Assessment of the individual renal function in chronic unilateral renal obstruction using functional CT as compared to 99mTc-DTPA renal scan

Document Type: Original Article

Author

Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

Abstract

Introduction: The selection of   optimal treatment of obstructive nephrouropathy requires information about the functional status of each kidney. Nuclear renal scanning objectively measure differential renal function, multiple studies have demonstrated the role of assessment of renal perfusion and GFR with triphasic CT. The aim of this study is to assess the role of CT based on renal parenchymal volume measurement in assessment of individual renal function compared to 99mTc-DTPA renal scan in patients with unilateral renal obstruction.
Methods: During the indicated time interval, 42 patients with chronic unilateral obstruction; the percentage of the individual renal functions by 99mTc-DTPA and by CT were assessed.
Results: The percentage of the individual renal functions as estimated by 99mTc-DTPA in obstructed kidneys ranged from 0% to 40.43% (13.22), while by CT is in range from 0 to 36.68% (15.52). The correlation between percent renal function by 99mTc-DTPA renal scan and percent renal volume by CT were assessed in obstructed kidneys and there were statistically significant relationship (r = 0.877, P < 0.0001).

Conclusion: CT scan can be used as an integrated modality to assess the functional and morphological status of unilateral chronic renal obstruction, however   99mTc-DTPA renal scan is a safe choice with less radiation exposure, further comparative studies are needed to assess the role of CT-based parenchymal volume in evaluation of individual renal functions in patients with acute obstruction, bilateral nephropathy and renal impairment.

Keywords

Main Subjects


Gong IH, Hwang J, Choi DK, Lee SR, Hong YK, Hong JY, Park DS, Jeon HG. Relationship among total kidney volume, renal function and age. J Urol. 2012 Jan;187(1):344-9.

Tsushima Y, Blomley MJ, Okabe K, Tsuchiya K, Aoki J, Endo K. Determination of glomerular filtration rate per unit renal volume using computerized tomography: correlation with conventional measures of total and divided renal function. J Urol. 2001 Feb;165(2):382-5.

Schlegel JU, Halikiopoulos HL, Prima R. Determination of filtration fraction using the gamma scintillation camera. J Urol. 1979 Oct;122(4):447-50.

Fawdry RM, Gruenewald SM, Collins LT, Roberts AJ. Comparative assessment of techniques for estimation of glomerular filtration rate with 99mTc-DTPA. Eur J Nucl Med. 1985;11(1):7-12.

Zubal IG, Caride VJ. The technetium-99m-DTPA renal uptake-plasma volume product: a quantitative estimation of glomerular filtration rate. J Nucl Med. 1992 Sep;33(9):1712-6.

Soga S1, Britz-Cunningham S, Kumamaru KK, Malek SK, Tullius SG, Rybicki FJ.  Comprehensive comparative study of computed tomography-based estimates of split renal function for potential renal donors: modified ellipsoid method and other CT-based methods. J Comput Assist Tomogr. 2012 May-Jun;36(3):323-9.

Hackstein N, Wiegand C, Rau WS, Langheinrich AC. Glomerular filtration rate measured by using triphasic helical CT with a two-point Patlak plot technique. Radiology. 2004 Jan;230(1):221-6.

Mulligan JS1, Blue PW, Hasbargen JA. Methods for measuring GFR with technetium-99m-DTPA: an analysis of several common methods. J Nucl Med. 1990 Jul;31(7):1211-9.

Yalçın H, Ozen A, Günay EC, Ozaslan IA, Ozer C.  Can Tc 99m DTPA be Used in Adult Patients in Evaluation of Relative Renal Function Measurement as the Reference Tc 99m DMSA Method? Mol Imaging Radionucl Ther. 2011 Apr;20(1):14-8.

Herts BR, Sharma N, Lieber M, Freire M, Goldfarb DA, Poggio ED. Estimating glomerular filtration rate in kidney donors: a model constructed with renal volume measurements from donor CT scans. Radiology. 2009 Jul;252(1):109-16.  

El-Ghar ME, Shokeir AA, El-Diasty TA, Refaie HF, Gad HM, El-Dein AB. Contrast enhanced spiral computerized tomography in patients with chronic obstructive uropathy and normal serum creatinine: a single session for anatomical and functional assessment. J Urol. 2004 Sep;172(3):985-8.

ACR Committee on Drugs and Contrast Media. ACR Manual on Contrast Media. American College of Radiology; 2033(Version 9). P. 33-36.

Feder MT, Blitstein J, Mason B, Hoenig DM. Predicting differential renal function using computerized tomography measurements of renal parenchymal area. J Urol. 2008 Nov;180(5):2110-5.

Morrisroe SN, Su RR, Bae KT, Eisner BH, Hong C, Lahey S, Catalano OA, Sahani DV, Jackman SV. Differential renal function estimation using computerized tomography based renal parenchymal volume measurement. J Urol. 2010 Jun;183(6):2289-93. 

Nawfel RD1, Judy PF, Schleipman AR, Silverman SG. Patient radiation dose at CT urography and conventional urography. Radiology. 2004 Jul;232(1):126-32.