional to the degree of phenotypical signs of CTSD which can prove our suggestion. CT was most accurate in demonstration of CTSD signs in the lungs.
Conclusion: In patients with infiltration pulmonary tuberculosis CTSD in the lungs manifests by their diminishing, deformity of the lung pattern, high position of the diaphragm cupola, mediastinum shift to the side of the pathology, which is better seen on CT. The degree of CTSD x-ray signs in the lungs depends on the number of phenotypical signs that is the degree of the disease manifestation.
CT allows more accurate determining of the signs of connective tissue dysplasia in which tuberculosis develops.
Key words: connective tissue systemic dysplasia, pulmonary tuberculosis, phenotipical signs.
2009, vol 17, # 2, page 157
R.Ya. Abdullaev, F.N. Gorleku
Ultrasound differential diagnosis of cavernous hemangioma and liver cancer
Objective: To determine the most significant differential diagnosis criteria of cavernous hemangiona (CH) and hepatocellular cancer (HCC) using two-dimensional, colored, energetic and pulsed wave modes.
Material and Methods Retrospective analysis of ultrasound findings of 28 patients with CH and 24 patients with HCC measuring over 40 mm (23 men and 29 women) aged 42-69 (mean age 53±5) was done.
Results: Spherical CH were significantly more frequent (p < 0.01) than spherical HCC (64.0 and 25.0 %), while oval-spherical HCC were more frequent (46.4 и 20.0 %, p < 0.05). CH of the liver were more frequently located in the subcapsular zone (p < 0.05), while HCC - in the parenchyma (p < 0.05). The outlines of CH were more frequently even (68.0 vs. 32.1 %,p< 0.01), while in HCC they were uneven (64.3 vs. 36.0 %, p < 0.05). The capsule in CH was not determined, while in HCC it was detected in 4 (14.3 %) cases. Hypoechoic rim was significantly more frequent in HCC than in CH (60.7 vs. 28.0 %, p < 0.05). Considerable degree of unevenness in HCC way registered significantly more frequently that in CH (57.2 vs. 24.0 %, p < 0,05). Dorsal pseudoenhancement was observed only in CH (64%), while attenuation of the echo-signal in the form of acoustic shadow - in HCC (14.3%), weak - in 19 (67.9%) cases of HCC and 3 (12.0%) cases of CH (p < 0,001). Calcified areas were observed only in HCC (5 cases - 17.9%). Septas were noted in 10 cases (25.7%). Colored Doppler failed to reveal blood flow within the node in 13 cases (52.0%) of CH and in 3 cases of HCC (10.7%). Moderately pronounced vascularization was significantly more frequent in HCC that in CH (57.1 vs. 20.0 %, p < 0,01),while increased one only in HCC (4 cases, 14.3%).
Conclusion: Sensitivity of primary US investigation in differentiation of cavernous hemangioma and nodular HCC measuring over 40 mm is 92.9 and 88.9%, their specificity is similar, i.e. 50.0%, accuracy 87.5 and 95.0%. Positive and negative predictive values were 80.0 and 91.1% and 50.0 and 33,3%, respectively. Sensitivity and specificity of repeated US investigation in diagnosis of HCC 3 months later are 100.0, accuracy - 94.7%.
Key words: ultrasound diagnosis, cavernous hemangioma of the liver, hepatocellular cancer.
2009, vol 17, # 2, page 163
Echosonographic control of the cervical tumor response to pre-operative chemoradiation therapy
Objective: To investigate the changes in the volume of the involved cervix under the influence of pre-operative chemoradiation therapy (CRT) when compared with radiation therapy (RT) in patients with uterine cervix cancer (UCC) using echosonography findings.
Material and Methods: Retrospective analysis of echosonography findings (Acuson) of 39 patients with stage IB - IIА, IIIB (T1b-2aN0-1M0) UCC treated at Grigoriev Institute for Medical Radiology from 2006 to 2008 was done.
Results: Mean values of the initial volume of the involved cervix correlated with the stage of UCC, i.e. maximal volume was observed at T2aN0M0 stage, 105.0 vs. 66.4 cm3 at T1bN0M0 stage. After pre-operative RT the volume of the involved cervix reduced 1.3 times, after CRT - 3 times.
Conclusion: The use of ultrasonography before and after the end of pre-operative antiblastoma therapy allows objective assessment of the uterine cervix response to the treatment and is an easy and reliable marker of the tumor regression.
