CAJ | 학술논문

目的：通过肾脏MDCT多期增强扫描，评价不同碘浓度对比剂对肾透明细胞癌(clear cell renal cell carcinoma， ccRCC)强化的影响。资料与方法回顾分析经手术病理证实的49例ccRCC MDCT增强扫描资料。根据对比剂碘浓度的不同分为低碘浓度对比剂组(A组，300 mgI/ml)和高碘浓度对比剂组(B组，370 mgI/ml)，测量平扫、皮髓质期(corticomedullary phase，CMP)、实质期(nephrographic phase，NP)ccRCC及邻近正常肾皮质的CT值。统计分析两组ccRCC的强化程度及ccRCC与邻近正常肾皮质CT值差值(取CT值差值的绝对值)。结果 B组ccRCC在皮髓质期和实质期强化程度高于A组。皮髓质期强化程度差异具有统计学意义(P＜0.05)，实质期强化程度差异没有统计学意义(P＞0.05)。B组ccRCC与邻近正常肾皮质CT值差值在皮髓质期及实质期均高于A组。皮髓质期差异没有统计学意义(P＞0.05)，实质期差异具有统计学意义(P＜0.05)。结论肾脏MDCT多期增强扫描中，对比剂注射速率相同时，ccRCC在高碘浓度时皮髓质期强化程度较高，实质期肾脏-肿瘤对比增加，因此高碘浓度对比剂对ccRCC的显示效果优于低碘浓度对比剂。
목적：통과신장MDCT다기증강소묘，평개불동전농도대비제대신투명세포암(clear cell renal cell carcinoma， ccRCC)강화적영향。자료여방법회고분석경수술병리증실적49례ccRCC MDCT증강소묘자료。근거대비제전농도적불동분위저전농도대비제조(A조，300 mgI/ml)화고전농도대비제조(B조，370 mgI/ml)，측량평소、피수질기(corticomedullary phase，CMP)、실질기(nephrographic phase，NP)ccRCC급린근정상신피질적CT치。통계분석량조ccRCC적강화정도급ccRCC여린근정상신피질CT치차치(취CT치차치적절대치)。결과 B조ccRCC재피수질기화실질기강화정도고우A조。피수질기강화정도차이구유통계학의의(P＜0.05)，실질기강화정도차이몰유통계학의의(P＞0.05)。B조ccRCC여린근정상신피질CT치차치재피수질기급실질기균고우A조。피수질기차이몰유통계학의의(P＞0.05)，실질기차이구유통계학의의(P＜0.05)。결론신장MDCT다기증강소묘중，대비제주사속솔상동시，ccRCC재고전농도시피수질기강화정도교고，실질기신장-종류대비증가，인차고전농도대비제대ccRCC적현시효과우우저전농도대비제。
Objective The 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. Materials and methods We 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. Results In 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). Conclusion Given 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.