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      腎臟MDCT多期增強(qiáng)掃描對(duì)比劑碘濃度對(duì)腎透明細(xì)胞癌強(qiáng)化的影響*

      2015-02-10 06:00:43四川省遂寧市中心醫(yī)院放射影像科四川遂寧629000
      中國(guó)CT和MRI雜志 2015年2期
      關(guān)鍵詞:髓質(zhì)實(shí)質(zhì)差值

      1.四川省遂寧市中心醫(yī)院放射影像科 (四川 遂寧 629000)

      2.川北醫(yī)學(xué)院附屬醫(yī)院放射科(四川 南充 637000)

      趙林偉1 董國(guó)禮2 楊國(guó)慶1

      付泉水1 趙秀華1

      腎臟MDCT多期增強(qiáng)掃描對(duì)比劑碘濃度對(duì)腎透明細(xì)胞癌強(qiáng)化的影響*

      1.四川省遂寧市中心醫(yī)院放射影像科 (四川 遂寧 629000)

      2.川北醫(yī)學(xué)院附屬醫(yī)院放射科(四川 南充 637000)

      趙林偉1董國(guó)禮2楊國(guó)慶1

      付泉水1趙秀華1

      目的通過腎臟MDCT多期增強(qiáng)掃描,評(píng)價(jià)不同碘濃度對(duì)比劑對(duì)腎透明細(xì)胞癌(clear cell renal cell carcinoma,ccRCC)強(qiáng)化的影響。資料與方法回顧分析經(jīng)手術(shù)病理證實(shí)的49例ccRCC MDCT增強(qiáng)掃描資料。根據(jù)對(duì)比劑碘濃度的不同分為低碘濃度對(duì)比劑組(A組,300 mgI/ml)和高碘濃度對(duì)比劑組(B組,370 mgI/ml),測(cè)量平掃、皮髓質(zhì)期(corticomedullary phase,CMP)、實(shí)質(zhì)期(nephrographic phase,NP)ccRCC及鄰近正常腎皮質(zhì)的CT值。統(tǒng)計(jì)分析兩組ccRCC的強(qiáng)化程度及ccRCC與鄰近正常腎皮質(zhì)CT值差值(取CT值差值的絕對(duì)值)。結(jié)果B組ccRCC在皮髓質(zhì)期和實(shí)質(zhì)期強(qiáng)化程度高于A組。皮髓質(zhì)期強(qiáng)化程度差異具有統(tǒng)計(jì)學(xué)意義(P<0.05),實(shí)質(zhì)期強(qiáng)化程度差異沒有統(tǒng)計(jì)學(xué)意義(P>0.05)。B組ccRCC與鄰近正常腎皮質(zhì)CT值差值在皮髓質(zhì)期及實(shí)質(zhì)期均高于A組。皮髓質(zhì)期差異沒有統(tǒng)計(jì)學(xué)意義(P>0.05),實(shí)質(zhì)期差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論腎臟MDCT多期增強(qiáng)掃描中,對(duì)比劑注射速率相同時(shí),ccRCC在高碘濃度時(shí)皮髓質(zhì)期強(qiáng)化程度較高,實(shí)質(zhì)期腎臟-腫瘤對(duì)比增加,因此高碘濃度對(duì)比劑對(duì)ccRCC的顯示效果優(yōu)于低碘濃度對(duì)比劑。

      腎臟;透明細(xì)胞癌;對(duì)比劑

      腎癌是最常見的腎臟上皮來源的惡性腫瘤,約占成人惡性腫瘤的2%[1]。腎透明細(xì)胞癌為最常見的腎癌亞型(占70%~80%),其預(yù)后較差,5年生存率為44%~69%[2,3]。組織學(xué)上,以腫瘤新生血管數(shù)量多,易侵襲血管和早期轉(zhuǎn)移為特征。隨著腎臟腫瘤的多層螺旋CT成像技術(shù)的進(jìn)展,其平掃,皮髓質(zhì)期、實(shí)質(zhì)期和排泄期增強(qiáng)掃描可以顯示這些惡性腫瘤的特征[4-6]。研究表明,腎透明細(xì)胞癌強(qiáng)化程度高于其它亞型[7,8],恰當(dāng)?shù)臄?shù)據(jù)采集和后處理方法對(duì)減少腎癌漏診和誤診是非常重要的[9]。但是腫瘤的強(qiáng)化程度受對(duì)比劑類型、數(shù)量、濃度、注射速率及圖像采集時(shí)間和腎臟功能等因素的影響。目前關(guān)于對(duì)比劑碘濃度對(duì)腎透明細(xì)胞癌強(qiáng)化影響的文獻(xiàn)報(bào)道較少。筆者回顧分析我院2010年3月~2014年3月經(jīng)手術(shù)病理證實(shí)的49例腎透明細(xì)胞癌的MDCT資料,觀察腎臟MDCT增強(qiáng)掃描中,腎透明細(xì)胞癌在不同碘濃度時(shí)的強(qiáng)化程度以及腫瘤-腎臟對(duì)比,探討其合理的對(duì)比劑應(yīng)用方案。

