Comparison of four different multi-detector computed tomography based split renal function (SRF) evaluation methods and their correlation with nuclear scintigraphy derived SRF for functional assessment of potential living renal donors

Background and Objectives: Preoperative anatomical and functional evaluation of donor kidneys is crucial for successful renal transplantation. While multi-detector computed tomography (MDCT) angiography is the standard imaging modality for anatomical assessment, nuclear scintigraphy using Technetium-99m Diethylenetriamine Pentaacetate (Tc-99m DTPA) remains the gold standard for evaluating split renal function (SRF). However, MDCT-based SRF estimation has recently emerged as a viable alternative. The aim of this study is to compare four different MDCT-based SRF measurement techniques and assess their correlation with SRF obtained from nuclear scintigraphy. Materials and Methods: This prospective study included 111 living kidney donors from 2019 to 2021 who underwent MDCT angiography. SRF was estimated using four CT-based methods: total renal volume, cortical renal volume, ellipsoid method (all using semi-automated ROI-Region of Interest), and differential attenuation of contrast. All measurements were performed using an Advantage Workstation (GE). The calculated SRFs were compared with Tc-99m DTPA-based SRF using the Pearson correlation coefficient. Results: The mean age of donors was 44.32±10.25 years (range: 22–69). All four MDCT-based methods showed statistically significant correlation with nuclear scintigraphy SRF. For the right kidney, correlation coefficients (r) were 0.574 (total renal volume), 0.509 (cortical volume), 0.288 (ellipsoid method), and 0.323 (contrast attenuation); for the left kidney, r-values were 0.513, 0.473, 0.262, and 0.251, respectively (all p