Revista
de la
Universidad
del Zulia
Fundada en 1947
por el Dr. Jesús Enrique Lossada
77
ANIVERSARIO
DEPÓSITO LEGAL ZU2020000153
ISSN 0041-8811
E-ISSN 2665-0428
Ciencias
Exactas,
Naturales
y de la Salud
Año 15 N° 43
Mayo - Agosto 2024
Tercera Época
Maracaibo-Venezuela
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
96
Benefits of Modern Imaging Techniques in Medicine
Danila AndreevichBogomolov*
Anton Evgenievich Antonov**
Aleksandr Igorevich Ilin***
Margarita Vladimirovna Beliaeva****
Tatiana Andreevna Bogomolova*****
ABSTRACT
Relevance. For more than 100 years, medical practice has used imaging methods to observe
pathological changes localized in the human body. The first method was radiography,
which became popular among doctors, but later it turned out that high radiation exposure
increases the incidence of tumor diseases, which is why standards for permissible radiation
doses were developed for patients and radiologists. The introduction of radiocontrast
agents also had contraindications that should be taken into account. Ultrasound, computed
tomography (CT), magnetic resonance imaging (MRI), and angiography methods have
significantly increased the diagnostic capabilities of instrumental methods. The purpose of
this review is to analyze the advantages and disadvantages of modern imaging methods in
medicine. Methods. To achieve the purpose of the review, a literature search was
conducted in Google Scholar and PubMed databases.
Results.
1) The main indication for
the X-ray method is visualization of bone structures. 2) X-ray contrast methods are optimal
for studying hollow organs and blood vessels. 3) The advantage of MRI is the ability to
visualize soft tissue well. 4) CT helps to reconstruct the spatial architecture of organs. 5)
Ultrasound allows you to observe the condition of the embryo and fetus, as well as internal
organs.
KEYWORDS: Imaging, radiography, computed tomography, ultrasound.
*Student of Federal State Budgetary Educational Institution of Higher Education «Yevdokimov A. I.
Moscow State University of Medicine and Dentistry» of the Ministry of Healthcare of the Russian
Federation, Moscow. ORCID: https://orcid.org/0009-0001-5802-2080. E-Mail: Danchik0711@mail.ru
**Student of Federal State Budgetary Educational Institution of Higher Education «Yevdokimov A. I.
Moscow State University of Medicine and Dentistry» of the Ministry of Healthcare of the Russian
Federation, Moscow. ORCID: https://orcid.org/0009-0000-7368-1634. E-mail: Dr.ant2000@yandex.ru
***Student of Federal State Budgetary Educational Institution of Higher Education «Yevdokimov A. I.
Moscow State University of Medicine and Dentistry» of the Ministry of Healthcare of the Russian
Federation, Moscow. ORCID: https://orcid.org/0009-0002-5532-0506. E-mail: sashailyinphone@gmail.com
****Student of Federal State Budgetary Educational Institution of Higher Education «Yevdokimov A. I.
Moscow State University of Medicine and Dentistry» of the Ministry of Healthcare of the Russian
Federation, Moscow. ORCID: https://orcid.org/0009-0005-0239-786X. E-mail: Rita.beliaeva@mail.ru
*****Student of I.M. Sechenov First Moscow State Medical University (Sechenovskiy University), Moscow.
ORCID: https://orcid.org/0009-0008-6228-7664. E-mail: Tanyabogo@mail.ru
Recibido: 09/01/2024 Aceptado: 20/03/2024
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
97
Beneficios de las técnicas modernas de imágenes en Medicina
RESUMEN
Relevancia. Durante más de 100 años, la práctica médica ha utilizado métodos de imagen
para observar cambios patológicos localizados en el cuerpo humano. El primer método fue
la radiografía, que se hizo popular entre los médicos, pero luego resultó que la alta
exposición a la radiación aumenta la incidencia de enfermedades tumorales, por lo que se
desarrollaron estándares para las dosis de radiación permitidas para pacientes y radiólogos.
La introducción de agentes de contraste radiológico también tuvo contraindicaciones que
conviene tener en cuenta. La ecografía, la tomografía computarizada (TC), la resonancia
magnética (RM) y los métodos de angiografía han aumentado significativamente las
capacidades de diagnóstico de los métodos instrumentales. El propósito de esta revisión es
analizar las ventajas y desventajas de los métodos modernos de imagen en Medicina.
Métodos. Para lograr el propósito de la revisión, se realizó una búsqueda bibliográfica en las
bases de datos Google Scholar y PubMed. Resultados. 1) La principal indicación del método
de rayos X es la visualización de estructuras óseas. 2) Los métodos de contraste radiológico
son óptimos para estudiar órganos huecos y vasos sanguíneos. 3) La ventaja de la resonancia
magnética es la capacidad de visualizar bien los tejidos blandos. 4) La TC ayuda a
reconstruir la arquitectura espacial de los órganos. 5) La ecografía permite observar el
estado del embrión y el feto, así como de los órganos internos.
PALABRAS CLAVE: Imagenología, radiografía, tomografía computarizada, ecografía.
Introduction
Medical imaging methods have been actively developing from the date of their first
application 130 years ago (Scatliff, Morris, 2014). Modern doctors can obtain a human body
image in minute details with the help of radiography, computer-assisted tomography (CT),
magnetic resonance imaging (MRI), positron-emission tomography (PET),
ultrasonography (U/S), etc. These technologies allowed significantly improving the
diagnostics and monitoring of pathological processes. Many methods are accompanied by
significant radiation exposure that enhances the likelihood of cancer formation in future.
