Multiphasic renal CT: comparison of renal mass enhancement during the corticomedullary and nephrographic phases.
OBJECTIVE
To evaluate thin-section computed tomography (CT) performed during the corticomedullary and nephrographic phases of contrast material enhancement in the characterization of renal masses.


METHODS
A prospective study of 30 patients was undertaken with CT to characterize 31 "indeterminate" renal masses. In all patients, 5-mm-thick, contiguous, high-tube-current (320-340-mA) scans were obtained through the kidneys before (axial mode), during (helical mode, 25-second delay, corticomedullary-phase images), and after (axial mode, 120-second delay, nephrographic-phase images) administration of a 117-second biphasic injection of intravenous contrast material.


RESULTS
Eight of 16 neoplasms measured less than 20 HU on CT scans obtained without contrast material enhancement; measurements of two of these corresponded to "cyst attenuation" during the corticomedullary phase. Enhancement of 10 HU or greater was demonstrated in 11 neoplasms during the corticomedullary phase and in all neoplasms in the nephrographic phase. No enhancement was seen in 15 radiologically benign cysts. Both renal neoplasms and normal renal cortex demonstrated significantly greater enhancement in the nephrographic phase compared with that in the corticomedullary phase (P = .0002 and P < .0001, respectively).


CONCLUSIONS
Enhancement of renal neoplasms is time dependent and may not be evident in hypovascular tumors analyzed during the early corticomedullary phase. Reliance on absolute CT attenuation measurements, without use of internal standards as controls, may lead to misdiagnosis of neoplasms as cysts.
Birnbaum
B A
BA
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
Jacobs
J E
JE
Ramchandani
P
P
D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007482:Iothalamate Meglumine / Q000008:administration & dosage; D007668:Kidney / Q000000981:diagnostic imaging*; D007672:Kidney Cortex / Q000000981:diagnostic imaging; D052177:Kidney Diseases, Cystic / Q000000981:diagnostic imaging; D007679:Kidney Medulla / Q000000981:diagnostic imaging; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000706:statistics & numerical data
D003287:Contrast Media; D007482:Iothalamate Meglumine