Key words: ultrasonography, uterine cervix cancer, volume of the involved cervix.
2009, vol 17, # 2, page 168
E.B. Radzishevskaya, L.Ya. Vasilyev, Ya.E. Vikmam, O.O. Solodovnikova
Comparative analysis of the course and long-term effects
of hormone-dependent tumors in women using case history data (by the examples of breast and uterine body cancer)
Objective: To compare some aspects of the course and consequences of hormone-dependent tumors in women using history data (by the example of breast cancer, BC, and uterine body cancer, UBC).
Material and Methods: Case histories of patients with BC and UBC treated at the hospital of Grigoriev Institute for Medical Radiology (AMSU) in 1980-2003 were investigated. Information analysis was done using Data Mining Technology - search for open knowledge using nonparametric statistics and actuarial calculation - analysis of survival tables. Statistical media WizWhy, Statistica, SPSS were used.
Results: The performed investigation allowed to check the influence of four factors (body mass index, time of menarche beginning, absence of deliveries and pregnancies) which, according to some literature sources, are risk factors of BC and UBC. It was shown that the time of menarche beginning and absence of deliveries could not be regarded risk factors, but body mass index and absence of pregnancies could not be regarded risk actors and were mediated factors of UBC but not BC development. It was proven that radiation therapy did not prevent separate long-term metastases (LTM) in patients with UBC and was expedient in BC patients when adjuvant chemotherapy was impossible. It was calculated that peaks of LTM in BC patients occur on the 3rd, 5th, 9th and 12th year after the surgery, for patients with UBC - 5th and possibly 12th years.
Conclusion: The use of modern information technologies and approaches of evidence-based medicine allowed obtaining additional information from the traditional data bases including that about the course of the disease from case histories.
Key words: uterine body cancer, breast cancer, risk factor, long-term metastases, methods of mathematical simulation.
2009, vol 17, # 2, page 196
I.A. Gromakova, P.P. Sorochan, N.E. Prohach, M.O. Ivanenko, O.V. Kuzmenko
Immune disorders in patients with uterine body cancer following radiotherapy
Objective: To investigate the disorders of hematoimmune parameters and analyze the influence of cortisol and pro-inflammatory cytokines on the development of lymphopenia at radiation therapy (RT) in patients with uterine body cancer (UBC).
Material and Methods: The study involved 26 patients with stage I-III UBC before and after the course of distance gamma-therapy using ROKUS-AM unit with small fractions at a total focal dose of 40-45 Gy to points A and B. The immune state (CD3 + -, CD8 + -, CD19 + - lymphocytes, phagocyte activity of neutrophils, circulating immune complexes, A, M, G immunoglobulins, IL-6, IL-10, TNF-a) as well serum cortisol level were investigated. Hematological parameters were determined using automatic analyzer M 2000 SYSMEX.
Results: Disturbances of hematological and immune parameters were revealed in patients with UBC after post-operative RT. The changes of the investigated parameters were various. The factors correlating with profound lymphopenia development were distinguished.
Conclusion: Radiation therapy in patients with UBC caused reduction of absolute amount of neutrophils, lymphocytes, thrombocytes in the peripheral blood and IL-10, IL-6 and TNF-a in the blood serum but did not influence the number of erythrocytes and hemoglobin level and did not change functional neutrophil activity. More profound lymphopenia after RT was observed in patients who had initially higher level of cortisol, IL-6, TNF-a and lower IL-10 level. Negative correlation between TNF-a and relative and absolute number of total lymphocytes as well as between TNF-a and relative and absolute amount of CD19+-B-lymphocytes were revealed.
Key words: uterine body cancer, immune state, radiation therapy.
2009, vol 17, # 2, page 201
N.A. Mitryaeva, T.S. Bakay, T.V. Segeda, N.O. Babenko
Influence of ionizing radiation and antitumor drug etoposid on sphingolipid amount and acid Zn2+-dependent sphingomyelinase activity in the blood serum of tumor-carrying rats
Objective: To assess the influence of ionizing radiation and etoposid on the activity of acid Zn2+-dependent sphingomyelinase in the blood serum of tumor-carrying rats.
