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Han JH, Jeong SH, Han S, Yuk HD, Ku JH, Kwak C, Kim HH, Jeong CW. Association between decreased ipsilateral renal function and aggressive behavior in renal cell carcinoma. BMC Cancer 2022; 22:1143. [PMID: 36344958 PMCID: PMC9639309 DOI: 10.1186/s12885-022-10268-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
To assess prognostic value of pre-operative ipsilateral split renal function (SRF) on disease-free survival (DFS) and its association with aggressive pathological features in renal cell carcinoma (RCC) patients.
Methods
We examined patients registered in SNUG-RCC-Nx who underwent partial or radical nephrectomy at Seoul National University Hospital between January 1, 2010 and December 31, 2020. Patients with the following criteria were excluded from the study. 1) non-kidney origin cancer or benign renal tumor, 2) no pre-operative Tc 99 m-DTPA renal scan, 3) single kidney status or previous partial or radical nephrectomy, and 4) bilateral renal mass. Finally, 1,078 patients were included.
Results
Among 1,078 patients, 899 (83.4%) showed maintained ipsilateral SRF on DTPA renal scan; 179 patients (16.6%) showed decreased SRF. The decreased SRF group showed significantly large tumor size (maintained vs. decreased SRF; 3.31 ± 2.15 vs. 6.85 ± 3.25, p < 0.001), high Fuhrman grade (grade 3–4) (41.7% vs. 55.6%, p < 0.001), and high T stage (T stage 3–4) (9.0% vs. 20.1%, p < 0.001). Pathological invasive features, including invasion of the renal capsule, perirenal fat, renal sinus fat, vein, and collecting duct system, were associated with low SRF of the ipsilateral kidney. Univariate Cox regression analysis identified higher SSIGN (The stage, size, grade, and necrosis) score and decreased ipsilateral SRF as significant risk factors, while multivariate analysis showed SSIGN (5–7) (hazard ratio [HR] 11.9, p < 0.001) and SSIGN (8–10) (HR 69.2, p < 0.001) were significantly associated with shortened DFS, while decreased ipsilateral SRF (HR 1.75, p = 0.065) showed borderline significance. Kaplan–Meier analysis showed that decreased ipsilateral SRF (< 45%) group had shorter DFS than the other group (median DFS: 90.3 months vs. not reached, p < 0.001).
Conclusions
Among unilateral RCC patients, those with low ipsilateral SRF showed poor prognosis with pathologically invasive features. Our novel approach may facilitate risk stratification in RCC patients, helping formulate a treatment strategy.
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Valind K, Jögi J, Minarik D, Brolin G, Trägårdh E. Dose-reduced [ 18F]PSMA-1007 PET is feasible for functional imaging of the renal cortex. EJNMMI Phys 2021; 8:70. [PMID: 34714424 PMCID: PMC8556440 DOI: 10.1186/s40658-021-00419-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background In Prostate-specific membrane antigen (PSMA) positron emission tomography with computed tomography (PET-CT), there is significant renal uptake. The standard in renal cortical functional imaging is scintigraphy with technetium-99m labeled dimercaptosuccinic acid (DMSA). Using [68Ga]Ga-PSMA-11 PET for renal imaging has been suggested, but using [18F]PSMA-1007 has not been explored. The aims of this study were to establish the optimal time point for renal imaging after [18F]PSMA-1007 injection, to investigate the reproducibility of split renal uptake measurements, and to determine the margin for reduction in administered activity. Methods Twelve adult male patients with prostate cancer underwent [18F]PSMA-1007 PET-CT at 8 time points up to 5.5 h post-injection (p.i.). List-mode data were binned to durations of 10 to 120 s per bed position (bp). Left renal percentage of total renal uptake (LRU%) was measured, and the difference between highest and lowest measurement per patient (“delta max”) was calculated. Images acquired at 1 h, 2 h, and 5.5 h p.i. with durations of 10 to 120 s/bp were rated regarding image quality. Results Imaging at 2 h p.i. with 60 s/bp yielded acceptable quality in all cases. Increasing acquisition time to 15 min for a single bp would allow reducing administered activity to 0.27 MBq/kg, resulting in an effective dose of 0.4 mSv for a 1-year old child weighing 10 kg. The median delta max of LRU% measurements was 2.7% (range 1.8–7.3%). Conclusions Renal [18F]PSMA-1007 PET-CT is feasible, with imaging 2 h p.i., acceptable split renal uptake variability, and effective dose and acquisition time comparable to those of [99mTc]Tc-DMSA scintigraphy.
