Perfusion computer tomography of the kidneys. Research technique. Perfusion indicators in the norm: case-control

Abstract

INTRODUCTION: Perfusion computed tomography (PCT) is a contrast research technique that allows one to assess blood flow in the cortical and medulla layers of the renal parenchyma at the level of the microcirculatory bed, the influence of additional renal vessels and stenoses of the renal arteries on hemodynamics in the renal parenchyma.OBJECTIVE: To optimize the technique of perfusion computed tomography of the kidneys. Determine the most informative indicators of perfusion in the renal parenchyma in the norm. Assess the relationship between perfusion parameters and the number of renal vessels, the presence of renal artery stenosis.MATERIALS AND METHODS: PCT was performed in 46 patients with no anamnestic and clinical laboratory data on kidney disease who were undergoing examination for other pathological conditions, including 35 patients aged from 20 to 90 years (average age — 63.1 years) without hemodynamically significant stenosis and 11 patients aged from 64 to 94 years (mean age 80.3 years) with renal artery stenosis of 50% or higher. Perfusion indices were calculated using maximum slope and deconvolution algorithms, kinetic curves were plotted on a time-density graph, and color parametric maps.RESULTS: A quantitative assessment of perfusion parameters in the cortical and medulla of the kidneys, a qualitative analysis of the state of its parenchyma on color parametric maps, and the shapes of kinetic curves on the time-density graph were analyzed. Changes in perfusion parameters were established depending on the age, number and condition of the renal vessels.DISCUSSION: In the renal cortical layer, there was a predominance of indicators of blood flow velocity (BF), blood flow volume (BV), the rate of increase in the density of the contrast agent (CM) in the tissue (MSI), capillary wall permeability (PS) and lower values of the average transit time of the contrast agent (MTT) and the time to reach the maximum contrast agent density in the tissue (TTP) in comparison with the medulla. On the color parametric maps BF, BV, MSI, the cortical layer was characterized by intense red coloring, the medulla — yellow-green, on the TTP map green and blue coloring of the layers was determined, respectively. In elderly patients, there was a decrease in BF, BV with a concomitant lengthening of TTP in the cortical layer without changes in coloring on color parametric maps. On the density-time graph, the kinetic curve of the cortical layer was characterized by the appearance of a peak 10 seconds after the onset of the peak value in the abdominal aorta with further continuation of the curve in the form of a plateau; the kinetic curve of the medulla was characterized by a gradual moderate rise in the curve from 15 seconds after the start of scanning without the formation of peaks values.CONCLUSION: PCT is an informative method for quantitative and qualitative assessment of perfusion in the renal parenchyma.