medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-1529medvis-1529Research ArticleБРЮШНАЯ ПОЛОСТЬ И ЗАБРЮШИННОЕ ПРОСТРАНСТВОABDOMEN AND RETROPERITONEALАнгиомиолипомы почек. Возможности применения КТ-перфузии в оценке лечебного эффекта эмболизации ангиомиолипом почек. Обзор литературы и клинические наблюденияRenal angiomyolipomas. Possibilities of CT perfusion implementation for assessment of therapeutic effect of renal angiomyolipomas embolization. A review of literature and clinical observationshttps://orcid.org/0009-0001-5980-8704ЛуневаТ. Ю.LunevaT. Yu.

Лунева Татьяна Юрьевна – врач-рентгенолог кабинета компьютерной томографии отделения рентгеновской диагностики КДЦ “Здоровье”, Ростов-на-Донуhttps://orcid.org/0009-0001-5980-8704

Tatiana Yu. Luneva – Radiologist of the Computed Tomography Cabinet of the X-ray Diagnostics Department, Clinical and diagnostic center “Health”, Rostov-on-Donhttps://orcid.org/0009-0001-5980-8704

Luta-06@mail.ruhttps://orcid.org/0000-0002-0788-1256ЛужанскийД. С.LuzhanskiyD. S.

Лужанский Даниил Сергеевич – врач по рентгенэндоваскулярным методам диагностики и лечения КДЦ “Здоровье”, Ростов-на-Донуhttps://orcid.org/0000-0002-0788-1256

Daniil S. Luzhanskiy – doctor of X-ray endovascular diagnostic and treatment methods, Clinical and diagnostic center “Health”, Rostov-on-Donhttps://orcid.org/0000-0002-0788-1256

dr.luzhanskiy@gmail.comhttps://orcid.org/0009-0003-6766-6253ВолконскаяН. Б.VolkonskayaN. B.

Волконская Наталья Бориславовна – заведующая отделением рентгеновской диагностики КДЦ “Здоровье”, Ростов-на-Донуhttps://orcid.org/0009-0003-6766-6253

Natalya B. Volkonskaya – Head of the X-ray Diagnostics Department, Clinical and diagnostic center “Health”, Rostov-on-Donhttps://orcid.org/0009-0003-6766-6253

volkonskaya@center-zdorovie.ruhttps://orcid.org/0000-0001-6468-5983ПакусС. М.PakusS. M.

Пакус Сергей Михайлович – канд. мед. наук, заведующий отделением онкоурологии КДЦ “Здоровье”, Ростов-на-Донуhttps://orcid.org/0000-0001-6468-5983

Sergey M. Pakus – Cand. of Sci. (Med.), Head of urologic oncology department, Clinical and diagnostic center “Health”, Rostov-on-Donhttps://orcid.org/0000-0001-6468-5983

sergejj.pakus@rambler.ruhttps://orcid.org/0000-0002-2798-368XАбоянИ. А.AboyanI. A.

Абоян Игорь Артемович – доктор мед. наук, профессор, главный врач КДЦ “Здоровье”, Ростов-на-Донуhttps://orcid.org/0000-0002-2798-368X

Igor A. Aboyan – Doct. of Sci. (Med.), Professor, Chief Physician, Clinical and diagnostic center “Health”, Rostov-on-Donhttps://orcid.org/0000-0002-2798-368X

kdc@center-zdorovie.ruhttps://orcid.org/0000-0002-3771-1354КапустинВ. В.KapustinV. V.

Капустин Владимир Викторович – доктор мед. наук, профессор кафедры лучевой диагностики с курсом радиологии Медико-биологического университета инноваций и непрерывного образования ФГБУ “Государственный научный центр Российской Федерации – Федеральный медико-биофизический центр им. А.И. Бурназяна”, Москваhttps://orcid.org/0000-0002-3771-1354

Vladimir V. Kapustin – Doct. of Sci. (Med.), Assistant Professor, Professor of diagnostic radiology and roentgenology at the Medical and Bilogical Innovations and Continuous Education University under the Federal State Budget-funded Institution State Scientific Center of Russian Federation – A. I. Burnazyan Federal Medical and Biophysical Center of the RFMBA, Moscowhttps://orcid.org/0000-0002-3771-1354

wwkapustin@yandex.ruГБУ Ростовской области “Клинико-диагностический центр «Здоровье» в г. Ростов-на-Дону”РоссияClinical and diagnostic center “Health” in Rostov-on-DonRussian FederationФГБУ “Государственный научный центр Российской Федерации – Федеральный медико-биофизический центр им. А.И. Бурназяна” Федерального медико-биологического агентстваРоссияState Scientific Center of the Russian Federation – Federal Medical Biophysical Center named after A.I. Burnazyan of the FMBA of RussiaRussian Federation2025180920252933650Copyright © Лунева Т.Ю., Лужанский Д.С., Волконская Н.Б., Пакус С.М., Абоян И.А., Капустин В.В., 20252025Лунева Т.Ю., Лужанский Д.С., Волконская Н.Б., Пакус С.М., Абоян И.А., Капустин В.В.Luneva T.Y., Luzhanskiy D.S., Volkonskaya N.B., Pakus S.M., Aboyan I.A., Kapustin V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/1529Цель исследования

Цель исследования: провести анализ данных отечественной и зарубежной литературы по применению компьютерно-томографической перфузии (КТП) в диагностике заболеваний почек, в том числе у пациентов с доброкачественными и злокачественными новообразованиями почки; оценить перспективы применения данной методики для определения эффективности различных малоинвазивных вмешательств (криотерапия, различные виды термоабляции, артериальная эмболизация) лечения пациентов с опухолями почек, а также для динамического наблюдения за пациентами этих групп.

