| Literature DB >> 31375734 |
Hyo Sang Lee1, Yeon-Koo Kang2, Hyunjong Lee2, Jeong Hee Han3, Byung Seok Moon3, Seok-Soo Byun4, Dong-Wan Chae5, Keon Wook Kang6,7, Won Woo Lee8,9.
Abstract
Accurate measurement of glomerular filtration rate (GFR) is essential for optimal decision making in many clinical settings of renal failure. We aimed to show that GFR can be accurately measured using compartmental tracer kinetic analysis of 18F-fluoride dynamic PET/CT. Twenty-three male Sprague-Dawley rats of three experimental groups (cyclosporine-administered [n = 8], unilaterally nephrectomized [n = 8], and control [n = 7]) underwent simultaneous 18F-fluoride dynamic PET/CT and reference 51Cr-EDTA GFR (GFRCrEDTA) test at day 0 and post-intervention day 3. 18F-fluoride PET GFR (GFRF-PET) was calculated by multiplying the influx rate and functional kidney volume in a single-tissue-compartmental kinetic model. Within-test repeatability and between-test agreement were evaluated by intraclass correlation coefficient (ICC) and Bland-Altman analysis. In the control group, repeatability of GFRF-PET was excellent (ICC = 0.9901, repeatability coefficient = 12.5%). GFRF-PET significantly decreased in the renally impaired rats in accordance with respective GFRCrEDTA changes. In the pooled population, GFRF-PET agreed well with GFRCrEDTA with minimal bias (-2.4%) and narrow 95% limits of agreement (-25.0% to 20.1%). These data suggest that the single-compartmental kinetic analysis of 18F-fluoride dynamic PET/CT is an accurate method for GFR measurement. Further studies in humans are warranted.Entities:
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Year: 2019 PMID: 31375734 PMCID: PMC6677809 DOI: 10.1038/s41598-019-47728-x
Source DB: PubMed Journal: Sci Rep ISSN: 2045-2322 Impact factor: 4.379
Model parameters.
| Group | Number of kidneys | VC (cm3) | vB | K1 (ml/cm3/min) | k2 (min−1) | |
|---|---|---|---|---|---|---|
| Cyclosporine | Baseline | 16 | 1.022 ± 0.074 | 0.111 ± 0.034 | 1.109 ± 0.259 | 0.802 ± 0.179 |
| Post | 16 | 1.021 ± 0.074 | 0.125 ± 0.036 | 0.978 ± 0.244 | 0.764 ± 0.215 | |
| Nephrectomy | Baseline | 16 | 1.150 ± 0.072 | 0.106 ± 0.027 | 0.967 ± 0.175 | 0.783 ± 0.221 |
| Post | 8 | 1.178 ± 0.057 | 0.133 ± 0.039 | 1.043 ± 0.100 | 0.958 ± 0.024 | |
| Control | 1st | 14 | 1.067 ± 0.135 | 0.093 ± 0.026 | 1.009 ± 0.269 | 0.787 ± 0.215 |
| 2nd | 14 | 1.065 ± 0.135 | 0.105 ± 0.029 | 1.043 ± 0.277 | 0.820 ± 0.215 |
The figures are expressed as mean ± standard deviation.
VC, renal cortical volume; vB, blood volume fraction; K1, influx constant; k2, efflux constant.
Figure 1Bland-Altman plots for repeatability of (A) GFRF-PET and (B) GFRCrEDTA. The solid lines represent biases, and the dashed lines represent 95% limits of agreement. Difference (%) = 100 × (GFR1st − GFR2nd)/(mean of GFR1st and GFR2nd).
GFR in subgroups.
| Subgroup | 18F-fluoride PET GFR (ml/min) | 51Cr-EDTA GFR (ml/min) | ||||
|---|---|---|---|---|---|---|
| Baseline | Post | Baseline | Post | |||
| Cyclosporine | 2.01 ± 0.43 | 1.73 ± 0.33 | 0.0113 | 2.08 ± 0.35 | 1.82 ± 0.38 | 0.0300 |
| Nephrectomy | 1.98 ± 0.34 | 1.06 ± 0.08 | 0.0001 | 1.97 ± 0.35 | 1.21 ± 0.07 | 0.0009 |
| Control | 1.98 ± 0.69 | 2.01 ± 0.69 | 0.4415 | 1.93 ± 0.68 | 1.90 ± 0.62 | 0.7603 |
Figure 2Agreement between GFRF-PET and GFRCrEDTA in the total population (46 measurements). (A) The scatterplot. (B) The Bland-Altman plot. Difference (%) = 100 × (GFRF-PET − GFRCrEDTA)/(mean of GFRF-PET and GFRCrEDTA).
Accuracy statistics.
| Group | ICC | 95% CI for ICC | Relative difference (%) | Absolute difference (ml/min) | P30 | P10 | ||
|---|---|---|---|---|---|---|---|---|
| Bias | LOA | Bias | LOA | |||||
| Total | 0.937 | 0.889–0.965 | −2.4 | −25.0 to 20.1 | −0.027 | −0.401 to 0.347 | 97.8 (45/46) | 60.9 (28/46) |
| Cys | 0.898 | 0.740–0.963 | −4.5 | −22.9 to 13.8 | −0.080 | −0.396 to 0.236 | 100 (16/16) | 81.3 (13/16) |
| Nx | 0.939 | 0.839–0.978 | −6.5 | −28.5 to 15.5 | −0.073 | −0.395 to 0.248 | 93.8 (15/16) | 50.0 (8/16) |
| Control | 0.941 | 0.833–0.981 | 4.6 | −17.9 to 27.2 | 0.086 | −0.329 to 0.502 | 100 (14/14) | 57.1 (8/14) |
ICC, intraclass correlation coefficient between 18F-fluoride PET GFR and 51Cr-EDTA GFR; CI, confidence interval; LOA, limits of agreement; Cys, cyclosporine; Nx, nephrectomy.
Figure 3Study concept. (A) A schematic diagram of the single-tissue-compartmental model. (B) Rate constants in the model.
Figure 4Study design. (A) 18F-fluoride dynamic PET/CT imaging and 51Cr-EDTA test protocol. CECT = contrast-enhanced computed tomography. (B) Animal experiment protocol.
Figure 5How to analyze the 18F-fluoride dynamic PET/CT. (A) Renal cortical regions of interest. (B) The left ventricular volume of interest. (C) 18F-fluoride PET images in the renal uptake phase (2.5 to 3 min post-injection; left panel) and excretory phase (25 to 26 min post-injection; right panel). (D) Time-activity curves of the right kidney (green), left kidney (blue), and left ventricle (red). R = right, L = left.