A recent clinical trial from Turkey involving 62 patients with RCC reported an 84% accuracy for contrast- enhanced FDG-PET/CT in staging RCC [60]. However, further studies are warranted before PET/CT can be used in the routine initial staging of RCC. At present, given the paucity of literature to support the use of FDG-PET/CT, the guidelines from the EAU and NCCN do not recommend routine FDG-PET/CT in the initial staging of RCC [5,13]. Fluoride PET/CT Skull Base to Mid-Thigh Preliminary results for other PET tracers are also becoming available. In a small prospective study of 10 patients with metastatic RCC, 18F-NaF PET/CT was found to be significantly more sensitive for the detection of RCC skeletal metastases than Tc-99m bone scintigraphy or CT, with sensitivities of 100%, 29%, and 46%, respectively. CT and Tc-99m bone scintigraphy in this study identified only 65% of the metastases detected by fluoride PET/CT [61]. However, given the paucity of litereature for utility of fluoride PET/CT in the initial staging of RCC, current guidelines from the EAU and NCCN do not support routine fluoride PET/CT to search for metastases in asymptomatic patients in the initial staging of RCC [5,13]. Staging of Renal Cell Carcinoma MRI Abdomen and Pelvis MRI of the abdomen without and with IV contrast is considered to be a reliable method for the staging of RCC and may be of greater benefit in patients with contraindications for iodinated contrast for CT. Various MR sequences, including T2-weighted, chemical shift T1-weighted, contrast-enhanced T1-weighted, and diffusion-weighted images, are typically obtained for the staging of RCC. In a study involving 40 patients with RCC, MRI was reported to have an accuracy of 81% to 86% for T staging [62]. Breath-hold MRI showing lack of perinephric fat involvement is reported to have a high negative predictive value for no perinephric tumor invasion [63].
Staging of Renal Cell Carcinoma. A recent clinical trial from Turkey involving 62 patients with RCC reported an 84% accuracy for contrast- enhanced FDG-PET/CT in staging RCC [60]. However, further studies are warranted before PET/CT can be used in the routine initial staging of RCC. At present, given the paucity of literature to support the use of FDG-PET/CT, the guidelines from the EAU and NCCN do not recommend routine FDG-PET/CT in the initial staging of RCC [5,13]. Fluoride PET/CT Skull Base to Mid-Thigh Preliminary results for other PET tracers are also becoming available. In a small prospective study of 10 patients with metastatic RCC, 18F-NaF PET/CT was found to be significantly more sensitive for the detection of RCC skeletal metastases than Tc-99m bone scintigraphy or CT, with sensitivities of 100%, 29%, and 46%, respectively. CT and Tc-99m bone scintigraphy in this study identified only 65% of the metastases detected by fluoride PET/CT [61]. However, given the paucity of litereature for utility of fluoride PET/CT in the initial staging of RCC, current guidelines from the EAU and NCCN do not support routine fluoride PET/CT to search for metastases in asymptomatic patients in the initial staging of RCC [5,13]. Staging of Renal Cell Carcinoma MRI Abdomen and Pelvis MRI of the abdomen without and with IV contrast is considered to be a reliable method for the staging of RCC and may be of greater benefit in patients with contraindications for iodinated contrast for CT. Various MR sequences, including T2-weighted, chemical shift T1-weighted, contrast-enhanced T1-weighted, and diffusion-weighted images, are typically obtained for the staging of RCC. In a study involving 40 patients with RCC, MRI was reported to have an accuracy of 81% to 86% for T staging [62]. Breath-hold MRI showing lack of perinephric fat involvement is reported to have a high negative predictive value for no perinephric tumor invasion [63].