Abstract
ObjectivesTo determine the feasibility of a dynamic CT angiography-protocol with regard to simultaneous assessment of renal anatomy and function.Methods7 healthy potential kidney donors (58±7 years) underwent a dynamic computed tomography angiography (CTA) using a 128-slice CT-scanner with continuous bi-directional table movement, allowing the coverage of a scan range of 18 cm within 1.75 sec. Twelve scans of the kidneys (n = 14) were acquired every 3.5 seconds with the aim to simultaneously obtain CTA and renal function data. Image quality was assessed quantitatively (HU-measurements) and qualitatively (grade 1–4, 1 = best). The glomerular filtration rate (GFR) was calculated by a modified Patlak method and compared with the split renal function obtained with renal scintigraphy.ResultsMean maximum attenuation was 464±58 HU, 435±48 HU and 277±29 HU in the aorta, renal arteries, and renal veins, respectively. The abdominal aorta and all renal vessels were depicted excellently (grade 1.0). The image quality score for cortex differentiation was 1.6±0.49, for the renal parenchyma 2.4±0.49. GFR obtained from dynamic CTA correlated well with renal scintigraphy with a correlation coefficient of r = 0.84; P = 0.0002 (n = 14). The average absolute deviation was 1.6 mL/min. The average effective dose was 8.96 mSv.ConclusionComprehensive assessment of renal anatomy and function is feasible using a single dynamic CT angiography examination. The proposed protocol may help to improve management in case of asymmetric kidney function as well as to simplify evaluation of potential living kidney donors.
Highlights
Assessment of accurate renal function as well as renal anatomy is necessary in the preoperative evaluation of potential living kidney donors, and for other kidney diseases where knowledge of split renal function may guide optimal patient management
Creatinine-based formulas always apply to both kidneys together and do not provide split renal function
While patients with vascular complications and mild impairment of renal function most likely benefit from revascularization [2] a mild decrease of the glomerular filtration rate (GFR) of the affected kidney will not be detected by creatininebased formulas
Summary
Assessment of accurate renal function as well as renal anatomy is necessary in the preoperative evaluation of potential living kidney donors, and for other kidney diseases where knowledge of split renal function may guide optimal patient management. Creatinine-based formulas always apply to both kidneys together and do not provide split renal function. Determination of single-kidney-GFR of the affected as well as the contralateral kidney is essential for selecting the appropriate therapeutic regimen in case of unilateral kidney diseases like atrophy, obstruction or renal neoplasm [1]. While patients with vascular complications and mild impairment of renal function most likely benefit from revascularization [2] a mild decrease of the GFR of the affected kidney will not be detected by creatininebased formulas. In healthy subjects evaluated for potential kidney donation, determination of split renal function is required. Minimum single-kidney-GFR values in this context are recommended in order to avoid postoperative renal insufficiency for both the renal donor and the transplant recipient [3]
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