Department of Radiology, Affiliated Hospital of Jiangsu University, No. 438, Jiefang Road, Zhenjiang, 212001, Jiangsu, China.
Department of Central Laboratory, The Fourth Affiliated Hospital of Jiangsu University, No. 20, Zhengdong Road, Zhenjiang, 212001, Jiangsu, China.
Abdom Radiol (NY). 2022 Aug;47(8):2845-2857. doi: 10.1007/s00261-022-03554-w. Epub 2022 May 28.
Although the guideline indicates that total kidney volume (TKV) is an important detection indicator in patients with autosomal dominant polycystic kidney disease (ADPKD), this study attempted to demonstrate that renal parenchymal information, combined with parenchymal volume and radiomics features, may have more valuable clinical guiding significance.
A totals of 340 ADPKD patients with normal renal function were prospectively collected and followed-up for five years, with renal function tests and non-contrast computed tomography (CT) performed every six months. The relationship between renal function impairment and renal parenchymal volume (RPV) as along with radiomics features was explored using a multiple linear regression model and multiple logistic regression. Then, a combined model of RPV with radiomics features was constructed to comprehensively evaluate its predictive value.
Compared with TKV, decreased RPV presented a closer relationship with renal function impairment, namely, with the impairment rate (RPV: 82.3% vs. TVK: 67.1%) and eGFR (RPV: r = 0.614, p < 0.001 vs. TKV: r = -0.452, p < 0.001), and showed higher predictive power (RPV: AUC = 0.752 [95%CI 0.692-0.805], p < 0.001 vs. TKV: AUC = 0.711 [95%CI 0.649-0.768], p < 0.001). Correspondingly, the radiomics analysis that was derived from the renal parenchyma also showed a satisfactory result (AUC = 0.849 [95%Cl 0.797-0.892], p < 0.001). Importantly, the predictive power for renal function impairment was further improved in the combined model of RPV and radiomics features (AUC = 0.902 [95%Cl 0.857-0.937], p < 0.001).
Renal parenchyma information may be a sensitive biomarker of renal function impairment in ADPKD, which can provide a new approach for clinically monitoring renal function, and may greatly improve the pre-hospital prevention and treatment effects.
虽然指南表明总肾体积（TKV）是常染色体显性多囊肾病（ADPKD）患者的重要检测指标，但本研究试图证明，结合实质体积和放射组学特征的实质信息可能具有更有价值的临床指导意义。
前瞻性收集 340 例肾功能正常的 ADPKD 患者，并进行为期 5 年的随访，每 6 个月进行肾功能检查和非对比 CT（NCCT）检查。采用多元线性回归模型和多元逻辑回归探讨肾功能损害与肾实质体积（RPV）及放射组学特征的关系。然后，构建 RPV 与放射组学特征的联合模型，综合评价其预测价值。
与 TKV 相比，降低的 RPV 与肾功能损害的关系更为密切，即与损害率（RPV：82.3%比 TKV：67.1%）和 eGFR（RPV：r=0.614，p<0.001 比 TKV：r=-0.452，p<0.001）更密切相关，且具有更高的预测能力（RPV：AUC=0.752[95%CI 0.692-0.805]，p<0.001 比 TKV：AUC=0.711[95%CI 0.649-0.768]，p<0.001）。相应地，从肾实质中提取的放射组学分析也取得了令人满意的结果（AUC=0.849[95%CI 0.797-0.892]，p<0.001）。重要的是，在 RPV 和放射组学特征的联合模型中，对肾功能损害的预测能力进一步提高（AUC=0.902[95%CI 0.857-0.937]，p<0.001）。
肾实质信息可能是 ADPKD 肾功能损害的敏感生物标志物，可为临床监测肾功能提供新方法，可能极大地提高院外预防和治疗效果。
