Original Article

pISSN 1738-2637 / eISSN 2288-2928

J Korean Soc Radiol 2017;76(5):337-345
https://doi.org/10.3348/jksr.2017.76.5.337

Analysis of the Effects of Different Iodine Concentrations on the

Characterization of Small Renal Lesions Detected by Multidetector
Computed Tomography Scan: A Pilot Study
CT에서 발견된 작은 신장 병변의 분석에 있어서
조영제의 요오드 농도에 따른 효과 분석
Hak Jong Lee, MD1,2,3,4, Sang Youn Kim, MD1,2,3,5,6, Jeong Yeon Cho, MD1,2,3,5,6,
Sung Il Hwang, MD1,2,3,4, Min Hoan Moon, MD1,2,3,7, Seung Hyup Kim, MD1,2,3,5,6*
1
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
2
Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
3
Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
4
Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
5
Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
6
Department of Radiology, Seoul National University Hospital, Seoul, Korea
7
Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea

Purpose: Our objective was to compare the effects of different iodine concentra- Index terms
tions on characterizing small renal lesions. Multidetector Computed Tomography
Materials and Methods: Thirty-eight patients were enrolled in this study. All patients Contrast Media
underwent an initial CT scan using 370 mgI/mL iodinated contrast media. Patients Kidney
were then randomized into two groups for a follow-up CT. Group A (n = 19) received Iodine
250 mgI/mL iodinated contrast media, and group B (n = 19) received 300 mgI/mL Diagnostic Imaging
contrast media. The mean Hounsfield units (HU values) of small renal lesions with a
maximum size of less than 2 cm were calculated. Signal to noise ratios (SNR values)
Received March 28, 2016
were likewise evaluated. Three uroradiologists assessed the lesion’s conspicuity and Revised May 31, 2016
the diagnostic influence of the artifact’s proximity to the adjacent renal parenchyma. Accepted October 1, 2016
Results: In group A, there were significant differences between the HU values of renal *Corresponding author: Seung Hyup Kim, MD
Department of Radiology, Seoul National University
lesions and those of the adjacent renal parenchyma between the initial and follow-up Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea.
CT. Conversely, in group B, there was no significant difference. Moreover, SNR values Tel. 82-2-2072-2987 Fax. 82-2-743-6385
showed no statistically significant difference between both groups. Regarding lesion E-mail: kimshrad@snu.ac.kr
conspicuity, only one reader identified a significant difference (p = 0.032) in group A; This is an Open Access article distributed under the terms
whereas in group B, there was no statistical difference. The artifact’s proximity to the of the Creative Commons Attribution Non-Commercial
adjacent renal parenchyma did not appear to have any diagnostic influence on differ- License (http://creativecommons.org/licenses/by-nc/4.0)
which permits unrestricted non-commercial use, distri-
entiating the two (p < 0.05). bution, and reproduction in any medium, provided the
Conclusion: In evaluating small renal lesions, 300 mgI/mL instead of 370 mgI/mL original work is properly cited.
contrast media can be used; however, it is important to note that the use of 250 mgI/
mL contrast media may reveal different results from that of 370 mgI/mL contrast
media.

INTRODUCTION imaging modality of routine clinical practice for the diagnosis,

treatment planning, and follow-up of many diseases. The diag-
Multidetector computed tomography (MDCT) of the abdom- nostic accuracy of CT examination is highly dependent on the
inal solid organs, including the liver and kidney, is an essential imaging protocols and, in particular, on contrast media (CM) in-

