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Wang S, Tong X, Zhang J, Fan Y, Wei W, Li J, Liu Y, Hu M, Chen Q, Liu L. Estimation of renal function using iodine maps in dual-energy spectral computed tomography urography: a feasibility and accuracy study. Abdom Radiol (NY) 2024; 49:997-1005. [PMID: 38244037 DOI: 10.1007/s00261-023-04146-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE To explore the feasibility of measuring glomerular filtration rate (GFR) using iodine maps in dual-energy spectral computed tomography urography (DEsCTU) and correlate them with the estimated GFR (eGFR) based on the equation of creatinine-cystatin C. MATERIALS AND METHODS One hundred and twenty-eight patients referred for DEsCTU were retrospectively enrolled. The DEsCTU protocol included non-contrast, nephrographic, and excretory phase imaging. The CT-derived GFR was calculated using the above 3-phase iodine maps (CT-GFRiodine) and 120 kVp-like images (CT-GFR120kvp) separately. CT-GFRiodine and CT-GFR120kvp were compared with eGFR using paired t-test, correlation analysis, and Bland-Altman plots. The receiver operating characteristic curves were used to test the renal function diagnostic performance with CT-GFR120kvp and CT-GFRiodine. RESULTS The difference between eGFR (89.91 ± 18.45 ml·min-1·1.73 m-2) as reference standard and CT-GFRiodine (90.06 ± 20.89 ml·min-1·1.73 m-2) was not statistically significant, showing excellent correlation (r = 0.88, P < 0.001) and agreement (± 19.75 ml·min-1·1.73 m-2, P = 0.866). The correlation between eGFR and CT-GFR120kvp (66.13 ± 19.18 ml·min-1·1.73 m-2) was poor (r = 0.36, P < 0.001), and the agreement was poor (± 40.65 ml·min-1·1.73 m-2, P < 0.001). There were 62 patients with normal renal function and 66 patients with decreased renal function based on eGFR. The CT-GFRiodine had the largest area under the curve (AUC) for distinguishing between normal and decreased renal function (AUC = 0.951). CONCLUSION The GFR can be calculated accurately using iodine maps in DEsCTU. DEsCTU could be a non-invasive and reliable one-stop-shop imaging technique for evaluating both the urinary tract morphology and renal function.
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Affiliation(s)
- Shigeng Wang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Urology, Shahekou District, Lianhe Road, Dalian, China
| | - Xiaoyu Tong
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Urology, Shahekou District, Lianhe Road, Dalian, China
| | - Jingyi Zhang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Urology, Shahekou District, Lianhe Road, Dalian, China
| | - Yong Fan
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Urology, Shahekou District, Lianhe Road, Dalian, China
| | - Wei Wei
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Urology, Shahekou District, Lianhe Road, Dalian, China
| | | | - Yijun Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Urology, Shahekou District, Lianhe Road, Dalian, China
| | - Mengting Hu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Urology, Shahekou District, Lianhe Road, Dalian, China
| | - Qiye Chen
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Urology, Shahekou District, Lianhe Road, Dalian, China
| | - Lei Liu
- Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
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Gandhi DB, Al Saeedi M, Krier JD, Jiang K, Glockner JF, Lerman LO. Evaluation of Renal Fibrosis Using Magnetization Transfer Imaging at 1.5T and 3T in a Porcine Model of Renal Artery Stenosis. J Clin Med 2023; 12:jcm12082956. [PMID: 37109291 PMCID: PMC10140905 DOI: 10.3390/jcm12082956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Renal fibrosis is an important marker in the progression of chronic kidney disease, and renal biopsy is the current reference standard for detecting its presence. Currently, non-invasive methods have only been partially successful in detecting renal fibrosis. Magnetization transfer imaging (MTI) allows estimates of renal fibrosis but may vary with scanning conditions. We hypothesized that MTI-derived renal fibrosis would be reproducible at 1.5T and 3T MRI and over time in fibrotic kidneys. Fifteen pigs with unilateral renal artery stenosis (RAS, n = 9) or age-matched sham controls (n = 6) underwent MTI-MRI at both 1.5T and 3T 6 weeks post-surgery and again 4 weeks later. Magnetization transfer ratio (MTR) measurements of fibrosis in both kidneys were compared between 1.5T and 3T, and the reproducibility of MTI at the two timepoints was evaluated at 1.5T and 3T. MTR at 3T with 600 Hz offset frequency successfully distinguished between normal, stenotic, and contralateral kidneys. There was excellent reproducibility of MTI at 1.5T and 3T over the two timepoints and no significant differences between MTR measurements at 1.5T and 3T. Therefore, MTI is a highly reproducible technique which is sensitive to detect changes in fibrotic compared to normal kidneys in the RAS porcine model at 3T.
