Because the risk of distant metastases is significantly lower in patients with localized RCC after ablation, MRI of the abdomen is preferred over MRI of the abdomen and pelvis. Post-treatment Follow-up of Renal Cell Carcinoma MRU There is no relevant literature suggesting that MRU offers any additional benefit over conventional MRI 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 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 There is no relevant literature regarding the use of conventional US of the kidney in follow-up of patients after localized RCC ablation, and the guidelines offer different recommendations. The National Comprehensive Cancer Network considers US an alternative for annual surveillance after negative evaluation with CT or MRI in the first 6 months [2]; the European Association of Urology recommends US only for surveillance after the treatment of RCC with a low-risk profile [11]; and the American Urological Association does not include US in their recommendations regarding follow-up after ablation [9].
Post Treatment Follow up and Active Surveillance of Renal Cell Carcinoma. Because the risk of distant metastases is significantly lower in patients with localized RCC after ablation, MRI of the abdomen is preferred over MRI of the abdomen and pelvis. Post-treatment Follow-up of Renal Cell Carcinoma MRU There is no relevant literature suggesting that MRU offers any additional benefit over conventional MRI 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 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 There is no relevant literature regarding the use of conventional US of the kidney in follow-up of patients after localized RCC ablation, and the guidelines offer different recommendations. The National Comprehensive Cancer Network considers US an alternative for annual surveillance after negative evaluation with CT or MRI in the first 6 months [2]; the European Association of Urology recommends US only for surveillance after the treatment of RCC with a low-risk profile [11]; and the American Urological Association does not include US in their recommendations regarding follow-up after ablation [9].