Copyrights © 2017 The Korean Society of Radiology 337

Effects of Different Iodine Concentrations on the Characterization of Small Renal Lesions
jection protocols, including the concentration of CM and injec-
tion speed (1-3).
With recent improvements in the temporal and spatial resolu-
tions in MDCT, the need for a more efficient approach in the use
of iodinated CM has increased (4). Several studies investigated
the influence of CM with different iodine concentration on pa-
renchymal and vascular enhancement in body imaging (1, 5-7).
Although the choice of contrast agent concentration and ad-
ministration techniques are still controversial, many authors have
shown that enhancement of the abdominal arteries directly cor-
relates to the amount of iodine per second (8, 9), which is also
known as the “iodine flux” (10). With greater iodine flux, the re-
gion of interest (ROI) will be higher in density. Conversely, be-
cause a lower amount of total iodine lowers the risk of contrast-
induced nephropathy (11-13), CT protocols should always find
a compromise between the required contrast enhancement and
the amount of iodine injected (10).
Small renal masses (SRM) are usually defined by a diameter
of up to 4 cm, and they constitute 48% to 66% of all newly diag-
nosed renal tumors and 38% of all excised renal masses (14-16).
However, most incidental renal masses now detected on cross-
sectional imaging are less than 2.5 cm in size (17). With increas-
ing utilization of diagnostic imaging modalities, detection of
smaller renal lesions has increased. Furthermore, the need for
greater characterization of the detected small renal lesions, in-
cluding contrast enhancement after the injection of CM, has in-
creased. It has become critical for planning further treatment or
evaluation. There have been several articles comparing the qual-
ities of images derived from different iodine concentrations in the
upper abdomen or renal arteries using 240, 300, or 370 mgI/
mL (18, 19). However, no reports have characterized small renal
lesions using these different iodine concentrations.
The purpose of this study is to compare the effects of two dif-
ferent iodine concentrations on the characterization of small re-
nal lesions that are detected via MDCT and are less than 2 cm in
diameter.
MATERIALS AND METHODS
Patient Population
This study was approved by the Institutional Review Board,
and informed consents were obtained from each patient. Be-
338
tween September 2009 and February 2012, 38 patients who un-
derwent both nephrectomy due to renal tumor and postopera-
tive follow-up CT were enrolled in this study. Thirty-seven of 38
patients were confirmed to have renal cell carcinoma. One patient
had oncocytoma. Patients consisted of 25 men and 13 women,
with a mean age [± standard deviation (SD)] of 61 (± 9.5) years.
On both the initial and follow-up CT, the small renal lesions
with a maximum diameter of less than 2 cm were evaluated.
These small lesions were thought to be mostly benign. Among
the 38 patients, 27 patients had 43 small renal lesions in either the
contralateral kidney (n = 29) or the postoperatively remaining
kidney (n = 14). Out of 43 small renal lesions, seven lesions
showed high attenuation [> 20 Hounsfield unit (HU)] on precon-
trast CT imaging, suggesting hemorrhagic cysts. And one high
attenuation lesion showed a decreased HU value upon follow-
up precontrast CT, which suggested that the hemorrhage was
resolved.
Multidetector Row CT Protocol
A contrast-enhanced CT was performed using multidetector
row helical CT systems (Somatom Definition, Siemens, Munich,
Germany; Sensation 16, Siemens; Mx 8000, Philips Medical Sys-
tems, Best, the Netherlands; Brillance 64, Philips Medical Sys-
tems). The CT parameters used were 120 kVp, a slice thickness of
5 mm, a rotation time of either 0.5 or 0.75 seconds, and pitches
ranging from 0.89 to 1.35. The milliamperage ranged from 137 to
303 mA as a result of automatic tube current modulation. CT im-
ages were obtained with the subject in a supine position with the
arms above the head in the cephalocaudad direction, imaging
from the base of the lungs to the upper border of the pelvic bones.
Contrast Injection Protocol
All patients underwent CT scanning after injection of 370
mgI/mL iodinated CM (Iopamidol, Pamiray 370, DongKook
Pharm. Co., Seoul, Korea) on the initial CT. Patients were then
randomized into two groups. Group A (n = 19) underwent a fol-
low-up CT scan after injection of 250 mgI/mL iodinated CM
(Iopamidol, Pamiray 250, DongKook Pharm. Co.), and group B
(n = 19) underwent a follow-up CT scan with 300 mgI/mL (Io-
pamidol, Pamiray 300, DongKook Pharm. Co.). In group A, 17
patients had 30 small renal lesions; and in group B, 10 patients
had 13 small renal lesions (Fig. 1). The injection rate was fixed
J Korean Soc Radiol 2017;76(5):337-345 jksronline.org
 Hak Jong Lee, et al

