PET/CT diagnosis of acute and chronic pyelonephritis using 3D reconstructions of the renal parenchyma: clinical observations
CLINICAL CASE
Abstract
Despite advances in imaging techniques, accurate assessment of morphofunctional changes in the renal parenchyma during inflammatory diseases at the ultrastructural level remains a complex clinical challenge. This work demonstrates an innovative comprehensive approach to the diagnosis of acute and chronic pyelonephritis, based on the integration of data from positron emission tomography combined with computed tomography (PET/CT), transmission electron microscopy (TEM), and three-dimensional modeling technologies. The study presents two clinical cases illustrating the relationship between the metabolic activity indices of the renal parenchyma obtained from whole-body positron emission tomography combined with computed tomography with11C-choline and the results of morphological and ultrastructural analysis. The standardized uptake value of 11C-choline in the renal parenchyma proved to be a sensitive indicator of inflammation activity: in acute destructive pyelonephritis, pronounced hypermetabolism in the renal parenchyma is observed (SUVmax 17.76), while in chronic pyelonephritis, hypometabolism was detected (SUVmax 8.5). The study demonstrates the application of proprietary software that enabled the creation of 3D reconstructions of the anatomical state of the renal parenchyma and 3D ultrastructural block models of the main nephron elements based on transmission electron microscopy images at ×10,000 magnification. A correlation was established between the digital positron emission tomography combined with computed tomography parameters and the ultrastructural manifestations of acute and chronic inflammation in the renal parenchyma. The obtained results suggest that positron emission tomography combined with computed tomography with11C-choline may serve as an additional non-invasive tool in the diagnosis and activity assessment of the clinical manifestations of acute and chronic pyelonephritis. The proposed multimodal approach opens new possibilities for the development of objective diagnostic algorithms and personalized patient management in modern nephrourology.
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