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Single-slice dynamic computed tomographic determination of glomerular filtration rate by use of Patlak plot analysis in anesthetized pigs

Kate Alexander DMV, MSc1, Jérôme R. E. del Castillo DMV, PhD2, Norma Ybarra MVZ3, Valérie Morin BSc4, Domianique Gauvin BSc5, Simon Authier DMV, MSc6, Patrick Vinay MD, PhD7, and Éric Troncy DV, PhD, DUn8
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  • 1 Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 7C6, Canada
  • | 2 Department of Veterinary Biomedicine, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 7C6, Canada
  • | 3 Department of Veterinary Biomedicine, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 7C6, Canada
  • | 4 Department of Veterinary Biomedicine, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 7C6, Canada
  • | 5 Department of Veterinary Biomedicine, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 7C6, Canada
  • | 6 Department of Veterinary Biomedicine, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 7C6, Canada
  • | 7 Department of Medicine, Centre Hospitalier de l'Université de Montréal–Notre-Dame Hospital, 1560 Sherbrooke St E, Montreal, QC H2L 4M1, Canada
  • | 8 Department of Veterinary Biomedicine, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 7C6, Canada

Abstract

Objective—To compare glomerular filtration rate (GFR) as estimated from Patlak plot analysis by use of single-slice computed tomography (CT) with that obtained from clearance of plasma inulin in pigs.

Animals—8 healthy anesthetized juvenile pigs.

Procedures—All pigs underwent precontrast, whole-kidney, helical CT; postcontrast single-slice dynamic CT; and postcontrast, whole-kidney CT for volume determination. On dynamic images, corrected Hounsfield unit values were determined for each kidney and the aorta. A Patlak plot for each kidney was generated, and plasma clearance per unit volume was multiplied by renal volume to obtain whole-animal contrast clearance. Mean GFR determined via inulin clearance (Inu-GFR) was measured from each kidney and correlated to mean GFR determined via CT (CT-GFR) for the left kidney, right kidney, and both kidneys by use of linear regression and Bland-Altman analyses.

Results—CT-GFR results from 7 pigs were valid. Total and right kidney Inu-GFR were correlated with total and right kidney CT-GFR (total, R 2 = 0.85; right kidney, R 2 = 0.86). However, left kidney CT-GFR was poorly correlated with left kidney Inu-GFR (R 2 = 0.47). Bland-Altman analysis revealed no significant bias between Inu-GFR and CT-GFR for the left kidney, right kidney, or both kidneys.

Conclusions and Clinical Relevance—CT-GFR as determined by use of a single-slice acquisition technique, low-dose of iohexol, and Patlak plot analysis correlated without bias with Inu-GFR for the right kidney and both kidneys (combined). This technique has promise as an accurate CT-GFR method that can be combined with renal morphologic evaluation.

Abstract

Objective—To compare glomerular filtration rate (GFR) as estimated from Patlak plot analysis by use of single-slice computed tomography (CT) with that obtained from clearance of plasma inulin in pigs.

Animals—8 healthy anesthetized juvenile pigs.

Procedures—All pigs underwent precontrast, whole-kidney, helical CT; postcontrast single-slice dynamic CT; and postcontrast, whole-kidney CT for volume determination. On dynamic images, corrected Hounsfield unit values were determined for each kidney and the aorta. A Patlak plot for each kidney was generated, and plasma clearance per unit volume was multiplied by renal volume to obtain whole-animal contrast clearance. Mean GFR determined via inulin clearance (Inu-GFR) was measured from each kidney and correlated to mean GFR determined via CT (CT-GFR) for the left kidney, right kidney, and both kidneys by use of linear regression and Bland-Altman analyses.

Results—CT-GFR results from 7 pigs were valid. Total and right kidney Inu-GFR were correlated with total and right kidney CT-GFR (total, R 2 = 0.85; right kidney, R 2 = 0.86). However, left kidney CT-GFR was poorly correlated with left kidney Inu-GFR (R 2 = 0.47). Bland-Altman analysis revealed no significant bias between Inu-GFR and CT-GFR for the left kidney, right kidney, or both kidneys.

Conclusions and Clinical Relevance—CT-GFR as determined by use of a single-slice acquisition technique, low-dose of iohexol, and Patlak plot analysis correlated without bias with Inu-GFR for the right kidney and both kidneys (combined). This technique has promise as an accurate CT-GFR method that can be combined with renal morphologic evaluation.

Contributor Notes

Supported in part by the Université de Montréal and a grant by the Canadian Institutes of Health Research/Heart and Stroke Foundation of Canada–New Emerging Team (No. 108291) program.

The authors thank Guy Beauchamp for assistance with the statistical analysis.

Address correspondence to Dr. Alexander.