This once required the revision of radiation tolerance doses and development of new more
attenuated technologies. On the other hand, many investigations required the
administration of radiopaque substances, having the toxic effect, into the body that is the
contraindication for patients with renal disease and intolerance to these compounds (Kaller,
An, 2023). Different resolution of imaging methods resulted in the differentiation of their
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
98
application field and development of the list of indications and contraindications for
different pathologies.
The purpose of this paper is to reveal the advantages of imaging methods most
widely spread in medical practice.
1. Materials and methods
To reach the goals set, we conducted the bibliographic search in databases Google
Scholar and PubMed. The following search queries were used to find the required articles:
“history of radiography” – 19988 results (PubMed, 10 years, free full text)
11 articles “history of radiography” – 11961 results (PubMed, 5 years, free full
text)
“interventional radiology” – 16998 results (PubMed, 5 years, free full text)
“ultrasound diagnostics” – 203715 results (PubMed, 5 years, free full text)
“CT MRI” – 16100 results (Google Scholar, since 2019)
“U/S application area” – 14700 results (Google Scholar, since 2019).
The maximum search depth was 10 years. The duplicating, close, less informative,
unrelated to the topic, and not available as a full text articles were disregarded. We have 41
publications (2 domestic and 39 English-language) in the final list.
2. Results
2.1. Radiography
In 1895 Wilhelm Roentgen saw the hand bone image on the photographic plate from
the opposite side of the cathode-ray tube for the first time. This photograph became one of
many X-ray photographs made since then. Roentgen’s researches were immediately
reproduced in other physical laboratories. A 3-hour X-ray photograph demonstrating the
non-transparency of metal bullets, rings and pins was made in Davidson College (North
Carolina) in January 1896. In a month the X-ray radiation was used for imaging Colles
fracture of a student of Darmouth College in Hanover (Scatliff, Morris, 2014). Very soon the
doctors appraised the advantages of the new technology and started practicing it, using
glass plates for getting the image. Mobile X-ray stations were used during World War I
already to diagnose bone injuries, as well as tuberculosis and other pulmonary damages.
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
99
Later, radiographic contrast studies of gastrointestinal tract with the use of barium meal
emerged. The radiation safety events started to be introduced in 1930s: lead aprons, gloves,
thereoid shields, safety goggles (for interventional radiologists) got into use. In the late
1940s the specialists began thinking about long-term risks of X-ray radiation. Sharply
narrowed X-ray beams and short-range expositions with three-phase generators started to
be applied for taking X-ray photographs. It was extremely important to take safety
measures with children and babies whose tissues are more sensitive to radiation damages.
By 1960s the radiation doses critically decreased, which allowed using radiopaque
substances for imaging a beating heart and vessels. This method gave the opportunity to
examine the heart noninvasively. In the same period, the X-ray film replaced glass plates.
The introduction of digitalization improved the quality of X-ray study even more (Scatliff,
Morris, 2014).
Radiography is the gold standard in osteoarthritis diagnostics. The method allows
finding the joint space width, which is the indirect marker of the cartilage thickness and
meniscus integrity in knees, though the direct imaging of these joint structures is
impossible. Besides, marginal osteophytes are found. The radiographically found joint space
width is the parameter approved by Federal Food and Drug Administration of the USA to
monitor the efficiency of pharmaceutical drugs for osteoarthritis treatment. The joint space
disappearance (bone on bone) is the indication for the joint replacement. The severity of
radiographic osteoarthritis is found by Kellgren-Lawrence semi-quantitative scoring
system. Digital radiography allows precisely measuring the distance between the edges of
thigh and shin bones (Hayashi, Roemer, Guermazi, 2016). Nevertheless, the X-ray method
does not give an idea about the condition of soft tissues surrounding the joint.
Radiography is widely accessible for outpatients and is often the initial examination
to evaluate the condition of patients with acute stomach ache. However, in this case, the
method has a limited diagnostic value and its results do not significantly influence the
patients’ treatment scheme. In case of acute abdomen, the X-ray method is necessary at
suspicion on gastrointestinal obstruction, perforation of hollow organs, concretions of
urinary tracts, foreign bodies (Cartwright, Knudson, 2015).
Radiography is traditionally used in dentistry and gives a general picture of teeth
condition. However, in some cases (for instance, when evaluating root resorption), the
diagnostics can be difficult, since ordinary X-ray photographs give only a 2D image and are
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
100
not precise when determining the character and localization of the pathological process. In
such cases, more accurate methods are applied (cone-beam CT) (Lima, Gamba, Zaia, Soares,
2016).
Such capabilities of the X-ray method, as obtaining of X-ray photographs using
protons instead of X-ray beams, should be discussed separately. The change in the density
inside a patient’s body influences the energy of protons going through it. The protons
crossing the region with increased density lose more energy than in less dense tissues.
These protons will have a shorter residual range. Measuring the energy of escaping protons
and their residual range, it is possible to reproduce inner structures of the body. Coulomb
scattering hinders the imaging precision. Another approach is the use of charged nuclei
instead of protons. In a series of experiments conducted by Seward and Claire in 1973 the
X-ray photographs of different samples were made and it was demonstrated that proton
radiography can be used for imaging the anatomy of soft tissues and available anomalies.
The introduction of proton CT into clinical practice started in Los Alamos in 1977. Proton
X-ray photographs were further used as control images to improve the accuracy of proton
beam therapy of patients (Hanson, Schneider, 2022).
In the light of the pandemic all over the world, mobile radiography became widely
spread, as well as tele-radiography, which allows distantly examining the picture obtained
(Tay, McNulty, 2023).
