Imaging recommendation · Abdomen · Pelvis

Family history or hypertension + bilateral renal cysts, suspected ADPKD

Q: What's the alternative imaging for family history or hypertension + bilateral renal cysts, suspected adpkd when tkv measurement for tolvaptan eligibility / disease severity?

MRI — MRI Abdomen (no contrast).

Q: What's the alternative imaging for family history or hypertension + bilateral renal cysts, suspected adpkd when cerebral aneurysm screening (family history of sah)?

MRI — MRA Brain (no contrast).

Recommended: Renal Ultrasound (Ravine criteria) or MRI Abdomen for TKV is the preferred imaging study for family history or hypertension + bilateral renal cysts, suspected adpkd. Most common inherited kidney disease (PKD1, PKD2).

Recommended study

Renal Ultrasound (Ravine criteria) or MRI Abdomen for TKV

US No contrast Preferred Abdomen · Pelvis OutpatientScreening Reviewed 2026-05

Most common inherited kidney disease (PKD1, PKD2). Bilateral cysts with family history. Total kidney volume (TKV) predicts progression.

If the default doesn't apply

TKV measurement for tolvaptan eligibility / disease severity

MRI MRI Abdomen No contrast

Cerebral aneurysm screening (family history of SAH)

MRI MRA Brain No contrast

Watch-outs

Intracranial aneurysms in ~10%

Screen with MRA if family history of SAH or before major surgery.

Cyst hemorrhage / infection

Acute flank pain in ADPKD — CT or MRI to distinguish hemorrhage from infection (DWI helpful).

Pearls

Ravine criteria for ultrasound diagnosis (age-dependent number of cysts).
Mayo Clinic imaging classification (1A-1E) based on TKV-for-height-and-age — guides tolvaptan eligibility.
Polycystic liver disease coexists in ~80%.