at 3 mL/sec, and the total amount of CM was variable accord-
ing to each patient’s body weight (2 cc/kg), ranging from 70 cc
to 120 cc. All patients underwent biphasic contrast-enhanced
CT that included unenhanced, corticomedullary phase, and ex-
cretory phase scans. Corticomedullary phase images were ac-
quired 30–40 seconds following injection. Excretory phase im-
ages were acquired 3 minutes following injection. Due to the
difficulties in renal lesion evaluation in the corticomedullary
phase, the excretory phase images from 3 minutes after CM in-
jection were evaluated. The mean time interval between the ini-
tial CT examination and second CT examination was 406.2 ±
149.4 days (range: 175–772 days).
38 patients who performed nephrectomy
- 37 pts: renal cell carcinoma
- 1 pt: oncocytoma
- Follow up CT using 370 mgI/mL contrast media
Randomized into
two groups
Group A Group B
- 19 patients - 19 patients
- 30 small renal lesions - 13 small renal lesions
- 300 mgI/mL contrast media - 250 mgI/mL contrast media
Fig. 1. Flow chart demonstrating the included patients. 38 patients
underwent CT examination after injection of 370 mgI/mL contrast me-
dia. Subsequently, for the follow-up CT, the patients were randomized
into two groups. Group A (n = 19) underwent their follow-up CT after
injection of 250 mgI/mL contrast media, and group B (n = 19) under-
went CT examination after injection of 300 mgI/mL contrast media.
Image Analysis
Quantitative Evaluation
Quantitative evaluation was performed by measuring the HU
values of small renal lesions. Patient data was anonymized by
an independent radiologist not involved in this imaging analy-
sis. Quantitative analysis was performed by a consensus of two
experienced uroradiologists (blinded S.Y.K., S.I.H.), who were
blinded to the CM protocol. In all examinations, attenuation
values were measured by placing circular ROIs, which were ap-
proximately 1 cm in diameter, on small renal lesions, renal pa-
renchyma adjacent to small renal lesions, and outside the image
of the patient’s body. The size of each ROI was kept smaller
than that of renal lesions to avoid differential diagnostic influ-
ence of proximity to the adjacent renal parenchyma. If the di-
ameter of the lesion was less than 1 cm, the size of the ROI was
modified to 75% of the lesion’s dimension. The attenuation mea-
surements were performed three times and then averaged. HU
values of the small renal lesions were compared in each group.
To investigate the influence of acquisition parameters on image
homogeneity attenuation values, signal to noise ratio (SNR)
values for all measurements were calculated. SNR was calculat-
ed by dividing the average HU value by the SD of ROI, located
outside the patient’s body (1, 20-22).
Qualitative Evaluation
Three uroradiologists (blinded S.I.H., J.Y.C., M.H.M.), who
had over 20 years of experience in analyzing body CT scans and

Table 1. Mean and SD of Each Small Renal Lesions and Surrounding Tissues
Group A (n = 30) Group B (n = 13)
Contrast Medium
370 mgI/mL 250 mgI/mL 370 mgI/mL 300 mgI/mL
Renal lesion HU
Mean 44.9 32.3 32.6 31.8
SD 26.0 24.4 28.6 28.1
p-value 0.002 0.552
Surrounding parenchyma HU
Mean 197.6 160.5 190.6 187.8
SD 29.9 24.8 34.2 28.6
p-value < 0.001 0.279
Signal to noise
Mean 34.4 29.0 26.6 32.1
SD 16.6 15.3 12.0 20.4
p-value 0.144 0.382
HU = Hounsfield unit, SD = standard deviation

jksronline.org J Korean Soc Radiol 2017;76(5):337-345 339

Effects of Different Iodine Concentrations on the Characterization of Small Renal Lesions

