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目的 探讨双能CT双期增强扫描诊断小透明细胞肾癌的最佳期相和最佳管电压条件.方法 回顾性分析27个经手术病理证实的小透明细胞肾癌病灶(直径≤3cm)术前双能量皮髓早期及延迟期扫描资料,以病理结果为标准,将图像(80 kV、140 kV及融合120 kV)对小透明细胞肾癌的显示清晰度进行评分,采用Wilcoxon和Friedman秩和检验比较各期不同管电压条件下图像显示病变的清晰度；采用单因素方差分析比较同一期相三组管电压条件下病灶CT值、噪声值、对比噪声比,以及病灶在皮髓早期与延迟期的CT值变化值.结果 在三组管电压条件下(80 kV、140 kV和融合120 kV),图像在皮髓早期对病变显示清晰度的得分分别为(3.30 ±0.87)、(2.81±0.92)和(3.11±0.85)分,延迟期分别为(3.70±0.54)、(3.30±0.82)和(3.52±0.64)分,延迟期对病变的显示清晰度均高于皮髓早期(Z值分别为-2.296、-2.446和-2.392,P值均＜0.05).无论在皮髓早期或延迟期,80 kV图像病灶CT值[分别为(302±80)和(152±31)HU]、噪声值[分别为(16.2±2.2)和(16.4±2.7)HU]和CNR值均最高[分别为(4.1±3.4)和(4.7±1.7)],和其他管电压下结果差异有统计学意义(P值均＜0.05).80 kV、140 kV和融合120 kV条件下,病灶在皮髓早期和延迟期的CT值变化值分别为(150±76)、(72 ±33)和(96 ±46) HU,差异有统计学意义(F=4.541,P＜0.01).结论 延迟期扫描有利于小透明细胞肾癌的显示；80 kV图像较140 kV和融合120 kV图像更有利于小透明细胞肾癌的显示和定性.

Objective To detect the best phase and best tube voltage for the diagnosis of small (diameter ≤ 3 cm) clear cell renal cell carcinoma with dual-energy dual-phase CT.Methods Image manifestations of 27 patients with small (diameter ≤ 3 cm) ccRCCs confirmed by pathology were retrospectively analyzed.All subjects underwent dual-energy biphase (early corticomedullary and delayed phase) scan preoperatively.Two senior radiologists analyzed the images in consensus.The definition of images in different phases and with different tube voltage was classified into 4 levels and was compared by Wilcoxon and Friedman test.The attenuation of the lesions and the adjacent renal parenchyma,the SD value of the anterior abdomen fat were measured.The contrast noise ratio (CNR),lesion kidney ratio (LKR) and the early corticomedullary phase and delayed phase value were calculated.They were all compared with oneway ANOVA.Results The score of definition of lesions in early corticomedullary phase at 80 kV,140 kV and average-weighted 120 kV were 3.30 ± 0.87,2.81 ± 0.92 and 3.11 ± 0.85,respectively,which in delayed phase were 3.70 ±0.54,3.30 ±0.82 and 3.52 ±0.64,respectively.Definition of lesions was better in delayed phase than that in early corticomedullary phase (Z =-2.296,-2.446 and-2.392,respectively; P ＜ 0.05).Either in early corticomedullary phase or in delayed phase,CT value,noise value and CNR were the highest on 80 kV images,which were(302 ± 80)HU,(16.2 ± 2.2) and (4.1 ± 3.4) in corticomedullary phase and (152 ± 31) HU,(16.4 ± 2.7) HU,and (4.7 ± 1.7) in delayed phase.The change of lesion attenuation between early corticomedullary phase and delayed phase on 80 kV,140 kV and averageweighted 120 kV images were (150 ± 76),(72 ± 33) and (96 ± 46) HU,respectively.There was significant difference among the three groups (F =4.541,P ＜ 0.01).Conclusions Delayed phase scan is in favor of small clear cell renal cell carcinoma display.80 kV images are the best for detecting and qualitation of small clear cell renal cell carcinoma when compared with 140 kV and the average-weighted 120 kV images.