Renal cell carcinoma MRI

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Similar to CT, an MRI may be used to diagnose and for follow-up of renal cell carcinoma. Due to the use of IV gadolinium in MRI, the risk of nephrogenic systemic fibrosis (NSF) must always be considered. It is a rare condition that often has cutaneous manifestations, but may affect any organ. Risk factors for development of NSF are as follows:

• High dose of gadolinium-based contrast
• Acute and chronic renal failure
• Vascular injury

Patient Profile	Use of MRI	Evidence Strength
Low Risk Patient (pT1, N0, Nx)	Baseline abdominal MRI (or CT) for nephron sparing surgery and CT (or US or MRI) for radical nephrectomy within 3-12 months following renal surgery Additional MRI (or US or CT) 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 MRI (or CT) 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 MRI (or CT) 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.}