who were blinded to the concentration of CM used, analyzed
the qualities of the MDCT images. They were asked to evaluate
the lesion’s conspicuity and diagnostic influence of the artifact’s
adjacency to the renal parenchyma.
For the evaluation of lesion conspicuity phase, 43 small renal
lesions from both groups were evaluated. A subjective 5-point
scale was used for qualitative assessment: 1 = unacceptable, 2 =
poor, 3 = fair, 4 = good, and 5 = excellent. The 5-point scale
method has been widely used in the evaluation of image quality
in different iodine concentrations (23, 24). The images were
graded as unacceptable if the margins of the small renal lesions
were indistinguishable on all images. The images with an indis-
tinct margin between the lesion and the renal parenchyma on
most images were graded as poor. Images were graded as fair if
the lesion margin and renal parenchyma were present only in
some images while not distinct in others. Images in which the
margin of the lesion and the parenchyma were present in all of
the images at the proper level were graded as good. Images were
graded as excellent if the margins of the lesion and the paren-
chyma were definite, leading to clear and easy evaluation.
In addition, the influence of each artifact’s proximity to the
adjacent renal parenchyma in differentiating between both was
also evaluated in both groups. The images were graded as 1 if the
lesion was influenced by the artifact from CM in the collecting
system. If not, the images were graded as 0.
Statistical Analysis
For quantitative assessment, a paired t-test was used to com-
pare the HU values of small renal lesions and SNR. For qualita-
tive assessment, a Wilcoxon signed rank test was used. A p-value
of less than 0.05 was considered to indicate a statistically signifi-
cant difference. For evaluation of interobserver agreement, wei-
ghted kappa values and overall proportion of agreements were
analyzed (25).
RESULTS
Quantitative Evaluation
Table 1 shows the mean and SD of attenuation in small renal
lesions and surrounding parenchyma in both groups. The mean
HU of group A and group B was 44.9 (± 26.0) and 32.6 (± 28.6),
respectively, when 370 mgI/mL of CM was injected. In group A,
where 250 mgI/mL of CM was used on a follow-up CT, the mean
HU was 32.3 (± 24.4). The mean HU was 31.8 (± 28.1) in the fol-
low-up CT of group B, where 300 mgI/mL of CM was used. In
group A, a comparison between 370 mgI/mL and 250 mgI/mL
yielded significant differences in the HUs of small renal lesions
(p = 0.002) and those of the adjacent renal parenchyma (p < 0.001)
(Fig. 2). In group B, with a comparison between 370 mgI/mL
and 300 mgI/mL, there was no significant difference in the HUs
of small renal lesions (p = 0.552) and those of the adjacent renal
parenchyma (p = 0.279) (Fig. 3).
The quantitative assessment of image homogeneity, based on
the comparison of SNR with different iodine concentrations, re-
vealed that no significant statistical differences were found to be
in evidence either in group A (370 mgI/mL vs. 250 mgI/mL, p =

A B
Fig. 2. Small renal lesion of a 54-year-old male patient; imaged using 370 mgI/mL (A) and 250 mgI/mL contrast medium (B).
A. The HU of the small renal lesion, imaged with 370 mgI/mL of contrast medium, was 50.
B. The HU of the same lesion, imaged with 250 mgI/mL of contrast medium, was 18.1. There was a significant difference in the HUs of the small
renal lesions in group A.
HU = Hounsfield unit

340 J Korean Soc Radiol 2017;76(5):337-345 jksronline.org

 Hak Jong Lee, et al

0.144) or in group B (370 mgI/mL vs. 300 mgI/mL, p = 0.382). respectively).

