Quantitative dynamic contrast-enhanced magnetic resonance imaging for renal perfusion measurement in autosomal dominant polycystic kidney disease

Background: Total kidney volume (TKV)-based indices are central to imaging classification in autosomal dominant polycystic kidney disease (ADPKD) but primarily reflect cumulative changes, limiting their ability to detect current disease activity. We evaluated quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as a complementary tool for assessing renal perfusion in mild and rapidly progressive ADPKD. Methods: Five healthy subjects and twenty patients were enrolled, 10 with mild ADPKD [estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 and htTKV ≤750 mL/m] and 10 with severe ADPKD (eGFR 750 mL/m). Healthy subjects underwent three DCE-MRI scans over three different scanners within a week, while patients underwent two DCE-MRI scans in a single scanner, 4.2±2.5 days apart, with P4 phantoms for scanner-specific error correction. Eleven pharmacokinetic (PK) parameters from the extended Tofts model (ETM), Tofts model (TM), and Shutter Speed Model (SSM) were measured before and after correction. Reproducibility or repeatability was evaluated via within-subject coefficient of variation (wCV), group differences via analysis of variance (ANOVA), and correlations via Pearson correlation coefficient (r). Results: The P4-based error correction strategy improved the reproducibility of ETM-derived volume transfer constant (Ktrans) in healthy subjects by nearly 5-fold and in ADPKD patients by almost 3-fold. The ETM-derived Ktrans was significantly higher in mild vs. severe ADPKD (0.17±0.04 vs. 0.09±0.02 min−1; P