CT volumetric measurements correlate with split renal function in renal trauma
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UROLOGY - ORIGINAL PAPER
CT volumetric measurements correlate with split renal function in renal trauma Paul H. Chung1 · Joel A. Gross2 · Jeffrey D. Robinson2 · Judith C. Hagedorn3 Received: 16 April 2020 / Accepted: 3 June 2020 © Springer Nature B.V. 2020
Abstract Purpose To evaluate whether volumetric measurements of segmental vascular injuries (SVIs) based on computed tomography (CT) imaging obtained during an initial trauma survey correlate with future nuclear medicine (NM) split renal function. Methods A retrospective review was performed of renal trauma patients treated at a level 1 trauma center between 2008 and 2015. Patients with unilateral SVIs on initial CT imaging with follow-up NM renal scans were evaluated. CT-based split renal function was calculated by assessing the ratio of ipsilateral uninjured kidney volume to bilateral total uninjured kidney volume by two separate radiologists. Results Eight patients with unilateral SVIs on initial CT trauma evaluation underwent follow-up NM renal scans at a mean of 4 months (range 2–6) after injury. Mean NM split renal function of the injured kidney was 43% (range 22–57). Based on the CT volumetric measurements of the affected kidney, mean percent injured was 23% (range 7–62) with a calculated mean split renal function of 44% (range 23–60). Calculated mean CT split function correlated with NM split function (R = 0.89). Intraclass correlation measuring inter-rater reliability for CT volumetric measurements was 0.94 (95% confidence interval 0.72–0.99). Conclusion Volumetric measurements based on CT imaging obtained during the initial trauma evaluation correlated with future NM split renal function after SVIs with high inter-rater reliability. This method utilizes pre-existing imaging and avoids additional radiation exposure, work burden, and financial cost from a NM scan. Further evaluation is required to assess feasibility with more complex injuries. Keywords Kidney · Trauma · Function · Computed tomography · Nuclear medicine Abbreviations ALARA As low as reasonably achievable CT Computed tomography DMSA Dimercaptosuccinic acid MAG3 Mercaptoacetyltriglycine NM Nuclear medicine SVI Segmental vascular injuries
* Paul H. Chung [email protected] 1
Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St. Ste. 1100, Philadelphia, PA 19107, USA
2
Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
3
Department of Urology, University of Washington Medical Center, Seattle, WA, USA
Introduction Renal injury occurs in 1–5% of trauma patients and is most frequently due to a blunt mechanism [1]. Protocols to evaluate for renal injury with computed tomography (CT) imaging during the initial trauma evaluation and immediate recovery period are generally agreed upon; however, few recommendations exist on how and whether to follow patients over time. The American Urologic Association’s Urotrauma Guidelines recommend periodic blood pressure monitoring for up to a year af
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