44 0 obj <> endobj > For example, renal masses that are homogeneous and have Hounsfield units (HU) measuring fluid density (between 10 HU and 20 HU) on noncontrast-enhanced CT are benign simple cysts. Renal Mass Characterization/Surgical Planning (if in conjunction with Pelvis CT w/contrast CPT Code 74178, IMG 783) Pancreatic mass characterization/surgical planning (if in conjunction . 2. `|G]&s If RENAL FAILURE (Creatinine over 1.8)-ORDER EXAM WITHOUT CONTRAST. . New HCPCS Level II modifier reports advanced diagnostic imaging provided to Medicare patients. Therenal mass CT protocol is a multi-phasic contrast-enhanced examination for the assessment of renal masses. Give 2L O2 if it will help with breath-holdsUNLESS PATIENT HAS COPD OR ANOTHER REASON NOT TO GIVE O2. Nephrographic phase is the most sensitive for detecting renal lesions. %%EOF p,PPD9DL{O,!s]7mV6Rlzu_aB[v RKov/ Sheth S & Fishman E. Multi-Detector Row CT of the Kidneys and Urinary Tract: Techniques and Applications in the Diagnosis of Benign Diseases. Do not start scan until the patient has stopped breathing. 8 ); therefore, tumor contrast enhancement is more conspicuous on the nephrographic phase compared with the earlier corticomedullary phase. . %PDF-1.7 (, CT in a 68-year-old woman with a clear cell RCC. Metal shrapnel or bullet, > The precontrast and nephrographic phase images are used to evaluate for changes of tumor size or enhancement characteristics in cases of active surveillance or detecting enhancing tumor in post-treatment settings ( Fig. 97 29 For others, it may consist of a corticomedullary phase (40-60 second delay) and/or an excretory phase (5-10 minute delay). INTRODUCTION. PDF Magnetic Resonance Imaging - Mri Magnetic Resonance Angiograhy - Mra 0000042057 00000 n 2 0 obj Slices must be sufficient to cover both kidneys anterior to posterior. Radiographics. [U]Non-joint [/U]studies are to be We have a separate company with an MRI unit and we were approved by Medicare. GU PROTOCOLS: CT cystogram: BCT G01: 3 phase: nc.90sec.6min, Primary eval or post-op bladder canc: CT Cystogram (Trauma) - Filled only: 1 phase (filled) Evaluate for bladder injury, or follow-up of bladder injury (low-dose) Renal Mass 3 phase: BCT G02: 3 phase: nc.90sec.6min: Evaluate renal mass: Renal Donor 3 phase: BCT G04: 3 phase: nc.art . 0000009995 00000 n Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Protocol Optimization for Renal Mass Detection and Characterization, Added Value of Magnetic Resonance Imaging for the Evaluation of Mediastinal Lesions, Clinical Review of Computed Tomography and MR Perfusion Imaging in Neuro-Oncology, Radiologic Clinics of North America Volume 58 Issue 5, May be helpful to differentiate urothelial cancer from RCC and parapelvic or peripelvic cysts from hydronephrosis and to diagnose calyceal diverticula, Prepartial nephrectomy or preablation planning for renal masses that have been previously completely characterized, Better depict the arteries and their relationship to the renal mass. q)q_=)kK'? Crosswalk to an anesthesia code and its base units, and calculate payments in a snap! JJW1iXC2wH(5Rm>^'cxTI YDLN!{4]. An important component of adrenal MRI protocol is chemical shift imaging (CSI). MRA carotid w/o contrast. Monitor that patient is breath-holding. Instruct the patient to hold their breath during image acquisition. Precontrast CT provides better detection of small amounts of intralesional fat compared with postcontrast CT ( Fig. CT is the most commonly used modality for the detection and characterization of renal masses as well as presurgical planning and post-therapy surveillance. (, CT in a 37-year-old woman with hypertrophied column of Bertin. Everyone's choice for imaging imaginghealthcare.com 2020 CPT Code Exam Ordering Guide T 858 658 6500 F 866 558 4329 IHS Radiology Medical Group - Tax ID# 47-3394746 Papillary RCCs typically have low-level progressive enhancement that peaks in the nephrographic phase. [B]MRI Extremity - Joint/Nonjoint[/B] Within the next several years providers will be required to observe appropriate use criteria AUC as a condition of payment when reporting certain services for Medicare beneficiaries. CPT Code 73721, Diagnostic Radiology (Diagnostic Imaging) Procedures, Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities - . . 