Comparison of mathematic models for assessment of glomerular filtration rate with electron-beam CT in pigs

• Published in: Radiology Vol. 242; no. 2; p. 417
• Main Authors: Daghini, Elena, Juillard, Laurent, Haas, John A, Krier, James D, Romero, Juan C, Lerman, Lilach O
• Format: Journal Article
• Language: English
• Published: United States 01.02.2007
• Subjects: Acetylcholine - pharmacology; Animals; Contrast Media; Glomerular Filtration Rate - physiology; Image Processing, Computer-Assisted - methods; Inulin - pharmacokinetics; Iopamidol; Kidney - diagnostic imaging; Kidney - physiology; Kidney Cortex - diagnostic imaging; Kidney Cortex - physiology; Kidney Function Tests; Kidney Medulla - diagnostic imaging; Kidney Medulla - physiology; Kidney Tubules - diagnostic imaging; Kidney Tubules - physiology; Metabolic Clearance Rate; Models, Biological; Subtraction Technique; Swine; Tomography, X-Ray Computed - methods; Vasodilator Agents - pharmacology
• ISSN: 0033-8419; 1527-1315
• DOI: 10.1148/radiol.2422052144

To prospectively compare in pigs three mathematic models for assessment of glomerular filtration rate (GFR) on electron-beam (EB) computed tomographic (CT) images, with concurrent inulin clearance serving as the reference standard. This study was approved by the institutional animal care and use committee. Inulin clearance was measured in nine pigs (18 kidneys) and compared with single-kidney GFR assessed from renal time-attenuation curves (TACs) obtained with EB CT before and after infusion of the vasodilator acetylcholine. CT-derived GFR was calculated with the original and modified Patlak methods and with previously validated extended gamma variate modeling of first-pass cortical TACs. Statistical analysis was performed to assess correlation between CT methods and inulin clearance for estimation of GFR with least-squares regression analysis and Bland-Altman graphical representation. Comparisons within groups were performed with a paired t test. GFR assessed with the original Patlak method indicated poor correlation with inulin clearance, whereas GFR assessed with the modified Patlak method (P < .001, r = 0.75) and with gamma variate modeling (P < .001, r = 0.79) correlated significantly with inulin clearance and indicated an increase in response to acetylcholine. CT-derived estimates of GFR can be significantly improved by modifications in image analysis methods (eg, use of a cortical region of interest).