Estimation of glomerular filtration rate by standard renal CT imaging.
6 affiliations
- 1Division of Radiology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
- 2Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden.
- 3Division of Transplantation Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
- 4Department of Pelvic Cancer, Genitourinary Oncology Division, Karolinska University Hospital, Stockholm, Sweden.
- 5Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
- 6Department of Radiology, Karolinska University Hospital, Stockholm, Sweden. [email protected].
Abstract
Objectives
To develop and evaluate a method to predict glomerular filtration rate (GFR) from clinical renal CT.Materials and methods
Medical records of adult living kidney donors operated between 2013 and 2022 and patients considered for neoadjuvant cisplatin prior to cystectomy between 2019 and 2024 were retrospectively reviewed. Inclusion criteria were (1) renal CT obtained at 100 or 120 kVp before and 5-15 min after contrast administration, and (2) iohexol clearance test within 2 months of imaging. The iohexol clearance test was performed on the same day as the cystatin C and creatinine measurements. Estimated GFR values included cystatin C-based eGFR (eGFRcystatin C), creatinine-based eGFR using the Cockcroft-Gault formula (eGFRCockcroft-Gault), and eGFR using the Revised Lund-Malmö formula (eGFRLMR18), which is based on both creatinine and cystatin C. Manual and automatic segmentations of the renal pelvis and bladder were performed in both the excretory and unenhanced phases.Results
In total, 139 patients were included in the analysis (mean age 52 ± 13 years; 60% women). Multivariate linear regression analysis combining the segmentation-derived variable with body surface area and age gave an adjusted R-square of 0.77 to mGFRiohexol (p < 0.001). GFRCT had the strongest relationship to mGFRiohexol with a mean absolute error of 12.8 mL/min, compared with 15.6 mL/min for eGFRCockcroft-Gault, 14.2 mL/min for eGFRcystatin C, and 13.0 mL/min for eGFRLMR18. Manual and automatic segmentations had similar performance. Patients evaluated for cisplatin treatment had greater variation in CT-estimated split renal function than donors.Conclusion
Renal function can be estimated with high precision from clinical renal CT.Key points
Question Accurate GFR assessment is critical, but current methods are either labor-intensive or imprecise. Can renal CT imaging provide a reliable alternative? Findings CT-derived eGFR showed the strongest correlation with iohexol clearance (R² = 0.77), with lower error compared to creatinine- and cystatin C-based estimates. Critical relevance statement Routine CT imaging can provide precise estimates of kidney function, supporting donor evaluations, chemotherapy dosing, and critical care decisions when accurate renal function is essential.
Related
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- A randomized trial of high versus low serum bicarbonate targets and glomerular filtration rate decline in stage 3–4 chronic kidney disease
- Molecular anatomy of the glomerular filtration barrier reveals topology-encoded albumin sieving
- Anemia and Red-Cell Size Across Estimated Glomerular Filtration Rate in a Hospital Laboratory Cohort
BibTeX
@article{sola2026estimation,
title = {{Estimation of glomerular filtration rate by standard renal CT imaging.}},
author = {Kristoffer Huitfeldt Sola and Helena Genberg and Joshua Webster-Ford and Anders Ullén and Torkel B Brismar},
journal = {Insights into imaging},
year = {2026},
month = oct,
doi = {10.1186/s13244-026-02431-0},
url = {https://europepmc.org/article/MED/42875613},
note = {CC BY},
}
RIS
TY - JOUR
TI - Estimation of glomerular filtration rate by standard renal CT imaging.
AU - Kristoffer Huitfeldt Sola
AU - Helena Genberg
AU - Joshua Webster-Ford
AU - Anders Ullén
AU - Torkel B Brismar
PY - 2026
DA - 2026/10/14
JO - Insights into imaging
DO - 10.1186/s13244-026-02431-0
UR - https://europepmc.org/article/MED/42875613
AB - Objectives To develop and evaluate a method to predict glomerular filtration rate (GFR) from clinical renal CT.Materials and methods Medical records of adult living kidney donors operated between 2013 and 2022 and patients considered for neoadjuvant cisplatin prior to cystectomy between 2019 and 2024 were retrospectively reviewed. Inclusion criteria were (1) renal CT obtained at 100 or 120 kVp before and 5-15 min after contrast administration, and (2) iohexol clearance test within 2 months of imaging. The iohexol clearance test was performed on the same day as the cystatin C and creatinine measurements. Estimated GFR values included cystatin C-based eGFR (eGFRcystatin C), creatinine-based eGFR using the Cockcroft-Gault formula (eGFRCockcroft-Gault), and eGFR using the Revised Lund-Malmö formula (eGFRLMR18), which is based on both creatinine and cystatin C. Manual and automatic segmentations of the renal pelvis and bladder were performed in both the excretory and unenhanced phases.Results In total, 139 patients were included in the analysis (mean age 52 ± 13 years; 60% women). Multivariate linear regression analysis combining the segmentation-derived variable with body surface area and age gave an adjusted R-square of 0.77 to mGFRiohexol (p < 0.001). GFRCT had the strongest relationship to mGFRiohexol with a mean absolute error of 12.8 mL/min, compared with 15.6 mL/min for eGFRCockcroft-Gault, 14.2 mL/min for eGFRcystatin C, and 13.0 mL/min for eGFRLMR18. Manual and automatic segmentations had similar performance. Patients evaluated for cisplatin treatment had greater variation in CT-estimated split renal function than donors.Conclusion Renal function can be estimated with high precision from clinical renal CT.Key points Question Accurate GFR assessment is critical, but current methods are either labor-intensive or imprecise. Can renal CT imaging provide a reliable alternative? Findings CT-derived eGFR showed the strongest correlation with iohexol clearance (R² = 0.77), with lower error compared to creatinine- and cystatin C-based estimates. Critical relevance statement Routine CT imaging can provide precise estimates of kidney function, supporting donor evaluations, chemotherapy dosing, and critical care decisions when accurate renal function is essential.
SN - 1869-4101
ER -