Home » Ukrainian Journal of Radiology » 2007, vol XV, # 4

2007, vol XV, # 4



2007, vol 15, # 4, page 408

A. Abramuk, K. Cefel, A. Koh, S. Tokalov, U. Ivanov, D. Mechev, N. Abolmaali

Retrospective analysis of the findings of combined 18 F-FDG PET/CT investigations in malignant tumors


Objective: To assess the diagnostic role of combination of CT and PET with F-18 fluorodeoxyglucose ( 18 F-FDG PET) in patients with malignant tumors.

Material and Methods: CT/PET were used to investigate 595 patients. CT protocols were assessed by radiologists individually. 18 F-FDG PET was performed 60 min after intravenous administration of 270-370 MBq of the radiopharmaceutical. The radiologist and nuclear medicine specialist immediately compared the received findings.

Results: In 56% of cases the information received at CT and PET was sufficient to solve definite clinical tasks. In 15% of cases CT/PET combination was necessary. In 24% the diagnosis was made using only PET findings, in 5% - only CT findings. In total CT findings corresponded to the final diagnosis in 61% of cases, 18 F-FDG PET in 80% of cases.

Conclusion: The findings of the research suggest high informatively of each method (PET and CT) in diagnosis of tumors. Combination of CT and PET expands the capabilities of diagnosis, assessment of local involvement and dissemination of the process. Retrospective final analysis shows that in 15% of patients the final diagnosis can be made only at combination of PET and CT. Simultaneous analysis of metabolic (PET) and morphological (CT) findings by radiologists and nuclear medicine specialists improves the efficacy of the investigations and reduces the number of false-positive and false-negative conclusions.

Key words: malignant tumors, PET/CT, diagnostic significance.

2007, vol 15, # 4, page 413

R. Y. Abdullaev, O. O. Mogila, S. O. Ponomarenko, M. M. Kisliy, I. E. Krivyakova

Ultrasonography diagnosis in intraarticular lesions of the knee joint


Objective: To study the capabilities of ultrasonography in diagnosis of intraarticular lesins: osteochondral fractures, rupture of meniscus and cruciate ligaments.

Material and Methods: Clinical instrumental (x-ray, ultrasound, MRI) investigation involved 45 persons aged 18-54 with injured knee joint. The diagnosis was verified with the help of diagnostic arthroscopy.

Results: Paracapsular fractures of the meniscuses (12 cases, 27%) were most frequent. Transchondral lesions (5 cases, 11%) were observed chiefly in the area of the posterior horn.

In 3 cases (7%) partial injury was determined as a considerable thickening of the ligament. In one patient (2%) complete rupture of the cruciate ligaments with detechment of a bone fragment in the place of tibia joining was observed. In 5 (11%) cases the lesions of the transchondral cartilage (transchondral fractures) the changes of the ultrasound stucture were noted (indistinct outlines, appearance of solitary or multiple hyperechoic inclusions of linear, circular or irregular shape.

Conclusion: In lesions of the knee joint, ultrasonography allows timely non-invasive diagnosis of the character of the lesion thus promoting correction of the treatment and assessment of its quality as well as determines the indications to surgery.

Key words: ultrasonography, intraarticular lesions of the knee joint, ultrasound structure.

2007, vol 15, # 4, page 417

S. O. Ponomarenko, R. Y. Abdullaev

Clinical ultrasonography diagnosis of intervertebral hernias of the lumbar spine


Objective: To specify ultrasound signs of various types of intervertebral hernias of the lumbar spine and compare the obtained findings with the clinical manifestations.

Material and Methods: The study involved 129 patients (62 women and 67 men) treated at orthopedics department of Kharkiv Regional Clinical Traumatology Hospital aged 20-60 with various clinical manifestations of pain syndrome in the area of the lumbar spine.

Results: In group 1 IVD ultrasonography (160 disks) demonstrated moderate structural changes of the IVD and allowed to diagnose 21 cases of disk protrusion (13% of disks). Hernias were not revealed. In group 2 IVD ultrasonography (265 disks) revealed inhomogeneous nucleus pulposus, its posterior and lateral shifts, considerable increase of echogenicity of the fibrous ring, lesions (clefts) of the fibrous ring. Seventy-eight protrusions (29% of disks) and 28 hernias (11% of disks) were diagnosed. In group 3 (220 disks), structural changes in the IVD characteristic for groups 1 and 2 with the signs of narrowing, deformity, asymmetry of the spinal canal and radical canals, reduction of the disk height, were revealed. Protrusions (48, 22%) were accompanied by hernias (40, 18%) at different levels. Hernial and protrusions were localized at L5-S1, L4-L5 levels in the majority of cases (87%), simultaneous involvement was present in 1/3 of cases. Lesions at L3-L4, L2-L3, L1-L2 level were rare.