Материал и методы

Материал и методы. Проведен поиск научных работ, опубликованных в электронных базах данных PubMed, Google Scholar, E-library, с использованием ключевых слов “angiomyolipoma”, “kidney”, “transarterial embolization of tumors”, “CT-perfusion of the kidneys”. В статье рассмотрены материалы 40 источников литературы за последние 10 лет, из них 25 статей за последние 5 лет, посвященных указанной тематике. Представлены собственные клинические наблюдения, демонстрирующие возможность применения КТП в оценке лечебного эффекта эмболизации ангиомиолипомы почки (пАМЛ).

Результаты

Результаты. Проведенный обзор литературы показал, что КТП почек является неинвазивной методикой, позволяющей провести дифференциальную диагностику между доброкачественными опухолями (пАМЛ с низким содержанием жира и онкоцитомой), а также со злокачественными образованиями почек, выявить особенности различных гистологических вариантов почечно-клеточного рака (ПКР). Кроме того, имеются работы, посвященные применению КТП в оценке эффективности таких малоинвазивных методик, как криоабляция, трансартериальная эмболизация (ТАЭ) (при лечении ПКР и пАМЛ соответственно), а также таргетной терапии ПКР. По предварительным результатам наших клинических наблюдений, основные показатели КТП позволили детализировать структуру пАМЛ (до и после ТАЭ), особенности кровотока ее микроциркуляторного русла и выявить рецидив на основании прогрессирующего роста значений перфузии при одновременном уменьшении объема опухоли, что демонстрирует возможности использования КТП в качестве дополнительного мониторинга после оперативного лечения.

Заключение

Заключение. Несмотря на наличие работ, посвященных анализу применения КТП в качестве методики оценки ангиогенеза опухолей почек, остается много пробелов по использованию ее как клинического потенциала в оценке раннего и последующего лечебного мониторинга при хирургическом лечении опухолей почек. На сегодняшний день не существует единого и тщательно валидированного метода визуализации эмболизированных опухолей. Отсутствуют работы по изучению возможностей КТП в оценке лечебного эффекта эмболизации пАМЛ. Результаты собственных клинических наблюдений позволяют предположить, что КТП может быть использована в качестве дополнительной методики мониторинга пАМЛ после оперативного лечения в виде ТАЭ и выявления рецидивов заболевания за счет оценки опухолевого неоангиогенеза.

Purpose of the study

Purpose of the study: to analyze the data of domestic and foreign literature on the use of computed tomographic perfusion (CTP) in the diagnosis of kidney diseases, including patients with benign and malignant kidney tumors. To evaluate the prospects of using this technique to determine the effectiveness of various minimally invasive interventions (cryotherapy, various types of thermoablation, arterial embolization) for the treatment of patients with renal tumors, as well as for follow-up of patients in these groups.

Material and methods

Material and methods. A search of scientific papers published in the electronic databases PubMed, Google Scholar, E-library using the key words “angiomyolipoma”, “kidney”, “transarterial embolization of tumors”, “CT-perfusion of the kidneys” was carried out. In the article the materials of 40 literature sources for the last 10 years, including 25 articles - for the last 5 years, devoted to the mentioned subject are considered. The authors present their own clinical cases demonstrating the CTP application usefulness to assess the therapeutic effect of renal angiomyolipomas (rAML) transarterial embolization (TAE).

Results

Results. The conducted literature review showed that renal CTP is a noninvasive technique that allows differential diagnostics between benign tumors (low-fat rAML and oncocytoma), as well as with malignant renal neoplasms, to reveal features of different histological variants of renal cell cancer. In addition, there are works devoted to the application of CTP in the evaluation of the efficacy of minimally invasive techniques such as cryoablation, TAE (in the treatment of renal cell cancer (RCC) and rAML, respectively), as well as target therapy for RCC. According to the preliminary results of our clinical cases, the main CTP parameters allowed to detail the structure of rAML (before and after TAE), blood flow features of its microcirculatory level and to detect recurrence on the basis of progressive growth of perfusion values with simultaneous reduction of tumor volume, which demonstrates the possibilities of using CTP as an additional monitoring technic after surgical treatment.

Conclusion

Conclusion. Despite the availability of papers analyzing the use of CTP as a technique to assess renal tumor angiogenesis, many gaps remain in its use as a clinical potential in the evaluation of early and subsequent follow-up in the cases of renal tumors surgical treatment. To date, there is no evident and thoroughly validated imaging method for embolized tumors. There are no works on studying the possibilities of CTP in assessing the therapeutic effect of rAML embolization. The results of our own clinical cases allowed us to suggest that CTP can be used as an additional technique for monitoring rAML after surgical treatment such as TAE and detecting disease recurrence by assessing tumor neoangiogenesis.

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The authors declare that there are no conflicts of interest present.