glomerular filtration rate with mdct€¦ · chade et al circulation, 2001. chade et al...
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![Page 1: Glomerular filtration rate with MDCT€¦ · Chade et al Circulation, 2001. Chade et al Circulation, 2001. PATIENTS Hypertension Unilateral RAS with FMD MR or Conventional angiography](https://reader034.vdocuments.mx/reader034/viewer/2022042917/5f5acc9a8a34f73d67381173/html5/thumbnails/1.jpg)
Glomerular filtration rate with MDCT
Dr Laurent Juillard, MD, PhDDépartement de Néphrologie, H. E. HerriotInserm ERI 22, Université de Lyon.Lyon, France
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• Functional parameter definition • Tools : – EBCT – Spiral CT – MDCT
•Modeling methods – Gamma variate– Patlak
• Experimental data
Outline
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The challenge of renal functional evaluation
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Renal Functional Imaging
MRI PETCT SCAN / EBCTMDCT•Non invasive evaluation
• Split renal function
•Absolute quantification
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Renal Functional parameters
Tissue InjuryBlood FlowPerfusion
REDUCTION Glomerular Filtration Rate
Oxygencontent GFROxydative
metabolism
CT , MR
CT , PET
PETMR BOLD CT, MR
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•Gamma variate : »Glomerular filtration rate»Renal blood flow»Renal perfusion
Electron Beam Computed-Tomography
MDCT
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• EBCT cardiac and renal functional imaging – Cortical and medulla volume– Regional blood flow, tissue perfusion– Glomerular filtration rate
• Split renal function
• Few evaluation in humans– Breath control
Electron Beam Computed-Tomography
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EBCT: Principles
High temporal resolutionGood spatial resolution
Multi slices
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Krier et al AJP, 2001
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INJECTION VVC : 0,5 mL/kg, 15 mL/s
EBCT: gamma variate
Krier et al AJP, 2001
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METHODS
0
20
40
60
80
100
120
0 50 100 150 200 250Temps (s)
Dens
ité C
ortic
ale (H
U)DataVasculaireProximalDistalTotal
Renal blood flowGlomerular filtration rate
INJECTION VVC : 0,5 mL/kg, 15 mL/s
Intratubular concentration Index
Time (s)Cortical density (HU)
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Krier et al AJP, 2001
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Chade et al Circulation, 2001
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Chade et al Circulation, 2001
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PATIENTS
Hypertension
Unilateral RAS with FMD
MR or Conventional angiography
« Hemodynamically significant » US
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Results: Regional Volumes
05
1015202530354045
Sténose Contra-lateralRein
Volum
e Rég
ional
(cm3
) CortexMedulla*
Stenosis Kidney ContralateralRegional volume (cm3)
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Results: Blood Flow
0
50
100
150
200
250
Sténose Contra-lateralRein
Débit
Sang
uin R
énal
Régio
nal
(ml/m
in) CortexMedulla
*
Stenosis Kidney Contralateral
Regional Blood Flow
(mL/m
in)
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Results: Perfusion
0
1
2
3
4
5
Sténose Contra-lateralRein
Perfu
sion R
égion
ale
(ml/m
in/g)
CortexMedulla
Stenosis Kidney Contralateral
Regional perfusion
(mL/m
in/g)
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0
5
10
15
20
25
30
35
1 2Rein
DFG
(ml/m
in)
Results: GFR
Sténose Contro-lateralStenosis Kidney Contralateral
Glomerular Flow Rate
(mL/m
in)
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Pelaez et al NDT, 2005
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Pelaez et al NDT, 2005
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MDCT : Principles
Vs EBCTIdentical parameters
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Daghini et al, Radiology, 2007
CorticalTDC MDCT EBCT
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Daghini et al, Radiology, 2007
MDCT EBCTMedullaTDC
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Daghini et al, Radiology, 2007
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Daghini et al, Radiology, 2007
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Gloviczki et al, Hypertension 2010
14 patients with ARAS14 patients with EHMRI BOLD for oxygen contentMDCT study
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Gloviczki et al, Hypertension 2010
GFR ??