Qualitative Evaluation
Table 2 shows the results of lesion conspicuity in both groups.
In group A, where the concentrations of CM were 370 mgI/mL
and 250 mgI/mL, readers 1 and 2 reported that there was no sig-
nificant difference between images derived from 370 mgI/mL
and 250 mgI/mL CM (p = 0.573 and 0.224), although reader 3
reported a significant difference (p = 0.032) between both. In
group B, where the concentrations of CM were 370 mgI/mL and
300 mgI/mL, all three readers showed no statistical differences
with respect to lesion conspicuity (p = 0.132, 0.086, and 0.380,
Table 3 shows the influence of the artifact’s proximity to the
adjacent parenchyma. The Wilcoxon signed rank test revealed
that there was no statistical difference in the number of cases that
showed an influence of the proximity of the artifact on diagnostic
differentiation from the adjacent renal parenchyma (p < 0.05).
The overall proportion of agreement among three reviewers was
94.7% in group A and ranged from 78.9% to 89.5% in group B.
DISCUSSION
The principal factors affecting the enhancement of CM in CT

A B
Fig. 3. A small renal lesion of a 41-year-old male patient; imaged using 370 mgI/mL (A) and 300 mgI/mL of contrast medium (B).
A. The HU of the small renal lesion, imaged with 370 mgI/mL of contrast medium, was 5.0.
B. The HU of the same lesion, imaged with 300 mgI/mL of contrast medium, was 7.0. There was no significant difference in the HUs of the small
renal lesions in group B.
HU = Hounsfield unit

Table 2. Qualitative Evaluation of Lesion Conspicuity in Both Groups

Group A (n = 30) (370 mgI/mL vs. 250 mgI/mL) Group B (n = 13) (370 mgI/mL vs. 300 mgI/mL)
Average Weighted Average Weighted Average Weighted Average Weighted
Lesion Conspicuity
p -Value Kappa Kappa p -Value Kappa Kappa ICC
(370 mgI/mL)* (250 mgI/mL)* (370 mgI/mL)* (300 mgI/mL)*
Reader 1 0.573 0.362 0.345 0.132 0.333 0.495
Reader 2 0.224 0.086
Reader 3 0.032 0.380
*Average weighted kappa: average weighted kappa value for reader 1 versus 2, reader 2 versus 3, and reader 1 versus 3.

Table 3. Influence of the Artifact to Adjacent Parenchyma

Group A (n = 19) Group B (n = 19)
(370 mgI/mL vs. 250 mgI/mL) (370 mgI/mL vs. 300 mgI/mL)
370 mgI/mL 250 mgI/mL 370 mgI/mL 300 mgI/mL
p -Value p -Value
Yes No Yes No Yes No Yes No
Reader 1 0 19 0 19 1.000 2 17 4 15 0.301
Reader 2 0 19 1 18 0.317 0 19 0 19 1.000
Reader 3 1 18 0 19 0.317 1 18 1 18 1.000
Proportion of agreements (%) 94.7 94.7 89.5 78.9

