Although it is likely that CT pelvis may not offer additional information in most patients with early stage RCC, pelvic imaging can be helpful in patients with more advanced RCC, in whom metastatic spread is suspected [47,48]. If pelvic imaging is indicated in patients with contraindications to iodinated contrast, pelvic MRI may be preferred to unenhanced CT pelvis. CT Chest Chest imaging is indicated in the staging of RCC, given that lungs are one of the most common sites of metastases in RCC [5,13]. There is a lack of literature that have directly compared the accuracy of chest CT with chest radiography for detecting pulmonary metastases in the initial staging of RCC. However, limited data have demonstrated that CT is more sensitive than radiography for the detection of pulmonary metastases from RCC [49]. Current literature supports use of IV contrast-enhanced CT chest for detecting pulmonary metastases, especially in patients with large renal tumors [5,13,34,63,64,74,75]. However, in patients with contraindications to iodinated contrast, unenhanced CT chest may be performed because that would be able to detect pulmonary nodules, despite the lack of IV contrast. Staging of Renal Cell Carcinoma CT Head Most patients with metastases to the central nervous system are symptomatic. Thus, current guidelines do not support routine imaging of the brain to search for metastases in asymptomatic patients in the initial staging of RCC. Brain imaging should be performed only in cases with suggestive signs or symptoms [5,13]. In patients with contraindication to IV contrast, MRI brain may be more helpful. CTU There is no relevant literature suggesting that CTU offers any additional benefit over conventional CT of the abdomen in the initial staging of RCC, and thus, this method is not included in the guidelines from the EAU and NCCN [5,13]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT has a limited role in the diagnosis and the local staging of RCC [58].
Staging of Renal Cell Carcinoma. Although it is likely that CT pelvis may not offer additional information in most patients with early stage RCC, pelvic imaging can be helpful in patients with more advanced RCC, in whom metastatic spread is suspected [47,48]. If pelvic imaging is indicated in patients with contraindications to iodinated contrast, pelvic MRI may be preferred to unenhanced CT pelvis. CT Chest Chest imaging is indicated in the staging of RCC, given that lungs are one of the most common sites of metastases in RCC [5,13]. There is a lack of literature that have directly compared the accuracy of chest CT with chest radiography for detecting pulmonary metastases in the initial staging of RCC. However, limited data have demonstrated that CT is more sensitive than radiography for the detection of pulmonary metastases from RCC [49]. Current literature supports use of IV contrast-enhanced CT chest for detecting pulmonary metastases, especially in patients with large renal tumors [5,13,34,63,64,74,75]. However, in patients with contraindications to iodinated contrast, unenhanced CT chest may be performed because that would be able to detect pulmonary nodules, despite the lack of IV contrast. Staging of Renal Cell Carcinoma CT Head Most patients with metastases to the central nervous system are symptomatic. Thus, current guidelines do not support routine imaging of the brain to search for metastases in asymptomatic patients in the initial staging of RCC. Brain imaging should be performed only in cases with suggestive signs or symptoms [5,13]. In patients with contraindication to IV contrast, MRI brain may be more helpful. CTU There is no relevant literature suggesting that CTU offers any additional benefit over conventional CT of the abdomen in the initial staging of RCC, and thus, this method is not included in the guidelines from the EAU and NCCN [5,13]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT has a limited role in the diagnosis and the local staging of RCC [58].