RADIOTHERAPY
The massive incidence of COVID-19 has led to reorganization of medical care for cancer patients. While maintaining an individual approach and maximum effectiveness, we're considering the possibility of changing the radiation therapy treatment in each clinical case. Spatio-temporal separation of patient's streams and algorithms for building the radiotherapy department were introduced to minimize the risk of COVID-19 infection of medical personnel and patients.
DIAGNOSTIC RADIOLOGY
The article presents the literature review of modern approaches in the diagnosis and treatment of squamous cell cancer of the oropharyngeal region and larynx. Various views on the treatment of patients with oropharyngeal tumors are presented. Special attention is paid to the ultrasound examination of patients with laryngeal tumors and to the possibilities of ultrasound in assessing the integrity of the laryngeal cartilage. Various ultrasound techniques for assessing the thickness and depth of invasion of oral tumors are highlighted. The features of regional anatomy that affect the informative value of visualization techniques are discussed. In the article presents criteria for assessing the prevalence of the tumor process in the adjacent organs and tissues, metastasis in regional lymph nodes.
Purpose: To evaluate the possibilities of ultrasound examination with contrast enhancement (CEUS) in assessing the effectiveness of treatment of patients with specific lesions of peripheral lymph nodes with lymphoproliferative lesions.
Material and methods: To assess the capabilities of CEUS in assessing the effectiveness of treatment, a study was carried out for 15 patients with lesions of peripheral lymph nodes in lymphoma in dynamics before the treatment and after 2 or 3 courses of chemotherapy using a contrast agent SonoVue® in a volume of 4.8 ml. The results of the study were analyzed and compared with traditional ultrasound techniques. Ultrasound examination was performed using Siemens Acuson S2000 and Philips Affiniti 70 devices with high-frequency linear transducers from 5 to 12 MHz.
Results: CEUS revealed a significant increase in the TTP parameter from 27 ± 12 s to 36 ± 13 s (p = 0.0496) and a significant decrease in the PI parameter from 9 ± 5 dB to 4 ± 3dB (p = 0.00047).
Conclusions: CEUS at any stage of the treatment seems to be promising since it allows diagnosing of structural changes in the affected lymph nodes even after one cycle of chemotherapy.
At present, immunotherapy is successfully used for the treatment of multiple malignant diseases, especially in the late stages of metastatic tumors, which until now, were difficult to treat using standards protocols. Positive therapeutic effects of immunotherapy were demonstrated in treatment of many common oncological diseases. However, despite the expressed positive effect, in some patients immunotherapy can demonstrate non-typical forms of the answer. To establish accurate diagnosis it is necessary to know radiological manifestations of immune-related adverse events (irAE), mainly, immune-mediated pneumonitis, colitis, hypophysitis, hepatitis and myositis. Early identification and the corresponding treatment of irAE may improve patient's outcomes.
PROFESSIONAL EDUCATION
CLINICAL CASES
Purpose: To evaluate the capabilities of the Combi-Elasto and CEUS ultrasound modes in the diagnosis of viral hepatitis B on the clinical case example of the middle-aged patient with chronic viral hepatitis B in the acute stage.
Material and methods: Comprehensive study of the patient's medical history, outpatient medical record, results of clinical, laboratory, instrumental and morphological methods with independent retrospective analysis of the histologic specimen of the liver.
Results: The materials of observation and diagnostic search of the 54-year-old patient with chronic viral hepatitis B in the acute stage are presented. The diagnosis establishing took 3 months of examination in the infectious department and morphological study. This episode of the disease debuted with abdominal discomfort, weakness, yellowing of the sclera and skin, darkening of the urine and lightening of the feces. Survey the following results were obtained: Combi-Elasto data on admission — fibrosis F4 of the METAVIR scale (2.09), expressed process activity (1.60), absence of steatosis (0.54). At the initial stage, CEUS was performed with an assessment of quantitative and qualitative parameters on the same equipment, cirrhosis of the liver was excluded, chronic viral hepatitis, the acute stage was diagnosed, and appropriate treatment was prescribed. As a result of systematic observation after 3 months of repeated Combi-Elasto, the following results were obtained: fibrosis F1-2 of the METAVIR scale (1,30), average process activity (1.26), absence of steatosis (0.55).
Conclusion: The presented clinical observation demonstrates the high efficiency of combining 2 modes (Combi-Elasto and CEUS) on the same equipment in the diagnosis of chronic viral hepatitis in the acute stage.
Mastitis is an inflammatory condition of the breast, which may or may not be accompanied by infection (WHO 2000).
Idiopathic granulomatous mastitis is one of the forms of non-infectious mastitis. Granulomatous lobular mastitis is a rare inflammatory disease of the breast that was first described by Kessler and Wolloch in 1972.
Idiopathic granulomatous mastitis (IGM) or granulomatous lobular mastitis is chronic inflammatory breast disease of unknown etiology, the clinical manifestation and radiological features of which may mimic other nosological entities.
We report a case of 29 year old woman who was diagnosed with breast carcinoma by radiological methods, such as contrast enhanced spectral mammography (CESM), magnetic resonance imaging with dynamic contrast enhancement (MRI with DCE), SPECT/CT. However, performed core needle biopsy of a lesion shows no tumor cells. The conservative treatment was suggested, based on obtained information.
Aim is a review of radiological features of IGM with contrast enhanced visualization methods, based on our clinical case; description of differential radiological features in comparison with similar diseases of the breast, such as inflammatory breast carcinoma, tuberculosis etc.
Purpose: To demonstrate a clinical case of metastatic lesions of the bones, which clearly reflects the difference in the sensitivity of diagnostic methods SPECT/CT and MRI.
Material and methods: A 69-year-old female patient with poorly differentiated gastric adenocarcinoma, which underwent WBS, SPECT/CT and MRI.
Results: MRI revealed several metastases that were not reflected on SPECT/CT examination.
Conclusion: Despite the high sensitivity and specificity of SPECT/CT, in some cases additional diagnostic methods are required. MRI allows to clarify and, possibly, detect previously undetected metastases.
ISSN 2713-167X (Online)