Multimodality approach to staging renal cell carcinoma

Renal imaging has dramatically improved since the introduction of ultrasound (US), computed tomography (CT), and most recently magnetic resonance (MR) imaging. US and MR imaging are ideal for patients with compromised renal function preventing administration of iodinated contrast material or those who have experienced reactions to contrast. Staging errors occur due to limitations in assessing microscopic tumor invasion of the renal capsule and perinephric fat, detecting metastatic deposits in normal sized lymph nodes and differentiating inflammatory hyperplastic lymph nodes from neoplastic ones. These limitations are shared by US, CT, and MR imaging. Vascular invasion by tumor can be evaluated by all imaging modalities including venography. The advantages and limitations of each examination will be presented.