Conclusion: Ultrasonography allows to visualize IVD hernias as well as determine their type, size and location and compare the obtained findings with the clinical manifestations. Due to its high informativity ultrasonography can be sufficient for diagnosis the disease, identification of the clinical morphological stage of the process and determining the causative disk.

Key words: protrusion, intervertebral disk hernia, ultrasonography, spinal cord.

2007, vol 15, # 4, page 421

V. O. Dinnik

Small pelvis ultrasonography characteristics in adolescent girls with pubertal uterine bleedings


Objective: To reveal the association of the clinical course of the disease, hormone supply and ultrasonography of the inner sex organs in adolescent girls with pubertal uterine bleedings (PUB).

Material and Methods: Small pelvis ultrasonography was done in 288 adolescent girls aged 11-18 with PUB during bleeding and after it. Serum LH and FSH were determined using immunoenzyme methods, prolactin, E2 T were determined using radioimmunological methods. The investigated patients were divided into 3 groups depending on the clinical course of the disease.

Results: It was determined that the uterus and ovaries were enlarged in all patients with PUB. Hypoplasia was registered in solitary cases. Uterine M-echo exceeding 10 mm was registered in more than 1/3 of the patients with PUB, which can be considered endometrium hyperplasia. Persisting ovarian follicles or cysts were observed in every 3-5 patients depending on the clinical variant of the disease. Coincidence of intrauterine M-echo and ovarian cyst was registered more frequently in girls with primarily detected bleedings. Intrauterine M-echo did not depend on the level of gonadotropins and was seldom seen. Persisting follicles and cysts of the ovaries were more frequently revealed against a background of high values of serum E2.

After homeostasis was gained using non-hormonal medication, ultrasonography parameters of the small pelvis reduced significantly when compared with the initial values though did not reach the normal values.

The number of patients with intrauterine M-echo and persisting ovarian follicles and cysts reduced. At hormonal homeostasis the size of the uterus on ultrasonography increased.

Conclusion: The changes of ultrasonographic parameters of the small pelvis (size of the uterus and ovaries) are similar at various clinical variants of PUB and do not depend from the hemorrhage duration. Visualization of intrauterine M-echo, persisting ovarian follicles or cysts depend on the clinical course of the disease and blood serum estradiol level. Dynamic observation allows recommending a wide use of non-hormonal methods of treatment in adolescents with PUB at presence of intrauterine M-echo, persisting ovarian follicles and cysts.

Key words: adolescent girls, pubertal uterine bleedings, ultrasonography of the small pelvis.

2007, vol 15, # 4, page 426

G. V. Grushka, G. I. Tkachenko, V.V. Demyanenko, O. I. Paskevich, L. Y. Vasiliev, O. M. Astapieva

Bone scan in assessment of metastases to the bones


Objective: To determine the role of bone scan (BS) in monitoring of cancer patients for early diagnosis of bone metastases.

Material and Methods: Bone scan was performed in 735 patients with various tumors. The representative sample comprised 291 female patients with breast cancer (BC) of various stages. Of them, in 69 the findings of BS were compared with radiography findings. In 30 patients BS and radiography findings were compared with CT findings. Bone scan was done using SPECT tomographic camera (Design and Technology Bureau Orison, produced in 2002) in planar mode with 99m Tc-pyrphotech as an indicator. The findings of the research were assessed using statistical analysis.

Results: The majority of the patients who were performed screening BS were women with stage 2A BC at the able-to-work age belonging to clinical group 2 with the disease duration of 1 year at the day of the investigation and had undergone special antitumor treatment by the day of the investigation. In 27.1-37.7% of them annual monitoring with BS suggested metastases to the skeleton, chiefly (88% ) in the spinal column.

