Disease: Study phase: Physician name: Raghunandan Vikram. Computed tomography of the abdomen and pelvis is an application of computed tomography (CT) . Fig. • The hepatic venous (or portal venous or parenchymal) phase of enhancement occurs ≈50 to 90 seconds after contrast administration, when hepatic . Initial single-phase CT image shows a 29-mm hyperdense lesion (arrow) in the right kidney, measuring 153 HUs. . Computed tomography of the abdomen and pelvis is an application of computed tomography (CT) . Image analysis PURPOSE: To evaluate the role of thin-section helical computed tomography (CT) performed during the corticomedullary phase (CMP) and nephrographic phase (NP) of contrast enhancement in the detection and characterization of renal masses. Rapid advances in CT technology accelerated the research into the application of this new technology in the evaluation of the UUT and readily proved to be superior to other imaging modalities. 10-15 minute delayed post-contrast acquisition through the adrenals GI It is common when imaging the posterior fossa of the brain for there to be streak artifacts. Excretory phase: diaphragm to iliac crests, axial, 3mm reconstruction section thickness with or without 50% overlap, at 7-10 minute delay. 3. . 1. Methods The EDCBs, which are comprised of unenhanced thin lines at the tumor-renal cortex border in the corticomedullary phase, on the CT . Brief Summary: Tumors of the UUT are rare and usually presenting as micro- or macrohematuria either symptomatic or asymptomatic. We constructed a dataset consisting of 1,035 CT images from 308 patients containing five major subtypes of renal tumors, including both benign and malignant tumors: oncocytoma, AML, clear cell RCC, papillary RCC, and chromophobe RCC. corticomedullary phase is best to delineate subcategories of renal cell carcinomas further nephrogenic phase is best for optimal enhancement of the renal parenchyma, including the renal medulla, and will demonstrate enhancing components of a mass excretory phase will demonstrate enhancement of calyces, renal pelvis and ureters. Protocols may include only the excretion phase, or may contain as many as 4 four phases, the plain CT study, corticomedullary, nephrographic and excretory. Renal veins are best visualised in corticomedullary phase and inferior vena cava is better visualized in nephrographic phase. 11: A: Asymptomatic 38-year-old man - Axial-view contrast enhanced CT corticomedullary phase shows incomplete rotation on the left kidney - renal pelvis (P) is located anteriorly; B: Asymptomatic 52-year-old woman - Sagittal/Coronal-view contrast enhanced CT corticomedullary phase reveals in the right kidney renal pelvis (P) and renal vessels are located superiorly This patient had a CT scan a . B,Nephrographic phase helicalCT scanobtained100secafterinitia-tionofcontrast injection reveals The EDCBs, which are comprised of unenhanced thin lines at the tumor-renal cortex border in the corticomedullary phase, on the CT images of 342 patients who underwent partial nephrectomy were evaluated. CT in a 46-year-old man illustrates various enhancement phases in the kidneys. TCC demonstrates arterial enhancement and can occur anywhere from the kidneys to the urinary bladder. Delayed or Excretory Phase - (5 min) MD Anderson Study Status . ( A ) Precontrast phase. 250 ml oral contrast immediately before the exam Adrenals The enhancement washout technique for CT characterization of adrenal masses include: 1. thin-section pre-contrast acquisition through the adrenals 2. Methods: The corticomedullary phase images of 119 cases of low-grade (I and II) and high-grade (III and IV) ccRCC based on 2016 ISUP/WHO pathological grading criteria were analyzed retrospectively. In all examinations, 5-mm-thick, contiguous, helical . Phone Number: 1-877-MDA-6789. Contrast material was given 3 days previously, and both kidneys are in corticomedullary phase with absent pyelograms. Utility of Corticomedullary Phase of a CT Urogram in Detecting Transitional Cell Carcinoma (TCC) and Metastatic Disease. The corticomedullary phase is characterized by enhancement of the renal cortex as well as the renal . 2. There was no statistically significant difference between corticomedullary and nephrographic phases ( p = 0.94). . • Sensitivity and NPV for bladder cancer detection were highest in corticomedullary phase . Following noncontrast scanning, intravenous contrast is injected and a corticomedullary phase is obtained at approximately 70 seconds (figure 7a, 7b). This may be overcome by 1) Decreasing slice thickness 2) Increasing kVp Following noncontrast scanning, intravenous contrast is injected and a corticomedullary phase is obtained at approximately 70 seconds (figure 7a, 7b). For general . Download as PowerPoint Open in Image Viewer Figure 17a. Objectives To retrospectively evaluate whether the early dark cortical band (EDCB) on CT can be a predictor to differentiate clear cell renal cell carcinoma (ccRCC) from fat poor angiomyolipoma (Fp-AML) and to detect peritumoral pseudocapsules in ccRCC. The presence of tiny fatty tissue cannot be determined on the basis of this CT image. In the CT urography protocol with enhancement-triggered scan, sensitivity and NPV were highest in the corticomedullary phase, and this phase should be used for bladder assessment. For context, see en:Computed tomography of the abdomen and pelvis. 