medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-902medvis-902Research ArticleСЕРДЦЕ И СОСУДЫHEART AND VESSELSМРТ и КТ-венография в диагностике гемодинамических нарушений у пациентов с хроническими заболеваниями вен нижних конечностей. Часть III. Возможности КТ-исследований в диагностике нарушений венозной гемодинамикиMRI and CT-venography in the diagnosis of hemodynamic disturbances in patients with chronic lower extremities venous disorders. Part III. Possibilities of CT-investigation in diagnosing of venous hemodynamics violationshttps://orcid.org/0000-0002-7260-4968ШайдаковЕ. В.ShajdakovE. V.

Шайдаков Евгений Владимирович – доктор медицинских наук, профессор ИМЧ РАН, президент Санкт-Петербургской ассоциации флебологов (SPSP).

197376 Санкт-Петербург, ул. Академика Павлова, д. 9.

Evgenij V. Shajdakov – Doct. of Sci. (Med.), Professor, Bekhterev Institute of human brain of the Russian Academy of Sciences (RAS); President of the Saint Petersburg Association of Phlebologists (SPSP).

9, Acad. Pavlov str., St. Petersburg 197376.

evgenyshaydakov@gmail.comhttps://orcid.org/0000-0003-1792-2434СанниковА. Б.SannikovA. B.

Санников Александр Борисович – кандидат медицинских наук, заместитель главного врача, сосудистый хирург Клиники инновационной диагностики “Медика”; доцент кафедры дополнительного профессионального образования специалистов здравоохранения РНИМУ имени Н.И. Пирогова Минздрава России.

600031 Владимир, ул. Вокзальная, д. 24; 117997 Москва, ул. Островитянова, д. 1.

Тел.: 8-999-776-47-73

Aleksandr B. Sannikov – Cand. of Sci. (Med.), assistant of chief physician, vascular surgeon of the Clinic of Innovative Diagnostics “Medika”; assistant of professor of the Department of additional professional education of health professionals of the Pirogov Russian National Research Medical University of the Ministry of Health of Russia.

24, Vokzal'naya str., Vladimir 1600031; 1, Ostrivityanova str., Moscow 117997.

Phone: +7-999-776-47-73

aliplast@mail.ruhttps://orcid.org/0000-0003-0909-1693ЕмельяненкоВ. М.EmelyanenkoV. M.

Емельяненко Владимир Михайлович – доктор медицинских наук, профессор, заведующий кафедрой дополнительного профессионального образования специалистов здравоохранения.

117997 Москва, ул. Островитянова, д. 1.

Vladimir M. Emelyanenko – Doct. of Sci. (Med.), Professor, chief of the department of additional professional education of health professionals of the Pirogov Russian National Research Medical University of the Ministry of Health of Russia.

1, Ostrivityanova str., Moscow 117997.

vla05@yandex.ruhttps://orcid.org/0000-0002-7674-8221РачковМ. A.RachkovM. A.

Рачков Mихаил Aлександрович – врач-рентгенолог кабинета КТ.

600031 Владимир, ул. Вокзальная, д. 24.

Mihail A. Rachkov – radiologist of the СТ office of the Clinic of Innovative Diagnostics “Medika”.

24, Vokzal'naya str., Vladimir 1600031.

rachkoff@gmail.comhttps://orcid.org/0000-0001-5128-5075КрюковаЛ. Н.KryukovaL. N.

Крюкова Людмила Николаевна – врач-рентгенолог кабинета МРТ.

600031 Владимир, ул. Вокзальная, д. 24.

Lyudmila N. Kryukova – radiologist of the MRI office of the Clinic of Innovative Diagnostics “Medika”.

24, Vokzal'naya str., Vladimir 1600031.

masha1ivanova@yandex.ruhttps://orcid.org/0000-0002-2448-4885БарановаА. Е.BaranovaA. E.

Баранова Анна Евгеньевна – врач-рентгенолог кабинета МРТ.

600031 Владимир, ул. Вокзальная, д. 24.

Anna E. Baranova – radiologist of the MRI office of the Clinic of Innovative Diagnostics “Medika”.