Conclusion: Bone scan can be used as a primary investigation to reveal bone metastases and should be performed both at the stage of making diagnosis and annual monitoring of cancer patients. This method is most sensitive and allows an early diagnosis or demonstration of larger amount of lesions when compared with radiography. Sensitivity and specificity of BS in determining the foci in the skeleton were 66.7 ± 14.2 and 68.4 ± 6.2%, respectively. Combination of BS and bone system radiography is more informative in diagnosis and detection of pathological metastatic changes and is 90% more sensitive than planar bone scan. Sensitivity and specificity of radiography and CT in detection of bone metastases are similar.

Key words: bone scan, breast cancer, bone metastases.

2007, vol 15, # 4, page 431

R. U. Churilin, I. O. Kramniy

X-ray characteristics of acute lung abscess


Objective: To investigate the features of x-ray picture of acute and chronic lung abscess depending on the character of the course and disease duration.

Material and Methods: The analysis of x-ray investigation of 35 patients with lung abscess aged 18-62 (of them, 57.1 % aged 41-60) is reported. The ratio of men to women was 4:1. Radiography in direct and lateral projections as well as tomography were performed.

Results: Investigation of the findings allowed to diagnose acute abscess in 19 examined patients (54.3 %) and chronic one in 12 (34.3 %), in 4 (11.4 %), pulmonary cysts were revealed. Unilateral localization dominated (65.7 %). The most frequent were abscesses measuring > 6 cm in diameter (45.7 % ), especially during the acute disease. The majority of the abscesses were characterized by rapid development. The amount of fluid in the cavity served as the criterion of cleavage rate. Sequestration was present in 20 % of acute disease. The shape of the abscesses was chiefly round or oval (in 34.3 %). Besides, 54.3 % of patients had abscesses with thick walls and the internal outlines of the cavity were chiefly distinct (65.7 %). The surrounding pulmonary tissue was changed as a result of infiltration or pneumo-fibrosis. The accompanying pleurisy, pneumothorax and empyema were revealed in single cases. The peculiarities and the nature of the above-mentioned radiological sings depending on the severity and duration of the process were determined. The obtained data allowed developing radiological classification of lung abscesses.

Conclusions: Our data allow to determine the early sings, to define the nature of radiological peculiarities of acute and chronic abscess and carry out differential diagnosis. The use of the classification will improve the diagnosis and the treatment of the patients.

Key words: acute and chronic lung abscess, radiological diagnosis, characteristic sings.

2007, vol 15, # 4, page 435

L. I. Simonova, P. M. Muzikant, G. V. Hmelevskay, V. Z. Gertman, L. V. Belogurova

The influence of sea hydrobiont additive Bipolan on the peripheral blood of persons exposed to ionizing radiation at their workplace


Objective: To investigate the capabilities of a biologically active additive Bipolan on the hemopoietic system of the persons exposed to chronic low-dose radiation due to their professional activity.

Material and Methods: Standard peripheral blood values (erythrocyte, leucocyte, thrombocyte, hemoglobin count) were determined in 46 persons of both genders working at South-Ukrainian Atomic Power Plant (category A) before and after a course of bioactive additive made from sea hydrobionts Bipolan. The course of treatment lasted 24-40 days.

Results: The analysis of primary findings showed that all blood values were within the physiological norm, but leucocyte count demonstrated a wide range of values, therefore the investigated persons were divided into two groups. In group 1 (38 persons), leucocyte count was at the level of the lower border of the norm (mean 3.98 ± 0.17 x 109/l), in group 2 (8 persons) at the level of the upper border (mean 8.35 ± 0.33 x 109/l). Group 2 consisted of men with chronic cardiovascular and gastrointestinal diseases.

Bipolan administration did not influence blood level of erythrocytes and hemoglobin in the both groups. Mean thrombocyte level showed a tendency to elevation in group 1 (by 12 %, p > 0.05) and was significantly increased in group 2 (by 31 % , p > 0.05).

Mean leucocyte values changed significantly in the both groups, i.e. in group 1 they were elevated by 16% (p<0.05), in group 2 reduced by 35%(p<0.05) reaching optimal mean population values in the both groups (4.6-5.4 x 109/l).

Conclusion: Bioactive additive Bipolan positively influences the state of the peripheral blood of the persons exposed to occupational low-dose irradiation. Administration of the additive optimizes peripheral blood leucocyte levels at their elevation or reduction as well as is able to increase thrombocyte level, i. e. positively influences the state of the most vulnerable links of hemopoiesis. Administration of biologically active additive Bipolan can be recommended to support the optimal state of hemopoiesis and increase general adaptation potential of the organism both in the professionals exposed to ionizing radiation and the persons with the history of radiation exposure (e.g. due to Chornobyl accident).

