Contrast-enhanced MRI for simultaneous evaluation of renal morphology and split renal function in living kidney donor candidates

Krumm, Patrick; Hupka, Tanja; Haußmann, Florian; Dittmann, Helmut; Mühlbacher, Thomas; Nadalin, Silvio; Königsrainer, Alfred; Nikolaou, Konstantin; Heyne, Nils; Krämer, Ulrich; Guthoff, Martina

doi:10.1016/j.ejrad.2021.109864

Cited by 3 publications

(10 citation statements)

References 34 publications

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“…Future studies should consider comparison of absolute values with scintigraphic results as presented by Krumm et al for contrast-enhanced MRI [27]. In general, ultrasound contrast agents are associated with very low adverse event rates and do not interact with renal function or lead to contrast-agent nephropathy [28].…”

Section: Discussionmentioning

confidence: 95%

“…To our knowledge, two studies have been published that investigated possible associations between renal function and perfusion in CEUS [17,27]. Both studies were conducted in patients with diabetic kidney disease (DKD) in comparison to control groups.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to our study, patient groups were small, with 33 and 55 patients with diabetic nephropathy. One of these studies, conducted by Ma et al, showed a positive correlation between GFR and the area under the curve (AUC) determined as a signal intensity parameter in CEUS [27]. Wang et al also reported a significantly increased area under the ascending curve for patients with early-stage DKD (eGFR (MDRD) ≥90 mL/min/1.73 m 2 ) compared to patients with moderate DKD (30-90 mL/min/1.73 m 2 ) [17].…”

Section: Discussionmentioning

confidence: 99%

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Kidney Perfusion in Contrast-Enhanced Ultrasound (CEUS) Correlates with Renal Function in Living Kidney Donors

El-Bandar

Lerchbaumer

Peters

et al. 2022

JCM

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Contrast-enhanced ultrasound (CEUS) is a widely used diagnostic tool for analyzing perfusion and characterizing lesions in several organs. However, to date, it has not been sufficiently investigated whether there is an association between CEUS findings and kidney function. This study aimed at identifying the potential relationship between kidney function and the renal perfusion status determined by CEUS in living kidney donors. A total of 30 living kidney donors examined between April 2018 and March 2020 were included in the study. All patients underwent various diagnostic procedures for evaluation of renal function. CEUS was performed in all 30 donors one day before nephrectomy. Kidney perfusion was quantified using a postprocessing tool (VueBox, Bracco Imaging). Various perfusion parameters were subsequently analyzed and compared with the results of the other methods used to evaluate kidney function. Of all parameters, mean signal intensity (MeanLin) had the strongest correlation, showing significant correlations with eGFR (CG) (r = −0.345; p = 0.007) and total kidney volume (r = −0.409; p = 0.001). While there was no significant correlation between any perfusion parameter and diethylenetriaminepentaacetic acid (DTPA), we detected a significant correlation between MeanLin and DTPA (r = −0.502; p = 0.005) in the subgroup of normal-weight donors. The results indicate that signal intensity in CEUS is associated with kidney function in normal-weight individuals. Body mass index (BMI) may be a potential confounder of signal intensity in CEUS. Thus, more research is needed to confirm these results in larger study populations.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Kidney Perfusion in Contrast-Enhanced Ultrasound (CEUS) Correlates with Renal Function in Living Kidney Donors

El-Bandar

Lerchbaumer

Peters

et al. 2022

JCM

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“…The present study showed specific changes in donor kidney perfusion based on pre-procurement CEUS in patients with post-transplantation DGF compared to non-DGF patients. To date, donor kidney quality has been assessed using imaging data, including dynamic contrast-enhanced magnetic resonance imaging (MRI), contrast-enhanced computed tomography (CT), and various types of angiography [ 18 - 20 ]. However, the inability to perform these methods at the bedside of brain-dead donors has limited their application.…”

Section: Discussionmentioning

confidence: 99%

“…imaging data, including dynamic contrast-enhanced magnetic resonance imaging (MRI), contrast-enhanced computed tomography (CT), and various types of angiography [18][19][20]. However, the inability to perform these methods at the bedside of brain-dead donors has limited their application.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasonography-based renal blood perfusion in brain-dead donors predicts early graft function