      1 資料與方法

      1.1 一般資料收集2010年3月~2014年3月在我院行腎臟檢查的49例腎透明細(xì)胞癌患者CT資料。根據(jù)對(duì)比劑碘濃度的不同,隨機(jī)分為A、B兩組:A組28例,其中男15例,女13例,年齡21~74歲(平均52±15);采用標(biāo)準(zhǔn)碘濃度對(duì)比劑(300mgI/ml),劑量為100ml,注射速率為3.5ml/s。B組21例,其中男13例,女8例,年齡28~70歲(平均48±12);采用高碘濃度對(duì)比劑(370mg I/ml),劑量為75 ml,注射速率為3.5ml/s。所有病例均經(jīng)手術(shù)后病理證實(shí)。病人排除標(biāo)準(zhǔn):嚴(yán)重心或者腎功能不全者;72小時(shí)內(nèi)作過含碘對(duì)比劑檢查者;孕期及哺乳期婦女。

      表1 不同碘濃度對(duì)比劑時(shí),腎皮質(zhì)及腎透明細(xì)胞癌強(qiáng)化程度

      表2 不同碘濃度對(duì)比劑腎臟與腎透明細(xì)胞癌CT值差值(取差值絕對(duì)值)比較(Hu)

      1.2 檢查設(shè)備及掃描參數(shù)采用SIEMENS SOMATOM Definition AS+64排128層螺旋CT及STELLANT CT高壓注射器。掃描參數(shù)為:管電壓120kv,管電流采用實(shí)時(shí)動(dòng)態(tài)曝光劑量調(diào)節(jié)(Siemens CARE Dose 4D)技術(shù)自動(dòng)調(diào)節(jié),采集層厚6.0mm,螺距1.5,重建層厚1.0mm,球管旋轉(zhuǎn)一圈需時(shí)0.33s?;颊呔茸銎綊撸缓蠼?jīng)肘前區(qū)淺靜脈注射非離子型對(duì)比劑行皮髓質(zhì)期、實(shí)質(zhì)期及排泄期掃描。增強(qiáng)掃描數(shù)據(jù)采集延遲時(shí)間由Siemens Bolus Tracking軟件系統(tǒng)監(jiān)測(cè)點(diǎn)而定,監(jiān)測(cè)點(diǎn)位于胸腹主動(dòng)脈交界區(qū)。于對(duì)比劑開始注射10s后,啟動(dòng)監(jiān)測(cè)掃描,當(dāng)監(jiān)測(cè)閾值達(dá)100Hu時(shí),分別延遲至15s和55s開始皮髓質(zhì)期及實(shí)質(zhì)期掃描;5~8分鐘開始排泄期掃描。

      1.3 定量分析CT平掃及增強(qiáng)圖像分析由2位長(zhǎng)期從事腹部CT診斷的放射科醫(yī)生獨(dú)立進(jìn)行。測(cè)量方法:1)分別測(cè)量腫瘤實(shí)質(zhì)部分及鄰近正常腎皮質(zhì)平掃、CMP、NP時(shí)的CT值。感興趣區(qū)(region of interest,ROI)設(shè)置在不均勻強(qiáng)化病變中強(qiáng)化最明顯部分或均勻強(qiáng)化病變中心,大小約為0.5~1.0cm2,并且ROI在各掃描期盡量保持一致(圖3-5)。2)腫瘤強(qiáng)化程度=腫瘤增強(qiáng)與平掃CT值差值。3)腫瘤-腎臟對(duì)比=腫瘤CT值與腎臟CT差值絕對(duì)值。

      1.4 數(shù)據(jù)分析觀察者間的一致性,采用Bland-Altman分析評(píng)估測(cè)值點(diǎn)分布情況。兩組病人CMP、NP腫瘤強(qiáng)化程度及腫瘤-腎臟對(duì)比采用Mann-Whitney U 檢驗(yàn)進(jìn)行統(tǒng)計(jì)學(xué)分析,由SPSS17.0統(tǒng)計(jì)軟件包和Microsoft Office Excel 2003完成。計(jì)量資料用均數(shù)標(biāo)準(zhǔn)差s)表示。P<0.05具有統(tǒng)計(jì)學(xué)意義。

