In a retrospective analysis of 23 tumors that progressed locally after ablation, CT or MRIs obtained 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 Head Most patients with metastases to the central nervous system are symptomatic. Thus, surveillance protocols for RCC 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]. US Kidney Retroperitoneal The major guidelines include US as another option for imaging surveillance of the abdomen after surgical resection of localized RCC [2,9,11]. Although US may be considered an appropriate alternative for patients with contraindications to CT or MRI, one important consideration is that US is likely to be less sensitive than CT or MRI for the detection of small recurrences or distant visceral and nodal metastases in the abdomen. In one study, among 14 patients who were found to have recurrence after RN or PN for T1-3 RCC, US correctly identified only 1 case of recurrence, whereas CT detected all cases of recurrence [40]. US failed to detect 4 out of 5 recurrences in the kidney after PN [40]. In another study investigating outcomes after PN for T1-2 RCC, CT/MRI detected 96.6% of recurrences in the abdomen, whereas US detected only 3.4% of abdominal recurrences [36]. US Abdomen with IV Contrast There is no relevant literature regarding the use of contrast-enhanced US (CEUS) in the follow-up of patients after surgical excision of RCC, and this method is not included in the guidelines [2,9,11].
Post Treatment Follow up and Active Surveillance of Renal Cell Carcinoma. In a retrospective analysis of 23 tumors that progressed locally after ablation, CT or MRIs obtained 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 Head Most patients with metastases to the central nervous system are symptomatic. Thus, surveillance protocols for RCC 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]. US Kidney Retroperitoneal The major guidelines include US as another option for imaging surveillance of the abdomen after surgical resection of localized RCC [2,9,11]. Although US may be considered an appropriate alternative for patients with contraindications to CT or MRI, one important consideration is that US is likely to be less sensitive than CT or MRI for the detection of small recurrences or distant visceral and nodal metastases in the abdomen. In one study, among 14 patients who were found to have recurrence after RN or PN for T1-3 RCC, US correctly identified only 1 case of recurrence, whereas CT detected all cases of recurrence [40]. US failed to detect 4 out of 5 recurrences in the kidney after PN [40]. In another study investigating outcomes after PN for T1-2 RCC, CT/MRI detected 96.6% of recurrences in the abdomen, whereas US detected only 3.4% of abdominal recurrences [36]. US Abdomen with IV Contrast There is no relevant literature regarding the use of contrast-enhanced US (CEUS) in the follow-up of patients after surgical excision of RCC, and this method is not included in the guidelines [2,9,11].