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Estimation of renal function using iodine maps in dual-energy spectral computed tomography urography: a feasibility and accuracy study

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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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Abbreviations

GFR:

Glomerular filtration rate

eGFR:

Estimated glomerular filtration rate

CTU:

Computed tomography urography

CM:

Contrast material

DECT:

Dual-energy computed tomography

DEsCTU:

Dual-energy spectral computed tomography urography

HU:

Hounsfield unit

Scr:

Serum creatinine

Cys C:

Cystatin C

Hct:

Hematocrit

VMI:

Virtual monochromatic images

ASIR-V:

Adaptive statistical iterative reconstruction-V

IC:

Iodine concentration

CMF:

Contrast material filtration

PC:

Plasma concentration

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Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Urology, Shahekou District, Lianhe Road, Dalian, China

    Shigeng Wang, Xiaoyu Tong, Jingyi Zhang, Yong Fan, Wei Wei, Yijun Liu, Mengting Hu & Qiye Chen

  2. CT Research, GE Healthcare, Dalian, China

    Jianying Li

  3. Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, China

    Lei Liu

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  1. Shigeng Wang
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Correspondence to Lei Liu.

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The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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This retrospective study was approved by the medical ethics committee of the First Affiliated Hospital of Dalian Medical University [Ethics References No: PJ-KS-KY-2019-110]. Written informed consent from subjects was waived by the ethics committee.

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Wang, S., Tong, X., Zhang, J. et al. Estimation of renal function using iodine maps in dual-energy spectral computed tomography urography: a feasibility and accuracy study. Abdom Radiol 49, 997–1005 (2024). https://doi.org/10.1007/s00261-023-04146-y

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