Key words: peripheral blood, workers of atomic power plant, biologically active additives, Bipolan.

2007, vol 15, # 4, page 440

S. M. Pushkar

Influence of chemotherapy with Taxotere on ceramide pathway of apoptosis activation in patients with breast cancer


Objective: To investigate the influence of ionizing radiation and combined action of irradiation and Taxotere on ceramide amount and cell apoptosis in breast cancer (BC).

Material and Methods: Ceramide amount in the tumor tissue and blood serum was investigated in 20 patients with II B - III B BC (T2-3N0-1M0 - T1-4N0-3M0) who were administered neoadjuvant radiation therapy and chemoradiation therapy with Taxotere.

Apoptosis level was determined in the biopsy specimens from the tumors. Quantitative assessment of apoptosis cells in the tumors was done using apoptosis index, which characterized the number of the cells with morphological signs of apoptosid.

Ceramides were determined using homogenate of the tumor tissue and blood serum of the patients with BC. Tissue and serum ceramides were separated using thin-layer chromatography with silica gel of commercially available Sorbfil (JS Sorbopolymer, Russia). Ceramide standards (Sigma) were used to identify the lipid.

For quantitative determining of tissue and serum ceramide amount lipid stains were taken to test tubes and eluded with mixture of chloroform with methanol (1:1) followed by elution with methanol. Mixed eluates were evaporated in vacuum and subjected to acid hydrolysis in 0.5 M HCl in methanol at 65° С for 15 hours. Ceramide mass was determined based on release of long-chain bases during lipid hydrolysis. Protein in homogenate and blood serum was determined using Lowry technique.

Results: It was established that radiation therapy of BC did not cause considerable changes in the mass of pro-apoptosis lipid, ceramide in the tumor tissue and blood serum and did not change apoptosis index in the tumor cells. Combination action of apoptosis inductor, Taxotere and ionized radiation considerably increased ceramide level in the tumor and blood serum of the patients as well as apoptosis index in the tumor cells.

Conclusion: Multimodality chemoradiation therapy with taxotere induces ceramide pathway of apoptosis in the cells of radioresistant BC tumor.

Key words: human breast cancer, ionizing radiation, Taxotere, radioresistance, ceramide, apoptosis.

2007, vol 15, # 4, page 445

A. V. Svinarenko

Toxicity assessment of neoadjuvant chronomodulated radiochemotherapy combined with Hydrea for unresectable rectal cancer


Objective: To compare the toxicity of chronomodulated radiotherapy (RT) with chemoradiomodification using Hydrea (Hydr) and traditional RT in patients with rectal cancer (RC) having contraindications to surgery and systemic PCT.

Material and Methods: During the period of 2003-2006 the study involved the patients with unresectable T3-4N RC with any M0 having contraindications to surgery or PCT. They were divided into 2 groups. Main group comprised 37 patients aged 48-86 (mean 69) who were administered chronomodulated RT with chemoradiomodification using Hydrea (25 x 2Gy + Hydr): RT to the small pelvis with traditional fractionation (SFD 2 Gy 5 times a week, TFD 50 Gy for 5 weeks) in chronomodulated mode (radiotherapy within the period of 8 a.m. - 10 a.m.) with simultaneous course of Hydrea at a dose of 20 mg/kg/day on the day of irradiation during the whole course of treatment. The controls were 47 patients aged 36-83 (mean 65) who received RT in the traditional mode up to TFD 50 Gy during 5 weeks without considering the time of the day (25 x 2 Gy).

Results: Chronomodulated RT with chemoradiomodification using Hydrea (25 x 2 Gy + Hydr) vs the traditional RT (25 x 2 Gy) promoted reduction of gastrointestinal toxicity (56.8 vs 72.3% , p=0.003) and inhibition of the red blood sprout (24.3 vs 46.8 % , p = 0.024). In the group of chronomodulation, the number of general reactions, cystitis and epidermitis decreased while the incidence of toxic reactions associated with Hydrea (inhibition of white blood sprout, nausea and vomiting) did not reduce.

Better tolerance of the protocol 25x2 Gy + Hydr allowed to avoid intervals in the treatment and reduction of the irradiation dose and cytostatics due to toxicity. The difference between the groups was statistically significant (16.2 vs 38.3 % , p = 0.031).