2.2. Magnetic Resonance Imaging (MRI)
1973 can be considered as the year of magnetic resonance imaging (MRI) emergence,
when Prof. Paul Lauterbur published his paper “Image Formation by Induced Local
Interactions: Examples of Employing Nuclear Magnetic Resonance” in Nature (Lauterbur,
1973). The clinical use of MRI initially started from the magnetic field intensity in the range
of 0.05-0.35 T. However, during the recent 40 years we have been observing the tendency to
apply stronger magnetic fields that, on the one hand, resulted in the data improved quality,
and on the other – more expensive equipment making it unaffordable for many medical
institutions. Nevertheless, in a number of cases, low-field MRI can be used, for example, in
diagnostics of congenital hydrocephalus accompanied by elevated intracranial pressure
(Marques, Simonis, 2019).
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
101
Despite the examination high cost, MRI, in a number of cases, is a valuable
diagnostic tool able to evaluate pathology in structures, which are not visualized with
radiography, including arthrodial cartilage, meniscuses, ligaments, synovium, capsule. MRI
can also detect fluid accumulation, state of bone marrow, organs and soft tissues. MRI
allows detecting pathologic changes in joints at the stage when they are not visible on the
X-ray image. Sometimes the availability of artefacts can result in wrong conclusions, for
example, detection of meniscal tear or cartilage loss. The same way as in the radiographic
examination, semi-quantitative scoring of the injury is conducted in MRI: knee joint
(WORMS, BLOCKS, MOAKS scales), arm osteoarthritis (OMERACT scale), hip joint
(HOAMS system). Composition MRI allows evaluating the cartilage tissue dynamics
during treatment. Changes in cartilage matrix are investigated by MRI with delayed
gadolinium enhancement (dGEMRIC), Т1 rho and Т2 mapping. The concentration of
sharply negatively charged glycosaminoglucans in hyaline cartilage is used in the first two
methods: the loss of these molecules in focal regions can be connected with early stages of
the disease and can influence the MRI picture. The concentration of Т2 is influenced by the
complex combination of collagen orientation and cartilage hydration (Hayashi, Roemer,
Guermazi, 2016).
Imaging at strokes can be obtained by MRI and CT methods. MRI has higher
sensitivity at acute ischemic injuries. Besides, MRI detects strokes in the system of
posterior cerebral arteries better than CT. Nevertheless, MRI is contraindicative if
implanted devices or claustrophobia are available. MRI is also more sensitive and specific
than CT and U/S in the diagnostics of vertebral artery stenosis. Cervical and intracranial
stenosis, intraplaque hemorrhage, vertebra wall hematoma, cervical arteriopathies,
atherosclerosis, vasculitis can be visualized with the help of MRI (Salerno et al., 2022).
MRI can be useful to evaluate acute cholecystitis with the sensitivity of 85% and
specificity of 81%, similar to U/S method. MRI is prescribed for the patients with unclear
U/S results for imaging diseases of liver and bile ducts not detected by U/S. MRI has high
sensitivity and specificity when diagnosing appendicitis with pregnant women
(Cartwright, Knudson, 2015).
MRI together with CT is widely used for gallbladder cancer diagnostics revealing
the mass occupying the bladder lumen and frequently invading into the liver parenchyma.
MRI can show the hypointense and hyperintense signal on Т1-suspended images of the
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
102
gallbladder and hyperintense signal on Т2-suspended images. MRI, the same as CT, reveals
the uneven intensive enhancement on the periphery to the early arterial phase, which is
preserved in fibroid components of the initial affection to the portal venous phase of the
disease (Fine, Smith, Stein, Madoff, 2019).
Different inflammatory anomalies of pancreas are able to imitate the adenocarcinoma
of its ducts when visualizing their cross-section. The incorrect diagnosis can result in the
unnecessary surgical interference. MRI and CT methods are able to differentiate the
adenocarcinoma of pancreas ducts (APD) and mass-forming chronic pancreatitis (MCP).
The combination of perfusion MRI and diffuse-suspended imaging allowed achieving good
results in differential diagnostics. The mean value of apparent diffusion coefficient (ADC)
was much lower at APD than at MCP (1.17±0.23 vs. 1.47±0.18, p<0.01, obtained at 3.0-Т MRI).
The slow diffusion coefficient and perfusion fraction were much lower at MCP than at APD.
The intravoxel coherent motion at diffuse-suspended imaging also allowed differentiating
these two pathologies (Schima el al., 2020).
MRI is an effective technique for diagnosing thrombi. Imaging using fluorine
19
, trace
superparamagnetic iron oxide (RGD-USPIO), magnetic-powder suspension is applied to
obtain the thrombus image. MRI can be also used to study the thrombus magnetic
properties using the magnetization method and diffusion imaging. The former better
characterizes old, dense thrombi, and the latter is more effective to detect new thrombi
sensitive to lysis (Lanza et al., 2019). MRI method, the same as CT with U/S, is effective in
diagnosing liver portal vein thrombosis (Ju et al., 2019).
MRI (and CT) method was recommended by European Society of Cardiovascular
Radiology (ESCR) when planning the surgery of aortic valve transcatheter replacement.
The diagnosis and classification of aortic valve severe syndrome were based on the
symptoms and imaging data related to the aortic valve anatomy and hemodynamics. It is
suggested to use MRI for quantitative evaluation of the aortic valve coverage area and
transvalvular rates using the planimetry and phase-contrast image with simultaneous
calculation of the left ventricle ejection fraction (Francone, 2020).
