Estimation of renal perfusion based on measurement of rubidium-82 clearance by PET/CT scanning in healthy subjects

Langaa, Stine Sundgaard; Lauridsen, Thomas Guldager; Mose, Frank Holden; Fynbo, Claire Anne; Theil, Jørn; Bech, Jesper Nørgaard

doi:10.1186/s40658-021-00389-0

Cited by 12 publications

(36 citation statements)

References 29 publications

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“…To position the scanner over the required FOV, an initial scout image was performed followed by a low-dose CT scan for attenuation correction purposes only (25 mAs, 100 kV). Immediately hereafter, a 555 MBq 82 Rb bolus injection was administered and a dynamic list-mode PET scan acquired for 8 min [ 18 , 19 ]. On Day A, the cubital catheter was removed after completion of the scan.…”

Section: Methodsmentioning

confidence: 99%

“…Initial human and method feasibility studies using pharmacokinetic analysis to provide flow estimation, have shown the human kidneys to have a high perfusion rate and homogeneity, as well as a high 82 Rb first pass extraction, uptake and renal accumulation, and as such, they are highly suitable for RBF dynamic PET studies [ 16 – 19 ] .…”

Section: Introductionmentioning

confidence: 99%

“…In a previous proof-of-method study [ 19 ], we have demonstrated the feasibility of measuring 82 Rb clearance using the abdominal aorta (AA) as the image-derived input function (IDIF) to a 1-tissue compartment model (Fig. 1 ), and shown the method to have a low intra-assay coefficient of variation and excellent inter-observer reliability.…”

Section: Introductionmentioning

confidence: 99%

“…1 ), and shown the method to have a low intra-assay coefficient of variation and excellent inter-observer reliability. This study also suggested an uncertainty in the physiological interpretation of what 82 Rb PET/CT clearance measurements actually represent: RBF, as is the current interpretation, or is the method in fact providing an estimate of the effective renal plasma flow (ERPF) [ 19 ]? Regardless of this uncertainty, 82 Rb PET/CT does provide a measure of renal clearance and further studies of the method’s accuracy, precision and its ability to detect genuine renal flow changes are required before its possible clinical implementation.…”

Section: Introductionmentioning

confidence: 99%

“…K 1 is the uptake rate from blood into tissue; k 2 is the washout rate from tissue into blood. No discernible 82 Rb activity has been observed in the urine [ 18 , 19 ] …”

Section: Introductionmentioning

confidence: 99%

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Reliability of rubidium-82 PET/CT for renal perfusion determination in healthy subjects

Langaa

Mose

Fynbo³

et al. 2022

BMC Nephrol

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Background Changes in renal perfusion may play a pathophysiological role in hypertension and kidney disease, however to date, no method for renal blood flow (RBF) determination in humans has been implemented in clinical practice. In a previous study, we demonstrated that estimation of renal perfusion based on a single positron emission tomography/computed tomography (PET/CT) scan with Rubidium-82 (82Rb) is feasible and found an approximate 5% intra-assay coefficient of variation for both kidneys, indicative of a precise method.This study’s aim was to determine the day-to day variation of 82Rb PET/CT and to test the method’s ability to detect increased RBF induced by infusion of amino acids. Methods Seventeen healthy subjects underwent three dynamic 82Rb PET/CT scans over two examination days comprising: Day A, a single 8-minute dynamic scan and Day B, two scans performed before (baseline) and after RBF stimulation by a 2-hour amino acid-infusion. The order of examination days was determined by randomization. Time activity curves for arterial and renal activity with a 1-tissue compartment model were used for flow estimation; the K1 kinetic parameter representing renal 82Rb clearance. Day-to-day variation was calculated based on the difference between the unstimulated K1 values on Day A and Day B and paired t-testing was performed to compare K1 values at baseline and after RBF stimulation on Day B. Results Day-to-day variation was observed to be 5.5% for the right kidney and 6.0% for the left kidney (n = 15 quality accepted scans). K1 values determined after amino acid-infusion were significantly higher than pre-infusion values (n = 17, p = 0.001). The mean percentage change in K1 from baseline was 13.2 ± 12.9% (range − 10.4 to 35.5) for the right kidney; 12.9 ± 13.2% (range − 15.7 to 35.3) for the left kidney. Conclusion Day-to-day variation is acceptably low. A significant K1 increase from baseline is detected after application of a known RBF stimulus, indicating that 82Rb PET/CT scanning can provide a precise method for evaluation of RBF and it is able to determine changes herein. Clinical Trial Registration EU Clinical Trials Register, 2017-005008-88. Registered 18/01/2018.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…K 1 is the uptake rate from blood into tissue; k 2 is the washout rate from tissue into blood. No discernible 82 Rb activity has been observed in the urine [ 18 , 19 ] …”