Conclusion: In patients with RC having contraindications to radical surgery and systemic PCT, administration of chronomodulated RT against a background of Hydrea at a dose of 20 mg/kg allows to prevent the risk of increased toxicity when compared with RT without consideration of the time of the day and use of chemoradiomodifiers.

Key words: rectal cancer, radiotherapy, Hydrea, chronomodulation.

2007, vol 15, # 4, page 449

I. M. Homazuk, O. S. Kovaliov, N. V. Kursina, L. M. Ovsyannikova

Radiation and non-radiation factors promoting myocardial infarction development in participants of Chornobyl accident clean-up


Objective: To determine the predispositions, structure and priorities of the factors preceding myocardial infarction (MI) development in participants of Chornobyl accident clean-up exposed to low-dose radiation with the purpose to optimize preventive mesures.

Material and Methods: The study involved 90 participants of Chornobyl accident clean-up who survived MI and 103 participants of Chornobyl accident clean-up wihout it. Influence of radiation and non-radiation factors was analyzed. Electrocardiography, chocardiography, biochemitry investigations were performed.

Results: At exposure to 25 cSv and more, MI was 21.1% more frequent (p < 0.05) than at 10 cSv. High level of negative recollections influenced this considerably. In patients who survived MI integral score was 25.1 vs 17.8 in the controls (p < 0.05). Generally accepted risk factors were revealed in 97.8% of the persons, of them 54.4 % had more than three factors. Heredity, professional contact with xenobiotics, smoking prevailed among the factors preceding MI development in young persons. Arterial hypertension, left ventricle hypertrophy, excessive body mass, diabetes mellitus were more typical for those aged over 45. The age of 45-55 was critical for MI development. The possibility of interaction of radiation and non-radiation factors increased at their combination.

Conclusion: MI development in participants of Chornobyl accident clean-up is determined by interaction of the factors associated with the accident, genetic and other factors of non-radiation origin. Combination of ionizing radiation of 25 cSv and more with generally known factors the risk of MI deve-lopemnt increased by 21.1% (p < 0.05), MI develops in younger persons. The revealed predispositions, peculiarities of the structure, priorities, interaction of radiation and non-radiation factors preceding MI development in participants of Chornobyl accident clean-up can be used in assessment of its risk and optimizing the privative measures.

Key words: participants of Chornobyl accident clean-up, myocardial infarction, radiation and non-radiation risk factors.

2007, vol 15, # 4, page 455

E. M. Mamotuk, V. A. Gusakova, V. G. Kravchenko, O. V. Nenukova

Morphological changes in the inner organs of the rats at influence of Tabari Noni juice Communication 1


Objective: To investigate morphological changes in the tissue of the thymus, spleen and liver of the rats who received 100% Tabari Noni juice at different doses with the fodder.

Material and Methods: The study involved 22 Wistar male rats weighing 160-190 g distributed into 3 groups: controls and two experimental groups.

For 15 days the rats received 100% Tabari Noni juice (JOY PRODUCTS, S.A) with the fodder. Group 2 received 2.5 ml/kg and group 3 - 5 ml/kg. The observation lasted for a month. In 30 days all animals were killed observing the rules of euthanasia. Histology was performed using standard techniques.

Results: It was established that administration of Tabari Noni juice with the fodder did not change the behavior and general condition of the rats in 30 days. At 2.5 ml/kg, the tendency to prevalence of the cortex structures over the medullar ones in the thymus, enlargement of the cellular structures in the red pulp of the spleen, enlargement of reticuloendothelial cells in the liver were noted by the 30 th day. The revealed changes were regarded as functional activation of the organs and possible increase of immunological capabilities of the organism. At 5 ml/kg, similar experiments demonstrated widening of thymus medulla, lymph node hyperplasia with diffuse and focal formations in the spleen, reduction in the number of starry reticuloendothelial cells of the liver. The above can be associated with increase of the physiological level of stimulation and manifestation of the signs of strain and exhaustion.

Conclusion: 100% Tabari Noni juice in the described protocols of administration causes morphological changes of stimulating character (2.5 ml/kg) and destructive signs (5 ml/kg) in the immunocompetent organs (thymus, spleen) and liver of the rats.

Key words: Tabari Noni juice, morphology, thymus, spleen, liver, immunological effects.

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