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Analysis of Changes in Attenuation of Proven Renal Cysts on Different Scanning Phases of Triphasic MDCT

¹ Department of Radiology – HB6, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195.
² The Glickman Urological Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195.
³ Department of Biostatistics, The Cleveland Clinic Foundation, Cleveland, OH 44195.
⁴ Present address: Department of Radiology, Weill Hospital, Cornell University Medical Center, New York, NY.

OBJECTIVE. The purpose of this study is to document changes in attenuation values on triphasic MDCT of histologically or surgically proven cystic renal lesions.

MATERIALS AND METHODS. A retrospective study of all renal lesions greater than 1 cm that underwent triphasic MDCT was performed in 90 patients before partial nephrectomy. Three reviewers independently measured the mean attenuation of all lesions in three phases (unenhanced, corticomedullary, and parenchymal) in a blinded retrospective fashion. Forty-three lesions identified at CT in 27 patients had pathologic or surgical confirmation as cysts (fluid-filled lesions). Mean change in attenuation between phases was calculated and correlated with size, unenhanced density, and percentage of the lesion exophytic from renal parenchyma. All scans were obtained after 150 mL of nonionic contrast material was injected at 3 mL/sec. Scanning delays were 30–40 sec (corticomedullary phase) and 120 sec (parenchymal phase).

RESULTS. The mean change in attenuation coefficient of the cysts from the unenhanced to the parenchymal phase was –1.8 H (SD, ± 4.4 H); from the unenhanced to the corticomedullary phase was –2.3 H (± 3.9 H); and from the corticomedullary to the parenchymal phase was 0.6 H (± 4.2 H). No cyst increased more than 10 H between the unenhanced and the parenchymal phases; more than 95% of cysts increased less than 8 H between any scanning phases. No significant difference was seen in enhancement related to lesion size (p > 0.054), unenhanced attenuation (p > 0.255), or percentage of the lesion that was exophytic (p > 0.124).

CONCLUSION. The attenuation coefficient of a cystic renal lesion increased by no more than 10 H among the unenhanced, corticomedullary, and parenchymal phase scans.

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