Love L, Lind J A, Olson M C
Department of Radiology, Loyola University Medical Center, Maywood, IL 60153.
Radiology. 1989 Jul;172(1):125-9. doi: 10.1148/radiology.172.1.2740495.
The prospective study involved 50 patients without known renal masses or previous renal surgery who received intravascular contrast medium for various radiologic procedures and subsequently underwent unenhanced computed tomography (CT) of the kidneys 22-26 hours later. In 42 patients, cortical readings did not exceed 50 HU and corticomedullary attenuation differences (CMADs) did not exceed 10 HU. In seven patients (intermediate group), there was persistent cortical enhancement (mean attenuation, 58.3-84.8 HU; CMAD, 10.3-40.3 HU), but there was no significant rise in levels of blood urea nitrogen or serum creatinine. A single patient had contrast nephropathy and exhibited a mean cortical attenuation of 141.6 HU and a mean CMAD of 85.8 HU on the 24-hour CT scan. The authors have seen two additional cases of contrast nephropathy presaged by mean cortical attenuations of 162 and 209 HU on the 24-hour CT scan. One of these patients had been in the intermediate group in the prospective study. A cortical attenuation of 55-110 HU on a 24-hour postcontrast scan may help identify a group of patients with subclinical renal impairment who are at high risk of nephropathy on subsequent exposure to contrast medium, while cortical attenuations in excess of 140 HU seem to be an early indicator of contrast nephropathy.
这项前瞻性研究纳入了50例无已知肾肿块或既往无肾脏手术史的患者，这些患者因各种放射学检查接受了血管内造影剂，随后在22 - 26小时后接受了肾脏非增强计算机断层扫描（CT）。42例患者的皮质读数不超过50 HU，皮质髓质衰减差异（CMAD）不超过10 HU。7例患者（中间组）存在持续性皮质强化（平均衰减，58.3 - 84.8 HU；CMAD，10.3 - 40.3 HU），但血尿素氮或血清肌酐水平无显著升高。1例患者发生造影剂肾病，在24小时CT扫描时平均皮质衰减为141.6 HU，平均CMAD为85.8 HU。作者还见过另外2例造影剂肾病病例，在24小时CT扫描时平均皮质衰减分别为162和209 HU，其中1例患者在前瞻性研究中属于中间组。造影剂注射后24小时扫描时皮质衰减为55 - 110 HU可能有助于识别一组亚临床肾功能损害患者，这些患者在随后接触造影剂时发生肾病的风险较高，而皮质衰减超过140 HU似乎是造影剂肾病的早期指标。