Material and Methods: Wistar rats weighing 160-180 g with subcutaneously inoculated Guerin’s adenocarcinoma were used as the experimental model. Local x-ray irradiation of the tumor area was delivered at a dose of 5 Gy with 24-hour intervals between the treatments (total dose to the tumor area 10 Gy) using РУМ-17 unit. Antitumor drug etoposid (Ebewe) was introduced intaperitoneally 24 hours before the first treatment at a dose of 5 mg/kg. Decapitation was done 24 hours after the last treatment. Lipid extraction from the blood serum was done according to Folch, ceramide and sphyngomyelin were separated with the use of chromatography on Sobril plates (JSS Sorbopolimer, Russia). To identify lipids standards of ceramide and sphyngomyelin (Sigma) were used. To assess the activity of acid Zn2+-dependent sphingomyelinase in the blood serum, [N-methyl -14C] sphyngomyelin (1924 MBq/mmol) was used. Sample radioactivity was measured using BETA-1 counter (Medpribor, Kyiv). Statistical analysis was performed by means of variation statistics using Student’s criterion.
Results: It was determined that both etoposid and radiation considerably increased ceramide level in the blood serum of tumor-carrying rats, while sphyngomyelin amount significantly decreased only at radiation exposure which can suggest activating influence of radiation on the enzyme, sphingomyelinase. It is shown that at combined action of etoposid and radiation, activity of acid Zn2+-dependent sphingomyelinase significantly increased.
Conclusion: Increase of acid Zn2+-dependent sphingomyelinase activity in the blood serum of tumor-carrying rats at combined action of etoposid and radiation induced increase of blood ceramide amount and apoptosis of microvascular endothelium of the tumor which is associated with its regression.
Key words: Guerin’s carcinoma, apoptosis, ceramide, sphyngomyelin, acid Zn2+-dependent sphingomyelinase, etoposid, ionizing radiation.
2009, vol 17, # 2, page 206
O.V. Kuzmenko, N.A. Nikiforova, M.O. Ivanenko
Individual peculiarities of immunity indices restoration in rats after total single x-ray exposure
Objective: To compare post-irradiation restoration of immunity parameters in rats with different initial reactivity of the hemopoietic system at irradiation at different time of the day.
Material and Methods: The study was done on 80 white mongrel male rats. Two weeks before irradiation the animals were exposed to 3-hour immobilization stress in the supine position. According to tlymphocyte / neutrophil ratio the animals were divided into hypo-and hyperreactive. The animals were exposed to a total single dose of 4 Gy at 8 a.m. and 8 p.m. The immunological parameters were determined on days 3, 7, 14, 21, 30 after the exposure. To study circadian rhythms of immunological indices (CIC, Ig G) the blood was taken with 6-hour intervals (at 6 a.m., 12 a.m., 6 p.m., 24 p.m. and 6 a.m. of the following day).
Results: It was shown that individual differences in the reaction of the animals on stress determined the degree of post-radiation disorders of humoral immunity beginning from day 3 after the exposure to x-rays. The changes in the blood immunological parameters in animals irradiated at 8 p.m. were significantly different between hypo- and hyperreactive animals in all terms of the observation. It was determined that irrespective of the time of irradiation, complete restoration of the immunological parameters was not observed both in hypo- and hyperactive animals up to the end of the observation (day 30). The exclusion was hyporeactive animals irradiated at 8 p.m.
Conclusion: Minimal effect of radiation on the investigated parameters (IgG, CIC) was observed in hyporeactive animals irradiated at 8 p.m. when compared with the hyperreactive animals as well as with all animals irradiate at 8 a.m. irrespective of the stress reaction.
Key words: immobilization stress, ionizing radiation, individual reaction, immunity.
2009, vol 17, # 2, page 211
L.I. Simonova, L.V. Bilogurova, V.Z. Gertman
Experimental investigation of monochromic optic radiation effect on development of local radiation lesions of the skin Communication 1. The course of local radiation lesions of the skin in rats
Objective: To investigate the influence of different ranges of monochromic optic radiation on the skin of white rats after local x-ray exposure.
Material and Methods: The experiments were performed on white female Wistar rats which were irradiated in the area on the femur at a dose of 80.0 Gy. The treatment with light diodes was started immediately after x-ray exposure (the course duration 5 days). Photodiode matrix unit Barva-Gflex with photomatrices of red, green and blue light were used. The efficacy of different light matrices was assessed according to the exit of skin local radiation lesions (LRL) of different severity (radiation ulcers, dermatitis); the changes in the area of LRL, coefficient of healing rate. The controls were irradiated animals with spontaneous wound healing.