MRI has significantly improved during the recent 20 years that resulted in the
emergence of safe, universal, noninvasive alternative to coronagraphy not requiring the
administration of iodine-containing contrast agent. MRI is considered the clinical gold
standard for evaluating cardiac structure, volume, function, tissue characteristic, presence
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
103
and condition of cardiac muscle scar, and myocardial perfusion (Mangla,
Oliveros, Williams, Kalra, 2017). Nevertheless, the quality of MRI-angiography is lower
than of CT-angiography and X-ray angiography, since the resolution is 1 mm vs. 0.4-0.6 and
0.1 mm, respectively. Besides, MRI-angiography differs in longer procedure duration, high
cost, complicated planning of stenting and deteriorated image quality due to the heart
motion and the patient’s breath. All this results in low sensitivity and specificity in
comparison with other angiographic methods. The application of MRI-angiography is
mainly limited by the assumption of the anomaly of coronary vessels, aneurysm and
evaluation of proximal segments of coronary rami. The innovations recently introduced into
MRI technology allow overcoming many of the indicated drawbacks. The main techniques
are as follows: imaging acceleration, motion and reconstruction structure correction,
simplified scanning planning, higher magnetic field intensity, use of opaque substances
based on gadolinium and nitrates. MRI ability to characterize vessel plaques is of research
and clinical interest for early diagnostics and treatment of atherosclerotic diseases
(Hajhosseiny et al., 2020).
2.3. Computed Tomography (CT)
The idea of laminography of human organs was initially proposed by American
doctor William Odendorf in 1959. In contrast to flat X-ray photographs the new method
allowed evaluating a 3D structure of anatomic formations. The first brain tomogram was
made in 1971 on the scanner developed by А. Cormac and G. Hounsfield, for which they
were awarded the Nobel Prize in 1979. The technology has been significantly improved
since then – the image is more clear, it is possible to evaluate the organ work in dynamics
(heart) (Klarov, Platonov, 2018)
CT allows imaging the bone and soft tissue calcification well, and evaluating the
condition of spinal column facet joints in osteoarthritis. The limitations for CT are the
radiation exposure and limited ability to evaluate soft tissues (Hayashi, Roemer, Guermazi,
2016).
CT prescription can be relevant at acute stomach ache. American College of
Radiology recommends using CT to evaluate the pain in the stomach right and left lower
quadrants. The broad CT application is accompanied by the worries about the ionizing
radiation resulting in the attempts to use CT with decreased radiation doses. CT is
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
104
recommended in abscesses, pancreatitis, appendicitis, Crohn disease, diverticulitis,
mesenteric ischemia, nephrolithiasis, intestinal blockage. The contrast medium is used in
many cases. In acute appendicitis CT has better sensitivity and specificity (91% and 90%)
than U/S (78% and 83%). The routine use of CT for appendicitis diagnostics resulted in
reduced frequency of appendectomies with the negative result from 24% to 3%, as well as
reduced treatment costs (Cartwright, Knudson, 2015). With the gallbladder cancer, CT
reveals the hypodense formation, and the contrast agent intravenous administration
demonstrates the hypervascular focus enhancement in 40% of cases (Fine, Smith, Stein,
Madoff, 2019).
The investigations of perfusion CT efficiency in APD and MCP differential
diagnostics demonstrated the promising results. The perfusion CT allowed clearly
distinguishing the normal parenchyma from the tumorous and inflammatory ones, as well
as distinguishing between the latter two. The average blood flow, blood volume and the
product of permeability and the surface area were much higher at MCP than at
adenocarcinoma. The combination of the indicated parameters demonstrated high
sensitivity and specificity in differential diagnostics of adenocarcinoma of pancreas ducts
and mass-forming chronic pancreatitis (Schima et al., 2020).
SPECT (single-photon emission CТ) with the use of opaque substances is applied
for detecting thrombi. The main targets (for radiopharmaceutical agents) for imaging are
thrombocytes and fibrin. An acute thrombus is easily detected with the help of SPECT,
however, it is difficult to visualize an old one. Besides, the intake of anticoagulants also
decreases SPECT diagnostic value (Lanza et al., 2029). Low-dose spiral CT can be an
effective tool for the pulmonary cancer screening, revealing small tumors well (Hajdu,
Vadmal, Tang, 2015).
The cone-beam computer-assisted tomography (CBCT) has been actively applied in
dentistry in recent years. It generates images in axial, coronary and sagittal directions that
allows performing 3D imaging of tooth structures. CBCT has become a valuable method of
studying periapical lesions and traumas of teeth, as well as the complications (fractures,
perforations, root resorptions). The CBCT image quality depends on the field of vision
(FOV) and voxel size. Images with smaller voxels have better resolution and visualize
endodontal lesions more accurately. The comparison between radiologic method
(periapical R) and CBCT when evaluating the root resorption revealed the increased CBCT
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
105
accuracy in diagnosing the external (р=0.0144) and internal (р=0.0038) resorptions. The
accuracy of both methods was the same in replacing resorption (Lima, Gamba, Zaia, Soares,
2016).
CT method appeared to be very highly-demanded during COVID-19 pandemic. CT
was recommended for patients with positive laboratory tests for the virus and with
moderate-to-severe disease progression, as well as for patients with negative test results.
The method was more effective than the ordinary X-ray photograph at the early stages of
the disease (Toussie, Voutsinas, Chung, Bernheim, 2022).