      2 結(jié) 果

      2.1經(jīng)Kendall's tau-b檢驗(yàn),每組病灶CT值的差值與均數(shù)間無相關(guān)性(P>0.05),可直接行Bland―Altman法分析一致性。經(jīng)Bland―Altman法分析,兩位觀察者對(duì)同一病人腎臟及病灶CT值的測(cè)量,一致性良好(圖1)。

      2.2 腎透明細(xì)胞癌及腎臟強(qiáng)化程度(表1,圖2-13) B組腎透明細(xì)胞癌在皮髓質(zhì)期和實(shí)質(zhì)期強(qiáng)化程度高于A組(圖6-9),皮髓質(zhì)期強(qiáng)化程度差異具有統(tǒng)計(jì)學(xué)意義(P<0.05),實(shí)質(zhì)期強(qiáng)化程度差異沒有統(tǒng)計(jì)學(xué)意義(P>0.05)。B組腎皮質(zhì)在皮髓質(zhì)及實(shí)質(zhì)期強(qiáng)化程度高于A組,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。

      2.3 腎透明細(xì)胞癌與腎臟CT值差值比較(表2,圖2-13) B組腎透明細(xì)胞癌與鄰近正常腎皮質(zhì)CT值差值(取CT值差值的絕對(duì)值)在皮髓質(zhì)期及實(shí)質(zhì)期高于A組(圖10-13)。皮髓質(zhì)期差異沒有統(tǒng)計(jì)學(xué)意義(P>0.05),實(shí)質(zhì)期差異具有統(tǒng)計(jì)學(xué)意義(P<0.05),說明在實(shí)質(zhì)期,高碘濃度對(duì)比劑對(duì)于病變的顯示效果優(yōu)于低碘濃度對(duì)比劑。

      3 討 論

      MDCT增強(qiáng)掃描中,病人自身因素(如體重、心臟功能、水合狀態(tài)及腎臟功能)和掃描技術(shù)(如對(duì)比劑的數(shù)量、濃度、注射速率以及從注射對(duì)比劑到開始圖像采集的延遲時(shí)間)都會(huì)影響器官(如腎臟)和病灶增強(qiáng)各時(shí)期的強(qiáng)化并導(dǎo)致CT值測(cè)量的變化。許多文獻(xiàn)都比較了在不同碘濃度對(duì)比劑時(shí)血管和器官實(shí)質(zhì)強(qiáng)化程度的差異,但這些結(jié)果經(jīng)常有爭(zhēng)議,多數(shù)研究表明采用高碘濃度對(duì)比劑時(shí)血管和器官?gòu)?qiáng)化程度均明顯增高[10-12]。然而,Behrendt等[13]以相等的總碘劑量和碘注射速率,在胸部MDCT掃描早期,除左心室外,所有解剖部位在300mgI/ml對(duì)比劑時(shí),其強(qiáng)化程度較370mgI/ml對(duì)比劑高;在腹部圖像,腹部血管和肝實(shí)質(zhì)強(qiáng)化的平均CT值差異沒有統(tǒng)計(jì)學(xué)意義。Rengo等[14]以相同碘注射速率(1.6gI/s)和總碘劑量(40gI)注射320mgI/ml和400mgI/ ml對(duì)比劑時(shí),肝實(shí)質(zhì)或血管強(qiáng)化程度差異沒有統(tǒng)計(jì)學(xué)意義。

      相對(duì)其它實(shí)質(zhì)器官而言,腎臟通過腎皮質(zhì)、髓質(zhì)、腎盞、腎盂系統(tǒng)排泄對(duì)比劑等廢物,可以應(yīng)用皮髓質(zhì)期和實(shí)質(zhì)期CT成像等特有的增強(qiáng)掃描技術(shù)來顯示其解剖細(xì)節(jié)。腎癌MDCT成像能夠進(jìn)行多期增強(qiáng)掃描并獲得清晰顯示受累腎臟解剖細(xì)節(jié)的高分辨率MPR和3D圖像[15,16]。但對(duì)比劑碘濃度對(duì)腎透明細(xì)胞癌強(qiáng)化的影響少有報(bào)道。在本組研究中,重點(diǎn)觀察腎臟MDCT中不同碘濃度對(duì)比劑(300mgI/ml vs 370mgI/ml)對(duì)腎透明細(xì)胞癌皮髓質(zhì)期及實(shí)質(zhì)期強(qiáng)化的影響。

