Imaging of renal cell carcinoma

Today, a large proportion of patients diagnosed with renal cancer are those with small tumors discovered incidentally on imaging studies. Radiologic studies should be tailored to enable further characterization of renal masses, so that nonmalignant lesions can be differentiated from malignant ones. Intravenous urography (IVU) is often obtained as the first imaging study to evaluate the urinary tract in patients with symptoms that may indicate the presence of renal cell carcinoma Ultrasound scanning, computed tomography (CT), magnetic resonance imaging (MRI), and imaging-guided percutaneous biopsy techniques should be used appropriately to achieve maximum accuracy in the detection and staging of renal carcinoma. Diagnostic angiography, largely supplanted by less invasive radiologic techniques, may be useful in selected situations. After surgical removal of renal cell carcinoma, follow-up imaging is especially important in the first 2 years, when recurrence is most likely, especially in patients with stage III or IV tumors. The clinical presentation will determine choices of specific imaging "algorithms" for detection and staging of renal cell cancer.