Understanding the strengths and limitations of the various imaging modalities for the detection of disease recurrence or progression is important when planning follow-up regimens. In this document, we provide an update on the appropriate use of imaging examinations for asymptomatic patients who have been treated for RCC with RN, PN, or ablative therapies. We also address the appropriate imaging examinations for asymptomatic patients with localized biopsy-proven or suspected RCC who are undergoing active surveillance. As in the previous version, this document does not address the imaging of complications from treatment and does not discuss the follow-up of patients with known residual or recurrent cancer. Special Imaging Considerations CT urography (CTU) is an imaging study that is tailored to improve visualization of both the upper and lower urinary tracts. There is variability in the specific parameters, but it usually involves unenhanced images followed by intravenous (IV) contrast-enhanced images, including nephrographic and excretory phases acquired at least 5 minutes after contrast injection. Alternatively, a split-bolus technique uses an initial loading dose of IV contrast and then obtains a combined nephrographic-excretory phase after a second IV contrast dose; some sites include arterial phase. CTU should use thin-slice acquisition. Reconstruction methods commonly include maximum intensity projection or 3-D volume rendering. For the purposes of this document, we make a distinction between CTU and CT abdomen and pelvis without and with IV contrast. CT abdomen and pelvis without and with IV contrast is Reprint requests to: publications@acr.org Post-treatment Follow-up of Renal Cell Carcinoma defined as any protocol not specifically tailored for evaluation of the upper and lower urinary tracts and without both the precontrast and excretory phases. MR urography (MRU) is also tailored to improve imaging of the urinary system.
Post Treatment Follow up and Active Surveillance of Renal Cell Carcinoma. Understanding the strengths and limitations of the various imaging modalities for the detection of disease recurrence or progression is important when planning follow-up regimens. In this document, we provide an update on the appropriate use of imaging examinations for asymptomatic patients who have been treated for RCC with RN, PN, or ablative therapies. We also address the appropriate imaging examinations for asymptomatic patients with localized biopsy-proven or suspected RCC who are undergoing active surveillance. As in the previous version, this document does not address the imaging of complications from treatment and does not discuss the follow-up of patients with known residual or recurrent cancer. Special Imaging Considerations CT urography (CTU) is an imaging study that is tailored to improve visualization of both the upper and lower urinary tracts. There is variability in the specific parameters, but it usually involves unenhanced images followed by intravenous (IV) contrast-enhanced images, including nephrographic and excretory phases acquired at least 5 minutes after contrast injection. Alternatively, a split-bolus technique uses an initial loading dose of IV contrast and then obtains a combined nephrographic-excretory phase after a second IV contrast dose; some sites include arterial phase. CTU should use thin-slice acquisition. Reconstruction methods commonly include maximum intensity projection or 3-D volume rendering. For the purposes of this document, we make a distinction between CTU and CT abdomen and pelvis without and with IV contrast. CT abdomen and pelvis without and with IV contrast is Reprint requests to: publications@acr.org Post-treatment Follow-up of Renal Cell Carcinoma defined as any protocol not specifically tailored for evaluation of the upper and lower urinary tracts and without both the precontrast and excretory phases. MR urography (MRU) is also tailored to improve imaging of the urinary system.