CT perfusion in the treatment of a swine model of unilateral renal artery stenosis: validation with microspheres.
OBJECTIVE
To assess the feasibility of using current computed tomography (CT) perfusion techniques for evaluating unilateral renal artery stenosis (RAS) with assessment of pre- and posttreatment perfusion and to compare those results against the standard of microsphere injection.


METHODS
Six juvenile swine with surgically created right RAS were examined in a combined angiography-CT suite. CT perfusion, injection of fluorescent microspheres, and digital subtraction angiography were performed before and after release of the stenosis. Cortical horseshoe-shaped regions of interest were used to measure blood flow (in milliliters/[100 g min]). Two cortical samples (superior and inferior) from each kidney were excised and sent to a reference laboratory for microsphere analysis. The relative blood flow ratio (RBFR) and posttherapy increase in blood flow were determined. The Pearson product correlation was calculated to compare the absolute blood flow, pretherapy RBFR, and posttherapy increase in blood flow between the two techniques. Bland-Altman analysis of the absolute blood flow measurements was performed.


RESULTS
Forty-eight blood flow measurements showed moderate correlation (r = 0.712, P < .001). However, Bland-Altman plots (bias, -19.21; limits of agreement, -156.1 to 117.7 mL/[100 g . min]) showed poor agreement. Measurements of RBFR with CT correlated well with microsphere data. Pretherapy RBFR showed moderate correlation with microsphere data (r = 0.859, P < .001, n = 12), whereas the posttherapy increase in blood flow was highly correlated (r = 0.898, P < .001, n = 12).


CONCLUSIONS
CT perfusion and microspheres produce similar indexes of relative renal cortical perfusion when normalized to the unaffected kidney. Further work is needed to determine the clinical utility of CT perfusion for pre- and posttherapy decision making.
Paul
Russell K
RK
Division of Interventional Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI 53792-3252, USA. jondomd@yahoo.com
Lum
Darren P
DP
Consigny
Daniel W
DW
Grinde
Julie R
JR
Grist
Thomas M
TM
D000792:Angiography / Q000379:methods*; D000818:Animals; D001783:Blood Flow Velocity; D003287:Contrast Media; D004195:Disease Models, Animal; D005240:Feasibility Studies; D006801:Humans; D008863:Microspheres; D011379:Prognosis; D011856:Radiographic Image Enhancement / Q000379:methods*; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D013552:Swine; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media