European Society of Cardiovascular Radiology recommends CT examination before
the transcatheter replacement of aortic valve for the quantitative evaluation of the aortic
valve calcification load based on CT for diagnostic purposes. Nevertheless, this examination
is recommended only for the patients with contradicting results of Doppler
echocardiography (Francone et al., 2020).
Computer-assisted coronary angiography (CTA) has come the considerable way of
evolution due to the innovation in the production of X-ray tubes, accelerated gantry
rotation, multiple parallel detector rings in tomographic scanner and decreased slice
thickness connected with it. The spatial resolution is 0.4 mm, the negative prognostic value
of the method is 90%. The examination is noninvasive and is distinguished by low cost
compared to invasive coronary angiography. CTA is recommended as a method for selecting
patients with IHD stable symptoms and low-to-average risks of ischemia. During CTA, the
fractional blood flow reserve is evaluated and the plaques are characterized (total mass of
the plaques, lesion calcification, suppression character of the plaques and remodeling
positive index). The application of CTA method is limited by the radiation exposure and
necessity to administer an iodine-containing contrast agent. The availability of artefacts
connected with vast calcification of coronary arteries handicaps the stenosis accurate
evaluation. There are contraindications for patients with renal disease, resistant
tachycardia/arrhythmia, hypersensitiveness to iodine-containing contrast agents,
pregnancy, and incapability to follow the instructions on holding breath (Hajhosseiny et at.,
2020).
2.4. Positron Emission Tomography (PET), scintigraphy
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
106
Scintigraphy with 99Tc-hydroxymethanediphosphonate (HDP) and positron-
emission tomography (PET) with 2-
18
fluorine-2-deoxy-D-glucose (
18
FDG) or
18
fluoride is
successfully applied to diagnose the condition of joints. With the help of scintigraphy it is
possible to completely examine the body, carry out the differential diagnostics between the
bone and soft tissue pain and localize the pain source at complex symptomatology. FDG-
PET reveals synovitis and bone marrow damages. Inferior anatomic resolution is the
limitation for radioisotopic methods, however, it is overcome with the help of hybrid
technologies (PET-CТ, PET-MRI) (Hayashi, Roemer, Guermazi, 2016). Cholescintigraphy
has better sensitivity and specificity (96% and 90%, respectively) than U/S (81% and 83%)
when diagnosing acute cholecystitis, although U/S is more accessible and can detect the
accompanying abdominal pathology (Cartwright, Knudson, 2015). With gallbladder cancer
(GBC) PET-CТ demonstrates high hypermetabolic activity of fluorinedeoxyglucose in the
place of tumor and metastases localization. In the beginning of the disease the diffuse, focal
or asymmetric wall thickening is observed in 20-30% of cases. The initial detection of GBC
can define the polypoid lesion in 15-25% of cases: malignant polyps are over 1 cm and should
provoke cancer alertness (Fine, Smith, Stein, Madoff, 2019).
PET based on Gu
64
can be used for thrombi imaging. It is proposed to use peptide
FBP8 for binding as a fibrin-specific probe, however, its efficiency is higher in respect of an
acute thrombus and it goes down with the thrombus ageing due to gradual decrease in the
fibrin content (Lanza et al., 2019).
At present, the diagnostics based on positron-emission tomography is widely
applied in inflammatory diseases of bones, joints, heart, sarcoidosis, diabetic foot, query
fevers, oncological diseases of varied localization, metastases, when planning radiation
therapy. As a rule, the enhancement by gadolinium or fluorinedeoxyglucose is used (Casali
et al.,, 2021; Chen, Chen, Wang, 2022; Kocher, Ruge, Galldiks, Lohmann, 2020; Kratochwil
et al., 2019; Pu et al., 2021; Rischpler et al.,, 2019; Yang et al., 2022).
2.5. Intervention radiology
Intervention radiology started developing in 1960s and its initial narrow
directedness has expanded and today it comprises the diagnostics and treatment of diseases
in many body systems. At the moment, a lot of treatment procedures, including
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
107
percutaneous biopsy, are carried out under the control of radiologic methods (Arnold,
Keung, McCarragher, 2019).
Technical achievements in radiology made it possible to implement the improved
imaging and intervention radiology. The most noticeable diagnostic contribution was made
by such methods as percutaneous cholangiography, endoscopic retrograde
cholangiopancreatography, angiography, percutaneous transthoracic biopsy under CT’s
control, intravenous or intraperitoneal administration of radioisotopes I
131
and Tc
99
to
localize tumors, diagnostic use of radiolabelled antibodies, etc. (Hajdu, Vadmal, Tang, 2015).
Invasive X-ray angiography and coronary computer-assisted tomography are the
recognized gold standards in coronary angiography. Nevertheless, they are connected with
certain contraindications, ionizing radiation and necessity to administer iodine-containing
contrast agents. This prompts seeking new techniques for imaging vessels. Among a
number of imaging methods, coronary cardiovascular magnetic resonance angiography can
be applied to seek and monitor the stenosis of coronary arteries. The method advantage is
in its universality, lack of radiation exposure, perfect imaging quality of soft tissues, lack of
necessity to administer iodine-containing contrast agents. The comparison between
unenhanced MRI-angiography and X-ray angiography demonstrated that sensitivity and
specificity of the first method are about 88-92% and 42-72%, respectively (Hajhosseiny et
al., 2020).
Quantitative invasive X-ray coronography gives good visualization of vessels at IHD.