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•Patlak : Glomerular filtration rate
Spiral CT Scanner
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Tsushima et al, AJKD 99
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Tsushima et al, AJKD 99
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Tsushima et al, AJR 01
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Tsushima et al, AJR 01
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Hackstein et al, Radiology 05
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Hackstein et al, Radiology 05
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Hackstein et al, Radiology 05
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Patlak GFR• Correlation between GFR Patlak and– Creatinine clairance– EDTA scintigraphy
• BUT– ROI cortex AND medulla– No comparaison with reference method
Dawson, Invest Radiol, 1993Miles, Br J Radiol, 1999Tsushima, AJKD, 1999Hackstein, Eur Radiol, 2001
Tsushima, AJKD, 1999
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Daghini et al, Radiology, 2007
PATLAK
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PATLAK r=0.12
Gamma Variater=0.79
PATLAK modified r=0.75
Daghini et al, Radiology, 2007
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PATLAK
Gamma Variate -12+/-10
PATLAK modified -29+/- 12
Daghini et al, Radiology, 2007
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Summary CTMost powerful method
GFR, RBF, Perfusion, ICT, Volume But
Remain invasiveContrast media toxicity
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Validation ofRenal Perfusion and Glomerular Filtration Rate measurement with MDCT and low rate CM
Injection. Sandrine LEMOINE, Laurent JUILLARD
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Aim •Validation of the measurement of–Cortical perfusion–Glomerular filtration rate
using MDCT•With a low rate CM injection (3mL/s) and using a peripheral vein injection•Using the gamma variate modeling •Using fluorescent microspheres as a reference for RBF and Inulin clearance for GFR
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Images dynamiques sur 144 secondes au niveau d’une coupe du porc n°6 après injection de dopamine. Une image toute les secondes les 30 premières secondes puis
une image toutes les 6 secondes
Materiel et Methods
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Régions d’intérêt tracée manuellement
Materiel et Methods
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Vascular
Proximal peak
= Perfusion
= GFR
Gamma variate
Materiel et Methods
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• 10 pigs• Protocole:
Dopamine10 µg/kg/min
Dopamine + SSI10 µg/kg/min
Angiotensine II(500ng/kg/min)
Sacrifice
DFG 3Urine + blood
DFG 1Urine + blood
DFG 2Urine + blood
MS 1 = Perf 1
MS 2= Perf 2
MS 3=Perf 3
MDCT:PERF 1GFR 1
MDCT:PERF 3GFR 3
MDCT:PERF 2GFR 2
Materiel et Methods
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Dopamine Dopamine + SSI
Angiotensine II
NS
NS
NSNS *
Perfusion scannerPerfusion microsphères
*
Results Perfusion
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Corrélation entre les mesures de perfusion avec le scanner et avec les microsphères.
y = 0,8421x + 0,2496R2 = 0,8758
R = 0,93
0
1
2
3
4
5
6
0 1 2 3 4 5 6Perfusion Microspheres
(mL.min.-1.g-1)
Perfu
sion
MDC
T (m
L.min.
-1.g-1
)p<0.0001
Results Perfusion
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-5
-4
-3
-2
-1
0
1
2
3
4
5
0 1 2 3 4 5 6
Mean (mL/min/g)
Perfu
sion
MDC
T-M
S
– 0,2 +/- 0,3 mL/min
Results Perfusion
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Corrélation entre les mesures de DFG mesurée avec la clairance de l’inuline et avec le scanner.
R2 = 0,0006
020406080
100120140160
0 10 20 30 40 50 60GFR MDCT (ml/min)
GFR
inulin
e (ml
/min)
Results GFR gamma variate
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Corrélation entre les mesures de DFG mesurée avec la clairance de l’inuline et avec le scanner.
Results GFR Patlak
y = 0,4844x + 13,186R2 = 0,4192
0
1020
30
4050
60
0 20 40 60 80GFR Patlak (mL/min)
GFR
Inulin
(mL/m
in)
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ConclusionMost powerful functional imaging modality for quantitative assessment of renal performance
Limits : CM toxicity and high rate injection for gamma variate
Low rate injection : compartmental modeling to be tested for GFR