66 0 obj <>/Filter/FlateDecode/ID[]/Index[44 37]/Info 43 0 R/Length 103/Prev 145237/Root 45 0 R/Size 81/Type/XRef/W[1 2 1]>>stream Procedure code. Such information can be helpful in guiding patient management. > X:/QEZfG oD}tw.. Last updated: 4/12/19. 4 0 obj For these masses, no further imaging is indicated. Trigger when contrast reaches SMA. Charge as: Abdomen W/WO CT and MRI of small renal masses - The British Journal of Radiology HlMr >/ non-contrast scan is best to determine the HU of homogenous renal mass or masses containing macroscopic fat 1, corticomedullary phase is best to delineate subcategories of renal cell carcinomas further, nephrogenic phase is best for optimal enhancement of the renal parenchyma, including the renal medulla, and will demonstrate enhancing components of a mass, excretory phase will demonstrate enhancement of calyces, renal pelvis and ureters. endobj 4u|29q9E15x=mB^y_o: Ehh5W O J2p71H q Notes: Indeterminate adrenal lesions are typically discovered incidentally on contrast enhanced hb```f``e`e`cd@ A(G x{LonCI%[p]W-m=J;::*$. Multiplanar reformats in the coronal and sagittal planes of each postcontrast scan series also can be done with 3-mm reconstruction section thickness without overlap. 70547. The Society of Abdominal Radiology (SAR) Disease-Focused Panel (DFP) on RCC is a multi-institutional working group aimed at addressing the unmet needs in the clinical care, research, and education in RCCs. For clinical responsibility, terminology, tips and additional info start codify free trial. > 0000005493 00000 n CT Abdomen with contrast (CPT 74160) or without and with contrast (CPT 74170) with suspicion of a solid organ lesion (liver, kidney, pancreas, spleen). %PDF-1.5 a,qN*)[6%Tz\ mv9xBFk$K/c1?gz3?t{A#!=)01ST`ipFY{\1>c$&34pR ?@Q6/g_1%H5zY^wm@2>^K~oY!QEm.f2Gw;rty^W=D *l !%/"2vGVc>|~{OmL tR7tH]VVB 50A'1|e8 Premedication Protocol. 0000006342 00000 n Corticomedullary phase typically is acquired 40 seconds to 70seconds after IV contrast injection (see Fig. 0000000876 00000 n With increasing utilization of cross-sectional imaging such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), the detection rates of an incidental kidney lesion have increased over time [].While most incidental kidney lesions can be left alone as they will have no clinical consequences, some are pathologies (eg, renal cell carcinoma, renal . CPT Code(s) to Precert MRI Breast Newly Diagnosed Breast Cancer . 125 0 obj <>stream JN In this diagnostic procedure, the provider performs magnetic resonance imaging of a lower extremity joint without using contrast material. Plan the axial slices on the coronal plane; angle the position block parallel to the right and left renal pelvis. % Those that are homogeneous with HU greater than 70 are hemorrhagic or proteinaceous cysts ( Fig. , For example, prior studies have shown that clear celltype RCCs demonstrate peak enhancement during the corticomedullary phase. In the setting of advanced RCCs, tumor extension into the renal vain or inferior vena cava may be best assessed on the nephrographic phase as well. CT Protocol Cheat Sheet | UW Emergency Radiology - University of Washington Frequently, these clinical scenarios involve an older patient with comorbidities and a small renal mass (4 cm). Protocol 1 Indications: Indeterminate renal mass Recommended scan series: Pre-contrast: kidneys only, axial, 3mm reconstruction section thickness with or without 50% overlap Nephrographic phase: kidneys only, axial, 3mm reconstruction section thickness with or without 50% overlap, at 100-120 second delay Optional additional scan series: 0000013275 00000 n Protocol Optimization for Renal Mass Detection and Characterization PDF MRI Abdomen Protocol - Adrenal - TRA Medical Imaging IV contrast material type, volume, and injection rate: type, low-osmolar or iso-osmolar contrast material; volume, 35-g to 52.5-g iodine equivalent (ie, for contrast material that contains 350mg of iodine/mL, the corresponding dose is 100150mL); and weight-based dosing injection rate, 25mL/s. Office of Civil Rights Investigations and Compliance. Contrast-enhanced ultrasound is discussed in detail in a separate chapter. . HUIn@aHY 8?"