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Affiliation(s)
- Deep B Gandhi
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Mina Al Saeedi
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - James D Krier
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Kai Jiang
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - James F Glockner
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Saulnier PJ, Bjornstad P. Renal hemodynamic changes in patients with type 2 diabetes and their clinical impact. Presse Med 2023; 52:104175. [PMID: 37783424 DOI: 10.1016/j.lpm.2023.104175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/19/2023] [Indexed: 10/04/2023] Open
Abstract
The dysfunction of the internal mechanics within the kidney's filtering units, known as glomeruli, has been linked to the emergence and progression of diabetic kidney disease (DKD). To better understand this crucial aspect of kidney function and the pathology of DKD, a variety of methods are employed in research, from the introduction of external compounds, such as inulin, iohexol, iothalamate and p-aminohippurate, to cutting-edge imaging techniques and computational analysis. Given the significance of intraglomerular hemodynamic dysfunction in the pathogenesis and treatment of DKD, it is essential to thoroughly examine the available data on this topic. Accordingly, the aim of this review is to provide a comprehensive appraisal of the role of intraglomerular hemodynamic dysfunction in the development of DKD and the effects of current therapies used to mitigate DKD. Through this analysis, we can gain a deeper understanding of the complex pathogenesis of DKD and potentially discover new avenues for tailored therapeutic management of patients with DKD.
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Affiliation(s)
- Pierre-Jean Saulnier
- Clinical Investigation Center INSERM CIC1402 CHU Poitiers, Poitiers University, School of Medicine, Poitiers, France, and NIDDK, Phoenix, AZ, USA.
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Jeong S, Park SB, Chang IH, Shin J, Chi BH, Park HJ, Lee ES. Estimation of renal function using kidney dynamic contrast material-enhanced CT perfusion: accuracy and feasibility. Abdom Radiol (NY) 2021; 46:2045-2051. [PMID: 33090257 DOI: 10.1007/s00261-020-02826-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/01/2020] [Accepted: 10/10/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE To measure glomerular filtration rates (GFRs) using kidney dynamic contrast material-enhanced (DCE)-CT perfusion scans and correlate them with estimated GFRs (eGFRs). MATERIALS AND METHODS Split-bolus CT urography, including pre-contrast and nephrographic-excretory phase imaging, was performed with a kidney DCE-CT perfusion scan protocol. We analysed 55 patients with suspected renal disease. All CT acquisitions were obtained on a 256-slice CT scanner for 3.5 min continuously with shallow breathing. Renal volume, perfusion and permeability values were calculated using a dedicated prototype software. Based on Patlak plots, split and total renal GFR values were determined. Paired t-tests, Pearson's correlation analysis and Bland-Altman plots were used for comparisons between kidney DCE-CT perfusion scan-derived GFR (CT-GFR) and the corresponding eGFR value. The p values < 0.05 were considered statistically significant. RESULTS The mean CT-GFR was 91.19 ± 20.71 mL/min/1.73 m2. The eGFR values based on the CKD-EPI and MDRD equations were 89.64 ± 19.74 mL/min/1.73 m2 and 89.50 ± 24.89 mL/min/1.73 m2, respectively. No statistically significant differences were found between CT-GFR and eGFRs (p > 0.05). Excellent correlation and agreement between CT-GFR and eGFRs (correlation coefficient r = 0.91 for CKD-EPI and 0.84 for MDRD equations, respectively) were confirmed. CONCLUSION Kidney DCE-CT perfusion is an accurate and feasible technique to assess renal function.
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Affiliation(s)
- Seokmin Jeong
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Korea.
| | - In Ho Chang
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jungho Shin
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung Hoon Chi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Korea
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Quantitative evaluation of chronically obstructed kidneys from noncontrast computed tomography based on deep learning. Eur J Radiol 2021; 136:109535. [PMID: 33460954 DOI: 10.1016/j.ejrad.2021.109535] [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: 07/28/2020] [Revised: 12/09/2020] [Accepted: 01/05/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To quantitatively report renal parenchymal volume (RPV), renal sinus volume (RSV), and renal parenchymal density (RPD) for chronically obstructed kidneys from noncontrast computed tomography (NCCT). METHODS This retrospective study was approved by the institutional review board of our hospital with a waiver of informed consent. We retrospectively collected 304 consecutive NCCT scans of urinary obstruction and constructed two datasets: one with 167 patient scans for parenchyma and sinus segmentation (segmentation dataset) and the other containing 137 scans from different patients diagnosed with chronic urinary obstruction (CUO dataset) and paired with split glomerular filtration rate (sGFR). A cascaded three-dimensional (3D) U-Net model was developed and validated for parenchyma and sinus segmentation. The RPV, RSV, and RPD of the CUO dataset were calculated by the model with manual editing. A multivariate analysis was performed to show the association between all parameters and the sGFR. RESULTS In the test dataset, the Dice values for parenchyma and sinus segmentation were 0.95 ± 0.04 and 0.90 ± 0.05, respectively. Compared with those of nonobstructed kidneys, the RSV and RPD of obstructed kidneys increased, but RPV and sGFR decreased (P < .001). For chronically obstructed kidneys, age (r = -0.292, P < .001), RPV (r = 0.849, P < .001), RSV (r = -0.331, P < .001), and RPD (r = -0.296, P < .001) were significantly correlated with sGFR. The fitted regression model was sGFR = 10.873-0.111 Age + 0.211 RPV - 0.022 RSV (r2 = 0.712). CONCLUSIONS NCCT combined with deep learning has the potential to be a single radiological procedure for morphological and functional evaluation of chronically obstructed kidneys.
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