title: CT perfusion technique for assessment of early kidney allograft dysfunction: preliminary results.
abstract: OBJECTIVE
  To assess the benefit of quantitative computed tomography (CT) perfusion for differentiating acute tubular necrosis (ATN) and acute rejection (AR) in kidney allografts.
  
  
  METHODS
  Twenty-two patients with acute kidney allograft dysfunction caused by either AR (n = 6) or ATN (n = 16) were retrospectively included in the study. All patients initially underwent a multiphase CT angiography (CTA) protocol (12 phases, one phase every 3.5 s) covering the whole graft to exclude acute postoperative complications. Multiphase CT dataset and dedicated software were used to calculate renal blood flow. Renal biopsy or clinical course of disease served as the standard of reference. Mean effective radiation dose and mean amount of contrast media were calculated.
  
  
  RESULTS
  Renal blood flow values were significantly lower (P = 0.001) in allografts undergoing AR (48.3 ± 21 ml/100 ml/min) compared with those with ATN (77.5 ± 21 ml/100 ml/min). No significant difference (P = 0.71) was observed regarding creatinine level with 5.65 ± 3.1 mg/dl in AR and 5.3 ± 1.9 mg/dl in ATN. The mean effective radiation dose of the CT perfusion protocol was 13.6 ± 5.2 mSv; the mean amount of contrast media applied was 34.5 ± 5.1 ml. All examinations were performed without complications.
  
  
  CONCLUSIONS
  CT perfusion of kidney allografts may help to differentiate between ATN and rejection.
  
  
  CONCLUSIONS
  • Quantitative CT perfusion of renal transplants is feasible. • CT perfusion could help to non-invasively differentiate AR from ATN. • CT perfusion might make some renal biopsies unnecessary.
authors: Department of Clinical Radiology, University Hospitals Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377, Munich, Germany. andreas.helck@med.uni-muenchen.de
authors: A
authors: A
authors: Helck
authors: M
authors: M
authors: Wessely
authors: M
authors: M
authors: Notohamiprodjo
authors: U
authors: U
authors: Schönermarck
authors: E
authors: E
authors: Klotz
authors: M
authors: M
authors: Fischereder
authors: F
authors: F
authors: Schön
authors: K
authors: K
authors: Nikolaou
authors: D A
authors: DA
authors: Clevert
authors: M
authors: M
authors: Reiser
authors: C
authors: C
authors: Becker
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D001783:Blood Flow Velocity; D003287:Contrast Media / Q000494:pharmacology; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007668:Kidney / Q000098:blood supply / Q000000981:diagnostic imaging*; D016030:Kidney Transplantation / Q000379:methods*; D007683:Kidney Tubular Necrosis, Acute / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010477:Perfusion; D012189:Retrospective Studies; D012984:Software; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018608:Ultrasonography, Doppler / Q000379:methods
chemical_list: D003287:Contrast Media
references: Am J Cardiol. 2006 Sep 18;98(6A):42K-58K
references: 16949380
references: Ultrasound Q. 2003 Sep;19(3):123-38
references: 14571160
references: J Am Soc Nephrol. 2002 Mar;13(3):773-778
references: 11856784
references: Invest Radiol. 2010 Jul;45(7):378-86
references: 20440213
references: J Nucl Med. 1963 Sep;4:404-9
references: 14072844
references: Kidney Int. 1996 Jul;50(1):235-42
references: 8807593
references: Kidney Int. 1999 Feb;55(2):713-23
references: 9987096
references: Eur J Radiol. 2011 Dec;80(3):692-8
references: 21111553
references: J Am Coll Cardiol. 2008 Jan 1;51(1):89-90
references: 18174044
references: Transplant Proc. 2004 Apr;36(3):753-4
references: 15110651
references: Circ Res. 2012 Jan 6;110(1):94-104
references: 22076637
references: Eur J Radiol. 1998 Oct;28(3):256-69
references: 9881262
references: Neth J Med. 2008 Nov;66(10):416-22
references: 19011267
references: Acad Radiol. 2009 Sep;16(9):1077-85
references: 19539502
references: J Am Soc Nephrol. 2003 Aug;14(8):2199-210
references: 12874476
references: Br J Radiol. 2006 Dec;79(948):968-80
references: 17213302
references: J Clin Ultrasound. 2005 Mar-Apr;33(3):127-39
references: 15756666
references: Invest Radiol. 2008 Feb;43(2):141-4
references: 18197066
references: JAMA. 1992 Jan 8;267(2):239-46
references: 1727520
references: Radiologe. 2007 Sep;47(9):778-84
references: 17717643
references: Radiology. 2011 Aug;260(2):414-20
references: 21673226
references: Circulation. 1970 Feb;41(2):217-24
references: 4904940
references: Med Phys. 2010 Feb;37(2):897-906
references: 20229899
references: N Engl J Med. 2004 Dec 23;351(26):2761-6
references: 15616214
references: J Magn Reson Imaging. 2011 Sep;34(3):595-607
references: 21761461
references: Eur Radiol. 2005 Dec;15 Suppl 5:E109-16
references: 18637238
references: Eur J Radiol. 2010 Dec;76(3):337-47
references: 20580179
references: Clin Hemorheol Microcirc. 2009;43(1-2):1-9
references: 19713597
references: Clin Hemorheol Microcirc. 2011;49(1-4):137-49
references: 22214685