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Split renal function in patients with suspected renal artery stenosis: a comparison between gamma camera renography and two methods of measurements with computed tomography
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology. (Magnusson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology. (Nyman)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
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2006 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 47, no 1, 107-113 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To validate a method for calculating split renal function from computed tomography (CT) compared with gamma camera renography, and to test a new method for the measurement based on a volume-rendering technique. MATERIAL AND METHODS: Thirty-eight patients, aged 65.7 +/- 11.6 (range 37.8-82.1) years, who had undergone both CT angiography and gamma camera renography for a suspected renal artery stenosis were included in this study. Split renal function was calculated from the CT examinations by measuring area and mean attenuation in the image slices of the kidneys, and also by measuring volume and mean attenuation from a 3D reconstruction of the kidneys. Gamma camera renography with 99mTc-MAG3 with or without captopril enhancement was used as a reference. RESULTS: The 2D CT method had good correlation with renography (r=0.93). Mean difference was 4.7 +/- 3.6 (0-12) percentage points per kidney. There was also excellent correlation between the two CT methods (r=1.00). CONCLUSION: CT is equivalent to renography in determining split renal function, and the measurement from the CT examination can be made more quickly and equally accurately with a 3D technique.

Place, publisher, year, edition, pages
2006. Vol. 47, no 1, 107-113 p.
Keyword [en]
Adult, Aged, Aged; 80 and over, Contrast Media/administration & dosage, Female, Humans, Imaging; Three-Dimensional/methods, Iohexol/administration & dosage/analogs & derivatives, Kidney/*physiopathology/radiography/radionuclide imaging, Kidney Function Tests/*methods, Male, Middle Aged, Prospective Studies, Radioisotope Renography/*methods, Renal Artery Obstruction/physiopathology/*radiography/*radionuclide imaging, Tomography; X-Ray Computed/*methods
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-96844DOI: 10.1080/02841850500406787PubMedID: 16498942OAI: oai:DiVA.org:uu-96844DiVA: diva2:171558
Available from: 2008-03-14 Created: 2008-03-14 Last updated: 2010-09-14Bibliographically approved
In thesis
1. Alternative Methods for Assessment of Split Renal Function
Open this publication in new window or tab >>Alternative Methods for Assessment of Split Renal Function
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Living kidney donation is a clinical situation with unique features in the sense that healthy individuals voluntarily expose themselves to certain risks and inconveniences. Therefore, eliminating as much of the associated discomfort as possible is crucial. The primary aim of this study was to evaluate whether it is possible to use the examination with computed tomography (CT), which is essential to the investigation, also for determining the ratio of the two kidneys’ function – the split renal function. If possible, an examination with gamma camera renography could be excluded from the work-up.

To investigate this possibility, 27 subjects who had underwent CT and renography as part of kidney donor investigation were studied retrospectively. The quantity of contrast material in each kidney was considered proportional to that kidney’s function, and measurement was made in each of the two available contrast phases. The results were compared to the results from renography. A similar analysis was conducted in 38 patients investigated for suspected renal artery stenosis with CT and renography, including a study of an automatized method for the acquisition of data from CT. For further scrutiny, a respiratory triggered dynamic contrast-enhanced magnetic resonance imaging (MRI) examination was investigated in 26 individuals. Results of split renal function were compared with renography and with CT in a subgroup. To study the possibility of facilitating the data analysis with CT, a formula for approximation of the contrast attenuation was studied in 64 subjects. An analysis of the significance of choice of contrast phase was also conducted in 43 subjects.

Unsatisfactory agreement with renography resulted from the CT analysis of previous donors, partly due to technical shortcomings. However, the technique was recognized to have a potential value. In the subsequent material, the settings were improved, with beneficial effects on the agreement. Respiratory-triggered MRI generated high quality examinations of renal uptake and excretion, with results harmonizing well with renography and CT. The approximation formula applied to CT resulted in higher accuracy for renal volume assessment than with the automatic method, and an acceptable agreement of the split renal function estimate.

From the presented results, a revision of the current donor investigation protocol is suggested. CT gives sufficient information to exclude renography as a routine examination. In cases of uncertainty, renography is recommended for secondary evaluation.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 76 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 319
Radiology, Split renal function, Live kidney donor, CT, Renography, Dynamic MRI, Renal volume, Respiratory triggering, Radiologisk forskning
urn:nbn:se:uu:diva-8513 (URN)978-91-554-7121-7 (ISBN)
Public defence
2008-04-04, Rosénsalen, Akademiska sjukhuset, Ing. 95/96 n.b.v., Uppsala, 09:15
Available from: 2008-03-14 Created: 2008-03-14Bibliographically approved

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