[_ fs)95=m>SMZ}5}K?OKb m#r+Y rQ`Iv ^3J&)-aGUbL+B3MRg\xh%PZ 7mJ2S\J>-F]dazBzaa9B-mh9c\9`RB 0000012425 00000 n PDF 2020 CPT Code Exam Ordering Guide - Imaging Healthcare 8 ). Patients with anaphylaxis or laryngeal edema should be discussed with radiologist before the exam and/or premedication is ordered. 0000003129 00000 n Many institutions will perform this around 5 minutes to demonstrate opacification of the ureters, mid-diaphragm to the iliac crest (covering kidneys), mid-diaphragm to the iliac crest (covering kidneys), contrast injection considerations (bolus tracking), level of the diaphragmatic hiatus or first lumbar vertebra at the aorta, 100 mL of non-ionic contrastat 3 to 5 mL/s (a higher flow rate will equal greater enhancement), 20-30 seconds post bolus trigger (30-40 s after injection), mid-diagram to lesser trochanter (covering entire renal system), pseudoenhancement, an artifact encountered where the calculated density of a lesion is inaccurately increased, is a problem often noted in renal mass scans,dual-energy CT via virtual monoenergetic images at a KeV range of 80 Kev to 90 KeV can minimize beam hardeningand partial volumingand overcome this issue, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Give 2L O2 if it will help with breath-holds UNLESS PATIENT HAS COPD OR ANOTHER REASON NOT TO GIVE O2. <> Patient with renal insufficiency or hemodialysis; Rib mass/fracture (bony chest) Patient pregnant; MRA/MRV Chest w/ and w/o contrast . CT protocols should be tailored to different clinical indications, balancing diagnostic accuracy and radiation exposure. endstream endobj 45 0 obj <> endobj 46 0 obj <> endobj 47 0 obj <>stream 0000025763 00000 n 2004;24(2):e20. This phase is useful in confirming anatomic variants, such as column of Bertin, which can mimic a tumor but which has the same corticomedullary differentiation as normal kidney parenchyma ( Fig. X-Rays, CT Scans, MRI, and Other Tests for Adrenal Glands Corticomedullary and excretory phases may be acquired optionally. CT EXAM CPT CODE REFERENCE Use this reference to quickly determine the correct exam for your patients based on the On the other hand, the presence of intralesional calcification, regardless of the presence of fat, should prompt suspicion for malignancy, such as RCC. <>/Metadata 1078 0 R/ViewerPreferences 1079 0 R>> CT images are acquired in the axial plane, with suggested 3-mm reconstruction section thickness. Oregon Health & Science University is dedicated to improving the health and quality of life for all Oregonians through excellence, innovation and leadership in health care, education and research. Renal masses increasingly are found incidentally during work-up for nonrenal indications, largely due to the frequent use of medical imaging. American Hospital Association ("AHA"), Appropriate Use Criteria (AUC) in Coding, Reimbursement, and Clinical Practice. MRI CPT Codes - Mallinckrodt Institute of Radiology - Washington Securely tighten the body coil using straps to prevent respiratory artefacts The corticomedullary and excretory phases together with the precontrast-phase and nephrographic-phase images may be helpful to subtype renal masses. Prednisone: 50 mg PO (three doses total) to be taken 13 hours, 7 hours and 1 hour prior to appointment. Measurement of HU change after contrast administration using the earlier corticomedullary phase in a papillary RCC may result in erroneous categorization of the lesion as a nonenhancing cyst (see Fig. Gadolinium should only be given to the patient if GFR is > 30 Renal tumors are incidentally discovered at an increasing frequency due to the widespread use of cross-sectional imaging. Optimized CT and MR imaging protocols enable analysis of imaging features that help narrow the differential diagnoses and guide management in patients with renal masses. Despite aggressive treatment in early stages of the disease, a clear positive effect in reducing kidney cancer-specific mortality is . (, Suggested computed tomography protocols from the Society of Abdominal Radiology Disease-focused panel on renal cell carcinoma. With and without Abdomen Only (Pancreatic Protocol) In a click, check the DRG's IPPS allowable, length of stay, and more. Premedication Protocol. 