Estimation of renal function using kidney dynamic contrast material-enhanced CT perfusion: accuracy and feasibility

Jeong, Seokmin; Park, Sung Bin; Chang, In Ho; Shin, Jungho; Hoon, Byung; Park, Hyun Jeong; Lee, Eun Sun

doi:10.1007/s00261-020-02826-7

Cited by 9 publications

(5 citation statements)

References 25 publications

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“…CT-based protocols typically involve CT-urography exams using iopromide or iomeprol as the contrast agent, and may have advantages over other techniques. E.g., the ability to identify asymmetric renal disease ( Hackstein et al, 2001 ; Hackstein et al, 2004 ; Yuan et al, 2016 ; You et al, 2018 ; Jeong et al, 2021 ; Stehlé et al, 2023 ). The widely used creatinine-based method for estimating GFR, however, is known to be quite inaccurate.…”

Section: Discussionmentioning

confidence: 99%

Determination of glomerular filtration rate “en passant” after high doses of iohexol for computed tomography in intensive care medicine—a proof of concept

Dejaco,

Dorn,

Paal

et al. 2024

Front. Pharmacol.

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Accurate assessment of renal function is of great clinical and scientific importance, as it is an important pharmacokinetic covariate of pivotal drugs. The iohexol clearance is nearly identical to the glomerular filtration rate, but its determination usually requires an intravenous injection and therefore bears intrinsic risks. This motivates to showcase an “en passant” approach to quantification of renal function without additional risk or blood sampling beyond routine care using real-world data. We enrolled 37 intensive care patients who received high doses of iohexol for computed tomography imaging, and quantified series of iohexol plasma concentrations by high-performance liquid chromatography (HPLC-UV). Iohexol clearance was derived by both log-linear regression and nonlinear least squares fitting and compared to glomerular filtration rate estimated by the CKD-EPI-2021 formulas. Nonlinear fitting not only turned out to be more accurate but also more robust in handling the irregularly timed data points. Concordance of iohexol clearance against estimations based on both creatinine and cystatin C showed a slightly higher bias (−3.44 mL/min/1.73 m2) compared to estimations based on creatinine alone (−0.76 mL/min/1.73 m2), but considerably narrower limits of agreement (±42.8 vs. 56 mL/min/1.73 m2) and higher Lin’s correlation (0.84 vs. 0.72). In summary, we have demonstrated the feasibility and performance of the “en passant” variant of the iohexol method in intensive care medicine and described a working protocol for its application in clinical practice and pharmacologic studies.

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Section: Discussionmentioning

confidence: 99%

Determination of glomerular filtration rate “en passant” after high doses of iohexol for computed tomography in intensive care medicine—a proof of concept

Dejaco,

Dorn,

Paal

et al. 2024

Front. Pharmacol.

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“…Результаты исследования S. Jeong и соавт. доказывают соответствие значений СКФ, рассчитанной по данным ПКТ и определенной на основе креатинина сыворотки крови по формулам Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) и Modification of Diet in Renal Disease (MDRD) [59]. По данным разных авторов, проводивших исследования на животных моделях, была отмечена связь параметров перфузии с макроскопическими и гистологическими особенностями паренхимы почек при ишемизации, а также соответствие характеристик кровотока, выявленных при оценке распределения флуоресцентных микросфер, с перфузионными данными [51,55].…”

Section: клиническое применение при оценке функциональных изменений п...unclassified

Application of perfusion computed tomography in renal diseases (review of literature)