Due to spatial resolution of up to 0.1 mm, the method is second to none in evaluating the
distal coronary anatomy. X-ray coronography is used during percutaneous coronary
intervention (PCI) required in emergency cases and it provides the precision of
manipulations and economic efficiency of the surgery. With patients with symptomatic
stable IHD the invasive evaluation of the physiology of coronary arteries and PCI with
functional control (with defining the fractional flow reserve) and pressure provision has a
good forecast and is the established gold standard of the approach to revascularization at
stable angina. Nevertheless, the complications connected with invasive radiology (death,
stroke, myocardial and vessel injury, pain, bleeding) long-term accumulated risk from
ionizing radiation and short-term risk of nephropathy conditioned by the administration of
iodine-containing contrast agents limit the application of this method as a screening tool at
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
108
suspicion on stable IHD. This method poorly characterizes intravascular plaques, especially
during the remodeling keeping the vessel lumen (Hajhosseiny et al., 2020).
2.6. Ultrasonic Signal (U/S)
For the first time, the ultrasonic signal captured on the photographic plate to
determine the cerebral ventricle anomaly was used by an Austrian neurologist
(psychiatrist) Karl Dusik and his brother Friedrich Dusik. Moving the transmitter around
the scull and registering the energy of the beam having passed, the brothers received the
image of dark and light spots, something like a TV picture, which was put onto the
photographic plate and was initially called “hyperphonogram”. The physical principle of the
new method was based on sound attenuation when it was going through the head structure.
The researchers’ conclusions were published in 1942 and 1947. Sound waves, the same way
as X-rays, lose energy when going through tissues, however, the ultrasound is easily
reflected, deflected and diffracted changing the wave direction and amplitude. In later
hardware developments it became possible to neutralize the number of reflections and
backscattering (Dietrich et al., 2022).
Due to low radiation exposure and good resolution U/S is widely used to diagnose
endocrine, gynecologic, oncologic, kidney diseases, pathology of abdominal cavity, heart
and lungs (Grani et al., 2020; Martire et al., 2020; Nicolau, Antunes, Paño, Sebastia, 2021;
Oskovi Kaplan, Ozgu-Erdinc, 2018; Radzina, Biederer ,2019; Riddell, Corallo, Albazaz,
Foley, 2023; Salzman, Collins, Hersh, 2019). Ultrasonography of heart and vessels allows
defining the myocardium stiffness, its functional consistency, and (application of
echocardiography with speckle tracing) gives the possibility to identify nearly invisible
myocardial injuries, find the ischemia regions with the creation of clear picture of affection
zone for differential diagnostics and treatment (Pastore et al., 2021; Pedreira et al., 2022).
The application of short focused U/S protocols helps to diagnose diseases of lower
extremities, aorta, pulmonary arteries, atherosclerotic changes in vessels (Balakhonova et
al., 2022). The development of supplementary reproductive technologies made U/S a key
method in the evaluation of ovarian syndrome, as well as the control method in ovary
paracentesis with ovum collection for IFV and monitoring of the patient’s condition after
the embryo transfer into the uterine cavity (Cortés-Vazquez et al., 2021). The absence of
radiation exposure resulted in the fact that U/S method is the most sought-after for
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
109
diagnosing pregnancy and fetus pathology. Apart from the endometrium state, U/S helps in
defining the fetus dimensions, growth rate, uteroplacental Doppler indices, carrying out
cardiotocography, revealing indications of the mother’s arterial hypertension, etc. (Lees et
al., 2022). U/S today is an accessible, safe and inexpensive method to reveal the pathology of
different organs and systems.
Conclusion
The information analysis in the literature references demonstrated that imaging
methods have been continuously developing and improving for nearly 130 years. Despite the
expectations, the very first X-ray imaging method has still been actively used, being, among
others, a mandatory component of the population’s general preventive medical examination.
Although initially it was used for diagnosing bone fractures, the diagnostic range has
gradually broadened and comprised pulmonary diseases, acute abdomen, scull images
(Turkish saddle), etc. The possibility to administer radiopaque substances made X-ray a
valuable tool for diagnosing diseases of gastrointestinal tract and vessels. The limitation
comprised high radiation exposure, intolerance to radiopaque substances with renal disease.
U/S and MRI methods, which emerged later, were not accompanied by radiation and had
high information value and good resolution of the picture obtained. MRI advantage is
excellent imaging of soft tissues, tendons, ligaments, vessels, internal organs. CТ and its
derivatives (PET-CТ, CТА) refer to the methods of the best imaging of internal structure,
however, the influence of artefacts is possible here. Besides, CТ-angiography has lower
resolution than X-ray and MRI-angiography, therefore, it is recommended to be used only
to evaluate the proximal part of coronary vessels. X-ray angiography is still considered to be
the best.
Therefore:
1. X-ray method provides clear imaging of bone structures but does not allow
evaluating soft tissues. Besides, the method is accompanied by considerable radiation
exposure.
2. Radiographic contrast studies allow defining the structure of hollow organs and
vessels well, however, the intolerance to radiopaque substances and enhancement of renal
disease are possible.
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
110
3. MRI advantage is expressed in good imaging of soft tissues and absence of
radiation exposure, however, MRI-angiography has lower resolution in contrast to X-ray
and CТ-angiography.
4. CТ allows recreating an organ spatial structure, however, radiation exposure and
insufficiently sharp imaging of soft tissues are the limitations.
5. U/S method is widely used in diagnosing pathology of soft tissues, conducting
supplementary reproductive technologies and evaluating embryo and fetus condition due to
the absence of radiation exposure.
References
Arnold M.J., Keung J.J., McCarragher B. (2019) Interventional Radiology: Indications and
Best Practices.
Am Fam Physician.
99(9): 547-556.
