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Перфузионная компьютерная томография в диагностике заболеваний почек (обзор литературы)

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Цель исследования: провести анализ литературных данных по использованию КТ-перфузии при заболеваниях почек и оценить дальнейшие перспективы применения методики в клинической практике.Материал и методы. В электронных базах данных (PubMed, E-library, Web of Science, Google Scholar) был проведен поиск опубликованных исследований, оценивающих возможности применения КТ-перфузии при заболеваниях почек как неопластического, так и неопухолевого характера. В статье проанализированы результаты 40 наиболее релевантных работ российских и зарубежных исследователей, посвященных этой тематике.Результаты. Согласно анализу полученных данных, перфузионная КТ является эффективным диагностическим инструментом в онкологии: методика позволяет неинвазивно оценить характер новообразования, в том числе дифференцировать доброкачественные узлы (ангиомиолипому с низким содержанием жира и онкоцитому) от рака почки, установить гистологический вариант почечно-клеточного рака и степень злокачественности опухоли по Fuhrman, охарактеризовать эффективность аблативных методик и системного лечения рака почки. Базируясь на корреляции данных КТ-перфузии почек и результатов различных методов определения функции органа, доказана возможность применения перфузионной КТ в качестве одного из прогностических факторов для определения тактики лечения больных с обструктивными уропатиями, аортомезентериальной компрессией, а также показан потенциал использования методики в трансплантологии как у пациентов после проведенной операции, так и при обследовании доноров.Заключение. Несмотря на то что роль КТ-перфузии почек в различных областях урологии и нефрологии достаточно изучена, некоторые важные аспекты вероятного применения этой методики остаются недооцененными. С учетом высоких показателей заболеваемости и значимого процента локализованных форм опухолей изучение роли КТ-перфузии в планировании и оценке результатов органосохраняющего лечения рака почки может открыть новые перспективы в оптимизации хирургической тактики.

Ключевые слова:
перфузионная компьютерная томография, опухоль почки, резекция почки, сосудистые заболевания почек, обструктивная уропатия, количественная оценка функции почки, perfusion computed tomography, renal tumor, partial nephrectomy, vascular renal diseases, obstructive uropathy, estimated renal function

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Application of perfusion computed tomography in renal diseases (review of literature)

Purpose. To analyze the literature data on the use of CT perfusion in kidney diseases and to assess the future prospects of using the technique in clinical practice.Materials and methods. In electronic databases (PubMed, E-library, Web of Science, Google Scholar), a search was conducted for published studies evaluating the possibilities of using CT perfusion in both neoplastic and non-neoplastic kidney diseases. The article analyzes the results of 40 most relevant works of Russian and foreign researchers devoted to this topic.Results. According to the analysis of the data obtained, perfusion CT is an effective diagnostic tool in oncology: the technique allows noninvasively assessing the nature of the tumour, including differentiating benign nodes (fat-poor angiomyolipoma and oncocytoma) from renal cell carcinoma; to establish the histological variant of renal cell carcinoma and Fuhrman grade, to characterize the effectiveness of ablative techniques and systemic treatment of renal cell carcinoma. Based on the correlation of CT kidney perfusion data and the results of various methods for determining organ function, the possibility of using perfusion CT as one of the prognostic factors for determining the tactics of treatment of patients with obstructive uropathies, aortomesenteric compression, and also shows the potential of using the technique in transplantology both in patients after surgery and during the examination of donors.Conclusions. Despite the fact that the role of CT kidney perfusion in various fields of urology and nephrology has been sufficiently studied, some important aspects of the likely application of this technique remain underestimated. Taking into account the high incidence rates and a significant percentage of localized forms of tumors, the study of the role of CT perfusion in planning and evaluating the results of nephron-sparing treatment of renal cell carcinoma may open up new prospects in optimizing surgical tactics.

Keywords:
перфузионная компьютерная томография, опухоль почки, резекция почки, сосудистые заболевания почек, обструктивная уропатия, количественная оценка функции почки, perfusion computed tomography, renal tumor, partial nephrectomy, vascular renal diseases, obstructive uropathy, estimated renal function