| Background: Renal carcinoma is one of the most common malignant tumor of the renal parenchyma, it often occurs in patients more than 40 years old, and the ratio between male and female is 2 : 1. The clinical symtome of renal carcinoma in its early stage is usually obscured, however blood urine may be the first sign of this entity, and it is only related to the size and position of the tumor, instead of its pathological feature. Thus, the diognosis of renal carcinoma is often being delayed. In recent years, CT and MRI have been proved to be of great value in the diagnosis of renal carcinoma, not only for the early discovery but also staging of the entity, which may contribute greatly to the choice of the treatment. Although MRI has a high speciality and accuracy rate in the diagnosis of renal carcinoma, it costs more money for the examination and is still not widely being used in our country. On the contrary, multi-phase spiral CT scanning is not only much cheaper, but also being used conventionally nowadays. It has the capability of showing the density, the bloodsupply as well as an accurate staging for the tumor. It is also a modality of choice to show the situation of the "normal" renal, which is a very important indication for the treatment. Follow-up spiral CT may be useful to recognize recurrency of the tumor. Above all, spiral CT scanning is one of the most reliable method of diagnosing renal carcinoma presently.Objectives: To analyze the pre and postcontrast multi-phase spiral CT findings of renal carcinoma in 56 patients vertified by operation and pathology. To assess the relation between the attenuation value of the tumor and its location within the renal being involved. The relation between the pathological nature of the tumor and its enhancement style on multi-phase spiral CT was also analyzed. Thus provided more information for the clinical physicians preoperationally.Methods: A series of 56 cases of renal carcinoma proved by operation and pathology. Among which, 41 were males and 15 females, ranging from 26 to 77 years old, with an average of 49.8. A total amount of 80-100 ml Omnipaque(300 mgl/ml ) was administered with a powerful injector at a flow rate of 3.0 ml/sec. A precontrast study was performed before the injection, and the multi-phase scaning were obtained at 23s, 63s and 5min respectively after the injection. In addition, a delayed scanning was also performed if necessary. The CT parameters were 120KV, 120mAs and the pitch=1.5. The procedure was carried out by a Picker Sele Sp device. While reviewing the literature and with reference to the Robson's staging criteria, all of the CT and surgico-pathological results were fully analyzed. The statistical analysis was performed with a SPSS 10.0 software package and the statistically significant standard was considered as "alpha equals 0.05".Results: The present study showed that renal carcinoma appeared to be a bulky mass with different size and heterogeneous density in most of the cases(n=44). Occasionally, calcification, lipoidal deposits were formed within the tumor. An extensive carcinoma that involved the whole kidney was rarely seen. There were enhancement of the tumor bed and its margin to different extent in most of thecases(n=49), and the enhancement style among different pathological nature of the tumor were varied. According to the statistical analysis, only the difference between the CT attenuation value of the cortical phase in the dynamic scanning showed significant (P<0.05), among various pathological tumors, which may serve as an indicator to predict the nature of the tumor before operation. The staging from I ~ IV in this group were 21, 10, 18, and 7 cases respectively. According to the pathological resultes, there were 40 transparent cell carcinomas, 12 granule cell carcinomas, and 4 papillary carcinomas. The correspondence rate of the tumor staging between pre and postoperation was stage I 91%, stage II89%, stage III 94% and stage IV 100%, with a total of 93%. The sensitivity of detecting metastatic lymph adenopathy, veneous and adjacent organs invasion as well as distant metastasis was of 75%, 100 % and 100% reciprocally in this group.Conclusions: The pre and postcontast multi-phase spiral CT may show the dense, extension and blood supply of a renal carcinoma. An accurate staging of the tumor may serve as an indicator for the choice of the treatment. The present study also showed the CT attenuation value of each phase in the dynamic scanning is not related with the position of tumor, but the style of pathology. It proved to be one of the most reliable radiological procedure for the diagnosis of renal carcinoma.
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