Balakhonova T.V., Ershova A.I., Ezhov M.V., Barabash O.L., Bershtein L.L., Bogachev V.Yu.,
et al. (2022) Focused ultrasound investigation of vessels. Cardiovascular Therapy and Preventive
Care. 21(7): 105-126. doi: 10.15829/1728-8800-2022-3333.
Cartwright S.L., Knudson M.P. (2015) Diagnostic imaging of acute abdominal pain in adults.
Am Fam Physician. 91(7): 452-9.
Casali M., Lauri C., Altini C., Bertagna F., Cassarino G., Cistaro A., et al. (2021) State of the
art of
18
F-FDG PET/CT application in inflammation and infection: a guide for image
acquisition and interpretation.
Clin Transl Imaging.
9(4): 299-339. doi: 10.1007/s40336-021-
00445-w.
Chen Z., Chen X., Wang R. (2022) Application of SPECT and PET / CT with computer-
aided diagnosis in bone metastasis of prostate cancer: a review.
Cancer Imaging
. 22(1): 18. doi:
10.1186/s40644-022-00456-4.
Cortés-Vazquez A., Goitia-Landeros G.A., Regalado M.A., León-Hernández S.R., Cortés-
Algara A.L., Bandala C., et al. (2021) Prediction of ovarian response in IVF/ICSI cycles.
JBRA
Assist Reprod. 25(3): 422-427. doi: 10.5935/1518-0557.20210003.
Dietrich C.F., Bolondi L., Duck F., Evans D.H., Ewertsen C., Fraser A.G., et al. (2022)
History of Ultrasound in Medicine from its birth to date (2022), on occasion of the 50 Years
Anniversary of EFSUMB. A publication of the European Federation of Societies for
Ultrasound In Medicine and Biology (ERSUMB), designed to record the historical
development of medical ultrasound. Med Ultrason. 24(4): 434-450. doi: 10.11152/mu-3757.
Fine G.C., Smith T.A., Stein S.I., Madoff D.C. (2019) Interventional radiology’s role in the
diagnosis and management of patients with gallbladder carcinoma. Chin Clin Oncol. 8(4): 40.
doi: 10.21037/cco.2019.07.09.
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
111
Francone M., Budde R.P.J., Bremerich J., Dacher J.N., Loewe C., Wolf F., Natale L., Pontone
G., Redheuil A., Vliegenthart R., Nikolaou K., Gutberlet M., Salgado R. (2020) CT and MR
imaging prior to transcatheter aortic valve implantation: standardization of scanning
protocols, measurements and reporting-a consensus document by the European Society of
Cardiovascular Radiology (ESCR). Eur Radiol. 30(5): 2627-2650. doi: 10.1007/s00330-019-
06357-8.
Grani G., Sponziello M., Pecce V., Ramundo V., Durante C. (2020) Contemprorary Thyroid
Nodule Evaluation and Management.
J Clin Endocrinol Metab.
105(9): 2869-83. doi:
10.1210/clinem/dgaa322.
Hajdu S.I., Vadmal M., Tang P. (2015) A note from history: Landmarks in history of cancer,
part 7.
Cancer.
121(15): 2480-513. doi: 10.1002/cncr.29365.
Hajhosseiny R., Bustin A., Munoz C., Rashid I., Cruz G., Manning W.J., Prieto C., Botnar
R.M. (2020) Coronary Magnetic Resonance Angiography: Technical Innovation Leading Us
to the Promised Land?
JACC Cardiovasc Imaging.
13(12): 2653-2672. doi:
10.1016/j.jcmg.2020.01.006.
Hanson K., Schneider U. (2022) History of proton radiography and tomography. Z. Med Phys.
32(1): 2-4. doi: 10.1016/j.zemedi.2021.11.005.
Hayashi D., Roemer F.W., Guermazi A. (2016) Imaging for osteoarthtitis. Ann Phys Rehabil
Med.
59(3): 161-169. doi: 10.1016/j.rehab.2015.12.003.
Ju C., Li X., Gadani S., Kapoor B., Partovi S. (2022) Portal Vein Thrombosis: Diagnosis and
Endovascular Management.
Rofo.
194(2): 169-180. doi: 10.1055/a-1642-0990.
Kaller M.O., An J. (2023) Contrast Agent Toxicity. 2023 May 1. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing;
https://www.ncbi.nlm.nih.gov/books/NBK537159/ [Access date: 21.06.2023].
Klarov L.A., Platonov F.A. (2017) Computer tomography (CТ) or magnetic resonance
imaging (МRI)?
Science and Engineering in Yakutia.
1(32): 28-31.
Kocher M., Ruge M.I., Galldiks N., Lohmann P. (2020) Applications of radiomics and
machine learning for radiotherapy of malignant brain tumors.
Strahlenther Onkol.
196(10):
856-867. doi: 10.1007/s00066-020-01626-8.
Kratochwil C., Flechsig P., Lindner T., Abderrahim L., Altmann A., Mier W., et al. (2019)
68
Ga-FAPIPET/CT: Tracer Uptake in 28 Different Kinds of Cancer.
J Nucl Med. 6
0(6): 801-805.
doi: 10.2967/jnumed.119.227967.
Lanza G.M., Cui G., Schmieder A.H., Zhang H., Allen J.S., Scott M.J., et al. (2019) An unmet
clinical need: The history of thrombus imaging.
J Nucl Cardiol.
26(3): 986-997. doi:
10.1007/s12350-017-0942-8.
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
112
Lauterbur P.C. (1973) Image Formation by Induced Local Interactions: Examples of
Employing Nuclear Magnetic Resonanse.
