Клинико-экономическая целесообразность КТ-технологий скрининга коронарного кальция и его значение в составе комбинированных профилактических программ типа BIG-3

Введение. До 34% всех смертей, обусловленных атеросклеротической болезнью, приходятся на бессимптомных пациентов. Согласно прогнозным данным, к 2050 г. кардиоваскулярные заболевания, хроническая обструктивная болезнь легких и рак легкого сохранят лидирующие позиции в общей структуре причин смертности. Данные нозологии относятся к группе большой тройки (Big-3), накладывающей тяжелое социально-экономическое бремя на системы здравоохранения большинства стран. Компьютерная томография (КТ) позволяет диагностировать Big-3-патологии на латентных стадиях. Высказано предположение, что одномоментный скрининг нескольких заболеваний (Big-3-скрининг) в рамках одного сеанса КТ-сканирования органов грудной клетки способен повысить результативность обследования при минимальных дополнительных затратах. Предварительные оценки медицинских технологий подтверждают экономический потенциал Big-3-скрининга. Материалы и методы. В работе проанализированы технологические КТ-инновации в области оценки коронарного кальция, современные подходы на основе искусственного интеллекта (ИИ) к реализации комбинированных протоколов КТ-визуализации, а также вопросы клинико-экономической целесообразности внедрения данных программ. Результаты. Установлено, что прорывные технологические решения, такие как КТ с двойным источником излучения (DSCT) и фотонно-счетная томография (ФСТ), демонстрируют высокую воспроизводимость результатов скрининга коронарного кальциноза. Данные методы позволяют надежно оценивать выраженность коронарного кальциноза по протоколу низкодозной компьютерной томографии (НДКТ) без применения ЭКГ-синхронизации. Для медицинских центров, не оснащенных сканерами с высоким временным разрешением, альтернативой выступают алгоритмы ИИ. Они обеспечивают автоматическую градацию тяжести кальциноза коронарных артерий с параллельным контролем качества изображений, верификацией надежности полученного результата и определением показаний к выбору маршрутизации и проведению дополнительной стандартной визуализации. Заключение. Совершенствование режимов выполнения КТ-скрининга, а также критериев включения и исключения пациентов должно основываться на результатах клинических исследований и математического моделирования. Это позволит сбалансировать клинико-экономическую пользу и ятрогенные риски и обосновать целесообразность оценки коронарного кальция в программах типа BIG-3.

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