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  • Review Article
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Imaging renal cell carcinoma with ultrasonography, CT and MRI

Nature Reviews Urology volume 7, pages 311–325 (2010)Cite this article

Subjects

Abstract

The increased use of abdominal imaging techniques for a variety of indications has contributed to more-frequent detection of renal cell carcinoma (RCC). Ultrasonography has been used to characterize the solid versus cystic nature of renal masses. This modality has limitations, however, in further characterization of solid tumors and in staging of malignancy, although contrast-enhanced ultrasonography has shown promise. Cross-sectional imaging with multiplanar reconstruction capability via CT or MRI has become the standard-bearer in the diagnosis, staging and surveillance of renal cancers. The use of specific protocols and the exploitation of different imaging characteristics of RCC subtypes, including variations in contrast agent timing, MRI weighting and digital subtraction, have contributed to this diagnostic capability. Cystic renal masses are a special case, evaluation of which can require multiple imaging modalities. Rigorous evaluation of these lesions can provide information that is crucial to prediction of the likelihood of malignancy. Such imaging is not without risk, however, as radiation from frequent CT imaging has been implicated in the development of secondary malignancies, and contrast agents for CT and MRI can pose risks, particularly in patients with compromised renal function.

Key Points

  • CT is considered the gold standard for the evaluation of a suspicious renal mass; protocols must involve pre-contrast images as well as images obtained at multiple time points after contrast administration

  • CT is also an excellent staging modality that can assess lymphadenopathy, metastatic disease, the risk of adrenal gland involvement and response to systemic therapy

  • Ultrasonography is rarely used alone in the evaluation of a solid renal mass; contrast-enhanced ultrasonography is not yet approved in the USA but might show vascularity of lesions without radiation

  • MRI is an excellent modality that does not employ ionizing radiation, and can aid in the differentiation of benign and malignant lesions; it is also helpful in the evaluation of a vascular tumor thrombus

  • Cystic renal masses require special attention and classification to determine the likelihood of malignancy; MRI is emerging as a useful tool in certain situations to differentiate benign from malignant cysts

  • Assessing response to minimally invasive therapy and systemic treatment with agents such as tyrosine kinase inhibitors is important, with CT currently the most utilized modality, although MRI is a reasonable alternative

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Figure 1: Multidetector CT.
Figure 2: The partial volume effect on CT.
Figure 3: CT to differentiate tumor subtypes.
Figure 4: A large clear cell renal cell carcinoma (RCC) ideal for staging by CT.
Figure 5: MRI, multidetector CT and ultrasonography of the same kidney lesion.
Figure 6: Effects of tyrosine kinase inhibitor (TKI) treatment on a clear cell renal cell carcinoma (RCC).
Figure 7: A comparison of the arterial phase of axial CT images at the same level in a Fuhrman grade II renal cell carcinoma (RCC) treated by radiofrequency ablation.

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Acknowledgements

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Division of Urology, Department of Surgical Oncology, University of Toronto, Princess Margaret Hospital and University Health Network, University of Toronto, 610 University Avenue 3-130, Toronto, M5G 2M9, ON, Canada

    Michael J. Leveridge, Peter J. Bostrom, Antonio Finelli & Nathan Lawrentschuk

  2. Melbourne Radiology Clinic, 100 Victoria Parade, East Melbourne, 3002, Vic, Australia

    George Koulouris

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Leveridge, M., Bostrom, P., Koulouris, G. et al. Imaging renal cell carcinoma with ultrasonography, CT and MRI. Nat Rev Urol 7, 311–325 (2010). https://doi.org/10.1038/nrurol.2010.63

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