Background and Objectives: Total kidney volume (TKV) is a validated prognostic biomarker for autosomal dominant polycystic kidney disease (ADPKD). TKV by magnetic resonance imaging (MRI) and manual segmentation is considered the "reference standard", but is time-consuming and not readily accessible. By contrast, 3-dimensional ultrasound (3D ultrasound) provides a promising technology for TKV measurements with unknown potential. Here, we report a comparative study of TKV measurements by 3D ultrasound vs. the conventional methods by ultrasound ellipsoid and MRI ellipsoid.
Design, setting, participants, and measurements: Single-center prospective study of 142 patients who completed a standardized 3D ultrasound and MRI. TKV by 3D ultrasound and ultrasound ellipsoid were compared to those by MRI. We assessed the agreement of TKV measurements by Bland-Altman plots and misclassification of the Mayo Clinic Imaging Classes (MCIC) between the different imaging methods, and prediction of MCIC 1C-1E by average ultrasound kidney length >16.5 cm.
Results: Compared to MRI manual segmentation, MRI ellipsoid, 3D ultrasound, and ultrasound ellipsoid underestimated TKV (mean difference: -3.2%, -9.1%, and -11.0%) with MCIC misclassified in 11%, 21% and 22% of patients, respectively; most misclassified cases by MRI ellipsoid (11/16), 3D ultrasound (23/30), and ultrasound ellipsoid (26/31) were placed into a lower MCIC. Prediction of the high-risk MCIC (1C-1E) by MRI ellipsoid, 3D ultrasound, and ultrasound ellipsoid all yielded high positive predictive value (96%, 95%, 98%), and specificity (96%, 96%, 99%). However, both negative predictive value (90%, 88%, 95%) and sensitivity (88%, 85%, 94%) were lower for 3D ultrasound and ultrasound ellipsoid compared to MRI ellipsoid. An average ultrasound kidney length >16.5 cm was highly predictive of MCIC 1C-1E only in patients aged <45 years.
Conclusions: TKV measurements in ADPKD by 3D ultrasound and ultrasound ellipsoid displayed similar bias, variability, and are less accurate than MRI ellipsoid. Prediction of high-risk MCIC (1C-1E) by all three methods provides high positive predictive value, but ultrasound ellipsoid is simpler to use and more readily available.