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Affiliation(s)
- Kristian Valind
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden. .,Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund and Malmö, Sweden.
| | - Jonas Jögi
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden.,Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund and Malmö, Sweden
| | - David Minarik
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden.,Radiation Physics, Skåne University Hospital, Lund and Malmö, Sweden
| | - Gustav Brolin
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden.,Radiation Physics, Skåne University Hospital, Lund and Malmö, Sweden
| | - Elin Trägårdh
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden.,Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund and Malmö, Sweden
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Brink A, Libhaber E, Levin M. Renogram image characteristics and the reproducibility of differential renal function measurement. Nucl Med Commun 2021; 42:866-876. [PMID: 33741865 PMCID: PMC8279895 DOI: 10.1097/mnm.0000000000001408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/16/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Patient factors such as age and glomerular filtration rate (GFR), have been implicated as causes for poor reproducibility of differential renal function (DRF) estimates on 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) renography. This study aims to investigate factors associated with the reproducibility of DRF measurements. METHODS The association between age, GFR and imaged derived image characteristics and reproducibility of repeated DRF estimates calculated using the area under the curve method and the Rutland Patlak method was analysed for cohort 1 (n = 127). The association between these variables and reproducibility of DRF was tested with univariate linear regression. The univariate linear regression results were used to plan the multiple linear regression combinations.The associations between variables identified and reproducibility of DRF values were then tested in a second cohort (n = 227). RESULTS The R2 values for goodness-to-fit for the multiple regression models ranged from 0.33 to 0.49 for cohort 1 and from 0.17 to 0.22 for cohort 2. Left kidney to background ratio (LKTBR) was significant in all the multiple linear regression combinations (P < 0.05). Right kidney to background ratio (RKTBR), right renal margins well defined, right renal margins poorly visualised, time visualisation right calyces and age were significant in most combinations. The reproducibility of DRF measurement was decreased when the kidney to background ratio (KTBR) was ≤2. CONCLUSION Only LKTBR, RKTBR, right renal margins well defined, time visualisation right calyces and age predicted reproducibility for the measurement of DRF on 99mTc-MAG3 renograms. The KTBR should be incorporated into the renal processing software as a quality control step. The DRF values should be interpreted with caution if the KTBR is ≤2.0.
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Affiliation(s)
- Anita Brink
- Division of Nuclear Medicine, Department of Paediatrics, University of Cape Town, Cape Town
| | - Elena Libhaber
- Department of Research Methodology and Statistics, Faculty of Health Sciences, School of Clinical Medicine and Health Sciences Research Office, University of Witwatersrand, Braamfontein, Johannesburg
| | - Michael Levin
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
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Krumm P, Hupka T, Haußmann F, Dittmann H, Mühlbacher T, Nadalin S, Königsrainer A, Nikolaou K, Heyne N, Kramer U, Guthoff M. Contrast-enhanced MRI for simultaneous evaluation of renal morphology and split renal function in living kidney donor candidates. Eur J Radiol 2021; 142:109864. [PMID: 34303151 DOI: 10.1016/j.ejrad.2021.109864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The evaluation process of potential living kidney donors focusses on renal anatomy and split renal function. This study aimed to evaluate a magnetic resonance imaging (MRI)-based approach for simultaneous evaluation of both and its impact on clinical decision making. METHOD Over a 3-year period, 65 potential living kidney donors were consecutively enrolled. The MRI protocol was extended by MR-nephrography to measure split renal function. Standard DTPA-scintigraphy was used for functional comparison. RESULTS Split renal function showed no systematic bias between the two methods (mean difference 0.3%, p = 0.08). Both methods would have yielded the same clinical decision for donor nephrectomy in 75% of the patients. In 25 % of the patients, one method indicated a relevant side difference while the other did not, and a different clinical decision could have been made based on split renal function alone. CONCLUSIONS MRI proved eligible for comprehensive living kidney donor evaluation and non-inferior to scintigraphy for determining split renal function. In clinical decision making, these two methods would have resulted in the same side for donor nephrectomy in a large proportion of potential donors. Whether MRN will be implemented in clinical practice depends on transplant centre infrastructure and policy.
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Affiliation(s)
- Patrick Krumm
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Germany
| | - Tanja Hupka
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Germany
| | - Florian Haußmann
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Germany
| | - Helmut Dittmann
- Department of Nuclear Medicine, University of Tübingen, Germany
| | - Thomas Mühlbacher
- Department of Internal Medicine IV, Section of Nephrology and Hypertension, University of Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Silvio Nadalin
- Department of General, Visceral- and Transplant Surgery, University of Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral- and Transplant Surgery, University of Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Germany
| | - Nils Heyne
- Department of Internal Medicine IV, Section of Nephrology and Hypertension, University of Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Ulrich Kramer
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Germany; Department of Radiology, Rems-Murr-Clinic, Winnenden, Germany.
