Optimized Temporal Window for Detection and Characterization of Renal Cell Carcinomas with Dynamic CT Scanning

摘要

OBJECTIVE To investigate the optimized time period for detection and characterization of renal cell carcinomas (RCC) when the specific CT features appear during spiral dynamic CT scanning, and to optimize an effective scanning protocol of spiral CT for evaluating RCC. METHODS Twenty -four patients with RCC verified by pathology had undergone a dynamic CT (D-CT) scan. A plain scan was employed to select the target slice. Single-level dynamic scanning started at 14-17 s after the intravenous contrast media had been administered, with a scan interval of 4.9 s acquiring a total number of 17-24 frames. A regular CT scan of the whole kidney followed by a delayed single slice acquisition through the target slice in the excretory phase was performed. Images were assessed in two ways: (1) A group of experienced radiologists reviewed the CT images to find when the specific signs appeared and when the CT features of RCC were optimally displayed; (2) Data measurement of the time-density curves (T -DC) of RCC. The exact time was obtained when the densities of the tumor, renal parenchyma, medulla and aorta reached their peak enhancement, thus also the time when the density difference between tumor and parenchyma was at maximum (Max T-M). Based on the slope of the contrast media uptake curve, T-DC types were ranked from the smallest to the biggest of slope as type A, B and C. RESULTS 1. The review of the CT images by the radiologists showed that the CT features of RCC were optimally demonstrated at 70.2 s. The earliest time at which RCC CT features were examined was at 23.9 s. 2. Image data analysis: the time that the density (or CT value) of the tumor mass reached peak enhancement was at 54 s and peak value was at 80.4 Hu for RCC. The time of the maximal difference of densities between tumor and renal parenchyma was at 102 s. CONCLUSION The following proposal is the scanning protocol for detecting RCC recommended by our research: After a plain scan to determine the target level, a single -level dynamic CT scan for renal tumors is to be programmed at scan delay time of 24, 38, 70,100 s, followed by a complete renal S-CT scan.