Ультранизкодозная компьютерная томография в диагностике заболеваний околоносовых пазух у детей: обзор литературы

Background. Sinonasal diseases are widespread in childhood. Radiological studies, including computer tomography, are an optimal and effective method of diagnosis. The child's body is more sensitive to radiation exposure than adults. The threshold of exposure, which may induce internal organs injury in children, requires a precise selection of the radiological method with minimal radiation dose. There is currently no unified position in the professional community on the appropriateness of the use of ultra-low-dose computed tomography in pediatrics.We reviewed the data on the appropriateness and effectiveness of paranasal low-dose computed tomography in pediatrics.Materials. 57 domestic and foreign publications, for the period from January 2001 to November 2019. In order to achieve the objective, we analyzed relevant domestic and foreign publications in scientific libraries e-LIBRARY, PubMed, Google Scholar per the keywords: “low-dose CT”, “children”, “paranasal sinus”, “pediatric”, “diagnosis”, “children”, “low-dose computed tomography”, “sinusitis”, “paranasal sinuses”.Results. The analysis of the available literature allowed summarizing the current data on pediatric paranasal disease diagnostics and the use of computed tomography, as well as to identify possible options for reducing radiation dose.Conclusions. Conducting many radiological examinations in a child leads to the risk of cancer. However, these examinations are an effective way to diagnose paranasal diseases, and a CT scan is the “gold standard”. The actual task is to develop a CT technique with reduced radiation exposure without compromising image quality. The need to review and optimize the standard protocols of radiological studies to determine the efficacy and feasibility of studies with minimal radiation exposure to children is justified.Актуальность. Заболевания придаточных пазух носа широко распространены в детском возрасте. Рентгенологические исследования, и в том числе рентгеновская компьютерная томография (КТ), являются оптимальным и эффективным методом диагностики. Организм ребенка более чувствителен к радиационной нагрузке, чем взрослых. Порог облучения, который может индуцировать поражение внутренних органов у детей, требует четкого выбора методики рентгенологического исследования с минимальной радиационной нагрузкой. В профессиональном сообществе в настоящее время отсутствует единая позиция по вопросу целесообразности применения ультранизкодозной КТ в педиатрии.Цель исследования: систематизация данных о целесообразности и эффективности применения низкодозной КТ при диагностике заболеваний околоносовых пазух в педиатрии.Материал и методы. Для выполнения поставленной цели проведен анализ 57 релевантных отечественных и зарубежных публикаций за период с января 2001 г. по ноябрь 2019 г. в научных библиотеках eLIBRARY, PubMed, Scholar.google по ключевым словам: “lowdose CT”, “children”, “paranasalsinus”, “pediatric”, “диагностика”, “дети”, “низкодозная компьютерная томография”, “синусит”, “околоносовые пазухи”.Результаты. Изучение опубликованных в доступной литературе результатов исследований разных авторов позволило обобщить современные данные о лучевой диагностике заболеваний околоносовых пазух у детей и использовании КТ, а также определить возможные варианты снижения дозы лучевой нагрузки.Заключение. Проведение большого количества рентгенологических исследований у ребенка приводит к риску развития онкологических заболеваний. Вместе с тем именно рентгенологические исследования являются эффективным способом диагностики заболеваний околоносовых пазух, при этом КТ является “золотым стандартом” диагностических исследований. Актуальной задачей является разработка методики КТ со снижением радиационной нагрузки без потери качества изображения. В обзоре изученных научных работ обоснована необходимость пересмотра и оптимизации стандартных протоколов рентгенологических исследований околоносовых пазух для определения эффективности и целесообразности методик лучевых исследований с минимальным риском радиационной нагрузки на ребенка

Ability of Evaluation Coronary Calcium Index Based on Ultra-Low-Dose Computed Tomography Used in Moscow Lung Cancer Screening Project

Aim. Determination of the possibility of reliable quantitative assessment of the coronary calcium index based on ultra-low-dose computed tomography (ultra-LDCT) which used in Moscow Lung Cancer Screening project.Material and methods. The study included the results of 254 ultra-LDCT studies conducted as part of the Moscow lung cancer screening project. For compare the parameters of coronary calcium on different images used 16 pairs of ultra-LDCT images with a slice thickness of 1 mm and CT images with a slice thickness of 3 mm, performed without ECG synchronization, performed with an interval of less than 10 days, as well as 18 pairs of ultra-LDCT with a slice thickness of 1 mm and CT with ECG synchronization with a slice thickness of 3 mm, performed on the same day after execution. Analysis of DICOM 3.0 standard images was performed. Quantitative indicators of coronary calcium in patients from lung cancer screening were analyzed, a comparative analysis of the calcium index for Agatstone, Volume, Mass, and using the CAC-DRS scale (assessment of the degree of calcification by scores from 0 to 3 and the number of affected arteries from 0 to 4 points) was performed.Results. Evaluation ultra-LDCT with a slice thickness in 1 mm and with a CT scan with slice thickness in 3 mm with and without ECG-synchronization for the presence of coronary calcium, and subsequent rating according to the index Agatston, Volume, Mass, as the total coronary calcium and for each coronary artery (right, left, left descending, left circumflex) received the complete data correlation (Pearson's - 1), with full correlation (Spearman's >0.9), with good rank correlations (>0,9). Compare qualitative (CAC-DRS V) and quantitative (CAC-DRS A) estimates on ultra-LDCT with CT with ECG synchronization in the same patients show a complete correlation of data was obtained (Pearson's formula - 1), with a complete correlation (Spearman's formula - 1).Conclusion. Coronary calcium which detected in lung cancer screening subjects should be included in the overall decision-making process for further routing of patients (cardiologist, interventional surgeon, pulmonologist, therapist). Ultra-LDCT is a method that has high diagnostic accuracy in detecting and evaluating the prevalence of coronary calcium in comparison with standard CT with and without ECG synchronization, as demonstrated in our study. Evaluation of coronary calcium according to ultra-LDCT without ECG synchronization used in screening, preferably with a 1 mm slice thickness. Despite the fact that the gold standard is CT with ECG synchronization with a 3 mm slice thickness, the diagnostic significance of ultra-LDCT which used in lung cancer screening is high in relation to detecting coronary artery calcification