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Inclusion criteria were (1) renal CT obtained at 100 or 120 kVp before and 5\u201315\u2009min 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\u2013based eGFR (eGFR\n                      <jats:sub>cystatin C<\/jats:sub>\n                      ), creatinine-based eGFR using the Cockcroft\u2013Gault formula (eGFR\n                      <jats:sub>Cockcroft-Gault<\/jats:sub>\n                      ), and eGFR using the Revised Lund\u2013Malm\u00f6 formula (eGFR\n                      <jats:sub>LMR18<\/jats:sub>\n                      ), 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 139 patients were included in the analysis (mean age 52\u2009\u00b1\u200913 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 mGFR\n                      <jats:sub>iohexol<\/jats:sub>\n                      (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). GFR\n                      <jats:sub>CT<\/jats:sub>\n                      had the strongest relationship to mGFR\n                      <jats:sub>iohexol<\/jats:sub>\n                      with a mean absolute error of 12.8\u2009mL\/min, compared with 15.6\u2009mL\/min for eGFR\n                      <jats:sub>Cockcroft-Gault<\/jats:sub>\n                      , 14.2\u2009mL\/min for eGFR\n                      <jats:sub>cystatin C<\/jats:sub>\n                      , and 13.0\u2009mL\/min for eGFR\n                      <jats:sub>LMR18<\/jats:sub>\n                      . Manual and automatic segmentations had similar performance. Patients evaluated for cisplatin treatment had greater variation in CT-estimated split renal function than donors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Renal function can be estimated with high precision from clinical renal CT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      Accurate GFR assessment is critical, but current methods are either labor-intensive or imprecise. Can renal CT imaging provide a reliable alternative?\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      CT-derived eGFR showed the strongest correlation with iohexol clearance (R\u00b2 = 0.77), with lower error compared to creatinine- and cystatin C\u2013based estimates.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Critical relevance statement<\/jats:italic>\n                      <\/jats:bold>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13244-026-02431-0","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T04:43:12Z","timestamp":1792039392000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Estimation of glomerular filtration rate by standard renal CT imaging"],"prefix":"10.1186","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9278-3326","authenticated-orcid":false,"given":"Kristoffer","family":"Huitfeldt Sola","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7851-1941","authenticated-orcid":false,"given":"Helena","family":"Genberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0679-0910","authenticated-orcid":false,"given":"Joshua","family":"Webster-Ford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Ull\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3409-1938","authenticated-orcid":false,"given":"Torkel B.","family":"Brismar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"2431_CR1","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1053\/j.ajkd.2021.04.016","volume":"78","author":"LA Inker","year":"2021","unstructured":"Inker LA, Titan S (2021) Measurement and estimation of GFR for use in clinical practice: core curriculum 2021. 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