Radiology in the diagnosis and staging of renal cell carcinoma

Renal cell carcinoma (RCC), a potentially curable lesion, is the most common primary renal malignancy. Due to the importance of early diagnosis and the lack of specific clinical features of RCC, imaging plays a vital role in the diagnosis and management of RCC. Newer imaging modalities have superseded plain-film radiography in the diagnosis of RCC by offering greater sensitivity and specificity in both diagnosis and staging. RCC can be diagnosed with computed tomography (CT) with greater than 95% accuracy. Once an RCC is detected, tumor staging becomes paramount for treatment planning. Greater than 90% staging accuracy can be accomplished with CT alone using techniques described in this article. Magnetic resonance imaging (MRI) can be used to achieve staging accuracy similar to CT. MRI and ultrasonography (US) should be used to aid the diagnosis and staging of RCC in equivocal CT cases. The appropriate use of additional staging adjuncts including arteriography, phlebography, skeletal and thoracic imaging is described in this article.