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First published online September 13, 2006
British Journal of Radiology (2006) 79, 935-942
© 2006 British Institute of Radiology
doi: 10.1259/bjr/53140218
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A simple processing method allowing comparison of renal enhancing volumes derived from standard portal venous phase contrast-enhanced multidetector CT images to derive a CT estimate of differential renal function with equivalent results to nuclear medicine quantification

J C Fowler, MA, FRCR, MSc C Beadsmoore, MBBS, MRCP, FRCR M T G Gaskarth, MA, FRCS, FRCR H K Cheow, MBChB, FRCR, MSc R Bernal, MD, MSc P Hegarty, FRCS (Urol), MCh K N Bullock, MD, FRCS H Taylor, MA, MRCP, FRCR A K Dixon, MD, FRCR, FMedSci and A M Peters, MD, FRCR, FMedSci

Departments of Radiology, Nuclear Medicine and Urology, Addenbrooke's Hospital and the University of Cambridge, Cambridge, UK


Figure 1
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  		Figure 1. Snapshot of Leonardo volume analysis software showing right(orange) and left (pink) renal volume of interest (VOI). Windowing has been applied to exclude perirenal and pelvicalyceal fat.

 

Figure 2
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  		Figure 2. (a) Correlation of contrast enhanced multidetector CT (CEMDCT) and nuclear medicine (NM)-derived differential renal function (DRF) with respect to the contribution by the left kidney (n = 25). (b) Correlation of non-enhanced volume from MDCT and NM-derived DRF with respect to the contribution by the left kidney (n = 25).

 

Figure 3
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  		Figure 3. Bland Altman plot of contrast enhanced multidetector CT(CEMDCT) and nuclear medicine (NM)-derived differential renal function (DRF) with respect to the contribution by the left kidney.

 

Figure 4
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  		Figure 4. Renal time-concentration curve of a small volume bolus indicator injection cleared by glomerular filtration indicating phases 1 (perfusion phase), 2 (uptake phase, terminating at the minimum parenchymal transit time (MPTT)) and 3 (drainage phase).

 

Figure 5
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  		Figure 5. (a) Contrast enhanced multidetector CT (CEMDCT) coronal reformat of patient 23 showing lack of enhancement of the right kidney. (b) 99Tcm-dimercaptosuccinic acid (DMSA) image of patient 23. CEMDCT derived differential renal function (DRF) agreed with nuclear medicine (NM) result that the right kidney was non-functioning. Unenhanced CT volume could not have been used as a method of deriving NM equivalent DRF.

 

Figure 6
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  		Figure 6. (a) Contrast enhanced multidetector CT (CEMDCT) coronal reformat of patient 12 showing similar attenuation of enhancing renal tissue and enhancing renal cell carcinoma. The volume and attenuation data would have included the tumour. (b) Early 99Tcm-mercaptoacetyltriglycine (MAG3) renography images show exclusion of the renal cell carcinoma. The described method for CEMDCT derived differential renal function (DRF) will overestimate the contribution made by the RCC containing kidney.

 




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