Unlike CT of the abdomen, in which images obtained without and with IV contrast may be appropriate in some circumstances, CT of the chest without and with IV contrast does not provide additional information in these patients and is considered inappropriate. Although some consider CT to be the standard chest imaging technique for surveillance after RCC resection [11], there are concerns regarding the risk of false-positive findings (ie, intrapulmonary lymph nodes and granulomas), particularly in patients with T1a RCC, which can lead to further unnecessary and potentially invasive investigations [9]. It is worth noting that in a recent pilot study, the authors suggested that CT of the chest may not be necessary to identify most cases of pulmonary recurrence when a CT examination of the abdomen with coverage of the lung bases to the T7 thoracic level is performed [26]. CT Head Most patients with metastases to the central nervous system are symptomatic. Thus, surveillance protocols after surgical excision of RCC have not supported routine imaging of the brain to search for metastases in asymptomatic patients. Brain imaging should be performed only in cases with suggestive signs or symptoms [2,9,11]. Post-treatment Follow-up of Renal Cell Carcinoma MRI Abdomen MRI of the abdomen without and with IV contrast is considered in all major guidelines as an adequate method for surveillance of the abdomen after surgical excision of RCC [2,9,11]. MRI has a high soft-tissue contrast resolution and is an accurate method for detecting metastases in the common sites of RCC recurrences (ie, liver, adrenal glands, lymph nodes, contralateral kidney, and bones) [38]. MRI can also assist in the distinction between residual/recurrent disease and postoperative changes after PN [39]. For patients in whom contrast is contraindicated (eg, previous anaphylactic reaction), MRI of the abdomen without IV contrast may be considered appropriate.
Post Treatment Follow up and Active Surveillance of Renal Cell Carcinoma. Unlike CT of the abdomen, in which images obtained without and with IV contrast may be appropriate in some circumstances, CT of the chest without and with IV contrast does not provide additional information in these patients and is considered inappropriate. Although some consider CT to be the standard chest imaging technique for surveillance after RCC resection [11], there are concerns regarding the risk of false-positive findings (ie, intrapulmonary lymph nodes and granulomas), particularly in patients with T1a RCC, which can lead to further unnecessary and potentially invasive investigations [9]. It is worth noting that in a recent pilot study, the authors suggested that CT of the chest may not be necessary to identify most cases of pulmonary recurrence when a CT examination of the abdomen with coverage of the lung bases to the T7 thoracic level is performed [26]. CT Head Most patients with metastases to the central nervous system are symptomatic. Thus, surveillance protocols after surgical excision of RCC have not supported routine imaging of the brain to search for metastases in asymptomatic patients. Brain imaging should be performed only in cases with suggestive signs or symptoms [2,9,11]. Post-treatment Follow-up of Renal Cell Carcinoma MRI Abdomen MRI of the abdomen without and with IV contrast is considered in all major guidelines as an adequate method for surveillance of the abdomen after surgical excision of RCC [2,9,11]. MRI has a high soft-tissue contrast resolution and is an accurate method for detecting metastases in the common sites of RCC recurrences (ie, liver, adrenal glands, lymph nodes, contralateral kidney, and bones) [38]. MRI can also assist in the distinction between residual/recurrent disease and postoperative changes after PN [39]. For patients in whom contrast is contraindicated (eg, previous anaphylactic reaction), MRI of the abdomen without IV contrast may be considered appropriate.