400-600 ml oral contrast 45-90 minutes prior to the exam 2. A 2. In addition to solid tumors, the CT and MRI findings of our 2 patients were similar to those of cavernous hemangiomas of the liver, including peripheral nodular enhancement in the corticomedullary phase, progressive centripetal enhancement in the nephrographic and delayed phases, and sometimes complete "filling in" in the delayed phase. MD Anderson Study Status . . Tumor segmentation Information and next steps. . Materials and methods Renal CT scans and medical records of 33 patients were retrospectively reviewed. The CT-images are of a patient who underwent two phases of arterial imaging at 18 and 35 seconds. If dedicated renal CT is requested for a suspected renal mass, the helical scan series to be obtained are unenhanced, corticomedullary and nephrographic phase images. In Bosniak v2019, the mass is considered indeterminate by a single-phase-enhanced CT. MRI (not shown) was performed and confirmed that the mass was a hemorrhagic cyst with no . Here, the . Objective: Comparing the prediction models for the ISUP/WHO grade of clear cell renal cell carcinoma (ccRCC) based on CT radiomics and conventional contrast-enhanced CT (CECT). The CT contrast agent is an extracellular fluid contrast agent. Note absence of To compare corticomedullary phase images and low keV VMIs (40 to 100 keV) from the nephrographic phase, the attenuation, image noise, SNR and subjective lesion visibility of the tumours and renal arteries were evaluated. B and C, Corticomedullary (B) and nephrographic (C) phase contrast-enhanced CT scans show lesion (arrow) has no gross fat attenuation. the CT consist of four phases; non-enhanced, corticomedullary, nephrographic and excretory phase. The CT-images show an early arterial phase in comparison to a late arterial phase. Selected images from a renal mass specific protocol CT. Corticomedullary phase (axial 7a) demonstrates peripheral enhancement of the renal cortex with minimal opacification of the renal medulla. The patterns of CT attenuation value and homogeneity were correlated with the subtypes of neoplasms, microvessel density, and the existence of . 4—Bilateral persistent nephrogram and delayed pyelogram in this 82-year-old man with acute tubular necrosis. (b, c) In a right . Fig. Graph shows the process of obtaining tumor tissue from original images by manual segmentation in unenhanced, corticomedullary, nephrographic, and excretory phase from left to right Full size image Texture features extraction Texture features were extracted using PyRadiomics [ 11 ]. And the excretory phase was scanned 5 min after onset of contrast injection. CMP, corticomedullary phase; LNP, late nephrographic phase; NPV, negative-predictive value; PPV, positive-predictive value. • The corticomedullary (or cortical) phase of enhancement occurs 25 to 70 seconds after contrast administration. (Exclude for young patients) ± Venous (nephrographic) phase of abdomen only. Utility of Corticomedullary Phase of a CT Urogram in Detecting Transitional Cell Carcinoma (TCC) and Metastatic Disease. Renal veins are best visualised in corticomedullary phase and inferior vena cava is better visualized in nephrographic phase. During the corticomedullary phase, ccRCCs with the loss of chromosome Y enhanced more than those without this anomaly (130.0 vs 102.5 HU, P =.04), and ccRCCs with trisomy 7 enhanced less than those without this anomaly (105.8 vs 139.3 HU, P =.04). MATERIALS AND METHODS: A prospective study of 30 patients was undertaken with CT to characterize 31 "indeterminate" renal masses. Corticomedullary-phase CT images provided much more valuable texture parameters than unenhanced images . The masses were presented in the . Conclusion The detectability of renal stones ≥ 6 mm on contrast-enhanced CT is extremely high. However, on contrast-enhanced sonography, small vessels are enhanced at the renal lymphoma periphery . corticomedullary phase is best to delineate subcategories of renal cell carcinomas further nephrogenic phase is best for optimal enhancement of the renal parenchyma, including the renal medulla, and will demonstrate enhancing components of a mass excretory phase will demonstrate enhancement of calyces, renal pelvis and ureters. Gas bubbles extend into the perinephric space. It occurs between 25 and 70 seconds after the initiation of contrast material injection. Xanthogranulomatous pyelonephritis in a 80-year-old woman with chronic pyuria. ( B ) Corticomedullary phase (obtained 40-70 second delay after contrast injection, showing differential enhancement of the renal cortex and medulla). (a) In corticomedullary phase, most RCCs have a ratio lower than 1.0, whereas nearly all RO have a ratio higher than 1.0. Arterial (corticomedullary) phase of abdomen only Conventional clear cell RCCs and their metastases demonstrate arterial enhancement. A 4-phase low-dose computed tomographic (CT) urography was indicated. Arterial Phase - (30s) Corticomedullary Phase - (40s) maximized