4 ) compared with postcontrast CT or MR imaging. Contrast-enhanced ultrasound with microbubble agents is a useful alternative for characterizing renal masses, especially for patients in whom iodinated CT contrast or gadolinium-based MR imaging contrast is contraindicated. These are fast single shot localisers with under 25s acqusition time which are excellent for localising abdominal structures. NB: This article is intended to outline some general principles of protocol . 0000007179 00000 n This modality enables the radiologist to detect intra-tumor fat resulting in a loss of signal intensity. I agree with what t Radiologist is performing MRI RT foot and ankle - the report talks about both areas. 0000007963 00000 n Plan the axial slices on the coronal plane; angle the position block parallel to the right and left renal pelvis. 0000004668 00000 n The specifics will vary depending on MRI hardware and software, radiologist's and referrer's preference, institutional protocols . Nephrographic phase also may improve the assessment of enhancement in poorly vascular tumors. Thirty patients undergoing four-phase renal CT scans for assessment of renal lesions (>10 mm) were included in the study. Coil: Torso Coil. (, CT in a 64-year-old man with a renal mass illustrating the utility of excretory phase in delineating involvement of the collecting system. Check the positioning block in the other two planes. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 14 0 R 15 0 R] /MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 1 ) 99% of the time. x]_s8OU&_6.IV=qcD ( @8nt7n\vysKw/seK?Dr)/bs9:_}? Give a pillow under the head and cushions under the legs for extra comfort Furthermore, imaging plays a key role in the presurgical planning of renal tumors and in surveillance after surgery or systemic therapy for advanced RCCs. (, Presurgical planning CT in a 65-year-old man with a left renal tumor. View any code changes for 2023 as well as historical information on code creation and revision. hoHaBRtMd0)iC{$;;] p%@;N)pWPMHsBi\sC: cRxoAYU&%o>tLT0* &AQCI>u. Minimize SENSE if there is mottling in the center of the image. CLINICAL GUIDELINES EXAM DESCRIPTION CT/CTA CPT CODES EXAM DESCRIPTION MRI/MRA CPT CODES Abdominal mass CT Abdomen & Pelvis w 74177 MRI Abdomen w & wo 74183 . If the patient has a MRI [U]Joint[/U] you can code [B]multiple[/B] studies [U](Upper: 73221-73223) (Lower: 73721- Hello, trying to get some help on understanding the use of modifier 26. Call 855-SAFE-RAD to schedule a radiology exam. Our radiologists work closely with OHSU MRI technologists in the art of creating optimal images using current technology. 10 ). MRI Abdomen with or without contrast 74183 Hematuria (blood in urine) Renal mass (cyst or solid) Transitional cell carcinoma of kidney Abnormal findings on other imaging studies Yes Body . startxref Instruct the patient to hold their breath for the breath hold scans (its better to coach the patient two to three times before starting the scan) Optimized imaging protocols enable analysis of imaging features that help narrow the differential diagnoses and guide management in patients with renal masses. 4 0 obj Hematuria (CT Urogram, CT IVP) CT Hematuria Protocol CT/IVP w & wo 74178 MRI Abdomen and Pelvis w . hb```b``)a`e``ld`@ 4">kvv6*g^.i#wVz7_[/P=6w,t9ijtOT ~+IbInz/?^zPY\ w > Ferromagnetic surgical clips or staples Multiphase renal CT in the evaluation of renal masses: is the - PubMed MRI CPT Codes Call 855-SAFE-RAD to schedule adenine roentgenology take. 0 Given the indolent nature of papillary RCCs in general, these may be appropriate for active surveillance rather than surgical resection, especially in patients who are poor surgical candidates. Indeterminate renal mass, renal adenocarcinoma, metastasis, monitoring of known renal mass. Computed tomography (CT) and MR imaging with intravenous (IV) contrast are the mainstays of renal mass evaluation. 