Results: The investigation demonstrated that the effect of red light on the irradiated skin area consisted in prevention of wet dermatitis, later development of radiation lesions, reduction in their number and accelerated healing. Preventive effect of blue light was accompanied by development of wet dermatitis in 30% of the rats and complete prevention of radiation ulcers and considerable reduction of healing terms. Preventive effect of green light was the least pronounced. 50% of animals developed wet dermatitis, radiation ulcers (but less than in the controls).
Conclusion: Photomodulation with light diodes of red, green and blue light positively influenced development of local radiation lesions of skin of white rats, reduced their frequency, severity and accelerated healing. All used types of visual light produced positively influenced the development of local radiation lesions but the effect of each range had its peculiarities. Comparative analysis of preventive efficacy of the three types of optic radiation allow to make a preliminary conclusion that blue light can be the most effective in prevention of local radiation lesions.
Key words: phototherapy, light diodes, optic spectrum, x-ray exposure, local radiation lesions.
2009, vol 17, # 2, page 218
L.I. Simonova, V.A. Gaychenko
Biogenic 137Cs migration in trophic chains
Objective: To determine the peculiarities of 137Cs migration in saprobe links of trophic chain of pasture type, especially in connected with utilization of dead organic substances and excretions.
Material and Methods: Samples of plants and animals from the territory of Chonobyl alienation zone were used in the investigation. Radiometry was performed using gamma-spectrometer АМА-02 Ф-1 with Ge-Li detector and was followed by calculation of specific activity per raw mass.
Results: The questions of biogenic 137Cs migration in the trophic chain of pasture type are discussed. It is shown that the highest accumulation coefficients are typical for saprobe portion of the trophic chain.
Conclusion: The obtained findings about radionuclide redistribution in the biogeocenosis for different links of the trophic chain suggest about considerable significance of biogenic radionuclide transformation.
Key words: ecosystem, radioactive contamination biocenosis, 137Cs migration.
2009, vol 17, # 2, page 221
N.O. Artamonova, O.V. Masich, Yu.V. Pavlichenko, A.G. Shepelev, Yu.L. Kurilo, T.O. Ponomarenko
Positron-emission tomography as a new direction in radiation medicine development (scientometric analysis)
Objective: To investigate the contemporary state and prospects of positron-emission tomography (PET) application in diagnosis of cancer diseases.
Material and Methods: Scientometric analysis of assessment the world information stream of scientific information was used to study the contemporary state of PET.
International electronic resources Medline and INIS (1999-2008) were used as information sources. Medline search of “positron-emission tomography” term was limited to 10 years, only “Humans” as well as the tem occurrence in “Title/Abstract” + localization name. The term “positron-emission tomography” was used doing search in INIS for 10 years limited to “patients” and occurrence in key DEC term.
Results: An information sample from two information search systems was obtained. The distribution and analysis of it represent the contemporary state and development trends of the questions of clinical use of PET. Their stable growth suggests outstanding prospects of PET as a functional method of molecular visualization of tumor foci. The comparative analysis of the image of the topical field in Medline and INIS allowed to allocate the zones of intensive investigation of PET efficacy at cancer diseases, investigations of the brain, lungs, heart as well as to establish the peculiarities of the search depending on the features of their search interfaces.
Conclusion: High significance of PET investigations of tumor metabolism and tumor process dissemination was proven. The comparative analysis of the image of the topical field in Medline and INIS allowed allocating the zones of intensive investigation of PET efficacy at cancer diseases, investigations of the brain, lungs, heart. It was established that in spite of cumulative growth of publications in 2007-2008, stabilization of the investigation, possibly associated with accumulation of sufficient amount of clinical data and transition of PET technologies to the stage of their standardization and including to the register of the methods accepted by insurance medicine, was observed.
Key words: positron-emission tomography, scientometrics, scientific publications, Medline database, INIS database.
We are proud to announce the annual scientific conference of young scientists with the international participation, dedicated to the Day of Science in Ukraine. The conference will be held on 20th of May, 2016 and hosted by L.T. Malaya National Therapy Institute, NAMS of Ukraine together with Grigoriev Institute for medical Radiology, NAMS of Ukraine. The leading topic of conference is prophylaxis of the non-infectious disease in different branched of medicine.
Since 1993 the Institute became the founder and publisher of "Ukrainian Journal of Radiology”: