Although some consider CT the standard chest imaging technique for surveillance after RCC resection [11], there are concerns about the risk of false-positive findings (ie, intrapulmonary lymph nodes and granulomas), particularly in patients with T1a RCC, which can lead to further unnecessary and potentially invasive investigations [9]. Additionally, some authors suggest that CT of the chest may not be necessary to identify most patients with pulmonary recurrence when CT of the abdomen with coverage of the lung bases at the T7 thoracic level is performed [26]. CT Head Most patients with metastases to the central nervous system are symptomatic. Thus, surveillance protocols after localized RCC ablation have not supported routine imaging of the brain to search for metastases in asymptomatic patients. Brain imaging should be performed only in cases with suggestive signs or symptoms [2,9,11]. CTU There is no relevant literature suggesting that CTU offers any additional benefit over conventional CT of the abdomen in the surveillance of patients after treatment of localized RCC, and this method is not included in the guidelines [2,9,11]. In a retrospective analysis of 23 tumors that progressed locally after ablation, CT or MR images in the corticomedullary phase were found to be sufficient for diagnosis of recurrence in 100% of the cases; noncontrast, nephrographic, and excretory-phase images, which are typically obtained in a CTU or MRU protocol, were able to detect recurrence in only 11%, 81%, and 44% of cases, respectively [35]. MRI Abdomen MRI of the abdomen is commonly used for follow-up after ablation of localized RCC [29]. MRI should be performed without and with IV contrast to assess tumor enhancement.
Post Treatment Follow up and Active Surveillance of Renal Cell Carcinoma. Although some consider CT the standard chest imaging technique for surveillance after RCC resection [11], there are concerns about the risk of false-positive findings (ie, intrapulmonary lymph nodes and granulomas), particularly in patients with T1a RCC, which can lead to further unnecessary and potentially invasive investigations [9]. Additionally, some authors suggest that CT of the chest may not be necessary to identify most patients with pulmonary recurrence when CT of the abdomen with coverage of the lung bases at the T7 thoracic level is performed [26]. CT Head Most patients with metastases to the central nervous system are symptomatic. Thus, surveillance protocols after localized RCC ablation have not supported routine imaging of the brain to search for metastases in asymptomatic patients. Brain imaging should be performed only in cases with suggestive signs or symptoms [2,9,11]. CTU There is no relevant literature suggesting that CTU offers any additional benefit over conventional CT of the abdomen in the surveillance of patients after treatment of localized RCC, and this method is not included in the guidelines [2,9,11]. In a retrospective analysis of 23 tumors that progressed locally after ablation, CT or MR images in the corticomedullary phase were found to be sufficient for diagnosis of recurrence in 100% of the cases; noncontrast, nephrographic, and excretory-phase images, which are typically obtained in a CTU or MRU protocol, were able to detect recurrence in only 11%, 81%, and 44% of cases, respectively [35]. MRI Abdomen MRI of the abdomen is commonly used for follow-up after ablation of localized RCC [29]. MRI should be performed without and with IV contrast to assess tumor enhancement.