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Lateral Posterior Method for Depth Correction while Using the Gates Protocol for GFR Estimation: Is it Comparable to

Shefali Madhur Gokhale1

  • 1Department of Nuclear Medicine, Sadhu Vaswani Missions Medical Complex, Pune, Maharashtra, India.

World Journal of Nuclear Medicine
|August 22, 2024
PubMed
Summary

Depth correction in Gates protocol for glomerular filtration rate (GFR) estimation using gamma camera renography did not improve accuracy. The lateral posterior method showed less bias than the gamma camera method but neither matched plasma sampling GFR.

Keywords:
GFRGFR by plasma samplingGates protocoldepth correctionlateral posterior method

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Area of Science:

  • Nephrology
  • Nuclear Medicine
  • Radiology

Background:

  • Glomerular filtration rate (GFR) estimation using the Gates protocol with gamma camera diethylenetriaminepentaacetic acid (DTPA) dynamic renography often shows discrepancies with the gold standard plasma sampling method.
  • This inaccuracy is attributed to the general lack of consideration for kidney depth in the standard Gates protocol.
  • Investigating manual depth correction methods aims to improve the accuracy of GFR estimation in renography.

Purpose of the Study:

  • To evaluate if manual depth correction, specifically using skin-to-kidney distance in lateral view and the posterior aspect-lateral posterior (PALP) method, reduces bias in Gates GFR measurements compared to plasma sampling.
  • To compare the effectiveness of two depth correction techniques: direct gamma camera measurement and the PALP method.

Main Methods:

  • A retrospective analysis of 27 adult prospective renal donors was conducted.
  • Participants underwent both plasma sampling for gold standard GFR and DTPA dynamic renography between January 2022 and April 2023.
  • Statistical analysis was performed using SPSS version 21.0.

Main Results:

  • No significant agreement was found between plasma sampling GFR and GFR estimated by the gamma camera method with or without lateral posterior depth correction.
  • The gamma camera method with depth correction showed a lower systemic bias compared to the lateral posterior method when contrasted with plasma sampling GFR.
  • Neither depth correction method adequately reconciled the discrepancies between renographic and plasma-based GFR measurements.

Conclusions:

  • The lateral posterior method for depth correction in gamma camera-based Gates protocol GFR estimation is unreliable for adult populations in Western India with preserved renal function.
  • Further research is needed to refine GFR estimation techniques in dynamic renography to achieve better correlation with plasma-based gold standards.