73721 is for an MRI of lower extremity joint; 73718 is an MRI for "other than joint". %PDF-1.5 % MRI Abdomen Protocol - Adrenal Reviewed By: Brett Mollard, MD; Anna Ellermeier, MD Last Reviewed: July 2018 Contact: (866) 761-4200 Standard uses: Evaluate indeterminate adrenal lesions for the presence of intracellular lipid (indicative of benignity). Subscribe to Anesthesia Coder today. Instruct the patient to hold their breath during image acquisition. MR imaging protocols should take advantage of the improved soft tissue contrast for renal tumor diagnosis and staging. [/U] The field of view, whether restricted to the kidneys themselves or expanded to include from the diaphragm to the iliac crest, also depends on the clinical questions. It outlines all sequences and protocols currently applied in our MRI section. It has been reported that up to 66% more small renal masses are detected in the nephrographic phase compared with the corticomedullary phase. h0 `UP i@`hhXXfrh%3.b+%|s?lpz@/a'A"VvCzl< > For the assessment of benign renal lesions (e.g. Slices must be sufficient to cover both kidneys from two slices above the upper pole of kidneys down to two slices below the lower pole of kidney. endobj PDF MRI EXAM CPT CODE REFERENCE - Wake Radiology 0000011681 00000 n (In our department we instruct the patients to breathe in and out twice before the breathe in and hold instruction. (attn kidney) 74183 Renal mass or complex cyst CT Abdomen . Last updated: 4/12/19 Instruct the patient to hold their breath during image acquisition. During this phase, there is intense enhancement of the renal cortex, allowing differentiation between the cortex and the medulla. (IMG 2390) - fMRI (Functional MRI w/ Tractography) CPT Codes 70551 & 76377 . For patient comfort, if you. 97 0 obj <> endobj 0000031716 00000 n However, Medicare is denying CO-B7 billing under our podiatrist. <> Chest w/o contrast (with 3D reconstructions), CTA Chest w/ contrast (with 3D reconstructions), EVT Abdomen Pelvis w/o contrast w/3D (with 3D reconstructions), Abdomen and Pelvis enterography w/ contrast, CTA Abdomen Pelvis (with 3D reconstructions), CTA EVT Chest Abdomen Pelvis w/o contrast w/3D (C) (with 3D reconstructions), CTA Chest Abdomen Pelvis (with 3D reconstructions), EVT Chest Abdomen Pelvis w/o contrast w/3D (C) (with 3D reconstructions), Urogram CT Abdomen and Pelvis w/ and w/o contrast w/3D reconstruction (with 3D reconstructions), Abdominal Aorta and Bilateral Iliofemoral Runoff (with 3D reconstructions), Internal Auditory Canal Cochlear Implant w/o contrast, CTA Head w/ and w/o contrast (with 3D reconstructions), CTA Head Neck w/ and w/o contrast (3D reconstructions), Arthrogram Shoulder (Arthrogram only; no IV contrast), Arthrogram Elbow (Arthrogram only; no IV contrast), Arthrogram Wrist (Arthrogram only; no IV contrast), Arthrogram Hip (Arthrogram only; no IV contrast), Arthrogram Knee (Arthrogram only; no IV contrast), Arthrogram Ankle (Arthrogram only; no IV contrast), Woodard to Lead Mallinckrodt Institute of Radiology, Sauk Named Interventional Radiology Chief, Miller-Thomas Receives Distinguished Service Teaching Award. PelviS: renal STone ProToCol . Adrenal glands protocol is an MRI protocol comprising a group of MRI sequences put together to further assess indeterminate adrenal lesions, in particular, lipid-poor adenomas.. xref endstream endobj startxref What CPT would you use 73718 or 73721 - I know I cannot code for both. 1 0 obj 0000009361 00000 n Kang S, Huang W, Pandharipande P, Chandarana H. Solid Renal Masses: What the Numbers Tell Us. PDF CT EXAM CPT CODE REFERENCE - Wake Radiology PDF CPT CodeCPT CodeCPT CodeCPT Code - South Florida Diagnostic Imaging > For the assessment of cystic kidney disease cardiac pacemaker, insulin pump biostimulator, neurostimulator, cochlear implant, and hearing aids) MRI CPT Codes - Mallinckrodt Institute of Radiology - Washington AJR Am J Roentgenol. 0000001785 00000 n In contrast, papillary RCCs demonstrate greater enhancement at later phases. > Hematuria, > IMG 238. Note: NPO 4 hours. CPT Code 74170. 