CT Imaging in Earthquake Trauma Patients with Different Levels of Creatine Kinase: Is There an Association with Renal Enhancement?

Abstract

Objectives: This study aimed to evaluate whether serum creatine kinase (CK) levels in patients with earthquake-related crush injuries are associated with alterations in renal enhancement patterns on contrast-enhanced computed tomography (CT), in the absence of overt acute kidney injury (AKI).

Methods: We retrospectively analyzed contrast-enhanced abdominopelvic CT scans of 45 adult survivors with crush injuries sustained during the 2023 earthquakes. Based on CK levels, patients were stratified into low- and high-risk groups for AKI. A control group with normal renal function and no trauma history was included. Renal perfusion was assessed by calculating enhancement ratios-specifically, the cortex-to-aorta and normalized medulla-to-cortex ratios-derived from attenuation measurements of the renal cortex, medulla, and vascular reference points. Correlation analyses were conducted to assess associations with biochemical parameters.

Results: Although none of the trauma patients developed AKI during follow-up, the cortex-to-aorta attenuation ratio was significantly lower in the high-risk group compared to controls (p = 0.042). A weak negative correlation was observed between serum CK levels and the cortex-to-aorta ratio (r = -0.295, p = 0.049). The normalized medulla-to-cortex ratio did not significantly differ between groups.

Conclusions: Contrast-enhanced CT may detect subclinical reductions in renal cortical perfusion in crush injury patients with elevated CK, even without overt AKI. The cortex-to-aorta attenuation ratio may serve as a noninvasive imaging marker of early renal involvement and warrants further investigation.

Advances in knowledge: Renal cortical hypoperfusion can be visualized on contrast-enhanced CT in asymptomatic crush injury patients, highlighting a novel radiologic marker for subclinical renal involvement.