Renal cell carcinoma CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

a CT may be used to detect neoplastic masses that may define renal cell carcinoma or metastasis of the primary cancer.

Computed Tomography

Both CT and MRI may be used to detect neoplastic masses that may define renal cell carcinoma or metastasis of the primary cancer. CT scan and use of intravenous (IV) contrast is generally used for work-up and follow-up of patients with renal cell carcinoma. Enhancing renal masses on CT scan is strongly indicative of the presence of a renal tumor.
It is always important to note the significance of radiation exposure in the recurrent use of CT scan for surveillance.
The following guidelines of the American Urological Association in 2013 state the following regarding the use of CT in renal cell carcinoma:

Use of CT in Renal Cell Carcinoma

Patient Profile	Use of CT	Evidence Strength
Low Risk Patient (pT1, N0, Nx)	Baseline abdominal CT (or MRI) for nephron sparing surgery and CT (or US or MRI) for radical nephrectomy within 3-12 months following renal surgery Additional CT (or US or MRI) may be performed in patients following radical nephrectomy if initial post-op baseline image is negative	Expert opinion C
Moderate to High Risk Patients (pT2-4N0 Nx or any stage N+)	Baseline chest and abdominal CT (or MRI) within 3-6 months following surgery with continued imaging (US, CXR, CT, or MRI) every 6 months for at least 3 years and annually thereafter to 5 years. Site specific imaging is warranted by clinical symptoms suggestive of recurrence or metastatic spread. Imaging (US, CXR, CT, or MRI) beyond 5 years may be performed at the discretion of the clinician	C
Active surveillance	Cross-sectional abdominal scanning (CT or MRI) within 6 months of active surveillance initiation to establish a growth rate. Further imaging is recommended at least annually thereafter	C
Ablation	Patients undergo cross-sectional CT or MRI with and without IV contrast unless contraindicated at 3 and 6 months following ablative therapy to assess treatment success. Annual abdominal CT or MRI should follow for 5 years. Individual CT (or MRI) beyond 5 years is based on individual patient risk factors	C

^{Adapted from Donat SM et al. Follow-up for clinically localized renal neoplasms: AUA guideline. J Urol. 2013; 190(2):407-16.}

Patient 1

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Patient 2

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Patient 3

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Patient 4

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