He¹,

Xu²,

Gong³

et al. 2023

Ultrasonography

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Purpose: The aim of this study was to quantify renal microcirculatory perfusion in braindead donors using contrast-enhanced ultrasonography (CEUS), and to establish an accurate, noninvasive, and convenient index for predicting delayed graft function (DGF) post-transplantation.Methods: In total, 90 brain-dead donor kidneys (training group, n=60; validation group, n=30) examined between August 2020 and November 2022 were recruited in this prospective study. CEUS was performed on the kidneys of brain-dead donors 24 hours before organ procurement and time-intensity curves were constructed. The main measures were arrival time, time to peak, and peak intensity of the kidney segmental arteries, cortex, and medulla. Recipients were divided into DGF and non-DGF groups according to early post-transplant graft function. The area under the receiver operating characteristic curve (AUC) was used to assess diagnostic performance.Results: The arrival time of the kidney segmental artery and cortex and the time interval between the time to peak of the segmental artery and cortex were identified as independent factors associated with DGF by multivariate stepwise regression analysis. A new index for the joint prediction model of three variables, the contrast-enhanced ultrasonography/Kidney Donor Profile index (CEUS-KDPI), was developed. CEUS-KDPI showed high accuracy for predicting DGF (training group: AUC, 0.91; sensitivity, 90.5%; specificity, 92.3%; validation group: AUC, 0.84; sensitivity, 75.0%; specificity, 92.3%).Conclusion: CEUS-KDPI accurately predicted DGF after kidney transplantation. CEUS may be a potential noninvasive tool for bedside examinations before organ procurement and may be used to predict early renal function after kidney transplants kidneys from donors after brain death.

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Can CT or MRI volumetry substitute scintigraphy in living kidney donor evaluation? A systematic review

López-Abad,

Prudhomme,

Pecoraro

et al. 2024

World J Urol

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Background Current potential living kidney donor’s assessment includes functional and anatomical evaluation. Scintigraphy is recommended in some cases and some centers include this test in the donor’s protocol. Recent studies advocate for the avoidance of this test as CT or MRI volumetry showed to accurately assess donor’s renal function. Objective To summarize scientific evidence on image tests for pre-donation and/or post-nephrectomy renal function evaluation. Evidence acquisition This review followed the guidelines set by the European Association of Urology and adhered to PRISMA 2020 recommendations. The protocol was registered in PROSPERO on 10th December 2022 (ID: CRD42022379273). Evidence synthesis Twenty-one studies met the inclusion criteria after thorough screening and eligibility assessment. According to QUADAS-2, patient selection and flow/timing domains showed a predominant low risk of bias. The correlation between split renal function (SRF) using CT and scintigraphy varied from weak (r = 0.21) to remarkably strong (r = 0.949). Bland–Altman agreement demonstrated moderate to excellent results, with mean differences ranging from -0.06% to 1.76%. The correlation between split renal volume (CT) and estimated glomerular filtration rate (eGFR) at 6 months or 1 year after nephrectomy showed a moderate correlation, with coefficients ranging from 0.708 to 0.83. The correlation between SRF (MRI) and renal scintigraphy reported a moderate correlation, with correlation coefficients of 0.58 and 0.84. MRI and scintigraphy displayed a good agreement, with a 66% agreement observed and mean differences of ± 0.3%. Conclusions Despite study heterogeneity, MRI or CT-based renal volumetry appears promising compared to scintigraphy, with favorable correlations and agreement.

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Contrast-enhanced MRI for simultaneous evaluation of renal morphology and split renal function in living kidney donor candidates

Cited by 3 publications

References 34 publications

Kidney Perfusion in Contrast-Enhanced Ultrasound (CEUS) Correlates with Renal Function in Living Kidney Donors

Kidney Perfusion in Contrast-Enhanced Ultrasound (CEUS) Correlates with Renal Function in Living Kidney Donors

Contrast-enhanced ultrasonography-based renal blood perfusion in brain-dead donors predicts early graft function

Can CT or MRI volumetry substitute scintigraphy in living kidney donor evaluation? A systematic review

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