      腎臟皮髓質(zhì)期是一種動(dòng)脈采集期,在皮髓質(zhì)期,腎皮質(zhì)和動(dòng)脈達(dá)到強(qiáng)化峰值,皮質(zhì)和髓質(zhì)達(dá)最大強(qiáng)化差異。文獻(xiàn)報(bào)道[17]高碘濃度(400mgI/ml)對(duì)比劑在增強(qiáng)早期主動(dòng)脈、雙腎動(dòng)脈、腎皮質(zhì)、髓質(zhì)、腎靜脈強(qiáng)化程度高于標(biāo)準(zhǔn)碘濃度(300mgI/ml)對(duì)比劑。本組采用相同的對(duì)比劑注射速率,皮髓質(zhì)期高碘濃度組腎皮質(zhì)強(qiáng)化程度高于低碘濃度組,二者差異具有統(tǒng)計(jì)學(xué)意義。這一結(jié)果與Jung等[18]的不同,Jung等在動(dòng)物模型中,采用相同的總碘劑量和碘注射率時(shí),300mgI/ml與370mgI/ ml比較,腎臟強(qiáng)化程度沒有顯著性差異。但他們采用的是相同的碘注射率,低碘濃度對(duì)比劑注射速率較快。腎透明細(xì)胞癌為富含血管的惡性腫瘤,皮髓質(zhì)期時(shí)對(duì)比劑主要停留在血管系統(tǒng),腫瘤明顯強(qiáng)化。本組49例觀察結(jié)果表明,盡管高碘濃度對(duì)比劑總碘劑量(27.75gI)較低碘濃度對(duì)比劑少(30gI),但腫瘤在高碘濃度時(shí)強(qiáng)化程度較低碘濃度高,二者差異具有統(tǒng)計(jì)學(xué)意義;但不同碘濃度時(shí),皮髓質(zhì)期腫瘤-腎臟對(duì)比差異沒有統(tǒng)計(jì)學(xué)意義。腎實(shí)質(zhì)期,腎皮質(zhì)和髓質(zhì)均勻一致的強(qiáng)化。腎透明細(xì)胞癌血供豐富,血流速度快,含對(duì)比劑的血流通過腫瘤的時(shí)間短,腫瘤強(qiáng)化程度迅速降低。一些研究表明腎實(shí)質(zhì)期能夠更好的顯示和檢測(cè)腎癌[19]。本組結(jié)果顯示,兩組腎透明細(xì)胞癌在腎實(shí)質(zhì)期強(qiáng)化程度差異沒有統(tǒng)計(jì)學(xué)意義,但高碘濃度對(duì)比劑組,腎臟-腫瘤對(duì)比增加,更有利于病變的顯示。推測(cè)其原因,可能與高濃度碘對(duì)比劑提高了腎實(shí)質(zhì)強(qiáng)化程度,從而提高了腎臟-腫瘤對(duì)比。

      圖1 兩位觀察者測(cè)量低碘濃度組皮髓質(zhì)期腫瘤CT值的Bland-Altman圖。以兩次測(cè)-量的差值d為縱坐標(biāo),兩次測(cè)量的均值a為橫坐標(biāo),95%一致性界限(d±1.96Sd)、差值均數(shù)以及理論參考線(0)作為參考線。從圖中可以看出,7.1%(2/28)的點(diǎn)在95%一致性界限以外。圖2條形圖顯示皮髓質(zhì)及實(shí)質(zhì)期不同碘濃度ccRCC強(qiáng)化程度均值及ccRCC與正常腎皮質(zhì)CT值差值均值(單位:Hu),誤差圖=95%均值置信區(qū)間。圖3-5典型腎透明細(xì)胞癌MDCT軸位 ROI設(shè)置示意圖。男,40歲,左腎透明細(xì)胞癌(370 mgI/ml),圖3-5分別為平掃、皮髓質(zhì)期及實(shí)質(zhì)期圖像;腫瘤在平掃、皮髓質(zhì)、實(shí)質(zhì)期CT值分別為36.06、167.95、127.79(單位:Hu)。圖6-9 男,28歲,右腎透明細(xì)胞癌(370 mgI/ml),圖6-8分別為軸位平掃、皮髓質(zhì)期、實(shí)質(zhì)期圖像,圖9為皮髓質(zhì)期腎靜脈曲面重建像。腫瘤在皮髓質(zhì)期、實(shí)質(zhì)期強(qiáng)化程度分別為:187.85,100.20;實(shí)質(zhì)期腫瘤與腎皮質(zhì)CT值差值=72.69(單位:Hu),皮髓質(zhì)期腎靜脈顯示良好。圖10-13 女,46歲,右腎透明細(xì)胞癌(300 mgI/ml),tu 10-12分別為軸位平掃、皮髓質(zhì)期、實(shí)質(zhì)期圖像,圖13為皮髓質(zhì)期腎靜脈曲面重建像。腫瘤在皮髓質(zhì)期、實(shí)質(zhì)期強(qiáng)化程度分別為:70.97,52.16;實(shí)質(zhì)期腫瘤與腎皮質(zhì)CT值差值=63.66(單位:Hu),皮髓質(zhì)期腎靜脈顯示良好。

