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Determination of Split Renal Function by 3D Reconstruction of CT Angiograms: A Comparison with Gamma Camera Renography

¹ University of Alabama at Birmingham School of Medicine, Birmingham, AL.
² Department of Radiology, University of Alabama at Birmingham, 619 19th St., South, JTN363, Birmingham, AL 35249-6830.
³ Department of Surgery, Division of Urology, University of Alabama at Birmingham, Birmingham, AL.
⁴ Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.

OBJECTIVE. The objective of our study was to examine the correlation between CT-based and radionuclide renography–based measures of split renal function in a healthy population of live potential kidney donors using 3D models generated from CT angiography.

MATERIALS AND METHODS. The records of 173 renal donor candidates who had undergone CT and radionuclide renography between March 1, 2005, and February 28, 2006, were retrospectively evaluated; of those 173 patients, 152 met study inclusion criteria. A blinded investigator using 3D models that were created semiautomatically from the unenhanced, arterial, and excretory phase data made measurements of CT renal volumes and attenuations. The mean renal attenuation and volume were used to calculate the net accumulation of contrast material and split renal function for comparison with radionuclide renography. Split function from CT was calculated in the arterial and excretory phases as well as based on split renal volume and the Patlak method.

RESULTS. All four CT-based methods for the calculation of split renal function showed correlation with no significant difference from radionuclide renography (p > 0.05, Student's t test). Pearson's correlation coefficients varied from 0.36 to 0.63 (p < 0.001 for each). Difference scores revealed that the excretory and renal volume splits had the narrowest range and showed a linear, nonzero relationship to the renography splits. Bland-Altman analysis confirmed that the majority of difference scores between each CT method and the radionuclide renography were within the 95% CI of the differences.

CONCLUSION. Split renal function based on 3D CT models can provide a "one-stop" evaluation of both the anatomic and the functional characteristics of the kidneys of living potential kidney donors. The excretory phase data and the split renal volume data show the best correlation and the smallest difference scores compared with radionuclide renography data.

Keywords: 3D kidney modeling • kidney transplantation • renal artery • renography • split renal function

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