corticomedullary differentiation. Timing of CT-series is important in order to grab the right moment of maximal contrast differences between a lesion and the normal parenchyma. Department: Diagnostic Radiology. PURPOSE: To evaluate thin-section computed tomography (CT) performed during the corticomedullary and nephrographic phases of contrast material enhancement in the characterization of renal masses. Citation, DOI & article data The late arterial phase, also known as the corticomedullary phase or early venous portal phase, is a contrast-enhanced CT or MRI series, in which there is an optimal enhancement of structures that get their blood supply directly from the arterial system. Download scientific diagram | Transversal a non-contrast, b corticomedullary phase and c nephrographic phase CT image of a 66-year-old female with a moderately complex renal cystic lesion (arrow . Results: In SSFP with Time-SLIP, corticomedullary contrast ratio was highest with TI of 1200 msec in eight subjects (40%), followed by 1100 msec in seven (35%) and 1000 msec in three (15%). Objective—To determine computed tomography . Conventional RCC metastases usually most conspicuous on arterial phase. Independent predictors among the clinical and CT findings for differentiating ccRCC from Fp-AML were identified using multivariate analyses. This growth pattern may be reflected in our findings. Key Points • More bladder tumours are detected during the corticomedullary phase than during other phases . A2, A3 and A4 represent the CT values of the aorta in corticomedullary phase, nephrographic phase, excretory phase respectively. ( C ) Nephrographic phase (100-120 seconds after contrast injection, with uniform enhancement of the entire renal parenchyma). The attenuation characteristics of RCC and TCC were compared to the attenuation of the normal renal cortex. Poor enhancement of the right renal parenchyma without corticomedullary differentiation on the corticomedullary phase (a) and nephrogenic phase (b) images. Clear cell RCCs also demonstrate rapid washout of contrast with T2 hypointensity on the excretory phase. Corticomedullary phase: kidneys only, axial, 3mm reconstruction section thickness with or without 50% overlap, at 40-70 seconds delay. This can be difficult to assess when the lesion is small and located in the renal cortex, which also enhances strongly. Arterial (corticomedullary) phase of abdomen and pelvis. The attenuation of the mass is 49 HU on the corticomedullary phase (a), 40 HU on the virtual non-enhanced CT (b) and on the iodine image (c) the mass shows no enhancement. If dedicated renal CT is requested for a suspected renal mass, the helical scan series to be obtained are unenhanced, corticomedullary and nephrographic phase images. A, Unenhanced CT scan shows lesion (arrow) has slightly higher attenuation than renal parenchyma. Patchy enhancement of the corticomedullary interface is a classic sign of acute pyelonephritis and can be seen on arterial-phase imaging. The presence of tiny fatty tissue cannot be determined on the basis of this CT image. MATERIALS AND METHODS: Renal CT scans and medical records of 33 patients were retrospectively reviewed. CECT Phases Phase Timing Corticomedullary 30-70 sec Nephrogram 80-120 sec Excretory 3-15 mins or longer CECT Phases are required for renal mass characterization, visualization of ureteric obstructions and strictures, bladder wall abnormalities and infections and inflammations. To determine optimal scan delays for renal arterial-, corticomedullary-, and nephrographic-phase imaging with multi-detector row computed tomography (MDCT) of the kidney using a bolus-tracking technique. We . The kidneys have an attenuation of 30 to 50 Hounsfield units (HU) on unenhanced CT. On MRI, the renal cortices have low T1-weighted The kidneys have an attenuation of 30 to 50 Hounsfield units (HU) on unenhanced CT. . Additionally, the highest accuracy (88%) was achieved in the corticomedullary phase images. English: Corticomedullary phase CT in axial and coronal plane, and parenchymal phase, of renal cell carcinoma. Sa represents the mean CT values of the corresponding layers of aorta in corticomedullary phase, nephrographic phase, and excretory phase respectively. Tools Share Abstract PURPOSE: To evaluate the role of thin-section helical computed tomography (CT) performed during the corticomedullary phase (CMP) and nephrographic phase (NP) of contrast enhancement in the detection and characterization of renal masses. Download scientific diagram | Unenhanced (A), corticomedullary phase CT scans showing a great amount of blood in the peri and para-renal left kidney zone, generated by a lesion of the kidney's . In all patients, 5-mm-thick, contiguous, high-tube-current (320-340-mA . (Exclude for young patients) ± Venous (nephrographic) phase of abdomen only A P 4. Deep Learning Differentiates Small Renal Masses on Multiphase CT Leesburg, VA, January 10, . Portal Venous Phase - (60s) Nephrogenic Phase - (100s), homogeneous appearance, contrast is exiting the cortical vasculature, filtered in the glomeruli and enters the Loop of Henle and collecting tubules.

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