ACR Appropriateness Criteria® Autosomal Dominant Polycystic Kidney Disease.

Abstract

Ultrasound is the imaging study of choice for the initial diagnosis of autosomal dominant polycystic kidney disease (ADPKD) due to its high diagnostic accuracy and ability to detect kidney cysts as small as 2 to 3 mm. MRI of the kidneys is also highly sensitive at detecting small cysts and is an alternative to US. MRI is the preferred modality for determining total kidney volume (TKV). TKV can be used as an imaging biomarker to predict kidney function decline, track disease progression, and evaluate the effectiveness of treatment. CT abdomen and pelvis with contrast is the test of choice for detecting suspected complications such as renal cyst hemorrhage, rupture, or infection. MRI of the abdomen without and with contrast can also be used for diagnosing complications of ADPKD and is usually appropriate regardless of kidney function. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.