Different phases of renal enhancement: Role in detecting and characterizing renal masses during helical CT

Although helical CT offers greater flexibility in data acquisition and reconstruction than does conventional axial CT, new opportunities for error must be understood so that optimal protocols are used that minimize the likelihood of misdiagnosis. Most nonrenal abdominal helical CT scans are obtained late in the corticomedullary phase of renal enhancement because of the preferable enhancement of other parenchymal organs. CT evaluation of the kidneys during the corticomedullary phase or at an intermediate phase between the corticomedullary and nephrographic phases has significant limitations. Therefore, dedicated renal CT performed for the detection of suspected renal masses or for the characterization of known renal masses must include images obtained during later phases of enhancement (i.e., nephrographic or excretory phase). Nephrographic or excretory phase images appear to be similar to one another but superior to corticomedullary phase images in the ability to both detect and characterize renal masses. Corticomedullary phase images should always be obtained when information about the renal vasculature is desired or when there is a possibility that a detected renal mass may represent an aneurysm or an arteriovenous malformation or fistula. Optimal technique of helical CT for staging renal cancers may require use of both corticomedullary and nephrographic or excretory phase images, although work in this area is still preliminary.