Radiography Intravenous Urography There is no relevant literature regarding the use of IV urography in the follow-up of patients after localized RCC ablation, and this method is not recommended by the guidelines [2,9,11]. Imaging of the pelvis with CT has been found to have limited benefit for the detection of metastases in initial staging and after RN or PN for RCC [25,32-34] and is considered optional in the surveillance guidelines [2,9,11]. Because the risk of distant metastases is significantly lower in patients with localized RCC after ablation, CT of the abdomen is preferred over CT of the abdomen and pelvis. Post-treatment Follow-up of Renal Cell Carcinoma CT Chest Limited data suggest that CT is more sensitive than radiography for the detection of pulmonary metastases from RCC during staging [27]. Although no direct comparison between the 2 methods has been reported in the posttreatment surveillance setting, one study demonstrated that the overwhelming majority of chest recurrences in asymptomatic cases are detected by chest CT examinations (92.3%) rather than by radiography (7.7%) [36]. In addition to a high sensitivity for the detection of pulmonary metastases, chest CT has a high sensitivity for the detection of intrathoracic nodal metastases from RCC; this finding has prognostic implications and may affect surgical planning for metastases resection [37]. The use of IV contrast is optional for chest CT, but it may be beneficial for the detection and characterization of hilar lymph nodes. In patients undergoing surveillance with CT of the abdomen with IV contrast, chest CT should also be performed after IV contrast administration. Unlike CT of the abdomen, in which images without and with IV contrast are appropriate, CT of the chest without and with IV contrast does not provide additional information in these patients and is considered inappropriate.
Post Treatment Follow up and Active Surveillance of Renal Cell Carcinoma. Radiography Intravenous Urography There is no relevant literature regarding the use of IV urography in the follow-up of patients after localized RCC ablation, and this method is not recommended by the guidelines [2,9,11]. Imaging of the pelvis with CT has been found to have limited benefit for the detection of metastases in initial staging and after RN or PN for RCC [25,32-34] and is considered optional in the surveillance guidelines [2,9,11]. Because the risk of distant metastases is significantly lower in patients with localized RCC after ablation, CT of the abdomen is preferred over CT of the abdomen and pelvis. Post-treatment Follow-up of Renal Cell Carcinoma CT Chest Limited data suggest that CT is more sensitive than radiography for the detection of pulmonary metastases from RCC during staging [27]. Although no direct comparison between the 2 methods has been reported in the posttreatment surveillance setting, one study demonstrated that the overwhelming majority of chest recurrences in asymptomatic cases are detected by chest CT examinations (92.3%) rather than by radiography (7.7%) [36]. In addition to a high sensitivity for the detection of pulmonary metastases, chest CT has a high sensitivity for the detection of intrathoracic nodal metastases from RCC; this finding has prognostic implications and may affect surgical planning for metastases resection [37]. The use of IV contrast is optional for chest CT, but it may be beneficial for the detection and characterization of hilar lymph nodes. In patients undergoing surveillance with CT of the abdomen with IV contrast, chest CT should also be performed after IV contrast administration. Unlike CT of the abdomen, in which images without and with IV contrast are appropriate, CT of the chest without and with IV contrast does not provide additional information in these patients and is considered inappropriate.