| Objective: To explore the feasibility research of renal clear cell carcinomas following split-bolus multidetector computed tomographic(MDCT) dual phase dynamic enhancement and effective radiation doses.Methods and materials: Between January 2014 and January 2016 we collected 60 patients who was highly suspected by urological surgery or abdominal ultrasonic discoverd renal space-occupying lesionsand underwent CT enhancement examination,confirmed by pathology of renal clear cell carcinoma(BMI: 18.5-28).The cases according to the check in the order is divided into control group(single note 3 period enhanced) and experimental group(split-bolus of dual phase dynamic enhanced scan group). Two groups of 30 cases each, complete image data.Two groups of 30 cases each, complete image data. Experimental group a total of 30 cases, 18 were male, the female 12 cases; Age 31-77, the average age was 57.30- 11.53 years old; 16 cases of tumor is in the left kidney, 14 cases of right kidney; The control group a total of 30 cases, 16 cases of male, female 14 cases; Aged 35 to 84 years, mean age was 54.10- 10.18 years old; right kidney 18 cases, 12 cases tumors located in the left kidney. Using GE company 64 row spiral CT scanner, using Volume Share AW 5 workstation to collect, analyze and process the CT image.Using MDERAD binocular high pressure syringe injection of iodine contrast agent.Preparation: before scanning patients after dinner the day before the diet, and bowel preparation, check before mannitol ratio of 1:1 150 ml with the warm boiling water, oral; After oral 2000 ml warm boiled water.Scan conditions: tube voltage 120 kv, Automatically adjust the tube current technology, layer spacing is 5 mm,thick is 5 mm, reconstruction image layer thickness of 0.625 mm.Enhancement scheme:Experimental component twice injection,concentration: 110 ml 300 built/ml, contrast medium: iodine amine on the street, the injection speed: 4.0 ml/s for the first time, dose: 40 ml,With the density of the abdominal aorta as trigger point(that is, when the density of the abdominal aorta reaches 150 Hu, start scanning), cortical phase(CMP) scan,After 180 s, the second injection speed: 4.0 ml/s, dose: 60 ml, second to 70 s N- EP scan(figure 1).The superior border of liver to levels seen in the lower imagescanning range。Control group:one-time injection contrast medium that concentration: 110 ml 300 built/ml, contrast medium: iodine amine that injection rate: 3.0 ml/s,with the density of the abdominal artery as a trigger point(that is, when the density of the abdominal aorta reaches 150 Hu, start scanning), cortical phase(CMP) scan,cortical phase of 47 s the scan, and then collect images NP and scan after the 180 s for EP(figure 2)。Acquisition range image with the experimental group.Two high quality CT doctor independently made an analysis and evaluation of CT enhancement scan images: 1, Renal clear cell carcinoma CT enhancement scanning quantitative analysis; 2, Renal clear cell carcinoma CT image quality of subjective evaluation; 3, Renal artery imaging analysis; 4, Effective radiation dose calculation of CT scanning. Application SPSS22.0 software of the data for statistical analysis.Results: 1. The renal clear cell carcinoma CT enhancement scanning quantitative analysis: the experimental group CMP tumor average CT value is lower than the control group, but both having no statistical difference(P = 0.083). Experimental group N- EP tumoraverage CT value is lower than the control group, but both having no statistical difference(P = 0.059); Experimental tumor N- EP average CT value compared with the control group tumor NP average CT value is higher, but no statistical difference was found between the two(P = 0.312). 2. The experimental group CNR renal parenchyma average CT value slightly higher than the control group, but no statistical difference was found between the two(P = 0.361). LKR value: The experimental group was 0.79 ± 0.10, the control group was 1.01 ± 0.20, the difference is statistically significant(P = 0.006). 3. Renal artery imaging analysis Control cortical phase of renal artery average CT value of 180.80±35.30 HU, the experimental group of cortical phase average CT value of renal artery were 145.20±2.84 HU, the difference has statistical significance(P = 0.03). 4. The experimental group and control group subjective image quality assessment: experimental group 8 people had 3 points, 22 people had 4 points, 6 people in the control group had 3 points, 24 people had 4 points,but no statistically significant difference(P = 0.542). 5. Contrast analysis of effective radiation dose : the experimental group of effective radiation dose averaged 13.95 m Sv; Control group effective radiation dose averaged 19.18 m Sv, the difference has statistical significance(P < 0.05).Compared with the control group, experimental group in this study cases effective radiation dose was reduced by 27%.Conclusions: Application by several times note double phase enhanced scan, renal clear cell carcinoma can achieve good strengthening effect, which is enough to make diagnosis, meanwhile can obviously reduce the effective radiation dose of client. |
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