Clinical Study Of CT Technique In Evaluating Glomerular Filtration Rate In Patients With Renal Tumor And Hydronephrosis

PartI Quantitative evaluation of single-kidney function in renal tumorand hydronephrosis patients by CT urographyPurpose:To evaluate the clinical value of CT urography in quantitative analysis of single-kidney glomerular filtration rate in patients with renal tumor and hydronephrosis,and with the ^99mTc-DTPA dynamic imaging GFR obtained by using the“Gates”method as the reference standard.Methods:A total of 39 patients with renal tumor or hydronephrosis from January 2018 to June 2018 in the Second Hospital of Tianjin Medical University were prospectively collected.In all cases,the CT urography and ^99mTc-DTPA renal dynamic imaging datas and related clinical datas were collected.Paired-sample t test,Pearson Correlation analysis and Bland-Altman mapping method were used to analyze the relationship between CT-GFR and Gates-GFR in single kidney,tumor,hydrops and healthy groups.The relationship between CT-GFR,Gates-GFR and RPV in varous groups were analyzed by Pearson Correlation analysis.Results:Paired difference between single-kidney CT-GFR?48.76±18.50?ml·min^-1·1.73m^-2 and single-kidney Gates-GFR?45.68±17.95?ml·min^-1·1.73m^-2 was?3.10±11.48?ml·min^-1·1.73m^-2,P<0.05,demonstrating 6.8%systemic overestimation.A good correlation?r=0.80,P<0.001?and consistency(±22.50 ml·min^-1·1.73m^-2,±49.2%measurement deviations)was revealed between both measurements.There were positive correlations between CT-GFR and Gates-GFR in the renal tumor group,hydronephrosis group,and healthy kidney group?r=0.67,0.916,0.80;P<0.001?respectively,and with good agreement.Pearson Correlation analysis showed that the correlations between CT-GFR and RPV in all groups were better than the correlation between Gates-GFR and RPV.Conclusions:This study demonstrated the feasibility of using CT urography to measure single-kidney GFR,verifying its application value in diseases such as kidney tumors and obstructive hydronephrosis,and proved that the proposed single-kidney CT-GFR correlates better than the Gates-GFR with RPV;therefore,this one-stop-shop CT technique has important clinical significance despite slight systemic overestimation,and expected to be an important alternative method to measure single-kidney GFR clinically.PARTII Applicability assessment of creatinine-based and CT technology determinated volume-based GFR estimation equation in patients with renal tumor and hydronephrosisPurpose: The CT 3D post-processing technique was used to measure the volume of the kidney and urinary system,and to compare the performance of the creatinine method and CT technology determinated volume-based GFR estimation equations in renal tumors and hydronephrosis patients.Methods: Prospective study was performed to analyze the serological and imaging data of 40 patients with renal tumor and hydronephrosis.GFR measured by 99mTc-DTPA clearance using the Gates method?Gates-GFR?was normalized by the surface area as a reference standard.The e GFR was measured using creatinine-based GFR estimation equations?C-G equation,CKD-EPI equation,simplified MDRD equation,and revised MDRD equation?and volume-based GFR estimation equations?Herts-GFR equation,Choi-GFR equation,CT-GFR equation?.Compare the correlation,bias,accuracy and consistency of e GFR with Gates-GFR.Results: The level of Gates-GFR in 40 patients with renal tumor and hydronephrosis was?91.30±23.70?ml·min-1·1.73m-2.Pearson correlation analysis showed that the coefficients of creatinine-based equations e GFR and Gates-GFR ranged from 0.447 to 0.602?P<0.05?,and the C-G equation?r=0.602,P<0.05?has the highest correlation.And the correlation coefficient range from 0.521 to 0.751 among volume-based equations,whereas CT-GFR and Gates-GFR had the highest correlation coefficient of 0.751.In addition,CT-GFR and Gates-GFR had the smallest deviation?5.72 ml·min-1·1.73m-2?and the highest 10% coincidence rate?47.5%?.Meanwhile,the Bland-Altman method showed that the CT-GFR equation had the smallest consistency interval.Conclusion: The CT technology determinated volume-based GFR estimation equation is more suitable for the estimation of GFR in renal tumor and hydronephrosis patients than the creatinine-based GFR equation,and CT-GFR has the best applicability.