Abstract
PurposeIn ADPKD patients total kidney volume (TKV) measurement using MRI is performed to predict rate of disease progression. Historically T1 weighted images (T1) were used, but the methodology of T2 weighted imaging (T2) has evolved. We compared the performance of both sequences.Methods40 ADPKD patients underwent an abdominal MRI at baseline and follow-up. TKV was measured by manual tracing with Analyze Direct 11.0 software. Three readers established intra- and interreader coefficients of variation (CV). T1 and T2 measured kidney volumes and growth rates were compared with ICC and Bland–Altman analyses.ResultsParticipants were 49.7 ± 7.0 years of age, 55.0% female, with estimated GFR of 50.1 ± 11.5 mL/min/1.73 m2. CVs were low and comparable for T2 and T1 (intrareader: 0.83% [0.48–1.79] vs. 1.15% [0.34–1.77], P = 0.9, interreader: 2.18% [1.59–2.61] vs. 1.69% [1.07–3.87], P = 0.9). TKV was clinically similar, but statistically significantly different between T2 and T1: 1867 [1172–2721] vs. 1932 [1180–2551] mL, respectively (P = 0.006), with a bias of only 0.8% and high agreement (ICC 0.997). Percentage kidney growth during 2.2 ± 0.3 years was similar for T2 and T1 (9.3 ± 10.6% vs. 7.8 ± 9.9%, P = 0.1, respectively), with a bias of 1.5% and high agreement (ICC 0.843). T2 was more often of sufficient quality for volume measurement (86.7% vs. 71.1%, P < 0.001).ConclusionsIn patients with ADPKD, measurement of kidney volume and growth rate performs similarly when using T2 compared to T1 weighted images, although T2 performs better on secondary outcome parameters; they are more often of sufficient quality for volume measurement and result in slightly lower intra- and interreader variability.
Highlights
Materials and methodsFor this study MR images were used of a subset of Autosomal Dominant Polycystic Kidney Disease (ADPKD) patients that participated in the DIPAK-1 study, a randomized controlled trial in which the efficacy of lanreotide to halt disease progression in ADPKD is assessed
Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most common hereditary renal disease, with a prevalence of 3–4 per 10,000 in the general population [1, 2]
In patients with impaired kidney function the use of gadolinium is avoided, because exposure to this contrast agent has been found to be associated with a higher incidence of nephrogenic systemic fibrosis [8], the risk for this complication is probably lower than previously assumed [9]
Summary
For this study MR images were used of a subset of ADPKD patients that participated in the DIPAK-1 study, a randomized controlled trial in which the efficacy of lanreotide to halt disease progression in ADPKD is assessed. The three readers were trained to measure TKV on both T1 as well as T2 weighted images During their training period, they measured 15 MR images per sequence, 30 kidney volumes, under supervision and guidance of an experienced MRI technician using a standard operating procedure. They measured 15 MR images per sequence, 30 kidney volumes, under supervision and guidance of an experienced MRI technician using a standard operating procedure After these readers completed their training, they were allowed to measure TKV. In a test set of 12 patients kidney volumes were measured twice by three readers This test set was used to assess the intra- and interreader reliability. Correlation between changes in TKV measured using T1 and T2 weighted images was assessed using orthogonal regression analysis, calculation of ICC, and Bland–Altman analyses. P < 0.05 was considered to be statistically significant
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