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.
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Abbreviations
- ALARA:
-
As low as reasonably achievable
- CT:
-
Computed tomography
- DMSA:
-
Dimercaptosuccinic acid
- MAG3:
-
Mercaptoacetyltriglycine
- NM:
-
Nuclear medicine
- SVI:
-
Segmental vascular injuries
References
Wessells H, Suh D, Porter JR, Rivara F, MacKenzie EJ, Jurkovich GJ, Nathens AB (2003) Renal injury and operative management in the United States: results of a population-based study. J Trauma 54(3):423–430. https://doi.org/10.1097/01.TA.0000051932.28456.F4
Morey AF, Brandes S, Dugi DD, Armstrong JH, Breyer BN, Broghammer JA, Erickson BA, Holzbeierlein J, Hudak SJ, Pruitt JH, Reston JT, Santucci RA, Smith TG, Wessells H, Assocation AU (2014) Urotrauma: AUA guideline. J Urol 192(2):327–335. https://doi.org/10.1016/j.juro.2014.05.004
Itoh K (2001) 99mTc-MAG3: review of pharmacokinetics, clinical application to renal diseases and quantification of renal function. Ann Nucl Med 15(3):179–190. https://doi.org/10.1007/BF02987829
Buckley JC, McAninch JW (2011) Revision of current American Association for the Surgery of Trauma Renal Injury grading system. J Trauma 70(1):35–37. https://doi.org/10.1097/TA.0b013e318207ad5a
Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR, Flint LM, Gennarelli TA, Malangoni MA, Ramenofsky ML et al (1989) Organ injury scaling: spleen, liver, and kidney. J Trauma 29(12):1664–1666
Keller MS, Green MC (2009) Comparison of short- and long-term functional outcome of nonoperatively managed renal injuries in children. J Pediatr Surg 44(1):144–147. https://doi.org/10.1016/j.jpedsurg.2008.10.022(discussion 147)
Wessells H, Deirmenjian J, McAninch JW (1997) Preservation of renal function after reconstruction for trauma: quantitative assessment with radionuclide scintigraphy. J Urol 157(5):1583–1586
Fiard G, Rambeaud JJ, Descotes JL, Boillot B, Terrier N, Thuillier C, Chodez M, Skowron O, Berod AA, Arnoux V, Long JA (2012) Long-term renal function assessment with dimercapto-succinic acid scintigraphy after conservative treatment of major renal trauma. J Urol 187(4):1306–1309. https://doi.org/10.1016/j.juro.2011.11.103
Soga S, Britz-Cunningham S, Kumamaru KK, Malek SK, Tullius SG, Rybicki FJ (2012) Comprehensive comparative study of computed tomography-based estimates of split renal function for potential renal donors: modified ellipsoid method and other CT-based methods. J Comput Assist Tomogr 36(3):323–329. https://doi.org/10.1097/RCT.0b013e318251db15
Breau RH, Clark E, Bruner B, Cervini P, Atwell T, Knoll G, Leibovich BC (2013) A simple method to estimate renal volume from computed tomography. Can Urol Assoc J 7(5–6):189–192. https://doi.org/10.5489/cuaj.1338
Alam A, Dahl NK, Lipschutz JH, Rossetti S, Smith P, Sapir D, Weinstein J, McFarlane P, Bichet DG (2015) Total kidney volume in autosomal dominant polycystic kidney disease: a biomarker of disease progression and therapeutic efficacy. Am J Kidney Dis 66(4):564–576. https://doi.org/10.1053/j.ajkd.2015.01.030
Choi SM, Choi DK, Kim TH, Jeong BC, Seo SI, Jeon SS, Lee HM, Choi HY, Jeon HG (2015) A comparison of radiologic tumor volume and pathologic tumor volume in renal cell carcinoma (RCC). PLoS ONE 10(3):e0122019. https://doi.org/10.1371/journal.pone.0122019
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PHC—acquisition and analysis of data, drafting and final approval of the manuscript. JAG—acquisition and analysis of data, drafting and final approval of the manuscript. JDR—acquisition and analysis of data, drafting and final approval of the manuscript. JCH—analysis of data, drafting and final approval of the manuscript.
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Chung, P.H., Gross, J.A., Robinson, J.D. et al. CT volumetric measurements correlate with split renal function in renal trauma. Int Urol Nephrol 52, 2107–2111 (2020). https://doi.org/10.1007/s11255-020-02534-7
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DOI: https://doi.org/10.1007/s11255-020-02534-7