      總之,皮髓質(zhì)期高碘濃度對(duì)比劑腎透明細(xì)胞癌強(qiáng)化程度較低碘濃度對(duì)比劑高,腫瘤供血?jiǎng)用}和腎動(dòng)、靜脈顯示更清晰;實(shí)質(zhì)期,采用高碘濃度對(duì)比劑,腎臟―腫瘤對(duì)比增加。高碘濃度對(duì)比劑更有利于腎透明細(xì)胞癌的顯示,同時(shí)有利于降低對(duì)比劑碘劑量。

      在我們的研究中存在一些不足。首先,對(duì)比劑碘劑量是采用臨床常規(guī)應(yīng)用方案,雖然利用bolus tracing技術(shù)對(duì)病人中對(duì)比劑傳遞時(shí)間(從肘靜脈到器官的時(shí)間)和循環(huán)時(shí)間進(jìn)行補(bǔ)償,但是沒有考慮體重、體表面積等個(gè)體因素所致強(qiáng)化程度差異。其次,在對(duì)比劑碘劑量上,沒有采用相同的總碘劑量,但我們的結(jié)果表明采用高碘濃度對(duì)比劑,有利于降低對(duì)比劑總碘劑量。我們會(huì)在后續(xù)研究中,采用對(duì)比劑個(gè)體化應(yīng)用方案,進(jìn)一步觀察對(duì)比劑碘濃度及劑量對(duì)腎透明細(xì)胞癌強(qiáng)化的影響。

      1. Gore ME, Larkin JM. Challenges and opportunities for converting renal cell carcinoma into a chronic disease with targeted therapies[J]. Br J Cancer, 2011, 104(3):399-406.

      2. Truong LD, Shen SS. Immunohistochemical diagnosis of renal neoplasms[J]. Arch Pathol Lab Med, 2011, 135(1):92-109.

      3. Hoffmann NE, Gillett MD, Cheville JC, et al. Differences in organ system of distant metastasis by renal cell carcinoma subtype[J]. J Urol, 2008, 179(2):474-477.

      4. Ljungberg B, Hanbury DC, Kuczyk MA, et al. European Association of Urology Guideline Group for renal cell carcinoma[J]. Renal cell carcinoma guideline, Eur Urol 2007, 51(6):1502-1510.

      5. 畢陽,謝寶君.CT血管造影術(shù)(CTA)后處理技術(shù)在腎癌分期中的臨床應(yīng)用[J].中國(guó)CT和MRI雜志,2014,01:85-88.

      6. Kuhn E, De Anda J, Manoni S, et al.Renal cell carcinoma associated with prominent angioleiomyomalike proliferation: report of 5 cases and review of the literature[J]. Am J Surg Pathol, 2006, 30(11):1372-1381.

      7. Young JR, Margolis D, Sauk S, et al. Clear cell renal cell carcinoma: discrimination from other renal cell carcinoma subtypes and oncocytoma at multiphasic multidetector CT[J]. Radiology, 2013, 267(2):444-453.

      8. Jinzaki M, Tanimoto A, Mukai M, et al. Double-phase helical CT of small renal parenchymal neoplasms: correlation with pathologic findings and tumor angiogenesis[J]. J Comput Assist Tomogr, 2000, 24(6):835-842.

      9. Johnson PT, Horton KM, Fishman EK, et al. How not to miss or mischaracterize a renal cell carcinoma: protocols, pearls, and pitfalls[J]. AJR Am J Roentgenol, 2010, 194(4):307-315.

