A Concise Review of the Multimodality Imaging Features of Renal Cell Carcinoma

Abstract

The evaluation of renal cell carcinoma (RCC) is routinely performed using the multimodality imaging approach, including ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). Ultrasonography is the most frequently used imaging modality for the initial diagnosis of renal masses. The modality of choice for the characterization of the renal mass is multiphasic CT. Recent advances in CT technology have led to its widespread use as a powerful tool for preoperative planning, reducing the need for catheter angiography for the evaluation of vascular invasion. CT is also the standard imaging modality for staging and follow-up. MRI serves as a problem-solving tool in selected cases of undefined renal lesions. Newer MRI techniques, such as arterial spin labeling and diffusion-weighted imaging, have the potential to characterize renal lesions without contrast media, but these techniques warrant further investigation. PET may be a useful tool for evaluating patients with suspected metastatic disease, but it has modest sensitivity in the diagnosis and staging of RCC. The newer radiotracers may increase the accuracy of PET for RCC diagnosis and staging. In summary, the main imaging modality used for the characterization, staging, and surveillance of RCC is multiphasic CT. Other imaging modalities, such as MRI and PET, are used for selected indications.

Keywords: ct; mri; rcc.

Figure 1. Clear cell renal cell carcinoma (arrows)

Computed tomography images taken in the corticomedullary (a) and excretory (b) phase images show typical hypervascularity and subsequent washout of the tumor. In the same patient after nephron-sparing surgery (c), no residual or recurrent tumor is detected.

Figure 2. Clear cell renal cell carcinoma (long arrows)

Computed tomography images taken in the axial (a), coronal (b), and sagittal (c) planes show a large heterogeneously enhancing left lower renal pole lesion with extension in the left renal vein (axial, long arrow). Sagittal and coronal reformats demonstrate penile and musculoskeletal metastatic disease (short arrows).

Figure 3. Papillary renal cell carcinoma (arrows)

Unenhanced (a), corticomedullary-phase (b), and nephrographic-phase (c) computed tomography images show a precontrast homogeneous hyperattenuating, hypovascular mass lesion without significant enhancement in the left kidney.

Figure 4. Papillary renal cell carcinoma (arrows)

Unenhanced axial T1-weighted (a), fat-saturated T2-weighted (b), and contrast-enhanced T1-weighted (c, d) magnetic resonance images show a well-demarcated, hypovascular cortical lesion with a hemosiderin rim in T1-weighted images in the right kidney.

Figure 5. Liver metastasis from renal cell carcinoma (arrows) before (a) and after (b) VEGF inhibitor therapy

The lesion has decreased in size only slightly but shows a prominent attenuation decrease after therapy.