Kidney volume measurement methods for clinical studies on autosomal dominant polycystic kidney disease.
Kidney volume measurement methods for clinical studies on autosomal dominant polycystic kidney disease.
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DOI：
10.1371/journal.pone.0178488
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Remuzzi A
中科院分区：
文献类型：
--
作者：
Sharma K;Caroli A;Quach LV;Petzold K;Bozzetto M;Serra AL;Remuzzi G;Remuzzi A
在常染色体显性遗传性多囊肾病（ADPKD）中，总肾脏体积（TKV）被认为是疾病进展的重要生物标志物，有不同的方法可用于评估肾脏体积。本研究的目的是确定最有效的肾脏体积计算方法，用于评价ADPKD进展治疗有效性的临床研究。我们测量了两个系列的MR和CT图像上的单个肾脏体积（SKV）从ADPKD的临床研究（实验数据集）由两个独立的操作员（专家和初学者），两次，使用所有可用的方法：手动跟踪（参考方法），徒手手动跟踪，半自动跟踪，体视学，中间切片和椭球方法。此外，专家操作员还测量了肾脏长度。我们比较了不同方法的重现性、准确度、精密度和所需时间。此外，我们进行了一项验证研究，以评价这些方法检测一年内TKV变化的治疗组间差异的灵敏度，使用既往临床研究的MR图像。所有方法的CT重现性均高于MR，手动和半自动轮廓绘制方法（测面法）的重现性最高。在MR上，平面测量显示出最高的准确度和精密度，而在CT上，平面测量和体视学方法的准确度和精密度相当。中间切片和椭圆体方法以及肾脏长度速度很快，但仅提供了肾脏体积的粗略估计。验证研究的结果表明，与其他方法相比，面积测量和体视学允许使用显著更少的患者数量来检测药物治疗诱导的肾脏体积变化。在准确监测ADPKD进展和评估药物治疗效果方面，平面测量法应优于快速和简化的方法。专家操作员，特别是在MR图像上，需要进行可靠的肾脏体积估计。使用有效的TKV定量方法大大减少了入组临床研究的患者数量，使其更具可行性和意义。
In autosomal dominant polycystic kidney disease (ADPKD), total kidney volume (TKV) is regarded as an important biomarker of disease progression and different methods are available to assess kidney volume. The purpose of this study was to identify the most efficient kidney volume computation method to be used in clinical studies evaluating the effectiveness of treatments on ADPKD progression. We measured single kidney volume (SKV) on two series of MR and CT images from clinical studies on ADPKD (experimental dataset) by two independent operators (expert and beginner), twice, using all of the available methods: polyline manual tracing (reference method), free-hand manual tracing, semi-automatic tracing, Stereology, Mid-slice and Ellipsoid method. Additionally, the expert operator also measured the kidney length. We compared different methods for reproducibility, accuracy, precision, and time required. In addition, we performed a validation study to evaluate the sensitivity of these methods to detect the between-treatment group difference in TKV change over one year, using MR images from a previous clinical study. Reproducibility was higher on CT than MR for all methods, being highest for manual and semiautomatic contouring methods (planimetry). On MR, planimetry showed highest accuracy and precision, while on CT accuracy and precision of both planimetry and Stereology methods were comparable. Mid-slice and Ellipsoid method, as well as kidney length were fast but provided only a rough estimate of kidney volume. The results of the validation study indicated that planimetry and Stereology allow using an importantly lower number of patients to detect changes in kidney volume induced by drug treatment as compared to other methods. Planimetry should be preferred over fast and simplified methods for accurately monitoring ADPKD progression and assessing drug treatment effects. Expert operators, especially on MR images, are required for performing reliable estimation of kidney volume. The use of efficient TKV quantification methods considerably reduces the number of patients to enrol in clinical investigations, making them more feasible and significant.