Imaging of advanced renal cell carcinoma

• Published in: World journal of urology Vol. 28; no. 3; pp. 253 - 261
• Main Authors: Mueller-Lisse, Ullrich G., Mueller-Lisse, Ulrike L.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.06.2010; Springer Nature B.V
• Subjects: Carcinoma, Renal Cell - diagnosis; Carcinoma, Renal Cell - pathology; Diagnostic Imaging - methods; Female; Fluorodeoxyglucose F18; Humans; Kidney Neoplasms - diagnosis; Kidney Neoplasms - pathology; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Neoplasm Invasiveness - pathology; Neoplasm Staging; Nephrology; Oncology; Positron-Emission Tomography - methods; Radiographic Image Enhancement; Radiopharmaceuticals; Sensitivity and Specificity; Tomography, X-Ray Computed - methods; Topic Paper; Ultrasonography, Doppler; Urology; Metastatic renal cell carcinoma; Angiogenesis inhibitor drugs; Cross-sectional imaging; Computed tomography; Magnetic resonance imaging; Renal cell carcinoma; Tyrosine-kinase inhibitor drugs; Ultrasonography; Positron emission tomography; Advanced renal cell carcinoma
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-010-0557-z

Objectives To describe current radiological cross-sectional imaging in the detection and staging of advanced renal cell carcinoma (RCC), defined here as RCC reaching beyond the renal capsule, whether by immediate extension or by metastasis. Methods Review and summary of current radiological and urological literature, including original articles and reviews, retrieved from the medical data base “PubMed”. Results Multi-detector-row computed tomography (MDCT) shows a sensitivity of up to 100% and specificity of about 90% for retroperitoneal disease, venous tumour thrombus, and metastasis, but limited accuracy for lymphadenopathy in RCC. Magnetic resonance imaging (MRI) is applied as a problem-solving modality, with particular strength in imaging metastasis to brain and bone. However, dynamic, contrast-enhanced- (DCE-) and arterial-spin-labelling (ASL-) MRI may help to monitor early response to angiogenesis inhibitor drugs. Ultrasonography (US) shows limited capability of identifying retroperitoneal disease, venous tumour thrombus extension, and metastasis. Positron Emission Tomography with 18-fluoro-desoxy-glucose (FDG-PET) demonstrates modest accuracy for metastasis of RCC, with positive studies being suspicious, while negative studies cannot reliably exclude disease. Conclusions MDCT represents the diagnostic mainstay for the detection and staging of RCC. In the wake of new systemic therapies for advanced RCC, including angiogenesis inhibitor drugs, monitoring treatment response may become a new task for cross-sectional imaging.