Nature.
242: 190-191. doi: 10.1038/242190a0.
Lees C.C., Romero R., Stampalija T., Dall'Asta A., DeVore G.A., Prefumo F., et al. (2022)
Clinical Opinion: The diagnosis and management of suspected fetal growth restriction: an
evidence-based approach. Am J Obstet Gynecol. 226(3): 366-378. doi:
10.1016/j.ajog.2021.11.1357.
Lima T.F., Gamba T.O., Zaia A.A., Soares A. (2016) Evaluation of cone beam computed
tomography and periapical radiography in the diagnosis of root resorption. J. Aust Dent J.
61(4): 425-431. doi: 10.1111/adj.12407.
Mangla A., Oliveros E. , Williams K.A. , Kalra D.K. (2017) Cardiac imaging in the diagnosis
of coronary artery disease. Curr Probl Cardiol, 42 , pp. 316-366.
https://doi.org/10.1016/j.cpcardiol.2017.04.005.
Marques J.P., Simonis F.F.J., Webb A.G. (2019) Low-field MRI: An MR physics perspective.
J Magn Reson Imaging. 49(6): 1528-1542. doi: 10.1002/jmri.26637.
Martire F.G., Lazzeri L., Conway F., Siciliano T., Pietropolli A., Piccione E., et al. (2020)
Adolescence and endometriosis: symptoms, ultrasound signs and early diagnosis. Fertil Steril.
114(5): 1049-1057. doi: 10.1016/j.fertnstert.2020.06.012.
Nicolau C., Antunes N., Paño B., Sebastia C. (2021) Imaging Characterization of Renal
Masses.
Medicina (Kaunas)
. 57(1): 51. doi: 10.3390/medicina57010051.
Oskovi Kaplan Z.A., Ozgu-Erdinc A.S. (2018) Prediction of Preterm Birth: Maternal
Characteristics, Ultrasound Markers, and Biomarkers: An Updated Overiew.
J Pregnancy
.
2018: 8367571. doi: 10.1155/2018/8367571.
Pastore M.C., Mandoli G.E., Contorni F., Cavigli L., Focardi M., D'Ascenzi F., et al. (2021)
Speckle Tracking Echocardiography: Early Predictor of Diagnosis and Prognosis
inCoronaryArtery Disease.
Biomed Res Int.
2021: 6685378. doi: 10.1155/2021/6685378.
Pedreira O., Correia M., Chatelin S., Villemain O., Goudot G., Thiebaut S., et al. (2022)
Smart Ultrasound Device for Non-Invasive Real-Time Myocardial Stiffness Quantification
of the Human Heart. IEEE Trans Biomed Eng. 69(1): 42-52. doi: 10.1109/TBME.2021.3087039.
Pu Y., Wang C., Zhao S., Xie R., Zhao L., Li K., Yang C., et al. (2021) The
clinical application of
18
F-FDG PET/CT in pancreatic cancer: a narrative review. Transl Cancer
Res. 10(7): 3560-3575. doi: 10.21037/tcr-21-169.
Radzina M., Biederer J. (2019) Ultrasonography of the Lung.
Rofo.
191(10): 909-923. doi:
10.1055/a-0881-3179.
Riddell Z.C., Corallo C,. Albazaz R., Foley K.G. (2023) Gallbladder polyps and
adenomyomatosis. Br J Radiol. 96(1142): 20220115. doi: 10.1259/bjr.20220115.
REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 15, N° 43, 2024
D. A. Bogomolov et al//Benefits of Modern Imaging Techniques in Medicine, 96-113
DOI: https://doi.org/10.46925//rdluz.43.07
113
Rischpler C., Nekolla S.G., Heusch G., Umutlu L., Rassaf T., Heusch P., et al. (2019)
Cardiac PET/MRI-an update.
Eur J Hybrid Imaging.
3(1): 2. doi: 10.1186/s41824-018-0050-2.
Salerno A., Strambo D., Nannoni S., Dunet V., Michel P. (2022) Patterns of ischemic
posterior circulation strokes: A clinical, anatomical, and radiological review.
Int J Stroke
.
17(7): 714-722. doi: 10.1177/17474930211046758.
Salzman B., Collins E., Hersh L. (2019) Common Breast Problems.
Am Fam Physician
. 99(8):
505-514.
Scatliff J.H., Morris P.J. (2014) From Roentgen to magnetic resonanceimaging: the history of
medical imaging. N C Med J. 75(2): 111-113. doi: 10.18043/ncm.75.2.111.
Schima W., Böhm G., Rösch C.S., Klaus A., Függer R., Kopf H. (2020) Mass-forming
pancreatitis versus pancreatic ductal adenocarcinoma: CT and MR imaging for
differentiation. Cancer Imaging. 20(1): 52. doi: 10.1186/s40644-020-00324-z.
Tay Y.X., McNulty J.P. (2023) Radiography education in 2022 and beyond – Writing the
history of the present: A narrative review.
Radiography
(Lond). 29(2): 391-397. doi:
10.1016/j.radi.2023.01.014.
Toussie D., Voutsinas N., Chung M., Bernheim A. (2022) Imaging of COVID-19. Semin
Roentgenol.
57(1): 40-52. doi: 10.1053/j.ro.2021.10.002.
Yang T., Ma L., Hou H., Gao F., Tao W. (2022) FAPI PET/CT in the Diagnosis of Abdominal
and Pelvic Tumors. Front Oncol. 11: 797960. doi: 10.3389/fonc.2021.797960.
