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.

Introduction. Survival rates and treatment algorithms for patients with bladder cancer (BC) depend on the depth of tumor invasion, in particular on the presence of the bladder muscle layer invasion and extraorganic spread. To assess the depth of bladder invasion, the VI-RADS system was developed in 2018, which is based on multiparametric MRI (mpMRI). According to published studies on the VI-RADS effectiveness, there is a high diagnostic accuracy for identifying formations with probable invasion into the muscle layer. The data on BC extraorganic spread are limited and the issue of assessing the sensitivity and specificity of this system requires further study.Aim of the study. To evaluate the diagnostic performance of mpMRI using the VI-RADS system in detecting muscle invasion and BC extraorganic growth.Materials and methods. A prospective study was conducted in the clinics of the National Medical Research Radiological Centre and included 75 patients aged 19 to 85 years, of which 39 (52%) had been newly diagnosed with BC, 36 (48%) had a relapse or continuous tumor growth. All patients underwent pelvic organs mpMRI on a tomograph with a magnetic field induction of 1.5T, followed by transurethral resection (TUR), TUR-biopsy of the bladder or cystectomy no later than 6 weeks after scanning.. The description of the bladder tumor included its measurements, localization and VI-RADS scale assessment. The data obtained by mpMRI were compared with the results of the morphological study using statistical analysis.Results. According to the results of the study, the overall VI-RADS scale sensitivity for categories above 3 (the presence of muscle invasion is equivocal) was 95.15% [90.11%; 99.95%], above 4 (muscle invasion is likely) – 92.59% [82.11%; 97.94%], specificity was determined at the level of 47.62% [25.71%; 70.22%] and 80.95% [58.09%; 94.55%] respectively. When assessing extraorganic spread in 30 patients, the sensitivity was 83.33% [62.62%; 95.26%], specificity – 83.33% [35.88%; 99.58%]. The accuracy and positive predictive value also had high levels from 80 to 95%, in contrast to the negative predictive value (55.56%).Conclusion. The scale for BC invasion depth assessing VI-RADS is characterized by high rates of sensitivity, specificity and accuracy, in particular when used in determining extraorganic spread.

В последние десятилетия за счет достижений в области медицинской визуализации и улучшения алгоритмов диагностического поиска отмечается тенденция к увеличению частоты выявления опухолей почек небольших размеров, для которых возможно проведение органосохраняющего лечения. Для прогнозирования потенциальной сложности выполнения резекции и снижения степени субъективности при выборе объема и методики хирургического вмешательства разными группами исследователей было предложено значительное число концепций оценки новообразований почек. Нефрометрическая шкала R.E.N.A.L., разработанная одной из первых, но сохраняющая свою актуальность, позволяет, исходя из совокупности анатомических особенностей, структурированно и стандартизированно характеризовать опухоли почек. В статье представлена методика оценки каждого из параметров, входящих в состав представленной нефрометрической системы, а также приведен краткий обзор литературы ее прогностической значимости.