MRI 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 violations
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.