In Vivo Peritoneal Surface Area Measurement in Rats by Micro-Computed Tomography (μCT)

Peritoneal dialysis (PD) uses the dynamic dialysis properties of the peritoneal membrane. The fraction of the anatomic peritoneal surface area (PSA) recruited is of importance for maximizing exchanges and is potentially impacted by parameters such as fill volume. We describe an in vivo assessment of the contact surface area by micro-computed tomography (μCT) using an iodinated contrast medium added to the PD fluid, a contrast agent presumed without surfactant property. In the isotropic volume (reconstructed voxel size 186 μm x 186 μm x 186 μm), the iodinated PD fluid is automatically selected, thanks to its contrast difference with soft tissues, and its surface area is computed. The method was first tested on phantoms showing the ability to select the PD fluid volume and to measure its surface area. In vivo experiments in rat consisted of μCT acquisition of rat abdomen directly after intraperitoneal administration (10 mL/100 g rat body weight) of a dialysis fluid containing 10% by volume iodinated contrast agent. Fluorescein isothiocyanate albumin was used as dilution marker. We found a strong linear relationship ( R2 = 0.98) between recruited PSA (cm2) and rat weight (g) in the range of 235 to 435 g: recruited PSA = (1.61 weight + 40.5) cm2. Applying μCT with a fill volume of 10 mL/100 g rat body weight, the in vivo measured PSA was in the order of magnitude of the ex vivo anatomic PSA as determined by Kuzlan's formula, considered in most instances as the maximal surface area that can be recruited by PD fluid. This new methodology was the first to give an in vivo high-resolution isotropic three-dimensional (3-D) determination of the PSA in contact with dialysate. Its sensitivity allows us to take into account the recruitment of fine 3-D structures of the PSA membrane that were not accessible to previous 2-D-based imaging methodologies. Its in vivo application also integrates the physiological natural tensile stress of tissues.