      10.Furuta A, Ito K, Fujita T, et al. Hepatic enhancement in multiphasic contrastenhanced MDCT: comparison of high- and low-iodineconcentration contrast medium in same patients with chronic liver disease[J]. AJR Am J Roentgenol, 2004, 183(1):157-162.

      11.Sultana S, Morishita S, Awai K, et al. Evaluation of hypervascular hepatocellular carcinoma in cirrhotic liver by means of helical CT: comparison of different contrast medium concentrations within the same patient[J]. Radiat Med, 2003, 21(6):239-245.

      12.Fenchel S, Boll DT, Fleiter TR, et al. Multislice helical CT of the pancreas and spleen[J]. Eur J Radiol 2003, 45[suppl 1]:S59 -72.

      13.Behrendt FF, Mahnken AH, Stanzel S, et al. Intraindividual comparison of contrast media concentrations for combined abdominal and thoracic MDCT[J]. AJR Am J Roentgenol, 2008, 191(1):145-150.

      14.Rengo M, Caruso D, De Cecco CN, et al. High concentration (400 mgI/mL) versus low concentration (320 mgI/ mL) iodinated contrast media in multi detector computed tomography of the liver: a randomized, single centre, non-inferiority study[J]. Eur J Radiol, 2012, 81(11):3096-3101.

      15.黃懷錢.多層螺旋CT在腎癌診斷中的應(yīng)用—附42例分析[J].中國(guó)CT和MRI雜志,2006,02:53-55.

      16.Sacco E, Pinto F, Totaro A, et al. Imaging of Renal Cell Carcinoma: State of the Art and Recent Advances[J]. Urol Int, 2011, 86(2):125-139.

      17.謝琦, 江新青, 吳紅珍,等.不同碘濃度對(duì)比劑在腎臟MSCT增強(qiáng)掃描中的作用對(duì)比[J].放射學(xué)實(shí)踐,2008,23(5):534-538.

      18.Jung SC, Kim SH, Cho JY. A Comparison of the Use of Contrast Media with Different Iodine Concentrations for Multidetector CT of the Kidney[J]. Korean J Radiol, 2011, 12(6): 714-721.

      19.Szolar DH, Kammerhuber F, Altziebler S, et al. Multiphasic helical CT of the kidney: increased conspicuity for detection and characterization of small (<3 cm) renal masses[J]. Radiology, 1997, 202(1):211-217.

      (本文編輯: 劉龍平)

      Effect of Iodine Concentration of Contrast Media on Enhancement of Clear Cell Renal Cell Carcinoma in Multiphasic Contrastenhanced MDCT of the Kidney*

      ObjectiveThe purpose of this study was to determine the influence of different concentration iodine contrast media on enhancement of clear cell renal cell carcinoma (ccRCC) in multiphasic contrast-enhanced MDCT of the kidney.Materialsand MethodsWe retrospectively reviewed the contrast-enhanced CT findings in 49 patients with ccRCCs proven postoperative pathology record, examinations were performed in multiple phases of enhancement with a MDCT scanner. According to the concentration of iodine contrast media, 49 patients were randomized into two groups. Group A received 100 mL of 300 mgI/mL and group B 75 mL of 370 mgI/mL. Attenuation values were measured at ccRCCs and the normal renal cortex in each phase (unenhanced, corticomedullary, and nephrographic). Statistical analysis was performed for comparison of the degree of enhancement of ccRCCs and the attenuation differences beween tumor and renal cortex.ResultsIn the corticomedullary phase, the 370 mgI/mL concentration showed significantly higher tumor enhancement than 300 mgI/mL in (p<0.05), and there was however no significant difference in the attenuation differences beween tumor and renal cortex (p>0.05). In the nephrographic phase there was no significant difference in tumor enhancement between the 370 mgI/mL and 370 mgI/mL concentrations (p>0.05), and there was a significant difference in the attenuation differences beween tumor and renal cortex (p<0.05).ConclusionGiven equivalent injection rate, the higher iodine concentration leads to a higher corticomedullary phase contrast enhancement of ccRCC and a higher nephrographic phase attenuation differences beween tumor and adjacent renal cortex in MDCT of the the kidney, therefore facilitate visualization of ccRCC in the corticomedullary phase and nephrographic phase.

      Kidney; Clear Cell Carcinoma; Contrast Media; Multidetector Computed Tomography

      R737.11; R445.3

      A

      四川省衛(wèi)生廳科研課題(編號(hào):140107)

      10.3969/j.issn.1672-5131.2015.02.17

      董國(guó)禮

      2015-01-05

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