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Effects of Different Iodine Concentrations on the Characterization of Small Renal Lesions
imaging include patients, the CT scan, and CM (26). Patient-
related factors including body weight, body surface area, cardi-
ac output, and cardiovascular circulation affect the magnitude
or timing of contrast enhancement (26).
Advancements in MDCT technology have revolutionized
scanning and contrast administration protocols in body imaging
(23). To take full advantage of MDCT, contrast enhancement
protocols and scan timing must be modified for each clinical im-
aging application. CT scanning parameters which critically affect
the contrast enhancement include scan duration, scan direction,
multiphasic acquisitions during different phases of contrast en-
hancement, and scan delay after CM injection.
CM injection protocols are determined by a combination of
several factors, including CM volume (27-31), CM concentra-
tion, rate of injection, and type of injection (27, 32). The rationale
of any injection protocol is to deliver an adequate amount of CM
in order to obtain optimal parenchymal and vascular enhance-
ment. In the liver, the parenchymal enhancement is directly de-
pendent on the total amount of iodine injected. Thus, it is affect-
ed by the total volume of CM. It can be modulated on the basis
of iodine concentration: The higher the iodine concentration,
the lower the volume of injected CM (1, 5, 31). For example, to
achieve optimal parenchymal enhancement of the liver (around
50–60 HU), it is necessary to deliver around 500–750 mgI per
kg of body weight (1). Conversely, vascular enhancement is di-
rectly dependent on the iodine delivery rate, which is the iodine
load given per unit of time (1, 5).
Intravenous CM are available commercially in a wide range of
concentrations (from 240 to 370 mgI/mL). When the volume,
injection rate, and duration of CM are fixed, a higher concentra-
tion CM will deliver a larger dose of iodine faster. This results in
a higher magnitude of peak contrast enhancement and a wider
temporal window for CT imaging at a given level of enhance-
ment.
Recently, CM with a high iodine concentration (350 mgI/mL)
have been commonly reported as being widely used with MDCT
(26). This trend reflects a consensus that a high rate of iodine
delivery is a desirable pairing with a fast MDCT scan to maxi-
mize arterial enhancement for CT angiography and improve
depiction of hypervascular tumors (26). However, an increased
concentration of iodine can exacerbate the adverse effects of
contrast materials.
342
There are a few reports regarding the concentration of CM in
evaluating either the upper abdomen, aorta, or chest (4, 19, 23).
Sandstede et al. (19) compared the effectiveness of six contrast
injection protocols (including iodine concentrations of 240, 300,
and 370 mgI/mL) and different injection rates (ranging between
3.3 and 5 mL/sec) in evaluating the upper abdomen (including
the liver, pancreas, and spleen). They concluded that there was
no significant difference between each methodology (19). Ren-
go et al. (1) made a comparison between high concentration io-
dine (400 mgI/mL) and low concentration iodine (320 mgI/
mL) in vascular and parenchymal CT enhancement of the liver.
They concluded that the same iodine delivery rate and total io-
dine load did not provide statistically significant differences in
liver parenchymal and vascular contrast enhancement.
There are also other reports regarding vascular enhancement
evaluation with different iodine concentrations in body imag-
ing (10, 24, 33). Loewe et al. (10) compared the diagnostic effi-
cacy of 350 mgI/mL and 400 mgI/mL CM in the evaluation of
the abdominal aorta and abdominal arteries in a prospective,
randomized, double-blind, multi-center trial. They demonstrated
the non-inferiority of the 350 mgI/mL versus the 400 mgI/mL
iodine concentration in the evaluation of abdominal MDCT
angiography.
A small renal mass corresponds to the clinical staging of a T1a
renal tumor according to the American Joint Committee on Can-
cer–and such a tumor is generally defined as a mass within the
kidney, with a maximum size of 4 cm (34, 35). With the advance-
ment of CT technology and screening programs, incidentally-
discovered renal masses currently comprise 48–66% of tumors as
compared with 3–13% in the 1970s (34, 36), showing a markedly
increased ratio. The evaluation of enhancement of the small re-
nal lesion (including SRM or cysts) after CM injection is critical
for the characterization of the lesion–i.e., whether the lesion needs
treatment or just follow-up.
We quantitatively and qualitatively evaluated the small renal
lesions of less than 2 cm in size as detected on CT images with
different CM concentrations. In the quantitative evaluation, the
HUs of small renal lesions imaged through usage of either 370
mgI/mL and 250 mgI/mL of iodinated CM were found to be
significantly different. In contrast, the HUs of small renal le-
sions imaged through usage of either 370 mgI/mL or 300 mgI/mL
of iodinated CM were found to be no different from each other.
J Korean Soc Radiol 2017;76(5):337-345 jksronline.org

