Studies evaluating the performance of CEUS after ablative treatment of renal masses have shown that CEUS has an excellent concordance with CT or MRI with regard to the presence or absence of residual or recurrent tumor after ablation, both immediately after treatment and through long-term follow-up [41-49]. One important consideration is that CEUS would still be less sensitive than CT or MRI for the detection of distant visceral and nodal metastases because the contrast-enhanced portion of the study would be limited to the surgical bed. Nevertheless, in patients at low risk for recurrence, CEUS may be considered an appropriate alternative to CT and MRI. Post-treatment Follow-up of Renal Cell Carcinoma Bone Scan Whole Body The prevalence of osseous metastases after treatment for localized RCC has been shown to be low in patients without symptoms (ie, bone pain) or without laboratory abnormalities suggestive of osseous metastases (ie, elevated serum alkaline phosphatase level) [50,51]. Furthermore, the sites commonly involved by osseous metastases, such as the thoracolumbar spine and ribs, are located in areas covered by chest and abdominal imaging. Thus, even though bone scanning can be helpful to confirm clinically or radiographically suspected metastatic disease, current guidelines do not support its routine use in surveillance after treatment for localized RCC [2,9,11]. Preliminary results for other PET tracers are also becoming available. For instance, in a prospective study of 28 patients with RCC undergoing initial staging or restaging, 11C-choline PET/CT was significantly more accurate than FDG-PET/CT (85.7% versus 57.1%). Among 120 lesions detected, 11C-choline PET/CT detected 75 lesions (62.5%), whereas FDG-PET/CT detected 47 lesions (39.2%) [54].
Post Treatment Follow up and Active Surveillance of Renal Cell Carcinoma. Studies evaluating the performance of CEUS after ablative treatment of renal masses have shown that CEUS has an excellent concordance with CT or MRI with regard to the presence or absence of residual or recurrent tumor after ablation, both immediately after treatment and through long-term follow-up [41-49]. One important consideration is that CEUS would still be less sensitive than CT or MRI for the detection of distant visceral and nodal metastases because the contrast-enhanced portion of the study would be limited to the surgical bed. Nevertheless, in patients at low risk for recurrence, CEUS may be considered an appropriate alternative to CT and MRI. Post-treatment Follow-up of Renal Cell Carcinoma Bone Scan Whole Body The prevalence of osseous metastases after treatment for localized RCC has been shown to be low in patients without symptoms (ie, bone pain) or without laboratory abnormalities suggestive of osseous metastases (ie, elevated serum alkaline phosphatase level) [50,51]. Furthermore, the sites commonly involved by osseous metastases, such as the thoracolumbar spine and ribs, are located in areas covered by chest and abdominal imaging. Thus, even though bone scanning can be helpful to confirm clinically or radiographically suspected metastatic disease, current guidelines do not support its routine use in surveillance after treatment for localized RCC [2,9,11]. Preliminary results for other PET tracers are also becoming available. For instance, in a prospective study of 28 patients with RCC undergoing initial staging or restaging, 11C-choline PET/CT was significantly more accurate than FDG-PET/CT (85.7% versus 57.1%). Among 120 lesions detected, 11C-choline PET/CT detected 75 lesions (62.5%), whereas FDG-PET/CT detected 47 lesions (39.2%) [54].