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Original ArticleCystic Kidney Disease
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Total Kidney Volume Measurements in ADPKD by 3D and Ellipsoid Ultrasound in Comparison with Magnetic Resonance Imaging

Pedram Akbari, Fatemah Nasri, Shirley X. Deng, Saima Khowaja, Seung H. Lee, William Warnica, Hua Lu, Anand Rattansingh, Mostafa Atri, Korosh Khalili and Pei York
CJASN June 2022, 17 (6) 827-834; DOI: https://doi.org/10.2215/CJN.14931121
Pedram Akbari
1Division of Nephrology, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Fatemah Nasri
2Department of Medical Imaging, University Health Network and University of Toronto, Toronto, Ontario, Canada
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  • ORCID record for Fatemah Nasri
Shirley X. Deng
1Division of Nephrology, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Saima Khowaja
1Division of Nephrology, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Seung H. Lee
1Division of Nephrology, University Health Network and University of Toronto, Toronto, Ontario, Canada
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William Warnica
2Department of Medical Imaging, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Hua Lu
3Cell Biology Program, Hospital for Sick Children, Toronto, Ontario, Canada
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Anand Rattansingh
2Department of Medical Imaging, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Mostafa Atri
2Department of Medical Imaging, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Korosh Khalili
2Department of Medical Imaging, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Pei York
1Division of Nephrology, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Abstract

Background and objectives Total kidney volume is a validated prognostic biomarker for autosomal dominant polycystic kidney disease. Total kidney volume by magnetic resonance imaging (MRI) and manual segmentation is considered the “reference standard,” but it is time consuming and not readily accessible. By contrast, three-dimensional (3D) ultrasound provides a promising technology for total kidney volume measurements with unknown potential. Here, we report a comparative study of total kidney volume measurements by 3D ultrasound versus the conventional methods by ultrasound ellipsoid and MRI ellipsoid.

Design, setting, participants, & measurements This single-center prospective study included 142 patients who completed a standardized 3D ultrasound and MRI. Total kidney volumes by 3D ultrasound and ultrasound ellipsoid were compared with those by MRI. We assessed the agreement of total kidney volume measurements by Bland–Altman plots and misclassification of the Mayo Clinic imaging classes between the different imaging methods, and we assessed prediction of Mayo Clinic imaging classes 1C–1E by average ultrasound kidney length >16.5 cm.

Results Compared with MRI manual segmentation, MRI ellipsoid, 3D ultrasound, and ultrasound ellipsoid underestimated total kidney volume (mean difference: −3%, −9%, and −11%, respectively), with Mayo Clinic imaging classes misclassified in 11%, 21%, and 22% of patients, respectively; most misclassified cases by MRI ellipsoid (11 of 16), 3D ultrasound (23 of 30), and ultrasound ellipsoid (26 of 31) were placed into a lower Mayo Clinic imaging class. Predictions of the high-risk Mayo Clinic imaging classes (1C–1E) by MRI ellipsoid, 3D ultrasound, and ultrasound ellipsoid all yielded high positive predictive value (96%, 95%, and 98%, respectively) and specificity (96%, 96%, and 99%, respectively). However, both negative predictive value (90%, 88%, and 95%, respectively) and sensitivity (88%, 85%, and 94%, respectively) were lower for 3D ultrasound and ultrasound ellipsoid compared with MRI ellipsoid. An average ultrasound kidney length >16.5 cm was highly predictive of Mayo Clinic imaging classes 1C–1E only in patients aged ≤45 years.

Conclusions Total kidney volume measurements in autosomal dominant polycystic kidney disease by 3D ultrasound and ultrasound ellipsoid displayed similar bias and variability and are less accurate than MRI ellipsoid. Prediction of high-risk Mayo Clinic imaging classes (1C–1E) by all three methods provides high positive predictive value, but ultrasound ellipsoid is simpler to use and more readily available.

  • polycystic kidney disease
  • kidney volume
  • ultrasonography
  • ADPKD
  • Received November 16, 2021.
  • Accepted March 23, 2022.
  • Copyright © 2022 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 17 (6)
Clinical Journal of the American Society of Nephrology
Vol. 17, Issue 6
June 2022
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Total Kidney Volume Measurements in ADPKD by 3D and Ellipsoid Ultrasound in Comparison with Magnetic Resonance Imaging
Pedram Akbari, Fatemah Nasri, Shirley X. Deng, Saima Khowaja, Seung H. Lee, William Warnica, Hua Lu, Anand Rattansingh, Mostafa Atri, Korosh Khalili, Pei York
CJASN Jun 2022, 17 (6) 827-834; DOI: 10.2215/CJN.14931121

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Total Kidney Volume Measurements in ADPKD by 3D and Ellipsoid Ultrasound in Comparison with Magnetic Resonance Imaging
Pedram Akbari, Fatemah Nasri, Shirley X. Deng, Saima Khowaja, Seung H. Lee, William Warnica, Hua Lu, Anand Rattansingh, Mostafa Atri, Korosh Khalili, Pei York
CJASN Jun 2022, 17 (6) 827-834; DOI: 10.2215/CJN.14931121
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More in this TOC Section

Original Article

  • Health Disparities in Autosomal Dominant Polycystic Kidney Disease (ADPKD) in the United States
  • Glomerular Exostosin as a Subtype and Activity Marker of Class 5 Lupus Nephritis
  • Machine Learning–Derived Integer-Based Score and Prediction of Tertiary Hyperparathyroidism among Kidney Transplant Recipients
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Cystic Kidney Disease

  • Health Disparities in Autosomal Dominant Polycystic Kidney Disease (ADPKD) in the United States
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Keywords

  • polycystic kidney disease
  • kidney volume
  • ultrasonography
  • ADPKD

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