Kryaneva

Golbits

Рубцова

et al. 2023

Medicinskaâ vizualizaciâ

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Purpose. To analyze the literature data on the use of CT perfusion in kidney diseases and to assess the future prospects of using the technique in clinical practice.Materials and methods. In electronic databases (PubMed, E-library, Web of Science, Google Scholar), a search was conducted for published studies evaluating the possibilities of using CT perfusion in both neoplastic and non-neoplastic kidney diseases. The article analyzes the results of 40 most relevant works of Russian and foreign researchers devoted to this topic.Results. According to the analysis of the data obtained, perfusion CT is an effective diagnostic tool in oncology: the technique allows noninvasively assessing the nature of the tumour, including differentiating benign nodes (fat-poor angiomyolipoma and oncocytoma) from renal cell carcinoma; to establish the histological variant of renal cell carcinoma and Fuhrman grade, to characterize the effectiveness of ablative techniques and systemic treatment of renal cell carcinoma. Based on the correlation of CT kidney perfusion data and the results of various methods for determining organ function, the possibility of using perfusion CT as one of the prognostic factors for determining the tactics of treatment of patients with obstructive uropathies, aortomesenteric compression, and also shows the potential of using the technique in transplantology both in patients after surgery and during the examination of donors.Conclusions. Despite the fact that the role of CT kidney perfusion in various fields of urology and nephrology has been sufficiently studied, some important aspects of the likely application of this technique remain underestimated. Taking into account the high incidence rates and a significant percentage of localized forms of tumors, the study of the role of CT perfusion in planning and evaluating the results of nephron-sparing treatment of renal cell carcinoma may open up new prospects in optimizing surgical tactics.

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“…One encouraging alternative is to assess the renal function and anatomy simultaneously by CT perfusion. 3,4 The main advantage for CT perfusion is that the complex evaluation of the urinary system including renal function and upper urinary tract anatomy visualization may be performed simultaneously, while when there are two separate studies used for that purpose, the patient has to request for investigation into two different organizations, which may be geographically inconvenient for him and associated with prolonged diagnostic time. Besides, the abundance of the CT tomographs is still higher than that for gamma cameras used for scintigraphy, the upgrade of conventional CT looks as the next step of the technology development, which may allow to refuse the renal scintigraphy.…”

Section: Introductionmentioning

confidence: 99%

Kidney computed tomography perfusion in patients with ureteral obstruction

Belyaeva,

Rudenko,

Serova

et al. 2024

Urologia

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Introduction: Kidney perfusion on CT is an encouraging surrogate for renal scintigraphy in assessing renal function. However, data on dynamic volumetric CT in patients with kidney obstruction is lacking. Thus, the aim of this study is to determine the feasibility of CT-based renal perfusion using a dynamic volume to assess renal hemodynamics at different degrees and durations of obstruction. Materials and methods: We included patients with unilateral kidney obstruction in our single-center, prospective study. The patients were divided into three groups. Patients without dilatation of the pelvicalyceal system (PCS) and normal parenchyma thickness were included into Group 1; patients with PCS dilatation and parenchyma thickness 1.8–2.4 cm—into Group 2; and patients with ureteropyelocalicoectasia and parenchyma thickness less than 1.8 cm—into Group 3. Results: Total of 56 patients were enrolled. In Group 1 mean values of cortical and medullar arterial blood flow, blood volume, and extraction fraction were within the normal range. Changes in contralateral kidney were not determined. Patients from Group 2 showed significant differences in blood flow parameters in the cortical and medulla of the obstructed kidney. No changes in perfusion values in the contralateral kidney was observed. In patients from Group 3 there was a marked decrease in perfusion on the side of obstruction compared to Group 2, indicating that the degree of expansion of the PCS directly correlates with the change in blood flow. However, in the contralateral kidney, these indicators exceeded the normal values of perfusion. Conclusion: CT perfusion allows to objectively assess changes in blood flow in the setting of renal obstruction. The degree of obstruction directly affects the measured rate of blood flow.

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Estimation of renal function using kidney dynamic contrast material-enhanced CT perfusion: accuracy and feasibility

Cited by 9 publications

References 25 publications

Determination of glomerular filtration rate “en passant” after high doses of iohexol for computed tomography in intensive care medicine—a proof of concept

Determination of glomerular filtration rate “en passant” after high doses of iohexol for computed tomography in intensive care medicine—a proof of concept

Application of perfusion computed tomography in renal diseases (review of literature)

Kidney computed tomography perfusion in patients with ureteral obstruction

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