0000011123 00000 n Combat the #1 denial reason - mismatched CPT-ICD-9 codes - with top Medicare carrier and private payer accepted diagnoses for the chosen CPT code. 0000001521 00000 n Patients with hives or rash must be pre-medicated for an IV contrast CT scan (not oral contrast). Search across Medicare Manuals, Transmittals, and more. 2 0 obj Scanner preference: 1.5T Excretory phase is obtained at 7 minutes to 10minutes after IV contrast injection. Some masses can be confidently characterized on these images without requiring a subsequent dedicated multiphase renal protocol CT or MR image. no financial relationships to ineligible companies to disclose. <>>> Prednisone: 50 mg PO (three doses total) to be taken 13 hours, 7 hours and 1 hour prior to appointment. The excretory phase may be helpful for distinguishing urothelial cancers from RCCs and parapelvic or peripelvic cysts from hydronephrosis and for diagnosing calyceal diverticula. RmGT3rqYDRMTGhNnjU}}LEe/yo9Q4p K_c_~(Q )2#q|$3OM"QeX 5zCcob]v361+pgsL}NCs{cD*9&#B:C)81h}\|/|-bUu 5|r. When further work-up for a renal mass is deemed necessary, additional imaging can be obtained using a multiphase renal protocol CT. Enhancement patterns across different phases after IV contrast injection can be used to distinguish renal cysts from solid tumors and may aid in subtyping of renal tumors. Contrast injection risk and benefits must be explained to the patient before the scan, T2 tse breath hold (TRUFI or HASTE)coronal, Use T1 VIBE fat sat axial and coronal after the administration of IV, CLICK THE SEQUENCES BELOW TO CHECK THE SCANS. The injection rate is suggested at 2 mL/s to 5mL/s. e~20GPU#L Metallic foreign body in the eye The patient had MRI w/o contrast for the HIP right side and MRI w/o contrast of the Knee right side. [QUOTE="bnmoody, post: 392628, member: 265484"] The MR sensitivity for adenomas measuring 10-20 HU is nearly 100%, while that for lipid-poor adenomas measuring greater than 30 HU is significantly lower (13 . Ask the patient to undress and change into a hospital gown Computed tomography (CT) protocols for renal mass evaluation should be tailored to the clinical indications with careful considerations of balancing diagnostic accuracy and radiation dose. q-5GXRR{uj[qma..v.Q Dj QcU)0M'(_5Acc:4A1g59{P ClWk38?l4 VL K;~ZDm*HI(cCccsFGZvcW |w`90nT`GaGX -mY Q#x\G)!oMZJ,BCd3s HYmVgU*# n(7g(m SeH+ZFZ l5nbsOY>p]9;? Renal masses increasingly are found incidentally, largely due to the frequent use of medical imaging. endstream endobj 103 0 obj <>stream 0000000016 00000 n trailer 0000003953 00000 n H= {,# $9N2)vELLc# qTxPec%={nv.lU'V{sMR7v';c9c%F. {"url":"/signup-modal-props.json?lang=us"}, Murphy A, Chieng R, O'Shea P, CT renal mass (protocol). Charge as: Abdomen W/WO. MRI kidneys (renal) planning | MRI kidneys protocol| indications for I am having controversial answers in our practice in reference to duplicate billing for code 72721. 1. An appropriate angle must be given in the sagittal plane (parallel to the long axis of kidney). Adding a U prior to the IV makes the exam ultralow dose, o BCT 02UIV abd pelv w/IV contrast, ultralow dose. 0000018234 00000 n (Liver Mass Protocol) Characterize masses previously seen on CT or US-hepatoma screening-metastasis follow-up/ post cryo or RF ablation-assessment of spleen-pancreatic masses with question of liver mets *This scan MAY include MRCP: if so the patient needs to fast 4 hours before scan. Most adrenal masses are detected first on abdominal CT scans, with an incidence of 0.6 to 1.3 percent on such scans. The widespread use of cross-sectional imaging has led to a continuous increase in the number of incidentally detected indeterminate renal masses. Axial (, CT in a 75-year-old woman with a left renal lesion demonstrating higher lesion conspicuity in the nephrographic phase compared with the corticomedullary phase. >, Any electrically, magnetically or mechanically activated implant (e.g. $_ @'a7H\?/ mWI > Phase oversampling and, in the case of 3D blocks, slice oversample, must be used to avoid wrap around artefacts. Diphenhydramine (Benadryl) (optional): 50 mg PO to be taken 1 hour prior to exam. relative or staff ) Breathe the patient slowly so they have time to follow instructions. An appropriate angle must be given in the sagittal plane (perpendicular to the long axis of kidney). An appropriate angle must be given in the sagittal plane (perpendicular to the long axis of kidney). Precontrast CT in a 62-year-old man shows a homogeneous hyperdense renal lesion (, CT in a 46-year-old man illustrates various enhancement phases in the kidneys. For example, papillary RCCs typically demonstrate low-level progressive enhancement, peaking at the nephrographic phase ( Fig.