Gold standards of CT-diagnostics of cancer
Background. Methods of diagnostics and staging of the disease in oncology can be divided into physical, laboratory, endoscopic, cytohistological, molecular, and radiation methods. Radiation diagnostics allows to establish the localization of the pathological process and to stage it. Medical imaging methods include ultrasound diagnostics, X-ray diagnostics, computed tomography (CT), magnetic resonance imaging, scintigraphy, single-photon positron emission CT, positron emission tomography. The choice of the imaging method depends on the specific clinical situation.
Objective. To describe the standards of CT diagnostics of cancer.
Materials and methods. Analysis of recommendations and literature sources on this topic.
Results and discussion. The advantage of multislice CT (MCT) is the possibility of one-step study of several anatomical areas. Thus, the study of the thoracic cavity includes the assessment of pathological conditions of the lungs, mediastinum, chest, visible neck, bones, as well as the assessment of the vascular bed (if contrast is used). Examination of the abdominal cavity allows to detect pathology of the digestive system, pelvis, retroperitoneal space, visible parts of the chest, bones and vascular bed (if contrast is used). Another advantage is the absence of “dumb” zones, as it is possible to estimate changes in different planes (coronary, sagittal, oblique) and in the three-dimensional image. When imaging tumors, contrast agents should always be used. Contrast testing is the gold standard of diagnosis worldwide because it improves organ and tissue differentiation. The main risk factors for post-contrast acute kidney damage are chronic kidney disease, kidney surgery, proteinuria, hypertension, diabetes, myeloma. In patients with risk factors, non-contrast MСT should be considered and, if this is not possible, the patient should be pre-hydrated (sodium bicarbonate solution or saline). The hydration protocol is selected individually based on a benefit/risk assessment. In order to prevent complications, it is advisable to use low- or isoosmolar contrast agents. After the contrast study, hydration should be continued according to the protocol and the glomerular filtration rate determined in 48 hours.
Conclusions. 1. Imaging studies in oncology are extremely informative. 2. The advantages of MСT include the option of one-time study of several anatomical areas and the absence of “dumb” areas. 3. When imaging tumors contrast agents should always be used. 4. Patients at risk of post-contrast acute renal injury may undergo the visualization in settings of pre- and post-contrast preparation/management.
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