Section: Introductionmentioning

confidence: 99%

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Reliability of rubidium-82 PET/CT for renal perfusion determination in healthy subjects

Langaa

Mose

Fynbo³

et al. 2022

BMC Nephrol

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Dynamic rubidium‐82 PET/CT as a novel tool for quantifying hemodynamic differences in renal blood flow using a one‐tissue compartment model

van de Burgt,

van Velden,

Kwakkenbos

et al. 2024

Medical Physics

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PurposeAssessing renal perfusion in‐vivo is challenging and quantitative information regarding renal hemodynamics is hardly incorporated in medical decision‐making while abnormal renal hemodynamics might play a crucial role in the onset and progression of renal disease. Combining physiological stimuli with rubidium‐82 positron emission tomography/computed tomography (82Rb PET/CT) offers opportunities to test the kidney perfusion under various conditions. The aim of this study is: (1) to investigate the application of a one‐tissue compartment model for measuring renal hemodynamics with dynamic 82Rb PET/CT imaging, and (2) to evaluate whether dynamic PET/CT is sensitive to detect differences in renal hemodynamics in stress conditions compared to resting state.MethodsA one‐tissue compartment model for the kidney was applied to cardiac 82Rb PET/CT scans that were obtained for ischemia detection as part of clinical care. Retrospective data, collected from 17 patients undergoing dynamic myocardial 82Rb PET/CT imaging in rest, were used to evaluate various CT‐based volumes of interest (VOIs) of the kidney. Subsequently, retrospective data, collected from 10 patients (five impaired kidney functions and five controls) undergoing dynamic myocardial 82Rb PET/CT imaging, were used to evaluate image‐derived input functions (IDIFs), PET‐based VOIs of the kidney, extraction fractions, and whether dynamic 82Rb PET/CT can measure renal hemodynamics differences using the renal blood flow (RBF) values in rest and after exposure to adenosine pharmacological stress.ResultsThe delivery rate (K1) values showed no significant (p = 0.14) difference between the mean standard deviation (SD) K1 values using one CT‐based VOI and the use of two, three, and four CT‐based VOIs, respectively 2.01(0.32), 1.90(0.40), 1.93(0.39), and 1.94(0.40) mL/min/mL. The ratio between RBF in rest and RBF in pharmacological stress for the controls were overall significantly lower compared to the impaired kidney function group for both PET‐based delineation methods (region growing and iso‐contouring), with the smallest median interquartile range (IQR) of 0.40(0.28–0.66) and 0.96(0.62–1.15), respectively (p < 0.05). The K1 of the impaired kidney function group were close to 1.0 mL/min/mL.ConclusionsThis study demonstrated that obtaining renal K1 and RBF values using 82Rb PET/CT was feasible using a one‐tissue compartment model. Applying iso‐contouring as the PET‐based VOI of the kidney and using AA as an IDIF is suggested for consideration in further studies. Dynamic 82Rb PET/CT imaging showed significant differences in renal hemodynamics in rest compared to when exposed to adenosine. This indicates that dynamic 82Rb PET/CT has potential to detect differences in renal hemodynamics in stress conditions compared to the resting state, and might be useful as a novel diagnostic tool for assessing renal perfusion.

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Randomized, Placebo-Controlled Trial on the Renal and Systemic Hemodynamic Effects of Empagliflozin

Nielsen,

Duus,

Buus

et al. 2025

Kidney International Reports

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Estimation of renal perfusion based on measurement of rubidium-82 clearance by PET/CT scanning in healthy subjects

Cited by 12 publications

References 29 publications

Reliability of rubidium-82 PET/CT for renal perfusion determination in healthy subjects

Reliability of rubidium-82 PET/CT for renal perfusion determination in healthy subjects

Dynamic rubidium‐82 PET/CT as a novel tool for quantifying hemodynamic differences in renal blood flow using a one‐tissue compartment model

Randomized, Placebo-Controlled Trial on the Renal and Systemic Hemodynamic Effects of Empagliflozin

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