Thus, when evaluating small renal lesions, the use of 300 mgI/mL
instead of 370 mgI/mL iodine CM would not change the results.
However, the use of 250 mgI/mL instead of 370 mgI/mL CM
could reveal different results in the evaluation of small renal le-
sions. In qualitative evaluations regarding the conspicuity of
small renal lesions, all three reviewers reported no significant
difference in group B, where we compared the results of 370
mgI/mL and 300 mgI/mL CM. However, in group A, where we
compared the results of 370 mgI/mL and 250 mgI/mL CM, one
reviewer reported a significant difference between both. Our re-
sults suggest that a CM of 300 mgI/mL can replace 370 mgI/mL–
but that a CM of 250 mgI/mL has limitations in replacing 370
mgI/mL (even though the diagnostic influence of the proximity
of the artifact to the adjacent parenchyma was found to have
been negligible).
The main limitation of our study is that small renal lesions
we evaluated were not pathologically confirmed, although we
assume that most renal lesions were benign cysts. However, re-
garding the most common clinical situation, our results proved
to be helpful in evaluating incidentally-detected small renal le-
sions found in post-contrast CT study. The second limitation of
our study is that the qualitative evaluation was subjective, despite
the attempted quantitative evaluation by measuring the HUs of
small renal lesions. However, it is also true that (as seen in other
publications) subjective assessment by experienced radiologists
is a common method for image quality analysis (23, 24). The
third limitation is that the number of cases in each group was
small. Another limitation is that we used different CT machines,
which might contribute to the confounding factors in this study.
These biases could not be controlled, and the comparison of en-
hancement is limited. Because the renal lesions are quite small,
the measurement errors due to pseudoenhancement and/or the
location of the renal lesions could affect the results.
In spite of these limitations, our results revealed that for the
characterization of small renal lesions with less than 2 cm in di-
ameter, 300 mgI/mL CM can be used instead of 370 mgI/mL.
However, our findings also showed that the use of 250 mgI/mL
CM may reveal insufficient results as compared with the better
CM of 370 mgI/mL. Lastly, because the quality of enhancement
of renal mass has been shown to be variable based on how much
iodine is used, more detailed renal mass evaluation follow-up
studies are needed to more precisely identify the amount opti-
jksronline.org J Korean Soc Radiol 2017;76(5):337-345
Hak Jong Lee, et al
mal for quality renal parenchymal enhancement.
Acknowledgments
This work was supported by Seoul National University Hos-
pital Research Fund (04-2009-0710).
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CT에서 발견된 작은 신장 병변의 분석에 있어서

조영제의 요오드 농도에 따른 효과 분석
이학종1,2,3,4 · 김상윤1,2,3,5,6 · 조정연1,2,3,5,6 · 황성일1,2,3,4 · 문민환1,2,3,7 · 김승협1,2,3,5,6*

목적: 작은 신장 병변의 CT 분석에 있어서 조영제의 요오드의 농도의 차이에 따른 효과를 분석하고자 한다.
대상과 방법: 38명의 환자를 대상으로 하여 370 mgI/mL의 요오드화 조영제를 사용하여 CT를 촬영하였다. 이후 환자들
을 두 군으로 나누어서, A군(n = 19)의 경우에는 이후 추적 검사 시 250 mgI/mL를 주입하였고, B군(n = 19)의 경우에는
300 mgI/mL의 조영제를 주입하였다. 각 검사에서 2 cm 이하의 신장 병변의 Hounsfield unit (이하 HU)과 신호 대 잡음
비율(signal to noise ratios; 이하 SNR)을 측정하였다. 병변의 명료성과 주위 신실질에 대한 허상의 영향 등도 평가하였다.
결과: A군의 경우, 초기와 추적 검사의 CT에서 작은 신장 병변의 HU 값은 유의한 차이를 보였지만, B군의 경우에는 큰
차이를 보이지는 않았다. SNR은 두 군 모두 유의한 차이를 보이지 않았고, 인공물의 영향도 유의한 차이는 없었다.
결론: 작은 신장 병변을 평가할 때, 300 mgI/mL의 조영제는 370 mgI/mL 대신 사용될 수 있을 것으로 사료되나, 250
mgI/mL의 조영제는 370 mgI/mL 조영제 사용 때와 다른 결과를 보여줄 수 있으므로 신중하게 고려되어야 한다.

1
서울대학교 의과대학 영상의학과, 2서울대학교 의과대학 신장연구소, 3서울대학교 의학연구소 방사선의학연구소,
4
분당서울대학교병원 영상의학과, 5서울대학교병원 임상의학연구소, 6서울대학교병원 영상의학과,
7
서울특별시 보라매병원 영상의학과

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