24, Vokzal'naya str., Vladimir 1600031.

annashik.baranova@mail.ruИнститут мозга человека имени Н.П. Бехтеревой РАНРоссияBekhterev Institute of human brain of the Russian Academy of Sciences (RAS)Russian FederationКлиника инновационной диагностики “Медика”; РНИМУ имени Н.И. Пирогова Минздрава РоссииРоссияInnovative Diagnostic Clinic “MEDICA”; Pirogov Russian National Research Medical University of the Ministry of Health of RussiaRussian FederationРНИМУ имени Н.И. Пирогова Минздрава РоссииРоссияPirogov Russian National Research Medical University of the Ministry of Health of RussiaRussian FederationКлиника инновационной диагностики “Медика”РоссияInnovative Diagnostic Clinic “MEDICA”Russian Federation2021120520212545374Copyright © Шайдаков Е.В., Санников А.Б., Емельяненко В.М., Рачков М.A., Крюкова Л.Н., Баранова А.Е., 20222022Шайдаков Е.В., Санников А.Б., Емельяненко В.М., Рачков М.A., Крюкова Л.Н., Баранова А.Е.Shajdakov E.V., Sannikov A.B., Emelyanenko V.M., Rachkov M.A., Kryukova L.N., Baranova A.E.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.vidar.ru/jour/article/view/902

В результате решения большого количества технических задач (увеличение зоны анатомического покрытия, скорости сканирования и отношения сигнал/шум, улучшение пространственного и контрастного разрешения, построение цветового качественного изображения в 3D-режиме, значительное снижение дозы облучения) метод компьютерно-томографической визуализации сосудистой системы завоевал на сегодня в мире лидирующую позицию. Однако если в диагностике артериальной патологии КТ-ангиография используется повсеместно и ежедневно, то у пациентов с хроническими заболеваниями вен данный метод до сих пор не получил клинического признания.

В данном обзоре литературы проводится анализ опубликованных в мире научных данных о результатах использования КТ-венографии. Описаны методики проведения непрямой и прямой контрастной КТ-венографии. Показаны возможности использования контрастной КТ-венографии в диагностике тромбоза глубоких вен, где точность, чувствительность и специфичность метода, по данным зарубежных авторов, составляют до 97,9, 96,8 и 100% соответственно. Особое значение данный метод приобретает в диагностике тромбоза вен таза и нижней полой вены, где информативность УЗДС оказывается ниже. Вторым клиническим направлением, имеющим активное развитие сегодня, является комбинированное использование КТ-венографии и КТ-ангиопульмонографии в диагностике смертельно опасного осложнения тромбоэмболии легочной артерии. Перспективность этих попыток продиктована следующими преимуществами: однократностью исследования и отсутствием необходимости использования дополнительного введения контрастного препарата, скоростью выполнения сканирования, получением дополнительной информации о состоянии периферической венозной системы при наличии у пациентов венозной тромбоэмболии.

Еще одним и незаменимым инструментом контрастно-усиленная КТ-венография может стать в изучении особенностей топографоанатомического строения венозного русла. На примере собственных исследований авторы демонстрируют возможности прямой КТ-венографии в визуализации венозной системы нижних конечностей.

Необходимость более точной топической диагностики с 3D-визуализацией венозной системы нижних конечностей и таза посредством КТ-венографии обусловлена нарастающим интересом в последние годы сосудистых и интервенционных хирургов к апробации и более активному внедрению во флебологическую практику эндовазальных методов коррекции венозного кровотока.

As a result of solving a large number of technical problems (increasing the area of anatomical coverage and scanning speed, increasing the signal-to-noise ratio, improving spatial and contrast resolution, building a color image quality in 3D mode, significantly reducing the radiation dose), the method of computed tomography imaging of the vascular system has won a leading position in the world today. However, if CT Angiography is used everywhere and daily in the diagnosis of arterial pathology, this method has not yet received clinical recognition in patients with chronic venous diseases.

This review of the literature analyzes the scientific data published in the world on the results of CT Venography. Methods of indirect and direct contrast CT Venography are described. The possibility of using contrast CT Venography in the diagnosis of deep vein thrombosis is shown, where the accuracy, sensitivity and specificity of the method according to foreign authors is up to 97.9%, 96.8% and 100%, respectively. This method acquires particular importance in the diagnosis of pelvic vein thrombosis and inferior Vena cava, where the informative value of USDS is lower. The second clinical direction that is actively developing today is the combined use of CT Venography and CT Angiopulmonography in the diagnosis of a deadly complication of pulmonary embolism. The prospects of these attempts are preferable by the following advantages: the single-time study and the absence of the need for additional administration of contrast agents, the speed of scanning, and obtaining additional information about the state of the peripheral venous system in patients with venous thromboembolism.

Another and irreplaceable tool of contrast-enhanced CT Venography can become in the study of the features of the topographic and anatomical structure of the venous bed. Using their own research, the authors demonstrate the possibilities of direct CT Venography in the visualization of the venous system of the lower extremities.

The need for more accurate topical diagnostics with 3D visualization of the venous system of the lower extremities and pelvis by CT-Venography is due to the growing interest in recent years of vascular and interventional surgeons to test and more actively implement endovasal methods of correction of venous blood flow in phlebological practice.

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