Renal Cyst Pseudoenhancement at Multidetector CT: What Are the Effects of Number of Detectors and Peak Tube Voltage?

Abstract

To determine the effect of the number of detectors and peak tube voltage on renal cyst pseudoenhancement in a phantom model. This study on computed tomographic (CT) phantoms did not require institutional review board approval. The renal compartments of a CT phantom were filled with iodinated contrast material diluted to attain attenuations of 40, 140, and 240 HU. Saline-filled cylinders simulating cysts of varying diameters (range, 0.7-3.0 cm) were serially suspended in the renal compartments and scanned at 80, 90, 100, 120, and 140 kVp in 16-detector (n = 3) and 64-detector (n = 2) CT scanners. Generalized estimating equations were used to determine predictors of cyst pseudoenhancement (defined as a >10 HU increase in cyst attenuation when the background renal attenuation increased from 40 to 140 or 240 HU). Pseudoenhancement was seen with higher frequency (59 [61%] of 96 cysts vs 52 [39%] of 132 cysts, P < .05) and magnitude (17 vs 13 HU, P < .005) with 64- rather than with 16-detector scanners. Pseudoenhancement was also seen with higher frequency (25 [42%] of 60 cysts vs 11 [18%] of 60 cysts, P < .005) and magnitude (18 vs 13 HU, P < .05) at 140 kVp than at 80 or 90 kVp. Cyst pseudoenhancement increased with higher background renal enhancement (P < .005) and smaller cyst diameter (P < .05). The number of detectors, peak tube voltage, renal parenchymal enhancement level, and cyst diameter were independent predictors of cyst pseudoenhancement. Lower tube voltage settings may be useful when accurate differentiation between small renal cysts and solid masses is critical, particularly for 64-detector CT scanners.