| | - Martina Guthoff
- Department of Internal Medicine IV, Section of Nephrology and Hypertension, University of Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
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Hamböck M, Staudenherz A, Kainz A, Geist B, Hecking M, Doberer K, Hacker M, Böhmig GA. Determinants of the intercept and slope of glomerular filtration rate in recipients of a live donor kidney transplant. Wien Klin Wochenschr 2020; 133:107-117. [PMID: 32016508 PMCID: PMC7875851 DOI: 10.1007/s00508-020-01610-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/10/2020] [Indexed: 11/18/2022]
Abstract
Background Donor kidney function is considered a critical determinant of allograft survival after live donor (LD) kidney transplantation, but its independent impact on the evolution of graft function is less well defined. The objective of this study was to dissect the relative contribution of LD kidney function to baseline estimated glomerular filtration rate (eGFR) of recipients and its decline. Methods In this study 91 LD kidney transplantations performed between 2007 and 2015 were included. The eGFR of donated kidneys (eGFR-dk) was calculated from total LD eGFR (eGFR-dt) based on the results of isotope nephrography. Recipient eGFR (eGFR-r) determined 6‑monthly until 36 months posttransplantation served as dependent variable in mixed linear models estimating changes in baseline allograft function (intercept) and eGFR‑r slope. Models were adjusted either for eGFR-dk or eGFR-dt, in addition to other potential confounders. Results Overall, unadjusted mean eGFR‑r at baseline (6 months) and its annual decline in allograft function were 56.5 mL/min/1.73 m2 and −0.2 mL/min/1.73 m2, respectively. In multivariate analysis, eGFR-dk impacted on baseline eGFR‑r (0.6 mL/min/1.73 m2 mean estimated increase per unit; P = 0.02) but not on its slope. In the eGFR-dt-adjusted model, a marginal effect was observed for LD age (P = 0.05). Both models identified antibody-mediated rejection (ABMR) as the strongest risk factor of accelerated loss of allograft function (eGFR‑r slope: approximately −6 mL/min/1.73 m2 per year; P ≤ 0.02). Conclusion Donor-related characteristics, most prominently the function of donated kidneys and LD age, were predictive of eGFR at baseline. The ABMR was identified as the cardinal cause of progressive deterioration of allograft function.
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Affiliation(s)
- Martina Hamböck
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Anton Staudenherz
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.,Department of Nuclear Medicine, Molecular Imaging and Special Endocrinology, University Hospital St. Pölten-Karl Landsteiner University of Health Science, St. Pölten, Austria
| | - Alexander Kainz
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Barbara Geist
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Manfred Hecking
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Konstantin Doberer
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Georg A Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Geist BK, Baltzer P, Fueger B, Hamboeck M, Nakuz T, Papp L, Rasul S, Sundar LKS, Hacker M, Staudenherz A. Assessment of the kidney function parameters split function, mean transit time, and outflow efficiency using dynamic FDG-PET/MRI in healthy subjects. Eur J Hybrid Imaging 2019; 3:3. [PMID: 34191174 PMCID: PMC8212313 DOI: 10.1186/s41824-019-0051-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/17/2019] [Indexed: 11/29/2022] Open
Abstract
Background Traditionally, isotope nephrography is considered as the method of choice to assess kidney function parameters in nuclear medicine. We propose a novel approach to determine the split function (SF), mean transit time (MTT), and outflow efficiency (OE) with 2-deoxy-2-[18F]fluoro-D-glucose (FDG) dynamic positron emission tomography (PET). Materials and methods Healthy adult subjects underwent dynamic simultaneous FDG-PET and magnetic resonance imaging (PET/MRI). Time-activity curves (TACs) of total kidneys, renal cortices, and the aorta were prospectively obtained from dynamic PET series. MRI images were used for anatomical correlation. The same individuals were subjected to dynamic renal Technetium-99 m-mercaptoacetyltriglycine (MAG3) scintigraphy and TACs of kidneys; the perirenal background and the left ventricle were determined. SF was calculated on the basis of integrals over the TACs, MTT was determined from renal retention functions after deconvolution analysis, and OE was determined from MTT. Values obtained from PET series were compared with scintigraphic parameters, which served as the reference. Results Twenty-four subjects underwent both examinations. Total kidney SF, MTT, and OE as estimated by dynamic PET/MRI correlated to their reference values by r = 0.75, r = 0.74 and r = 0.81, respectively, with significant difference (p < 0.0001) between the means of MTT and OE. No correlations were found for cortex FDG values. Conclusions The study proofs the concept that SF, MTT, and OE can be estimated with dynamic FDG PET/MRI scans in healthy kidneys. This has advantages for patients receiving a routine PET/MRI scan, as kidney parameters can be estimated simultaneously to functional and morphological imaging with high accuracy.
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Merguerian PA. Should Geometric Mean Calculation of Differential Renal Function be Used When Evaluating Children with Moderate to Severe Hydronephrosis? J Urol 2016; 195:247-8. [DOI: 10.1016/j.juro.2015.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Paul A. Merguerian
- Division of Pediatric Urology, Seattle Children’s Hospital, Seattle, Washington
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