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

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.